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Purpose. To define the centre of the hip joint and the bone stock around the hip joint from the supra-acetabular portion or pelvic brim so as to avoid penetration of guidewire into the hip joint when performing internal fixation using the anterior approach. Methods. A total of 42 cadavers were utilised. Measurements were completed before and after cutting the pelvis into 4 pieces. Before cutting the pelvis, the centre of the hip joint was measured on the pelvic brim. After cutting the pelvis, the bone stock around the hip joint was measured in each section. The pelvic brim and the anteroinferior iliac spine were utilised as guide points in the measurements, because these parameters could be determined during an anterior surgical procedure. Results. On the pelvic brim, the reflected centre of the hip joint centre was located approximately 3.2 mm anterior to the distal edge of the anteroinferior iliac spine. The mean minimum bone stock of the pelvic brim was 14.0 mm in the centre of the hip joint section. Conclusion. This study described the anatomical reference points around the hip joint, and the ways in which they can be utilised to increase the safety of the anterior approach for internal fixation. It is important to define the centre of the hip joint from the supra-acetabular portion or pelvic brim, given that it is not visualised during surgery using an anterior approach.

Curved periacetabular osteotomy is a modified Ganz's procedure and requires an intrapelvic osteotomy. In order to establish the osteotomy line and the chisel inserting angles during the procedure, 32 cadavers and 28 three-dimensional computed tomographs were utilized. The guidepoints for the osteotomy line were obtained from the cadaveric analysis and the inserting angles of the chisel were measured from the radiological analysis. On the supra-acetabular portion, the C-shaped osteotomy line, starting from the proximal end of the anteroinferior iliac spine, should pass above the intersection point of the arcuate line and the line passing from the proximal end of the anteroinferior iliac spine to that of the ischial spine, and the chisel inserting angle should be 17° to the anterior surface of the ilium. On the quadrilateral surface, the C-shaped line should locate one finger width anterior to the greater sciatic notch, and the chisel inserting angle should be 25° to the quadrilateral surface. On the anterior aspect of the ischium, the chisel should advance with an inserting angle of 60° to the ground at the level of one finger width below the distal joint edge.

Reconstructive musculoskeletal surgery is important for preventing infections. Usually, antibiotics are used for this aim. The concentration of antibiotics must exceed MIC in the venous blood and bone marrow. In this study, we measured the concentration of Isepamicin of venous blood and bone marrow.The subjects consisted of 8 males and 1 female who underwent reconstruction of the rotator cuff. Their ages ranged from 36 to 66 years (average 54.6). Four hundred mg of Isepamicin was administered intravenously during 60 minutes. Their venous blood and bone marrow were taken immediately after the admistration, 30 minutes later, and 60 minutes later. The blood of the bone marrow was extracted from the bony sulcus made on the humeral head during the operation. The serum of the venous blood and bone marrow was measured to determine the concentration of the Isepamicin.There were no statistical significance between the Isepamicin concentrations of venous blood and bone marrow. They were higher than MIC to prevent infections in both venous blood and bone marrow. No side effects of Isepamicin were found in all cases. The shift to the bone marrow of Isepamicin administered intravenously was excellent.

A rare case of peroneal spastic flat foot (P. S. F. F) associated with accessory scaphoid is reported. The patient is an 11 years old boy. His chief complaint was left foot pain and restriction of varus motion. On examination, his left foot had valgus deformity. No valus motion existed due to apparent spasm of the peroneal tendon. Roentgenographic revealed no significant findings except for accessory scaphoid. The symptoms were completely relieved by resection of the accessory scaphoid.

Introduction:In orthopedic surgery, it is important to prevent infections, and antibiotics are used for this aim. The concentration of antibiotics must exceed MIC in the venous blood and bone marrow. In this study, we measured the concentration of isepamicin of the venous blood and bone marrow.Subjects and methods:The subjects consisted of 4 males and 2 females who underwent reconstruction of the rotator cuff. Their ages ranged from 40 to 65 (average is 56.7 years old). We administend 400mg of Isepamicin for 30 minutes and extracted the venous blood and bone narrow immediately after, 30 minutes, and 60 minutes later. The blood of the bone narrow was extracted from the surgical neck of the humerous during the operation, separated the venous blood and bone marrow at a rate of 3000/min for 10 minutes, and measured the blood plasma.Results:The concentration of Isepamicin was higher than MIC in both the venous blood and bone marrow. Side effects of Isepamicin were found in all cases.Conclusions:Isepamicin is an effective antibtic agent for orthopedic surgery.

