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BACKGROUND: Shortening of tensor fasciae latae is one factor that causes a functional leg length discrepancy. A shoe lift has been used to correct the compensatory posture resulting from the discrepancy. Despite the potential therapeutic benefit of a shoe lift, the mechanism by which it exerts its effect is unclear. OBJECTIVE: To investigate the effect of a shoe lift on tensor fasciae latae length during standing with an artificial functional leg length discrepancy using ultrasonic shear wave elastography. METHODS: Twenty-two healthy individuals performed static standing under three conditions: drop of the pelvis and flexion of the leg resulting from fixing in the hip abduction position using a hip orthosis (functional leg length discrepancy condition); drop of the pelvis by the orthosis, but no flexion of the leg due to a shoe lift (shoe lift condition); and normal bilateral standing condition. The shear elastic modulus of tensor fasciae latae was calculated using ultrasonic shear wave elastography. RESULTS: The shear elastic modulus was significantly lower in the functional leg length discrepancy condition than in the shoe lift and normal conditions (p= 0.038). CONCLUSIONS: Using a shoe lift for the functional leg length discrepancy can result in a functional hip position that elongates tensor fasciae latae.

Rotator cuff tears are common in the older population. Atrophy and fat infiltration develop un-evenly in torn supraspinatus (SSP) muscles leading to pre- and post-surgical complications. The purpose of the current study was twofold: first, to implement a volumetric and quantitative magnetic resonance imaging (MRI) approach to quantify the degree of muscle atrophy and fat infiltration within the SSP muscle and its four sub-regions (AS, PS, AD, and PD); second to compare 3-D MRI outcomes to the standard 2-D assessment and investigate their relationship with tear size. Fifteen cadaveric shoulders were obtained and MRI performed. Quantitative 3-D outcomes included SSP muscle volume, fossa volume, fat-free muscle volume, and fat fraction for the whole SSP muscle and its four sub-regions. 2-D and qualitative measurements included tear size, 2-D fat infiltration using the Goutallier classification, tangent sign, and occupation ratio. Linear regression outcomes with tear size were not significant for both cross-sectional area (r = − 0.494, p = 0.061) and occupation ratio (r = − 0.011, p = 0.969). Tear size negatively correlated with fat-free muscle volume for both AS and PS sub-regions (AS: r = − 0.78, p

PurposeThe purpose of this study was to investigate if the three partitions (superior, middle, and inferior partitions) of the infraspinatus muscle previously described in anatomical studies will present different behavior during scapular plane abduction(scaption)as described using shear-wave elastography, especially during initial range of motion.MethodsEight volunteers held their arm against gravity 15° intervals from 30° to 150° in scaption. Shear-wave elastography was implemented at each position to measure shear modulus at rest and during muscle contraction, as a surrogate for muscle stiffness, of each partition. Muscle activity was defined as the difference in stiffness values between the resting positions and those during muscle contraction (ΔE = stiffness at contraction—stiffness at rest).ResultsThe activity value for the middle partition was 25.1 ± 10.8 kPa at 30° and increased up to 105° (52.2 ± 10.8 kPa), with a subsequent decrease at larger angle positions (p p p ConclusionStiffness measured using shear-wave elastography in each partition of the infraspinatus muscle demonstrated different behavior between these partitions during scaption. The middle partition generated force throughout scaption, while the superior and inferior partitions exerted force at end range.

