29TH ANNUAL MEETING OF THE JAPAN SHOULDER SOCIETY

Sapporo, Japan

September 20-21, 2002

● OPERATIVE TREATMENT FOR SUBCUTANEOUS RUP-TURE OF THE LONG HEAD TENDON OF BICEPS BRACHIIK. Suzuki, MD, T. Tanaka, MD, K. Wada, MD, Dept of Orthopae-dic Surgery, Fujita Health Univ Sch of Med

We treated the subcutaneous ruptures of the long headtendons of biceps brachii by key hole method. There were 12patients (mean age: 52.5 years, 11 men and 1 woman). Themean follow-up period was 35 months. Recurrence of tendontear was not seen in all patients. All patients had pain anddisturbance of working and sports preoperatively but did nothave them after surgery. Muscle strength was 4 preoperativelyand improved to 5 postoperatively in all patients. The JOA scoreimproved significantly from 63 preoperatively to 96 postopera-tively.

● CLINICAL FEATURES OF ROTATOR CUFF TEARS ASSO-CIATED WITH INJURIES OF THE LONG HEAD OF BICEPSTENDONG.-I. Yoshikawa, MD, K. Hori, MD, H. Kaneko, MD, N. Tanaka,MD, M. Murakami, MD, Y. Matsusue, MD, Dept of OrthopaedicSurgery, Shiga Univ of Med Sci, Shiga, Japan

Rotator cuff tear clinical features were studied in relation toassociated long head biceps (LHB) tendon injuries. Forty-twoshoulders, 38 patients, with a complete cuff tear underwentsurgery. Three groups were classified according to injury degree(none, injured, ruptured). The injured group was divided into 2subgroups according to treatment (tenodesis, ignored). Clinicalfeatures and surgical results for all were evaluated. Averagetotal post operation JOA scores were significantly improved ineach group, as were pain scores in the tenodesis group com-pared to the ignored group. Preoperative assessment was infor-mative, as foreknowledge of injury and treatment influencedsurgical results.

● COMPLICATION OF THE ROTATOR CUFF INJURY INTHE ACROMIOCLAVICULAR DISLOCATIONST. Naniwa,a K. Ogawa,b I. Ikegami,b W. Inokuchi,b N. Naka-michi,b S. Kobayashi,b Saseikai Mukoujima Hosp,a Keio Univb

We studies the 59 shoulders of 59 patients, who were diag-nosed as Rockwood type III and operated between 1993 and2001. There were 57 males and 2 women, who at the time ofsurgery ranged from 13-68 years old. The operative procedure ofRockwood modified was performed. There were 9 shoulders thatthe rotator cuff injury was complicated and the age was 20-55years old, average 29.6 years old. Some patients among thesewere delayed rehabilitation because of the pain of the rotator cuff,but all return daily livings and social work at the time of finalmedical examination.

● PERCUTANEOUS KIRSCHNER WIRE FIXATION IN AC-ROMIOCLAVICULAR DISLOCATIONKimio Nakagaki,a Goro Sakurai,b Tomohisa Hashiuti,b Jiro Oza-ki,b Yasuharu Tomita,c Yoshiyuki Nakagawa,d Dept of OrthopSurg, Gojo Prefectural Hospital,a Nara Rehabilitation Center,bNara Medical University,c Haibara General Hospitald

A 3-mm Kirschner wire was passed percutaneously under theacromion and into the clavicle after reduction of the acromiocla-vicular dislocation in six patients. The wires were removed 7–8weeks after operation. In two patients the shoulder was a acromi-oclavicular subluxation shape. Only two patients maintained nor-mal acromioclavicular shape. A wire migration occurred in the78-year-old patient. Percutaneous Kirschner wire fixation passedunder the acromion into the clavicle in the recent acromioclaviculardislocation was easy and useful. We cannot recommended thismethod for elder patients with osteoporosis.

