Yoshiki Yamano

Arthroplasty of the Proximal Interphalangeal Joint Using Costal Cartilage Grafts

Seven intra-articular fractures in five patients with partial bone loss at the PIP joint were reconstructed using a graft of costal cartilage. In all cases there were total or partial cartilagenous defects of the proximal phalangeal side of the joint. Early treatment of two joints, using only costal cartilage grafts, resulted in bony ankylosis due to necrosis of the grafted cartilage. In five joints the grafted cartilage included osseous portions using the costo-osteochondral junction, leading to an average range of movement of 64° with satisfactory clinical results. The technique is a useful alternative to other forms of arthroplasty or arthrodesis, and can provide satisfactory functional results when there is a partial defect of the head of the proximal phalanx.

Replantation of fingertips

During the period between 1976 and 1990, 207 fingertips have been replanted in 133 male and 55 female patients whose ages ranged from 14 months to 80 years, with an average of 32.7 years. Of the 207 fingers with complete amputation, 131 were injured in zone 1 and 76 in zone 2. The minimum follow-up period was 6 months. The results of zone 1 amputation have been analyzed according to the type of injury. The survival rate was 100% in clean-cut amputation, 95% in blunt-cut, 64.3% in crush and 65.5% in avulsion. From the point of view of survival and function, satisfactory results were obtained in amputations in zone 2, and in all cases in zone 1 that were clean-cut or blunt-cut.

Comminuted fractures of the proximal humerus treated with hook plate

SummaryGood results were obtained using a hook plate to fix bone in 18 cases of fracture of the proximal humerus in which the bone was greatly comminuted or dislocated. The hook plate protects the fixed area against rotation, shear stress and flexion much better than other fixation methods.

Safe method of supraclavicular brachial-plexus anesthesia

SummaryUsing the needle direction we devised, we applied brachial-plexus anesthesia in the supraclavicular approach originated by Kulenkampff to 561 patients 6 to 85 years of age. In this method, 20 ml of anesthetic was enough to obtain more than 95% anesthetic effect without any complications such as pneumothorax. Moreover, by using a long-acting drug (bupivacaine), we could get an effect lasting for more than 10 h, so that it was useful for long operations such as digital replantations, or for operations with severe postoperative pain.ZusammenfassungMit der von uns entwickelten Punktionstechnik haben wir die Anaesthesie des Plexus brachialis durch den von Kulenkampff angegebenen supraclaviculären Zugang bei 561 Patienten durchgeführt, die zwischen 6 and 85 Jahre alt waren. Bei dieser Methode genügen 20 ml des Anaesthetikums, um eine mehr als 95%ige anaesthetische Wirkung zu erzielen, ohne daß irgendwelche Komplikationen, wie etwa ein Pneumothorax, auftreten. Darüber hinaus kann man bei Verwendung eines Anaesthetikums mit Langzeitwirkung (Bupivacaine) eine Anaesthesie mit mehr als 10stündiger Dauer erreichen. Dies war nützlich bei langdauernden Eingriffen, wie Fingerreplantationen, oder bei Eingriffen mit starken postoperativen Schmerzen.

Hemodialysis-associated amyloidosis of bone of beta-2 microglobulin origin.

SummaryA case of hemodialysis-associated amyloidosis in a patient who had been on hemodialysis for 10 years is described. Bone lesions were found in the humeral heads, carpal bones, and femoral heads and necks. Specimens obtained from the pathologically fractured left femoral neck revealed amyloid deposits histologically. Immunoperoxidase staining for beta-2 microglobulin was positive in the amyloid at the light-microscopic level. We reconfirmed that bone lesions associated with long-term hemodialysis are manifestations of amyloidosis of beta-2 microglobulin origin. Hemodialysis-associated amyloidosis should be considered in the treatment of long-term hemodialysis patients.

Electrophysiological study of nerve grafting.

After using the sural nerve for cable grafting in three children with nerve defects of the upper limb, we conducted electrophysiological studies on the regeneration of the nerve. After nerve grafting, nerve regeneration was delayed as compared to that of the end-to-end suture, but muscle power recovered to 80% of normal. Electromyography showed isolated motor unit potentials with high amplitude and polyphasic waves at maximum voluntary contraction. The motor conduction velocity recovered to about 70% of the normal level, but the sensory conduction velocity was less than this. The motor conduction velocity was delayed in the graft site, which, for measurement purposes, included the two suture lines.

Some Methods for Bone Fixation for Digital Replantation

Solid bone fixation constitutes one of the important factors in obtaining good function after replantation of amputated digits. Comparison has been made of various methods of bone fixation including a newly designed ceramic intramedullary screw which we have found useful for cases of amputation of a middle or proximal phalanx around its middle.

Experimental study of interfascicular grafts in the peroneal nerve of the rabbit

SummaryTo elucidate the nerve, especially motor nerve, regeneration after interfascicular grafting, the method most often used clinically, the nerve grafting was performed on 40 adult rabbits. By resecting 2.0 cm of the right peroneal nerve, the sural nerve was made into 4 interfascicular grafts under a operating microscope. The cross section area of the grafts was about the same as that of peroneal nerve. Histological and evoked electromyographic observations were conducted on the maturation of regenerating nerves of up to 24 post-operative months, when the maturation would have been completed. The present histological and evoked electromyographic observations revealed that about 70% of nerve, especially motor nerve, recovery was attained after interfascicular grafts as compared with normal nerve. In the nerve regeneration after interfascicular grafts, several factors differing from the case of suture are involved, and these factors were considered from the experimental findings.

Disc herniation of cervical spine.

SummaryThe so-called soft disc herniation (the extruded or sequestered type) of cervical spine is relatively rare. For such a diagnosis precise neurological examination, myelography and discography are employed, but among them the specific reproduction of the patients symptoms and the radiographic appearance of the disc by discography are especially important. Our 8 cases of soft disc herniation have been classified into central-paracentral and posterolateral types by the direction of extruded material from discographic pictures. Every type shows the complications of root pain. Discussion relates to the pain that accompanies this soft disc herniation. In half of the cases extruded disc material has been removed but others have been improved by conservative treatment.

Stress fracture of the body of pubis in a pregnant woman

SummaryA case with stress fracture of the body of the pubic bone which occurred in a 35-year-old pregnant woman is described. No underlying pathologic process was found and it would seem that the mechanical load acting on the pubic bone to cause stress fracture is brought about by both the muscle imbalance and ligament laxity. In a few weeks after delivery, the fracture showed a complete bony union.ZusammenfassungFallbericht über eine Streßfraktur im Körper des Schambeines bei einer 35jährigen Frau am Ende der Schwangerschaft. Eine Ursache für die Streßfraktur, insbesondere eine pathologische Veränderung, konnte nicht festgestellt werden. Wenige Wochen nach der Entbindung war die Streßfraktur knöchern wieder vollkommen durchgebaut.