Purpose This study aimed to morphologically and histologically investigate the relationship between deep subregions of the rotator cuff muscle and shoulder joint capsule as well as the relationship between the rotator cuff tendon or capsule and bony insertion. Methods We examined 13 shoulders of embalmed cadavers and measured the capsular attachments and footprints macroscopically. We also histologically examined the fibres in three shoulders. Results Loose attachment, which was less tight with spaced connective tissue, and firm attachment, which was tight with dense connective tissue, were found under the surface of the supraspinatus and infraspinatus. The anterior-deep and posterior-deep subregions of the supraspinatus and the middle partition and inferior partition of the infraspinatus formed firm attachments to the capsule. The mean areas of firm attachment for the anterior-deep subregion, posterior-deep subregion and middle partition were 118.8 mm2, 267.8 mm2 and 399.3 mm2, respectively, while the area of the inferior partition was small. The transverse fibres were located just lateral to the medial edge of the firm attachment area. The thick capsule had a substantial footprint. Both tendon fibres and the capsule inserted into the superior and middle facets through the attachment fibrocartilage. Conclusions The posterior-deep subregion of the supraspinatus and middle partition of the infraspinatus evenly occupied the capsular attachment area. The transverse fibres were located just lateral to the medial edge of the firm attachment area, and the thick capsule had a substantial footprint. Both tendon fibres and the capsule inserted into the superior and middle facets through the attachment fibrocartilage.

Background The purpose of this study was to evaluate the effect of fat infiltration, tear size, and post-operative tendon integrity, on post-operative contractility. Methods Thirty-five patients who underwent rotator cuff repair were included. The fat infiltration, tear size, and post-operative tendon integrity were evaluated by Goutallier stage, Cofield classification, and Sugaya classification, respectively. The muscle elasticity at rest and at contraction was assessed by real-time tissue elastography pre- and one-year post-operatively. We defined the difference in elasticity between at rest and at contraction as the activity value which reflects muscle contractility. Results The activity value in patients with Sugaya Type I tended to increase regardless of Cofield classification, whereas those with Sugaya Type III and IV tended to decrease. While the activity value in the patients classified as stage 1 and Type I tended to increase, patients classified as stage 2 showed decreased or constant in contractility even in those subjects classified as Type I. Stepwise multiple regression analysis showed both pre- (p = 0.004, r = -0.47) and post-operative activity values (p = 0.022, r = -0.39) to be significantly correlated only with the Goutallier stage. Conclusion Multiple regression analysis indicated only the Goutallier stage was a significant independent factor for contractility of the supraspinatus muscle. Supraspinatus muscle contractility in patients classified as Types III and IV based on the Sugaya classification tended to decrease post-operatively, while patients whose contractility increased post-operatively were characterized by having a Type I tendon integrity.

Rotator cuff tears are common in the older population. Atrophy and fat infiltration develop un-evenly in torn supraspinatus (SSP) muscles leading to pre- and post-surgical complications. The purpose of the current study was twofold: first, to implement a volumetric and quantitative magnetic resonance imaging (MRI) approach to quantify the degree of muscle atrophy and fat infiltration within the SSP muscle and its four sub-regions (AS, PS, AD, and PD); second to compare 3-D MRI outcomes to the standard 2-D assessment and investigate their relationship with tear size.Fifteen cadaveric shoulders were obtained and MRI performed. Quantitative 3-D outcomes included SSP muscle volume, fossa volume, fat-free muscle volume, and fat fraction for the whole SSP muscle and its four sub-regions. 2-D and qualitative measurements included tear size, 2-D fat infiltration using the Goutallier classification, tangent sign, and occupation ratio.Linear regression outcomes with tear size were not significant for both cross-sectional area (r = - 0.494, p = 0.061) and occupation ratio (r = - 0.011, p = 0.969). Tear size negatively correlated with fat-free muscle volume for both AS and PS sub-regions (AS: r = - 0.78, p 0.001; PS: r = - 0.68, p = 0.005, respectively) while showing no significant correlation with fat fraction outcomes. AD and PD sub-regions positively correlated with tear size and fat fraction outcomes (AD: r = 0.70, p = 0.017; PD: r = 0.52, p = 0.045, respectively), while no significant correlation was observed between tear size and fat-free muscle volumes.Quantitative 3-D volumetric assessment of muscle degeneration resulted in better outcomes compared to the standard 2-D evaluation. The superficial supraspinatus muscle sub-regions primarily presented muscle atrophy, while the deep sub-regions were mainly affected by fat infiltration. 3-D assessments could be used pre-surgically to determine the best course of treatment and to estimate the muscles' regenerative capacity and function.

