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We developed a drilling instrument (Type 1) for the coracoid process two years ago, and have been performing a modified Boytchev's procedure for patients with recurrent shoulder disloction using this instrument.When we inserted a screw into the coracoid process using the Type 1 instrument, the axis of the screw was directed caudally toward the coracoid process. We have now developed a new drilling instrument for the coracoid process (Type 2) that is able to insert the screw correctly into the center of the coracoid process. We performed a comparative study concerned with direction of the screw for three groups. Group 1: 13 cases had a screw inserted without intstrumentation. Group 2: 14 cases had their screw inserted using the Type 1 instrument. Grupe 3: Five cases had their screw inserted using the Type 2 instrument. Angles of inserted screw toward the coracoid process were compared in each group and were measured in antero-postero views, scapular outlet views and axial views by plain X-ray after the modified Boytchev procedure. The angles of Group 1 revealed a larger deviation than one of Group 1 and Group 2. The angles of Group 2 and Group 3 were less than the one of Group 1 in A-P views and Y-views. Using the improved drilling instrument for the coracoid process (Type 2), a hole can be easily made in the center of the coracoid process.The Type 2 instrument is available for various shoulder operations, for example, Bankart's procedure, capsular shift, Dewar's procedure, Bristow's procedure and total replacement of the shoulder joint.

Thirty cases with fractures of the Distal end of the tibia were treated.Radiographic results were eusluated as anatomical in 20 cases, fair in 7 and poor in 3. Subjective results were judged to be good in 23 cases, fair in 4 and poor in 3. Anatomical results were related to subjective results.Accurate reduction and internal fixation following the four principles of AO group sufficient to allow early mobihzation are important for good treatment results.

To analyze the frequency of methicillin resistant staphylococcus aureus (MRSA) infection, we investigated the cases who were infected with MRSA in our hospital. From 1989 to 1993, 9906 cases of hospitalized patients were available for investigation. Of these 8372 cases required surgical treatment. There were 31 cases whose wounds were infected. Of these 10 cases were identified as having MRSA infection. Wound infection with MRSA increased in association with the increase in usage of third generation cephem antibiotics after surgical treatment. Another 10 cases, aged from 62 to 92 years (average 78.4 years), contracted MRSA infections, although they had not had not any surgical treatment although all of these patients were compromised hosts. The mortality rate of MRSA pneumonia was 33.3%. For prevention of nosocomial MRSA infection, systemic organization of an MRSA infection team is very important.

When the surgeon operates on the shoulder joint, osteotomy of the coracoid process is necessary in order to explore the anterior portion of the gleno-humeral joint. Due to great variation in the size and slope of the coracoid process, surgeons need to make a whole in the center of the coracoid process. If a hole in the center of process is not made, fracture of the coracoid process may happen when the screw is tightened. We experienced 5 cases of coracoid fracture in 120 cases of Boytchev's procedure for recurrnt anterior shoulder dislocation. If the coracoid process is fractured the suregeon is obliged to change the postoperative care. We have developed a new drilling instrumnt which makes it easier to drill a hole in the coracoid process. This instrumnt can pinch out a chip of coracoid process and has a drill guide which can make a hole in the coracoid center. The size of the instrument was decided by measuring shoulder X-P. Using this instrument, a hole can be made easily in the coracoid process and this instrument is available for various shoulder operations, for example Bankart repair, capsular shift, Dewar's procedure, Bristow's procedure and total replacement of the shoulder joint.