Yoichi Nakatsuka

High complication rate of reconstruction using Ilizarov bone transport method in patients with bone sarcomas

Abstract We performed five reconstructions by bone transport in patients with bone sarcoma: three osteosarcomas, one Ewing’s sarcoma and one chondrosarcoma. Four sacromas were in the distal femur and one in the shaft of the tibia. Four patients received multidrug chemotherapy. The average length of the skeletal defect after tumour resection was 17 (range 10–25) cm. All patients underwent double elongation from both proximal and distal sites of the bone defect. The average follow-up period was 48 (range 40–66) months, and the average duration of external fixation was 32 months (range 579–1340 days). In one case, bone formation was satisfactory, but in the other cases, it was poor and slow. The average treatment index was 95 (range 53–191) days per 1 cm of elongation. In one case, the bone fragment disappeared during the bone transport. In one case, the end of the bone protruded from the skin, and osteomyelitis set in. This patient underwent above-knee amputation due to failure of infection control. Three patients suffered talipes equinus. One patient died of pulmonary metastasis. Two patients had fair and three had poor function. This method is not recommended for patients with bone sarcoma who may have a poor prognosis, as it has an unacceptably high complication rate.

Polyostotic fibrous dysplasia. A long term follow up of 8 patients

Summary. Eight patients who had polyostotic fibrous dysplasia were followed up for more than 10 years. One had the Albright syndrome. Two of 3 proximal femoral lesions which were treated before puberty by either curettage and bone grafting or by osteotomy, developed progressive deformity during the growth period. One of 2 proximal femoral lesions treated by curettage and bone grafting after the age of 18 also developed a deformity. Two tibial lesions operated on at the age of one and 30 years remained stable. The histological findings showed more active lesions in young patients compared with adults.Résumé.L’évolution de la maladie chez 8 patients présentant une dysplasie fibreuse diffuse suivie plus de 10 ans (moyenne 19,5 ans) a été annalysée rétrospectivement. Un patient avait un syndrome d’Albright. Deux des trois lésions du fémur proximal chez les patients qui eurent soit un curetage et une greffe osseuse, soit une ostéotomie avant la puberté ont été le siège d’une aggravation de la déformation pendant la croissance. Une des deux lésions du fémur proximal chez des patients qui eurent un curetage et une greffe osseuse après l’âge de 18 ans, furent le siège d’une déformation. Deux lésions du tibia qui ont été opérées à l’âge de 1 et de 30 ans sont ensuite restées stables. L’aspect histologique était plus actif dans les lésions des patients jeunes que chez ceux ayant terminé leur croissance.

Coxa magna after open reduction for developmental dislocation of the hip

We studied coxa magna after open reduction of developmental hip dislocation, including the etiology, incidence, and influence on the long-term results and acetabular development. Forty-seven hips in 47 patients were radiographically examined for at least 10 years, and another 20 hips in 20 patients were examined arthrographically at an early stage after open reduction. At follow-up, the incidence of coxa magna, which was defined as a femoral head with a size > or = 20% greater than the opposite side, was 34.0%, and that seemed to be one of factors that worsened the long-term results. One of the most important causes of coxa magna is to overwiden the acetabular capacity by excising the limbus; another cause is the surgical invasion and synovitis of the hip joint after operation.

Treatment of developmental dislocation of the hip in children after walking age. Indications from two-directional arthrography.

We treated 120 children between the ages of 12 and 31 months with 137 developmental dislocations of the hip and reviewed them at a mean follow-up of 14 years. We had used two-directional arthrography of all hips before reduction to evaluate the anterior, superior, and posterior portions of the limbus. Of the 137 hips, 64 had no interposed limbus in the AP view of the arthrogram, but 45 of these had an interposed anterior or posterior portion of the limbus. The hips with good stability and no interposed limbus in either AP or lateral arthrograms had excellent results by closed methods; in the other cases the results were less satisfactory. Our findings suggest that hips suitable for management by closed reduction can be identified by two-directional arthrography. Hips shown to have an interposed limbus are best managed by open reduction.

Polyostotic lesions compatible with osteofibrous dysplasia - A case report

An 18-month-old girl with lesions in the cortex of the bilateral tibiae and ulnae and right fibula is reported. The lesion in the right tibia disappeared after curettage and xenogeneic bone grafting, and the other lesions disappeared spontaneously by the age of 12 years. All lesions involved the bone cortex. The right tibial lesion exhibited the histopathological features of “zonal architecture” and a osteoblast rim formation around the trabeculae. We consider that osteofibrous dysplasia can involve systemically any long bone.

Long-term results of open reduction for residual subluxation in congenital dislocation of the hip: A new open reduction method involving 360 ~ circumferential capsulotomy

We report satisfactory results with a new operative treatment, conducted via an extensive anterolateral approach, involving 360 degree circumferential capsulotomy, for residual subluxation in congenital dislocation of the hip (CDH). Long-term radiographic results of this procedure (group A) were compared retrospectively with the results of partial capsulotomy (group B), which preserved the posteroinferior joint capsule. The mean center edge angle in group A (22.5°) was greater than that in group B (16.0°). Satisfactory results were achieved in 11 of 15 hips (73%) (Severin class I or II) in group A, and in 5 of 12 hips (42%) in group B. These results suggest that whole circumferential capsulotomy can remove obstacles to complete reduction, and that acetabular development can be expected in hips reduced by the procedure, without the performance of innominate osteotomy. We believe that our technique is a useful alternative for the treatment of residual subluxation in CDH.

Polyostotic Fibrous Dysplasia

A case of polyostotic fibrous dysplasia in an African female is described. The case also had bilateral loss of smell sense and involvement of left paranasal sinuses, but no evidence of hormonal derangement or other changes in the skeleton.