Quadratus plantae (QP), one of the plantar intrinsic foot muscles, assist plantarflexion of the lesser toes. QP has medial and lateral muscle heads with different anatomical structures. The two heads of this muscle may have different roles in foot function. Ultrasound real-time tissue elastography (RTE) measurements have allowed quantitative assessment of deep-layer muscle elasticity. The purpose of this study was to determine the activity of the QP in flexion movements of the lateral four toes using RTE. Thirteen healthy subjects performed maximal voluntary contractions using a hand-held dynamometer with external belt fixation for each toe flexion movement. The elasticity of the muscles were measured using RTE during rest and flexion of each toe. The strain ratio of the muscle to that in an acoustic coupler was calculated as an index of muscle elasticity. Higher strain ratio values imply lower elasticity. The strain ratio of the medial head of QP for second toe flexion (0.10 ± 0.11) was significantly stiffer than at rest (0.34 ± 0.33). The strain ratios of the lateral head of QP for flexion of the second (0.32 ± 0.19), third (0.41 ± 0.37), fourth (0.33 ± 0.26), and fifth (0.45 ± 0.39) toes were significantly stiffer than at rest (1.02 ± 0.68). These results suggest that the medial head of QP has a role in assisting second-toe flexion, and the lateral head has a role in assisting flexion of all four lateral toes.

Yuta Takano,1 Hiroto Kobayashi,2 Takuma Yuri,1 Saori Yoshida,2 Akira Naito,2 Yoshiro Kiyoshige1 1Graduate School of Health Science, Yamagata Prefectural University of Health Science, Yamagata, Japan; 2Department of Anatomy, Yamagata University Faculty of Medicine, Yamagata, Japan Purpose: Fat infiltration (FI) in the gluteus minimus muscle (GMin) has been reported as being restricted to the anterior part. The aim of this study was to verify whether FI is localized only to the anterior part of the GMin through the dissection of large number of elderly cadavers and to clarify the underlying mechanism of FI localized to a specific region. Materials and methods: Thirty-eight hips from 20 embalmed elder cadavers were dissected for verification of FI localization. The samples of three regions – the fat infiltrated region of the anterior part (FI), the region without FI (non-FI), and the posterior region – were harvested from nine hips for the histological fiber type assessment. Results: The FI area was distributed at 2.6°–38° from the anterior border within the anterior part, of which function is responsible for hip extension and internal rotation and is likely reduced by disuse following aging. The number of type I fibers was lowest in FI, followed by non-FI, while the number of type I fibers was highest in the posterior. Meanwhile, the number of type II fibers was equivalent across the three regions. Atrophic type II fibers were observed in overall samples of the three regions, and grouped atrophy, which is evidence of denervation, was observed in FI and non-FI samples. Type grouping, which suggests to be reinnervated, was found in the non-FI and posterior samples but very little in the FI samples. Conclusion: FI in the GMin in older adults restricted to deep within the anterior part is secondary to disuse and is strongly related to impaired denervation–reinnervation process. Keywords: gluteus minimus, fat infiltration, disuse, denervation, fiber type

