Yoshio Uchida

A new three-dimensional osteotomy for cubitus varus deformity after supracondylar fracture of the humerus in children.

In the past, supracondylar osteotomy for the correction of cubitus varus deformity has been associated with a high failure rate and significant complications, even in simple lateral closing wedge osteotomy. This is because the supracondylar area is thin and fixation is difficult to maintain. In cubitus varus deformity, not only medial, but posterior, tilt and internal rotation of the distal fragment also frequently occurs. To correct all these deformities and to achieve a wide bony contact and more rigid fixation than simple lateral closing wedge osteotomy, we propose a new three-dimensional osteotomy. Among 12 patients who received this osteotomy, 11 had an excellent result and one had a good result.

Electrodiagnosis of Martin-Gruber connection and its clinical importance in peripheral nerve surgery

We propose new criteria for the electrodiagnosis of Martin-Gruber connection. Forty-seven patients with cubital tunnel syndrome were studied, and 8 (17%) were found to have a Martin-Gruber connection. Eighty-seven patients without cubital tunnel syndrome were also studied, and 14 (16%) had a Martin-Gruber connection. The rate of occurrence of the anastomosis in these two groups was approximately the same. No sensory communication was demonstrated, and the lateral intrinsic muscles received more innervation from the communicating branch than the hypothenar muscles. The entry point of the crossing fiber from the median nerve to the ulnar nerve was 3 to 10 cm distal to the medial humeral epicondyle, and there may be a significant risk of injury in ulnar nerve transposition.

Long-term follow-up on the use of vascularized fibular graft for the treatment of congenital pseudarthrosis of the tibia

BackgroundCongenital pseudoarthrosis of the tibia (CPT) is one of the most difficult conditions to treat.MethodsFive girls and 3 boys with CPT were treated by vascularized fibular grafting (VFG). The average age at VFG was 7.0 years (range: 1.9–11.5 years) with an average follow-up term of 11.7 years (range: 4.9–19.6 years). Five of the children had undergone multiple operations before VFG, while the other 3 had no such history.ResultsBone consolidation was obtained in all cases after an average term of 6.6 months (range: 4–10 months); this was with the first VFG in 7 cases but with the second VFG in 1 case. Complication of stress fracture and ankle pain occurred in 1 and 3 cases, respectively, only in cases undergoing multiple operations. Leg-length discrepancy was more prominent in the patients with multiple previous operations (mean: 7.5 cm), than in the cases with no prior surgery (mean: 0.7 cm).ConclusionThe long-term results of VFG for CPT were excellent, especially in the cases, with no prior surgery. VFG should be considered as a primary treatment option for CPT.

Peripheral Nerve Palsy Associated with Congenital Constriction Band Syndrome

Of 21 patients with congenital constriction band syndrome treated in our clinic from 1967 to 1988, four had constriction bands proximal to the wrist. Three of these also had a peripheral nerve palsy. Late surgical decompression does not help but early diagnosis, using electrodiagnosis methods, and neurolysis or nerve grafting as soon as possible may improve nerve function.

Ulnar nerve palsy after supracondylar humerus fracture

Six patients with cubitus varus deformity after a supracondylar fracture of the humerus had ulnar nerve palsy 7 (3-14) years following the fracture. All the patients showed anterior dislocation of the ulnar nerve during elbow flexion. In cubitus varus deformity, medial shifting of the triceps muscle occurs, which pushes the ulnar nerve anteriorly and frequently causes ulnar-nerve dislocation. Five of the 6 patients underwent surgery with subsequent improvement.

Radial closing wedge osteotomy for Kienbock's disease

Twenty-six patients with Kienböcks disease who were treated with a radial closing wedge osteotomy and then followed for a total of 4 years and 5 months were studied. Their mean age at surgery was 31.7 years. Clinical results were excellent in 8, good in 11, fair in 6, and poor in 1 patient using the Nakamura scoring system. Nineteen (73%) patients had excellent or good results, and 25 (96%) were content with their results. Factors affecting the clinical results included the postoperative Ståhl index and the preoperative radiolunate angle. It was concluded that radial closing wedge osteotomy is an effective procedure for patients with Kienböcks disease but that a flexion deformity of the lunate limits clinical success.

Vascularised fibular graft for congenital pseudarthrosis of the tibia. Long-term results

Five children with congenital pseudarthrosis of the tibia treated by free vascularised fibular grafts were followed up until skeletal maturity. The ipsilateral fibula was used in four cases, the contralateral fibula in one. All our cases achieved bone union, but leg length discrepancy, atrophy of the foot and ankle stiffness were frequent complications, due perhaps to the many previous operations. Vascularised fibular grafting might achieve better results if it were done as the primary procedure.

Macrodactyly in Proteus syndrome.

A case of Proteus syndrome in a 13-year-old boy with macrodactyly, hemihypertrophy, exostosis of the skull, epidermal naevi, palmar and plantar masses, and scoliosis is reported. Macrodactyly involving the left thumb was treated surgically. The usual findings in macrodactyly, hypertrophy of the digital nerves and proliferation of subcutaneous fat, were not observed in this case. Macrodactyly associated with Proteus syndrome should be distinguished from other forms of macrodactyly because of its poor prognosis and high rate of recurrence.

Extensor tendon rupture associated with smith's fracture: A case report

A 14-year-old boy sustained closed rupture of the extensor digitorum communis, extensor pollicis longus, and extensor indicis proprius tendons following a volarly displaced Salter-Harris Type II fracture of the distal end of the radius. The condition was treated with tendon grafts, but some limitation of metacarpophalangeal flexion remained.