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ABSTRACT: We describe a case report of dorsal radiocarpal dislocation with fracture of the radial styloid process. A 21-year-old right-handed male was injured in a fall while snowboarding. Plain radiographic findings revealed dorsal dislocation of radiocarpal joint with fracture of the radial styloid process; we performed CT studies to examine the radius fracture in greater detail. These findings revealed a radial styloid fracture with avulsion fracture of dorsal articular margin of the distal part of the radius. Surgical treatment was performed 4 days after the injury. However, it was impossible to reduce the dorsal dislocation of radiocarpal joint only after the fixation of the radial styloid process. The dorsal radiocarpal ligaments and articular capsule had ruptured transversely on the radiocarpal joint with avulsion fracture of dorsal articular margin of the distal part of the radius. To repair the torn ligaments and capsule, we inserted three mini suture anchors into the dorsal edge of the radius and fixed these tissues on the radius. At present, 1 year after surgery, he has no pain with activity or at rest, and satisfactory results have been obtained.
European Journal of Orthopaedic Surgery & Traumatology 08/2012; · 0.10 Impact Factor
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The Journal of hand surgery, European volume. 04/2012;
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ABSTRACT: The distal clavicle fractures are divided into three types according to Neer's classification. Types 1 and 3 fractures are treated with a sling to immobilize the upper extremity. However, the treatment of type 2 fractures is controversial. We paid attention to the anatomic basis of type 2 fractures that the disruptions of the conoid ligament lead to the distraction between the two bony fragments. In this study, we describe the arthroscopic procedure to reconstruct the disrupted ligament and stabilize the fracture as a minimally invasive method. The subjects were seven patients with the distal clavicle fractures. According to Neer's or Rockwood's classification on plain radiographs, all seven patients were evaluated as type 2 or 2B, respectively. Our surgical procedure was performed with the patient in the beach chair position. We have used the artificial ligament with an EndoButton (Smith & Nephew Endoscopy, Andover, MA) as the substitute ligament to reconstruct the disrupted conoid ligament. The mean duration of postoperative follow-up was 2 years and 5 months. The bony union was achieved in all patients at a final follow-up. When concerning the range of motion at final examinations, mean forward flexion was 171°, mean abduction was 165°, mean internal rotation was Th11, and mean horizontal adduction was 132°. It is possible to treat the distal clavicle fractures by a minimally invasive arthroscopic procedure without opening the fracture site of clavicle.
Archives of Orthopaedic and Trauma Surgery 03/2012; 132(3):399-403. · 1.37 Impact Factor
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ABSTRACT: Irreducible isolated dislocation of the radial head is a rare injury. In this study, we describe a patient with irreducible dislocation of the radial head associated with an undisplaced fracture of the olecranon. A 6-year-old girl fell down while walking and suffered injury to the posterior aspect of the proximal ulnar shaft with the right elbow in a slightly flexed position. Plain radiographs of the elbow revealed an anterior-medial dislocation of the radial head and an undisplaced fracture of the olecranon. However, the attempted closed reduction was not successful. An open reduction was then performed through a lateral approach. The radial head was found to be protruding through a buttonhole tear of the anterior joint capsule, causing the joint to become interposed between the articular surfaces of the joint, precluding closed reduction. Once the interposed capsule was extricated from the joint, the radial head could be easily reduced. At this point, no tear of the annular ligament was observed. Six months after the surgery, the patient was able to use her elbow fully and without pain. The range of motion was 0-140° for both extension and flexion and 90° for pronation and supination. Plain radiographs revealed a united bone of the olecranon and good reduction of the radial head. The radial head pushed through the tear of the anterior joint capsule. This buttonhole effect on the radial head prevented closed reduction of the radial head.
Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 03/2011; 20(5):345-8. · 0.66 Impact Factor
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Katsumi Takase
Orthopedics 01/2011; 31(10):e1-3. · 2.66 Impact Factor
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ABSTRACT: Osteoid osteoma is a relatively common osteoblastic lesion of benign skeletal neoplasms and occurs most commonly in the cortex of long bones, especially the femur and the tibia. Radiological characteristics are a nidus that appears as a small, relatively radiolucent zone within an area of extensive reactive sclerosis. Clinically, the lesion presents with increasing pain, is worse at night, and is relived by nonsteroidal anti-inflammatory drugs (NSAIDs). Osteoid osteomas involving the phalanges of the toes are uncommon, and its accurate preoperative diagnosis is difficult due to the unique clinical and radiological features. The features in the phalanx of the toe are soft tissue swelling and a nidus frequently located in the cancellous without osteosclerosis. This article presents a case of a 22-year-old man with osteoid osteoma in his distal phalanx of the hallux. A needle biopsy of his great toe revealed a small number of bacteria, so he was initially treated for osteomyelitis but with unsatisfactory results. The particular characteristics of clinical and imaging findings supported a diagnosis of osteoid osteoma in the distal phalanx of the hallux. After surgical removal of the tumor, his symptoms resolved. The pathological examination confirmed the suspected diagnosis. In a patient with chronic foot pain that changes to become nocturnal and disappears with NSAID administration, it is important to include osteoid osteoma as a differential diagnosis. A detailed assessment of both clinical and radiological features can lead to the correct diagnosis, which must be confirmed with histopathological examination to ensure adequate excision.