Although recent morphological studies have revealed that the infraspinatus muscle is subdivided, the functions of the subregions remain unknown. The aim of this study is to investigate the functions of the infraspinatus subregions during lateral rotation using real-time tissue elastography (RTE). Ten young male volunteers participated in the study. In addition to the infraspinatus subregions, the teres minor and two of six subregions of the supraspinatus determined by Kim were examined. The muscle stiffness of these subregions was measured in six conditions during lateral rotation, i.e., at rest and during manual muscle testing (MMT) 3 contraction at 0°, 35°, and 70° of lateral rotation. The middle and inferior subregions of the infraspinatus, teres minor, and the posterior deep supraspinatus acted as a lateral rotator. The inferior subregion of the infraspinatus was somewhat an abductor. The superior subregion of the infraspinatus was an abductor but did not contribute to the lateral rotational motion at 35° and 70° of rotation. The anterior superficial supraspinatus played an abduction role at neutral rotation but this role gradually decreased with an increasing lateral rotational angle. Three subregions of the infraspinatus are functionally distinct. The superior subregion contributes to abduction, the middle subregion acts as a lateral rotator, and the inferior subregion has both functions.

The aim of this study was to investigate the functions of the six subregions of the supraspinatus muscle (SSP) determined by Kim et al. in Clin Anat 2007;20:648-655, using real-time tissue elastography (RTE). Twelve young male volunteers participated. The muscular hardness of the SSP was measured at rest and with contraction of the MMT3 in internal, neutral and external rotations. The SSP was functionally divided into five groups on the basis of the RTE results. These functional areas were roughly classified into three property groups: the anterior-superficial, anterior-middle, and anterior-deep subregions, which produce contractile force for abduction; the posterior-deep subregion, which produces contractile force for external rotation; and the posterior-superficial and posterior-middle subregions, which maintain tension. RTE was appropriate for measuring the functions of these muscular subregions. Clin. Anat. 30:347-351, 2017. © 2017 The Authors Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

SUMMARY: The articularis genus, which lies under the vastus intermedius, has been regarded as part of the quadriceps femoris. However, they are well known to have different function because their respective origins and insertions are mutually distinct. These muscles are considered to work almost simultaneously when the knee is extended. The electromyogram has been used to demonstrate muscle co-contraction. However, the articularis genus is deeper than other muscles. Moreover, it is difficult to analyze it by surface electromyogram. The relative proportions of muscle fiber types and the characteristics of these fiber types are important determinants of the surface electromyogram. Furthermore, biomechanical analysis of AG has remained unclear. This study investigated the ratio of muscle fiber types in these muscles. Muscle samples from seven human cadaveric specimens were used with application of immunofluorescence double staining. Results show that in the vastus intermedius and articularis genus, the percentage of Type I fibers was significantly higher than that of Type II fibers. No significant difference was found in the mean percentages of Type I and Type II fiber types. The percentages of Type I and Type II fibers in articularis genus muscle were correlated positively to the percentage in the vastus intermedius. These results suggest that similar muscle fiber compositions of these muscles might reflect their contraction during the same active phase of knee extension, despite their different functions.

Hypothesis In the restoration of shoulder abduction, decreased contractility of the torn rotator cuff muscle may be a cause of a poor result. The aim of this study was to investigate the relationship between the contractile property of the torn supraspinatus muscle measured by real-time tissue elastography and the Goutallier stage as modified by Fuchs et al. Methods The muscular hardness of the torn supraspinatus muscle was measured in 32 patients at rest and during isometric contraction with the shoulder abducted to 60° in the scapular plane. The muscular hardness was calculated as the strain ratio. Fatty degeneration was assessed according to the modified Goutallier stage. Because the activity value (defined as the difference between the strain ratio at rest and the strain ratio during isometric contraction) estimated the contractile property of the muscle, stepwise multiple regression analysis was used to compare the activity value with age, sex, side, time from injury onset to obtaining the measurements, and modified Goutallier stage. Results The mean activity value was 0.26 ± 0.16. Fatty degeneration of the supraspinatus muscle was grade 0 in 5 patients, grade 1 in 16, grade 2 in 10, and grade 3 in 1. The activity value was significantly correlated only with the modified Goutallier stage (r = –0.78, P Conclusion The contractile property of the supraspinatus muscles decreased with an increase in the modified Goutallier stage. Real-time tissue elastography can measure the contractile property of the muscles before surgery and thus may be a predictor for the resulting restoration of lost muscle function.