To elucidate the essential nature of the human obturator externus muscle (OE), the gross anatomy of the anomalous muscle and anomalous fasciculus originating from this muscle as well as the posterior division of the obturator nerve (P) were examined in 73 thighs of 45 Japanese adult cadavers. The investigation of anomalous muscle and anomalous fasciculus was effected by observation of the supernumerary muscular branch and supernumerary muscular twig from the P. The anomalous muscle occurring between the adductor brevis muscle (AB) and adductor minimus muscle (AMi) (37/73 thighs; 50.7%) and the anomalous fasciculus fused to the posterior surface of the AMi (18/73 thighs; 24.7%) were detected. It was demonstrated by the course of the P and the suppling nerve, that the OE was divided into its superior fasciculus (or fasciculi) (SF) and main belly by the P, moreover the anomalous muscle originated from the former and the anomalous fasciculus from the latter. Presumably, in the process of ontogeny, the SF of the original OE retained its original morphology (23/73 thighs; 31.5%), a part of the SF was converted to anomalous muscle (27/73 thighs; 37.0%), the entire SF was converted to anomalous muscle (10/73 thighs; 13.7%), and the entire SF underwent retrogression and disappeared (13/73 thighs; 17.8%). The presence (50/73 thighs; 68.5%) or absence (23/73 thighs; 31.5%) of piercing of the OE by the P seemed to depend upon the circumstances surrounding the morphological change in the SF. The original OE was considered to occur as an OE pierced by the P not possessing any supernumerary muscular branch or twig. Actually, the original OE was confirmed to occur with a low frequency (15/73 thighs; 20.5%). It was inferred that the original OE readily underwent variation in the process of ontogeny due to the influence of the obturator nerve. The segmental composition of the obturator nerve was considered not to be involved in the morphological change in the OE.

The periacetabular osteotomy described by Ganz et al is used widely, and includes an outward osteotomy from the quadrilateral surface. Because intraarticular extension of the osteotomy can complicate the Ganz osteotomy, it is important to image the margin of the hip. To prevent this complication, and to do this procedure more safely, 32 hemipelves from cadavers were used in the current study. Some landmarks were selected that can be clarified on the quadrilateral surface during the periacetabular osteotomy. The acetabulum was hollowed out using an acetabular reamer of the same size as each femoral head, and the margin of the penetrated hole through the acetabulum was determined using these landmarks. The posterior margin of the hip is located approximately 2 cm anterior to the sciatic notch. The anatomic guidepoint for the osteotomy of the ischium averaged 14 mm inferior to the distal margin of the hip. By clarifying the margin of the hip presumed on the quadrilateral surface in this way, the periacetabular osteotomy can be done more safely, without causing complications such as intraarticular chisel penetration.

Rotational acetabular osteotomies are performed to correct dysplastic hips in young adults. However, there is a potential risk of intrapelvic vascular injury. To define the relation of these vascular structures to the bone around the acetabulum, we measured the distance and direction from the anteroinferior iliac spine to the external iliac artery and from the base of the superior pubic ramus to the obturator artery in 34 cadaveric hemipelves (17 male, 17 female; 19 left, 15 right). The distance to the external iliac artery was significantly shorter in females (average 31.7 mm) than in males (average 38.2 mm); and the distance to the intrapelvic entry portal of the obturator canal, through which the obturator artery passes, was significantly shorter in females (average 27.2 mm) than in males (average 33.4 mm). In addition, the external iliac artery was located significantly more ventral and closer to the anteroinferior iliac spine in right hemipelves than in left hemipelves. The intrapelvic entry portal of the obturator canal was located more caudodorsal to the base of the superior pubic ramus in females than in males. Care should thus be taken during surgery in light of our findings.