Yoshio Shimamura

Hamatometacarpal fracture-dislocation: distinctive three dimensional computed tomographic appearance☆

We report here two fully documented cases of hamatometacarpal fracture-dislocation following trauma and treated in our hospital. In our cases, the patients suffered hamate fracture in association with metacarpal dislocation. In the first case, a dorsal oblique fracture of the hamate was associated with a dorsal dislocation of the base of the fourth metacarpal. In the second case, a dorsal oblique fracture of the hamate was not associated with a dorsal dislocation of the base of the fifth metacarpal. This diagnosis should be suspected on initial review of plain radiographs, which must include an oblique view because of diagnostic difficulty for this injury. We recommend three dimensional computed tomography (3D-CT) in any patient presenting with pain after blunt trauma to the hand to prevent in diagnosis. Open reduction and internal fixation of the fracture is indicated and relevant for displaced fracture.

Posterolateral dislocation of the ankle without fracture

We report an unusual case of open posterolateral dislocation of the ankle without fracture following a motor vehicle accident. Most of previously reported cases are posteromedial dislocation. The anterolateral, posterolateral, and purely superior dislocations of the talus make up smaller percentage. The mechanism of this injury appears to be forced eversion of the foot when it is maximally plantar flexed and axially loaded. Our case was treated by manual reduction and percutaneous fixation and anatomical repair of the disrupted deltoid ligament at the time of initial débridement, also achieved good long-term functional and radiographic results.

The biologic response to particles from a potential disc prosthesis material.

Study Design. An in vivo study of material from a potential disc prosthesis. Objective. To examine the histopathologic effect of particulate debris on the dura and neural tissue in sheep. Summary of Background Data. Disc prostheses are emerging as alternatives to spinal fusion for the treatment of symptomatic degenerative lumbar disc disease. Preclinical biocompatibility trials must be conducted before any device is considered for general use. Methods. Artificially generated wear particles of a material known as Sinux (DePuy Spine, Raynham, MA) were implanted directly onto the lumbosacral dura and nerve roots of 18 sheep that were randomly allocated to 3 groups to survive between 1 and 6 months. Tissue sections from T12 to the sacrum were examined for histopathological evidence of inflammation and wound healing in response to the particles and for the effects on the neural elements. Results. There was no significant evidence of inflammation, macrophage accumulation, or other tissue response. Other observations included some minor tissue pigmentation due to microhemorrhage, occasional but minimal lymphocyte infiltration, and crystalline Sinux in the fibroadipose connective tissue external to the dura. Conclusion. Artificially generated particles of Sinux placed directly onto the dura and nerve roots did not induce any significant biologic response in a sheep model.

Recurrent palmar dislocation of the distal radioulnar joint. A case report.

Recurrent palmar dislocation of the distal radioulnar joint is not a common injury. We report one case in a 73-year-old female. This injury was incorrectly diagnosed at the first presentation because there has been no distinct deformity at the wrist and extension-flexion was normal. The need for proper physical examination and accurate radiographic positioning is stressed. Distal diaphysis resection combined with distal radioulnar arthrodesis (modified Sauve-Kapandji procedure) was the preferred method of treatment in an old patient. Two years after the injury, the patient was asymptomatic.

Vertical dislocation of the talus without malleolar fractures

We report an unusual case of open vertical dislocation of the talus without malleolar fracture following motor vehicle accident.Most previously reported cases are medial, lateral, posteromedial and posterior dislocations. The anterolateral, posterolateral, and purely superior dislocations of the talus make up smaller a percentage. The mechanism of this injury appears to be forced eversion of the foot when it is maximally plantar flexed and axially loaded.Our case has treated by open reduction of the talus and anatomical repair of the disrupted deltoid ligament at the time of initial incision and open reduction with internal fixation of the calcaneus also achieved good long-term functional and radiographic results.

Acute posterior neck pain in adult: a case series

Calcification around the cervical spine is thought to be relatively rare case, among these conditions the calcification at the longus colli muscle is called retropharyngeal tendinitis and only several cases were reported in the literature. In this disease, the three characteristic clinical features are acute severe posterior neck pain without any trigger, severely restricted range of motion, and odynophagia. The radiographic findings include swelling of the retropharyngeal space and amorphous calcification anterior to C1-C2 in lateral view of the cervical spine. Diagnosis is established by sound history taking coupled with computed tomography (CT) scan of the affected area, treatment is the administration of oral non-steroidal anti-inflammatory drugs (NSAID), for a few weeks and/or oral steroid. We present a new 3 cases (27, 35, and 24 years old, male) and review of literature.

Novel diagnosis and subsequent management of a very large Giant Cell Tumour of bone arising as a rarity in the thoracic spine

A 34-year-old male, who presented with mild upper back pain of recent onset was discovered to have a large intrathoracic mass, which was in continuity with tumour which had extensively destroyed the T5 and T6 vertebrae. Microscopy of an aspirated pleural effusion unexpectedly revealed many large multinucleated giant cells and the subsequent needle biopsy confirmed the diagnosis of a Giant Cell Tumour (GCT) of bone. In addition to being the first reported occasion when a GCT has been provisionally diagnosed by cytological examination of a pleural effusion, this case report also considers the unusual features and unpredictable behaviour of a tumour, which very rarely originates in the thoracic spine. The complex and prolonged surgical procedure adopted to extirpate tumour, which had permeated important mediastinal structures and to restore stability to the spinal column is outlined.

Traumatic Dislocation of the Hip in a Child Caused by Trivial Force for Age

Traumatic hip dislocation in children has a relatively rare occurrence. There are some residual complications, such as avascular necrosis of the femoral head, growth disturbance caused by premature fusion, neurological injury, recurrent dislocation, and posttraumatic arthritis. There is no consensus in the literature about the period of non-weight bearing after reduction. A rare case of a 13-year-old boy of hip dislocation caused by trivial force for age is reported followed by review of the pediatric literatures with treatment recommendation.

Traumatic occipito-atlantal dislocation caused by motorcycle accident while wearing a full-face helmet

Pure dislocation injuries resulting from severe trauma at the occipito-atlantoaxial junction most commonly result in death. Either the medulla oblongata or the spinomedullary junction may be severed. It is commonly believed that full-face helmets are protective during a motorcycle accident. However, previous reports have suggested that full-face helmets have little effect on neck injuries. Two cases showing occipito-atlantoaxial dislocation are presented here. The effect of full-face helmets on cervical injuries has been controversial. Although full-face helmets are considered effective in preventing head injury, the traction of full-face helmets during a crash and removal of the full-face helmet may promote cervical spine or occipito-atlantal dislocation. We think that traction of full-face helmets during a crash participated in the cause of death in both of the cases reported here.

Longitudinal fracture of the sacrum

A longitudinal fracture of the sacrum without an associated neurological deficit was described. A 47-year-old man was involved in a motor vehicle crash, suffering from multiple injures including a vertical displaced fracture of the sacrum unassociated with neurological deficit, fracture of the pelvis, and second lumbar burst fracture.A three-dimensional computed tomographic (CT) scanning was also discussed for proper clinical evaluation. The sacral nerve roots were pushed to either side of the fracture, there were no neurological problems in the present case.