The aim of this study was to investigate the functions of the six subregions of the supraspinatus muscle (SSP) determined by Kim et al. in Clin Anat 2007;20:648-655, using real-time tissue elastography (RTE). Twelve young male volunteers participated. The muscular hardness of the SSP was measured at rest and with contraction of the MMT3 in internal, neutral and external rotations. The SSP was functionally divided into five groups on the basis of the RTE results. These functional areas were roughly classified into three property groups: the anterior-superficial, anterior-middle, and anterior-deep subregions, which produce contractile force for abduction; the posterior-deep subregion, which produces contractile force for external rotation; and the posterior-superficial and posterior-middle subregions, which maintain tension. RTE was appropriate for measuring the functions of these muscular subregions. Clin. Anat. 30:347-351, 2017. © 2017 The Authors Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

The cause of falls is multifactorial, however, hip fractures in elderly would be prevented if accidental falls are predictable. We assessed magnetic resonance images of 38 patients with groin pain after taking a fall whose fracture could not be detected by plain X-rays, and 45 patients with no episode of falls. Their ages were over 65 years. Fatty degeneration of muscles, gluteus maximus, gluteus medius, gluteus minimus, obturator externus, adductor longus, rectus femoris and iliopsoas muscles, were evaluated by Goutallier's staging. Odds ratio was calculated by a logistic regression analysis allocating dependent variable for falls and independent variables for Goutallier's stage, age and gender. The fatty degeneration of gluteus maximus muscle was generalized, while that of gluteus minimus muscle was unevenly distributed, especially in anterior area. Gluteus minimus muscle initiated its fatty degeneration earlier than gluteus medius muscle. Odds ratio of falling was 3.2 (95% confidence intervals: 1, 14, 8.94) for Goutallier' stage of the gluteus medius muscle. Fatty degeneration of gluteus medius muscle has a crucial role in providing stability of the pelvis including hip joint. Evaluating fatty streaks in the gluteus minimus muscle could help give early indication to those who have a higher risk of falling.

Inherited predisposing risk factors for deep venous thrombosis (DVT) have been clearly identified in Caucasians, but there are fewer reports evaluating these factors in the Japanese. This study was undertaken to assess the predisposing risk factors for DVT following elective total hip arthroplasty (THA) in Japanese patients.We studied 60 patients who underwent THA. The study group consisted of 30 patients who developed DVT diagnosed by duplex sonography examination; the 30 patients who did not develop DVT served as a control group. They were matched in age, sex distribution, diagnosis (osteoarthritis secondary to dysplastic hip), and operation side(s) (bilateral or unilateral). Protein C, protein S, antithrombin III, and plasminogen activities and the plasma homocysteine level were measured. Three polymorphisms were screened for the factor V Leiden polymorphism, the factor II G20210A polymorphism, and the methylene tetrahydrofolate reductase C677T polymorphism.Plasma protein C activity was 82.39% +/- 14.24% in the DVT patients and 88.76% +/- 23.27% in the controls. Plasma protein C activity was significantly reduced in the study group, whereas other serologic and genetic analyses revealed no significant differences.Three genetic risk factors established in Caucasian patients are not valuable for evaluating DVT risk in Japanese patients. Reduced protein C activity may be a risk factor for DVT after THA.

I previously reported a new reduction and fixation technique for extra-articular distal radius fracture associated with osteoporosis. I developed the technique and applied it to intra-articular fracturea. I present here the technique and verify its reliability, comparing the functional results of intra-articular fracture cases to those of extra-articular cases.