● SURGICAL RESULTS OF ARTHROSCOPIC MUMFORDPROCEDURET. Takiuchi, MD, K. Okamura, MD, K. Kagaya, MD, T. Hirose, MD,N. Yamamoto, MD, R. Nagasawa, MD, M. Aoki, MD, Dept ofOrthop Surg, Sapporo Med Univ, Sapporo, Japan

The purpose of this study was to report our results of arthro-scopic resection of the distal clavicle. We evaluated 6 shoulders of6 patients. All patients were male and the average age at thesurgery was 39.2 years (24-66 years), and the average follow-upperiod was 38.5 months (25-57 months). Preoperative diagnoseswere internal derangement after an acromioclavicular joint sprainin 4 cases and osteoarthritis in 2 cases. There were significantimprovements of the JOA score, the JSS sports score, and the JSSAC joint score postoperatively. This procedure has the advantageof low morbidity.

● POSTOPERATIVE RESULTS OF ACUTE AND CHRONICGRADE 3 DISLOCATIONS OF THE ACROMIOCLAVICLARJOINTM. Maeda, Dept of Orthopaedic Surgery. Functional Reconstruc-tion, Tokai University School of Medicine

Postoperative results of modified Phemister methods with 22acute and of Neviaser methods with 10 chronic acromioclavicular(AC) dislocations (Tossy’s grade 3) were studied, respectively. Inacute cases, the relationships between superior migration of thedistal clavicle and pain, fatigability, and satisfaction were ob-served statistically significant. Chronic cases showed no correla-tions among all factors studied. Considering the intraoperativefindings, a secure repair of the coracoclaviclar ligament seemsessential to avoid postoperative superior migration. Residual ofdislocations may cause pain or fatigue, so that the anatomicalreconstruction is necessary for the patients, especially those who doheavy routine work.

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● OPERATIVE TREATMENT OF COMPLETE ACROMIOCLA-VICULAR DISLOCATION WITH TETRON TAPE FOR REIN-FORCING CORACOCLAVICULAR LIGAMENTT. Komatsuda, MD,a K. Sato, MD,a S. Sone, MD,a J. Kumagai,b K.Ishibashi, MD,c Dept of Orthop Surg, Tohoku Rosai Hospital,aIwate Prefectual Central Hospital,b Ishibashi Hospital,c Sendai,Japan

Surgical results of 31 fresh complete acromioclavicular (AC)dislocations utilizing the Tetron tape for reinforcing coracoclavicu-lar (CC) ligaments were evaluated. Patients were followed for anaverage of 50 months (25-77) and evaluated with JSS-ACj score.The average score was 95.1 � 6.2 points (73-100). The displace-ment was within 50% of the AC joint height in 25 cases (group I),while its was over 50% in the remaining 6 cases (group II). JSS-ACjscore was significantly higher in group I (96.6 � 4.3) than that ingroup II (88.8 � 9.5) (P � .01). No bone erosions of clavicle norcoracoid process were found.

● VARIANCE IN CRITICAL PATH OF ROTATOR CUFF RE-PAIRM. Hirano, MD, K. Nomura, MD, Department of OrthopedicSurgery, Kumamoto National Hospital, Kumamoto, Japan

Twenty-seven cuff repairs were treated with critical path. Therewere 15 cases of positive variance (early discharge) and 12 casesof negative variance (late discharge) on hospital days. Of negativevariance 7 cases were delayed because of patients’ physicalconditions. Of positive variance 5 patients went back to their homemore than 5 days earlier than the day on which critical path saysas discharge. These 5 patients had relatively small tears (1.8 cm �1.3 cm on average). Critical path is very useful for proper improve-ment of postoperative therapy and useful for proper hospital days.

● DOUBLE FRACTURE OF THE CLAVICLET. Mondori, MD, Y. Nakagawa, MD, M. Oshima, MD, Dept ofOrthop Surg, Odai Kosei Hospital, Mie, Japan

We treated 9 cases of double fractures of the clavicle. Themechanism of them has two patterns except for direct force to theclavicle. The distal end fracture was the initial fracture in all cases.The cases of the mid and distal fracture were struck on the supero-lateral side of the shoulder, and then, the clavicle approaches thefirst rib. The cases of the proximal and distal fracture were struck onthe lateral side of their shoulder; the shoulder rolled backwards andthen produced a fracture of the proximal third of the claviclesecondly.

