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From January 1996 to January 2002, we operated on 18 cases of subtrochanteric fractures of the femur, using the ¥-nail on 8 cases, CHY-nail on 5 cases, IMHS on 4 cases, and Gamma nail on 1 case. In this study, we evaluated the post-operative results of the ambulation status and alteration in X-rays. Eleven (69%) of the 16 patients who could walk before injury regained the ability to walk. In 15 patients (83%), bone union was obtained. Two cases of delayed union developed nail fracture. It is necessary to consider dynamization for delayed union. If good reduction can not be achieved, we should expose the broken bone location and reduce it.

We report our experience using the Wolter Claviclar Plate for nine cases with Distal Clavicular Fracture (Neer type II) and twelve cases with Acromioclavicular Joint Dislocation (Tossy grade II; 1 cases, Tossy grade III; 11 cases).All cases with Distal Clavicular Fracture had bone union and good reduction. The results for the Acromioclavicular Joint Dislocation were comparatively good, but one case had diaphysial fracture of the clavicula. We realized the need for plate remodeling through these experiences.The Wolter Clavicular Plate provided strong fixation and early ROM exercise. We think that it is very useful for Distal Clavicular Fractures and Acromioclaviclar Joint Dislocations.

Operative cases in thoraco-lumbar fracture-dislocations were investigated. Nine males underwent surgical reduction, decompression and posterior instrumentations using ISOLA in 7 patients and VSP in 2 from June 1993 to July 1998. The age at the surgery ranged from 24 to 49 years old (average 33 years old) and follow-up period from 4 months to 65 months (average 17 months). The dislocated vertebrae ranged from T9 to L2 and 3.4 vertebrae on average were included into fusion area. Four patients underwent urgent operations and 5 patients elected operations.The duration of bed rest averaged 2 weeks. Six patients represented complete paraplesia preoperatively and no one improved postoperatively. Three patients with incomplete paraparesis improved completely (2 patients D→E, 1 patient B→E). After surgery the mean kyphotic angle before, justafter, at follow-up were 12°, 0°, and 4° respectively. Therefore good reduction was achieved and the correction loss was small. Three patients complained of persistent girdle pain of the torso but there was no relation with the correction loss of the kyphosis after surgery.

We investigated the results of surgical treatment of 49 trochanteric femoral fractures using the compression hip screw.The patients included 13 males and 36 females, with the mean age of 83 years. According to the classification of Evans, 33 cases were stable and 16 cases were unstable.Local complications were observed in 2 cases; loosening of the lagscrew in 1, cutting out with rotational displacement in 1. The telescoping amount of the lagscrew was significantly (p

Coraco-acromial ligament transfer for 5 male patients with antero-inferior instability of the shoulder was reviewed. Averaged age was 19.8 years, ranging from 18 to 23 years. The follow up period ranged from one year and 5 months to 14 years, with a mean of 7 years and 3 months. In 3 patients without general Joint laxity, the rate of inferior instability was reduced from 72.1% to 18.3%, but the reduction was not satisfactory in 2 cases with general joint laxity. In 4 cases with voluntary subluxation, all had good reduction postoperatively. The average JOA score was improved from 66.4 points preoperatively to 91.2 points postoperatively. These results indicate that coraco-acromial ligament transfer seems to be effective for patients with antero-inferior instability of the shoulder, especially for patients with voluntary subluxation.

Nine cases with displaced fractures of the distal end of the clavicle (Neer type II) and six cases with acromioclavicular separation (Tossy grade III) were treated using the Wolter plate.All cases had good reduction and bone union. In addition, all cases except one had an almost full range of motion at the shoulder joint.The Wolter plate provided stable fixation which allowed an early range of motion of the shoulder joint without impairing the acromiocravicular joint.

This paper discusses the method of closed reduction for mallet finger with fracture, which was first reported by Ishiguro.We clinically and radiographically evaluated ten cases operated on using this method. Clinical results were almost all good, but radiologically four cases had unacceptable results. Three of these cases had a gap in the articular surface in the distal phalange. One case had a deformity on the articular surface. These findings were due to poor reduction which we believed to have been due to inadequacy in the insertion point of the extension block pin. We concluded that the insertion point of the extension block pin was very important to ensure good reduction.

We studied the postoperative displacement after each intrafocal pinning procedure (Kapandji) and conventional cross or parallel pinning for Colles' fracture. Fifty-eight cases of Colles' fracture were treated by percutaneous pinning in our hospital from 1994 to 1998. The rate of postoperative displacement after intrafocal pinning was 28% (7 cases of 25 intrafocal-pinning cases) and conventional cross or parallel pinning was 48% (16 cases of 33 conventional cases).The common causes of the displacement in conventional procedures are malreduction and loosening of the Kirschner wire. On the other hand, the intrafocal pinning procedure enables good reduction but tends to result in hyperreduction, which causes volar flexion deformity. We concluded that percutaneous pinning should not be performed if good reduction cannot be obtained and fixation by osteotaxis is necessary to maintain reductin.

Radiological and clinical evaluations were carried out on 38 joints (19 wrists, 8 elbows and 11 knees) in 26 rheumatoid patients treated by synovectomy.In all 3 joints, good reduction in pain and swelling was achieved. But differences did exist between these 3 joints regarding improvement in postoperative R. O. M.. In 81% of the knee patients, postoperative R. O. M. was decreased, however, in the majority of the wrist and elbow patients, increased or remained unchanged.The stage of operated joint remained unchanged or progressed in all 3 joints and there was no improved joint, but the majority of the all patients are satisfied with the results of synovectomy.It is suggested that synovectomy seems to be valuable in treating the rheumatoid joints.

We have tried manual reduction as the first choice in the treatment of the fractures of the calcaneus. If good reduction cannot be achieved by this method, we reduce the joint surface using the Westhues' method. Then K-wires are used for internal fixation. At two weeks postoperatively the patient is allowed to walk with PTB cast (modified Graffiin's cast). The clinical follow-up 14 patients was obtained. The clinical results were as follows: three excellent, cases (15 percent) eight very good cases (40 percent), one fair case (0.5 percent) and no poor case. This manual reduction is recommended for the initial treatment of the fractures of the calcaneus.

This report describes the treatment of the lumbosacral spondylolisthesis associated with scoliosis. Scoliosis was treated by posterior spinal fusion with Harrington instrumentation, and 27 days later, spondylolisthesis was treated by anterior spinal fusion. Good reduction and fixation was obtained by the treatment.

Ninety-seven patients with supracondylar fractures of the humerus in children were treated during 11-year period from 1977 to 1987; 47 were available for follow-up assessment.Out of ten patients with poor results, nine were from ulnar displacement type fracture, and one from medial crush type fracture.To have satisfactory results, it is important to obtain good reduction, especially in coronal tilting, as soon as possible and to keep it until the enough callus formation occurs.

We have experienced 33 cases of acromioclavicular dislocation during past 15 years.Good therapeutic results were not always obtained in those cases who received operative procedure.From the results described above, closed reduction using Spigelman's Harness were performed in 8 cases, and good reduction and fixation were obtained in 6 cases of them.