The author established a new reduction and fixation technique for osteoporotic distal radius fracture with a use of AO/ASIF volar distal radius plate, referring to the condylar plating technique in distal femoral fracture. This technique is performed in three steps. First, distal fixation is through the insertion of buttress pins just beneath the subchondral bone with a convergent angle of 10 degrees to the articular surface under fluoroscopic assistance. Second, the proximal limb of the plate is lined up with the radius shaft so that the fracture is reduced automatically and anatomically. Third, by rotating the proximal limb of the plate ulnarly and lifting up the ulnar border of the articular surface, the fracture is fixed less than the contralateral ulnar variance, to apply an adequate tension on the triangular fibrocartilage complex (TFCC). This method represents a valuable treatment modality for the most frequent types of unstable distal radius in elderly women.

This article details a 7- to 12-year follow-up of seven young male baseball players with osteochondritis dissecans of the capitellum that we treated using closed-wedge osteotomy. This procedure was established by Yoshizu in 1986 for the treatment of “Little League elbow.” The bone of the capitellum was revascularized and remodeled within 6 months in all seven patients. Six of the patients were able to return to full athletic activity and continued to play baseball. Radiographic assessment during the follow-up study revealed minimal osteoarthritic change and suggests that the treatment is useful for such an injury.

There have been few clinical reports of successful replantation assisted with hyperbaric oxygen (HBO) therapy. In order to improve replant survival, the author has used HBO in ten digital replantations of crush avulsion, and degloving amputations Seven of ten replants survived and the other three failed The failed three digits demonstrated remarkable color changes during HBO therapy. No color changes were observed in six of the seven surviving digits under HBO. The remaining digit showed a slight colo were observed in six of the seven surviving digits under HBO. The remaining digit showed a slight colo difference between pre- and post-therapy. It appears that hyperbaric oxygen is potentially effective in distinguishing uneventful replants in which color does not change during HBO therapy, while hyperbaric oxygen could not salvage those congestion to necrosis replants in which the color became bright vermilion under hyperbaric oxygen therapy. The difference in digital color reaction to hyperbaric oxygen may be helpful in early decisions to employ salvaging procedures.

A septum between the abductor pollicis longus tendon and the extensor pollicis brevis (EPB) tendon in the first extensor compartment is frequently encountered during surgical treatment of de Quervain's disease. It was hypothesized that de Quervain's disease was secondary to EPB entrapment and the decision was made to decompress only the EPB subcompartment. Twenty-two patients were treated with this method. Sixteen patients had a septum in the first extensor compartment and 6 patients had a single canal. After surgery, all patients had complete relief of pain and tenderness over the first extensor compartment. The results of Finkelstein's test were negative in all cases. We conclude that de Quervain's disease is secondary to EPB entrapment. In those cases with a septum, it is sufficient to decompress only the EPB subcompartment.

The recognition of postmicrosurgical minute skin color changes is an important element in assessing vascular insufficiency that has traditionally relied on a skilled microsurgeon's subjective clinical impression. This study investigates the use of a color monitor for the objective quantitative evaluation of such skin color changes. Twenty-two replanted digits were monitored postmicrosurgically with a color meter while deep skin temperature recordings, an established method of postmicrosurgical monitoring, were taken simultaneously. The results showed that the digits' clinical courses, namely, "uneventful," "necrosis," "congestion," and "acute arterial obstruction," showed characteristic patterns of postmicrosurgical circulation that were reflected in skin color change measurements. The reliability of the color measurements was confirmed by the deep skin temperature recordings. This study suggests that skin color after microsurgery can be evaluated quantitatively with the proposed color monitoring system and that this system is useful for the diagnosis of postmicrosurgical vascular insufficiency.

Experiments have been performed using CO2 laser-assisted microvascular anastomoses, and they demonstrated the following features, in comparison with conventional anastomoses: ease in technique; less time consumption; less tissue inflammation; early wound healing; equivalency of patency rate and inner pressure tolerance; but only about 50 percent of the tensile strength of manual-suture anastomosis. Six clinical applications in 16 vessels are reported, using this procedure. The preliminary results of these cases would appear to be the first successful replantations and free tissue transfers using CO2 laser-assisted microvascular anastomoses in man. The procedure offers increased safety and speed in microvascular anastomoses.