Orthopedics 01/2011; 34(8):e432-5. · 2.66 Impact Factor
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Katsumi Takase
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ABSTRACT: Dupuytren contracture is not a rare disorder. However, the contracture limited to the DIP joint is rare conditions. In this study, we describe a case of Dupuytren contracture limited to the DIP joint occurred in the ring finger.
Joint, bone, spine: revue du rhumatisme 10/2010; 77(5):470-1. · 2.25 Impact Factor
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Katsumi Takase
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ABSTRACT: The treatment for the acromioclavicular joint dislocations has focused on anatomic restoration of the coracoclavicular ligaments. We reviewed the detailed anatomy of trapezoid ligaments and conoid ligaments using cadavers.
The subjects were 40 shoulders of the 20 cadavers. We investigated the distributed direction and attachment sites of both trapezoid and conoid ligaments.
The trapezoid ligaments began at about 2 cm away the central point of the distal coracoid process and directed toward the undersurface of the clavicle. The attachments extended from 13 to 26 mm in sagittal dimension and from 13 to 15 mm in coronal dimension. The conoid ligaments began at the medial posterior margin of the coracoid process and directed toward to the conoid tubercle in the clavicle. The attachments extended from 15 to 30 mm in sagittal dimension and from 3 to 6 mm in coronal dimension.
The findings are important indices for the accurate reconstruction of the coracoclavicular ligaments in acromioclavicular joint dislocations.
Anatomia Clinica 05/2010; 32(7):683-8. · 0.93 Impact Factor
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Katsumi Takase
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ABSTRACT: We have performed arthroscopic Bankart procedures using absorbable or metallic suture anchors for traumatic anterior shoulder instability for over a decade. This article describes the frequency, pathology, and therapeutic results of patients treated for superior labrum anterior and posterior (SLAP) lesions concomitant with Bankart lesions. Twenty patients (Group A) had a mean age of 33.8 years at the time of surgery. On arthroscopic findings, SLAP lesions were classified type 2 in 15 patients and type 4 in 5, based on Snyder's criteria. In addition, intra-articular free bodies were present in 2 SLAP lesions, and a capsular tear was present in 1. We performed debridement (Group A1) or reattachment (Group A2) to the superior glenoid edge of these lesions, considering whether they communicated to Bankart lesions. The therapeutic results were evaluated according to the Japanese Orthopaedic Association (JOA) score and Japan Shoulder Society (JSS) shoulder instability score. Mean JOA and JSS shoulder instability scores were 95.1 and 90.8 points, respectively. All Group A patients remained pain free, and no instability recurred in any patient. Meanwhile, mean JSS shoulder instability function and range of motion scores were 18.9 and 15.1 points, respectively, in Group A1, and 17.5 and 10.1 points, respectively, in Group A2. A significant correlation in range of motion was observed in Groups A1 and A2 (P=.04). Regarding postoperative limitation in external rotation with the arm at the side, the difference in range from that on the healthy side was 9.8 degrees in Group A (7.0 degrees in Group A1 and 12.6 degrees in Group A2). When SLAP lesions communicated to Bankart lesions, we had satisfactory results without SLAP repair; therefore, unnecessary repairs for the concomitant pathology should be avoided, and different postoperative care should be performed for patients with Bankart repair with reattachment of a SLAP lesion.