To examine the precise tissue distribution of dendritic cells (DC) and indoleamine 2,3-dioxygenase (IDO)-expressing cells in synovial tissue and synovial fluid (SF) from patients with rheumatoid arthritis (RA) and osteoarthritis (OA).Synovial tissues from 30 patients with RA and 7 with OA were immunohistochemically stained for DC markers. The examined areas were classified into 5 categories based on pathobiological staging and histopathological grading systems. Myeloid DC (mDC) and plasmacytoid DC (pDC) were isolated using positive and negative magnetic sorting systems, respectively, from SF samples (7 patients with RA and 4 with OA) and synovial tissues (3 RA, 4 OA).mDC were mainly observed in lymphoid aggregations. pDC were scattered around perivenular infiltration areas, and small and large lymphoid aggregations in RA. The mDC/pDC ratio increased significantly, with higher grading in RA SF tissues compared to OA synovial tissues (p0.05). IDO-immunoreactivity was detected in pDC by serial sectioning and staining of RA synovial tissues.Our results indicate that mature mDC play a central role in the RA inflammatory process. Although there were fewer pDC than mDC, the presence of IDO-positive pDC suggests a possible tolerance mechanism in RA synovial tissues. However, it is probably modest due to the marked inflammation in RA, in which mDC are dominant.

We treated 5 proximal humeral fractures associated with advanced osteoporosis with conventional plate and screw fixation augmented by intramedullary bone cement. These osteosyntheses remained stable during a 1 -year follow-up and the outcome was similar to that after fractures in younger patients without osteoporosis.

A case of obsolete intramuscular cysticercosis diagnosed definitively by mitochondrial DNA analysis of extremely calcified cysts was reported. X-ray and computed tomography findings highly suggested cysticercosis due to Taenia solium; however, no direct evidence of cysticercosis was obtained through serological or histopathological examinations. Mitochondrial DNA analysis of a histopathological specimen confirmed the causative agent to be the Asian genotype of T. solium.

Dysplasia epiphysealis hemimelica was defined by Trevor (1950) as a rare congenital growth disorder of the tarsus and of the epiphysis of the long bone. In this report, a rare case of dysplasia epiphysealis hemimelica associated with multiple extraskeletal osteochondromas is presented. Although different modes of expression of the same pathologic process have been suggested for dysplasia epiphysealis hemimelica and osteochondroma, the biological feature of cartilaginous overgrowth in the skeletal system still seems unclear.

To investigate a relation between the degree of initial fracture displacement and nerve complication, 53 consecutive acute extension-type supracondylar humeral fractures in children during 10 years were analyzed. From the initial roentgenographs, the direction and degree of displacement of each fracture were plotted on the coronal two-dimensional coordinates at the fracture site. The degree of displacement was represented by a diameter of the humeral shaft. Of 53 fractures, 42 were displaced. Six patients had nerve injuries, representing an 11.3% incidence of neurologic complication. Their displacements were90% of the diameter of the shaft. Predictive negative and positive displacements of the median nerve were90% of the diameter and150% of that in posterolaterally displaced fractures, respectively. Those of radial nerve were130% and190% in posteromedially displaced fractures, respectively.