Orthopedics 09/2009; 32(8). · 2.66 Impact Factor
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ABSTRACT: This article presents a rare case of simultaneous triple joint injuries in the same digit. A 54-year-old, right-handed man sustained simultaneous triple joint injuries in a digit, composed of a fracture of the dorsal base of the distal phalanx involving one-third of the phalanx, dorsal dislocation of the proximal interphalangeal joint with a volar plate fracture, and ulnal dislocation of the metacarpophalangeal joint. Surgery was performed on the patient. Two years postoperatively, active range of motion of the distal interphalangeal joint improved from 0 degrees to 40 degrees, of the proximal interphalangeal joint improved from -20 degrees to 100 degrees, and of the metacarpophalangeal joint improved from 5 degrees to 90 degrees. Grip strength was 32 kg compared to 35 kg on the nonaffected side. No ligamentous laxity was demonstrated in the finger joints. A fracture involving one-third of the phalanx may be caused by forced hyperextension of that joint. This hyperextension may result in a tear of the volar plate of the proximal interphalangeal joint, leading to a dislocation at that joint. This continuous force directs the metacarpophalangeal joint in a slight ulnal shift, and may result in rupture of the medial collateral ligament in the metacarpophalangeal joint. To our knowledge, this injury has not been reported in the literature.
Orthopedics 05/2009; 32(4). · 2.66 Impact Factor
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Katsumi Takase
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ABSTRACT: All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. Two mechanisms of the injury may result in a carpal dislocation: direct and indirect. Most dorsal perilunate dislocations are the result of an indirect mechanism of injury, usually consisting of an extreme extension of the wrist joint, associated with variable degree ulnar deviation and radiocarpal or midcarpal supination. Many factors may explain the occurrence of one or another type of injury: age, differences in direction and magnitude of the deforming forces, and differences in position of the wrist joint at the time of impact.
Orthopedics 11/2008; 31(10). · 2.66 Impact Factor
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ABSTRACT: We treated a combined fracture of the greater and lesser tuberosity with head shaft continuity in the proximal humerus. This case is impossible to classify in three of the classifications, the Neer classification, AO Müller classification, or Jakob classification. However, this case has been described as fracture types in two different categories in the Codman classification. Based on our experience with this case, we concluded that both the plain radiographs and the CT scans were necessary to make a correct diagnosis and classify the fractures of the proximal humerus.
Archives of Orthopaedic and Trauma Surgery 01/2008; 127(10):895-8. · 1.37 Impact Factor
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ABSTRACT: All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.
The Journal Of Hand Surgery 04/2006; 31(3):414-7. · 1.35 Impact Factor
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ABSTRACT: Diagnostics of intraarticular lesions is important in the treatment of traumatic anterior shoulder instability.
We studied 30 patients: 26 men and 4 women. For all patients preoperative examinations involved arthrography, CT arthrography, MR arthrography, and 3D-CT.
The articular capsule adhered to the margin of the glenoid in only 3 cases. In the remaining 27 patients, the joint capsule was detached, showing medial translation. Hill-Sachs lesions were present in 24 cases. Bankart lesions were detected in all cases, and they extended over 2-5 h. Osseous Bankart lesions were detected in 13 cases. MR arthrography revealed the articular labrum in all cases, but AIGHL in only 16 cases. Bankart lesions were found in all cases. When the patients were divided according to the frequency of dislocation, there was a correlation between both distance of the detached joint capsule and visualization of AIGHL and the frequency of dislocation.
From this study, the frequency of dislocation was higher in the patients with severe detachment of the joint capsule, in whom AIGHL could not be visualized by MR arthrography.
Acta Orthopaedica 12/2005; 76(6):854-7. · 2.17 Impact Factor
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ABSTRACT: We examined histological changes in the undersurface of the acromion in patients with symptoms of subacromial impingement, in order to clarify whether or not these changes are the main cause of rotator cuff tear.
We studied 39 shoulders. The undersurface of the acromion and the coracoacromial ligament were examined by light microscopy and transmission electron microscopy.
The distinct four-layer structure seen in the undersurface of the acromion of normal subjects was not found in any of our patients. In patients with full-thickness cuff tear, the extent of the tear had a greater association with the degree of degeneration in the undersurface of the acromion than age or the duration of illness. There was little association between structural changes in the coracoacromial ligament and the extent of or the presence of full-thickness cuff tear, or the duration of illness, but there was a strong association with patient age.
The histological changes in the undersurface of the acromion in patients without cuff tear were merely minute changes compared to those in patients with full-thickness cuff tear. We conclude that the advanced degenerative changes in the undersurface of the acromion result from full-thickness cuff tear.
Acta Orthopaedica 07/2005; 76(3):386-91. · 2.17 Impact Factor
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ABSTRACT: We have performed the surgical procedure on the patients with the fracture of the scaphoid using mini-acutrak screws (ACUMED, Inc.). A 25-year-old man was injured in a fall. Surgical treatment for non-union of the scaphoid using a mini-acutrak screw was performed. However, this screw was broken, despite the absence of any obvious trauma mechanism. A structural examination was performed with a metal microscope and a hardness test was performed. A hardness evaluation was conducted on this broken screw and similar screws. Cannulated screws having diameters of 2.7 and 3.5 mm were also evaluated in the strength test as controls for comparison. The breakage of screw occurred due to fatigue. The screw provides the strength equivalent to that of a 3.5 mm cannulated screw but the bending strength of the head end portion in which the breakage occurred was assumed to be the strength of about one-third that of the intermediate portion.