Background: This study focuses on the analysis of snowboarding versus skiing injuries, especially fracture, dislocation, or both, of the elbow, based on 7 years of medical records and roentgenograms of patients injured at a ski-snowboard area, Mt. Zao National Park, and demonstrates the precise characteristics of snowboard injury in the elbow region. Methods: A retrospective study of 1,445 injured snowboarders and 10,152 injured skiers was undertaken to assess both snowboarding and skiing injuries. Sixty-four cases of snowboarding injuries and 152 cases of skiing injuries were available for precise analysis of fracture, dislocation, or both, in the elbow region. Results: Fractures, dislocations, or both, in the elbow were more frequently observed for snowboarders (30 of 64 cases, 46.9%) when compared with that for skiers (26 of 152 cases, 17.1%) (p < 0.001). The rate of dislocation with or without fracture of the elbow was also significantly higher for snowboarders (17 of 64 cases, 26.6%) than for skiers (8 of 152 cases, 5.3%, p < 0.001). Seventeen cases of elbow dislocation in snowboarding were all of the posterior type, which accompanied two coronoid process fractures and two radial neck fractures. Fractures of the coronoid process (five cases), radial head (one case), radial neck (five cases), olecranon (one case), proximal ulnar shaft (one case), and extension-type fracture of distal humerus (four cases) were the fracture types observed in the analysis. Conclusion: Posterior dislocation; fractures of coronoid process, radial neck, and radial head; and extension-type fracture of the distal humerus characterize the particular and frequent injury mechanism responsible for snowboarding trauma in the elbow region. Thus, snowboarding injury of the elbow is recognized as a severe injury and is characterized by a frequent risk of posterior dislocation, fracture, or both. The severity of elbow injuries in snowboarding mainly seems to be due to direct mechanical force on the elbow, receiving the full impact of falling down, combined with an outstretched hand and elbow extension, or with an outstretched hand and longitudinal thrust force, to the proximal radius and ulna and distal humerus.

Background: Although the upper extremity, especially the wrist, has been reported to be the most commonly injured site in snowboarding, the severity of these injuries is still unknown. The purpose of this study is to compare the severity of wrist injuries in snowboarding with those in alpine skiing for insight into the treatment of snowboarder's wrist. Materials and Methods: The cases of 11,598 patients injured while snowboarding and skiing who presented to the Zao clinic during the past 7 seasons were reviewed and compared. Demographics were studied, focusing on fractures around the wrist joint. Roentgenographically precise assessment of the distal radial fracture was performed according to AO classification. Results: Snowboarders were more likely to injure the wrist than were skiers (18.7% vs. 2.5%, p < 0.01). In these wrist injuries, distal radial fractures occurred at a rate of 0.28 per 1000 snowboarders and 0.008 per 1000 skiers. Comminuted and articular fractures classified as AO type A3, B and C, which required surgical treatment, were 49.4% of distal radial fractures in snowboarders and 23.8% in skiers. Conclusion: Wrist injury sustained while snowboarding is characterized as a severe and complex injury. Thus, we call attention to its severity in the treatment of snowboarder's wrist.

Since 1984, the author used a low output carbon dioxide laser for microsurgical anastomoses in the experimental investigation with rats. The series of experiments demonstrates the following characteristics, in comparison with conventional microsurgical anastomoses: ease in technique; less time consumption; equivalency of patency rate and bursting pressure; but only about 50% of the tensile strength of manual suture anastomosis. These findings suggested that low output carbon dioxide laser has the potential for clinical application. Then this technique has been applied in six clinical cases with digital replantations and free vascularized flap since 1988. The procedure offers increased safety and speed in reconstructive microsurgery.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The fracture of the distal end of the radius in elderly patients (more than 75 years of age) were treated with internal fixation by filling the cavity with bone cement.

To investigate a relation between the degree of initial fracture displacement and nerve complication, 53 consecutive acute extension-type supracondylar humeral fractures in children during 10 years were analyzed. From the initial roentgenographs, the direction and degree of displacement of each fracture were plotted on the coronal two-dimensional coordinates at the fracture site. The degree of displacement was represented by a diameter of the humeral shaft. Of 53 fractures, 42 were displaced. Six patients had nerve injuries, representing an 11.3% incidence of neurologic complication. Their displacements were >90% of the diameter of the shaft. Predictive negative and positive displacements of the median nerve were 150% of that in posterolaterally displaced fractures, respectively. Those of radial nerve were 190% in posteromedially displaced fractures, respectively.