Hand Surgery 02/2005; 10(2-3):225-30.
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ABSTRACT: Accurate reproduction of anatomic relationship is important in non-constrained prosthetic arthroplasty. The accurate lateral glenohumeral offset, which indicates a parameter of the lever arm of the deltoid and supraspinatus muscles, is one of the most important elements in achieving the efficient shoulder functions after prosthetic reconstruction. However, to our knowledge, there has been no detailed study on the influence of minute changes in the neck shaft angle, within the normal range, on lateral glenohumeral offset. In this study, we evaluated the relationship between the neck shaft angle and various geometric measurement values in the glenohumeral joint. Radiographs of 471 shoulders without osseous lesions in the glenohumeral joint and greater tuberosity were reviewed. There were 265 males and 206 females, and a mean age was 53.5 years old. The final diagnosis was impingement syndrome in 269 patients, rotator cuff tear in 147, and control group in 55 patients. Eight parameters were measured on true anteroposterior radiographs. The lateral glenohumeral offset correlated with the radius of the curvature of the humeral head and the humeral head diameter. The neck shaft angle was not correlated with the offset value. However, when the offset value was divided by the humeral head diameter, to eliminate the affection of the size of the humeral head toward the offset, a correlation was observed with the neck shaft angle. Based on these correlations, we could obtain the equation of the lateral glenohumeral offset according to the neck shaft angle. Using the equation, when the neck shaft angle is decided, the lateral glenohumeral offset can be estimated based on the correlation between the parameters, which achieve the efficient shoulder functions after prosthetic components. Therefore, inaccurate determination of the neck shaft angle in the humeral head component design and selection may induce dysfunction of the abductor muscles.
Journal of Orthopaedic Research 04/2004; 22(2):298-305. · 2.81 Impact Factor
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Katsumi Takase
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ABSTRACT: Good therapeutic results can be obtained by conservative treatments for the proximal humeral neck fractures. However, surgical treatment is sometimes required in patients with 2- or 3-part fractures (Neer's classification) in whom the reduction of the fracture is unable to be maintained by conservative treatments. In this study, we performed the surgical treatment using anatomical bone plate on these patients and evaluated the therapeutic results. The materials consisted of twenty patients. The surgical procedure was performed plate fixation using anatomical bone plate by delto-pectral approach. The postoperative follow-up period ranged from one year to eight years and six months (mean;three years and two months). No patient showed ununited fracture site or humeral head necrosis. The average range of motion in the shoulder was 172 degrees in elevation, 164 degrees in abduction, and ninth thoracic level in internal rotation. Favorable therapeutic results can be obtained by plate fixation using anatomical bone plate in patients with 2- or 3-part fracture of the proximal humeral neck. However, there is necessary in consideration to treat using anatomical plate in patients with severe osteoporosis.
Clinical calcium 11/2003; 13(10):1317-22.
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ABSTRACT: Accurate reproduction of the anatomic relationship is important in nonconstrained prosthetic arthroplasty. However, the geometry of the glenohumeral joint for prosthetic components has not been established. In this study, we evaluated the relationship between the position of the greater tuberosity and various geometric measurements in the glenohumeral joint. Radiographs of 519 shoulders without osseous lesions were reviewed. There were 296 male and 223 female patients, with a mean age of 49.7 years. Four parameters were measured on true anteroposterior radiographs, including the distance between the humeral head-greater tuberosity junctional point and the top of the humeral head, as well as the neck shaft angle. There were significant differences in all parameters between males and females. The distance between the humeral head-greater tuberosity junctional point and the top of the humeral head significantly correlated with the neck shaft angle in both males (P <.01, r = 0.468) and females (P <.01, r = 0.639). If the neck shaft angle of the replacement is smaller than the anatomic neck shaft angle of the patient, the placement of the humeral head component with the same distance between the humeral head-greater tuberosity junctional point and the top of the humeral head as that before surgery might not reproduce the anatomic glenohumeral joint. We conclude that determining the distance between the humeral head-greater tuberosity junctional point and the top of the humeral head and its relationship to the neck shaft angle is important for the prevention of postoperative subacromial impingement.
Journal of Shoulder and Elbow Surgery 11(6):557-61. · 2.75 Impact Factor