● REVISION TOTAL SHOULDER ARTHROPLASTY FORTHE TREATMENT OF GLENOID ARTHROSIS AFTER THE HEMI-ARTHROPLASTYYasuaki Nakagawa, MD, Takashi Suzuki, MD Shuzo Okudaira,MD, Takashi Nakamura, MD, Department of Orthopaedic Sur-gery, Faculty of Medicine, Kyoto University

Purpose. Although the development of painful glenoid arthrosisis the most common reason for reoperation after the hemiarthro-plasty, there are few reports in Japan. We reported such a casebecause of high activity.

Case report. He was 67-year-old man. The hemiarthroplasty(Neer II) to his left humerus was performed in 1993. After that, theelevation of his shoulder was able to be 170 degrees. In 2001 heagain suffered from left shoulder pain because of the left glenoidarthrosis. After the revision total shoulder arthroplasty, his shoulderpain decreased, and the elevation of his shoulder was 170 de-grees.

● SHOULDER PROBLEMS IN ELITE VOLLEYBALL ATH-LETES: THE EFFECT OF SUBACROMIAL IMPINGEMENT ONRANGE OF MOTIONY. Fujii, MD, H. Kakoi, MD, Health Service Center, NationalInstitute of Fitness and Sports, Kanoya, Japan

Purpose. To determine the effect of subacromial impingementon the range of motion (ROM) of the shoulder of elite volleyballplayers.

Methods. We examined 36 athletes by measuring flexion androtation at both 90° abduction (2nd position).

Results. 14 showed a positive impingement sign, in whomflexion and internal rotation at the 2nd position of the throwinghand were smaller than those of the nonthrowing hand, and ROMexcept for the internal rotation at the 2nd position was smaller thanthat in the others (P � .05).

Conclusion. The tightness of the posteroinferior capsule maylead to subacromial impingement.

● LOSS OF INTERNAL ROTATION OF THE THROWINGSHOULDERS IN LITTLE LEAGUERSY. Iwahori, MD, M. Kato, MD, K. Sato, MD, Dept of OrthopaedicSurgery, Aichi Med Univ Sch of Med

Purpose. We measured the range of internal and externalrotation of the shoulders in little leaguers.

Materials and methods. Medical check was performed on 52little leaguers (range of age, 9 to 12 years), and measurements ofthe range of shoulder rotation were made with the patients supineand the shoulder at 90° abduction.

Results. They demonstrated significantly increased external ro-tation and significantly decreased internal rotation range of motioncompared with the opposite shoulders. The significant differenceswere found in all ages.

Conclusion. We found significant loss of internal rotation of thethrowing shoulders even in little leaguers.

● MEASUREMENT OF INTERNAL ROTATION OF THESHOULDER WITH A MAGNETIC TRACKING DEVICEI. Wakabayashi, MD, E. Itoi, MD, H. Minagawa, MD, M. Koba-yashi, MD, Department of Orthopedic Surgery, Akita UniversitySchool of Medicine

To clarify the relationship between the vertebral level reachedby the thumb and the internal rotation angle of the humerus, wemeasured the angles of humeral rotation, shoulder abduction,extension, and elbow flexion in seven shoulders using a magnetictracking device with the 4 sensors (ulnar head, lateral epichondyle,acromion, and Th1). Measurements were repeated at the hangingarm position, with the thumb at the buttock, sacrum, and eachvertebral level. Internal rotation angle of the humerus increasedgreatly between the hanging position and the buttock (average39.8°). However, the increase was much smaller above the buttock(average 2.6°).

● THREE AGED CASES OF RAPIDLY DESTRUCTIVE AR-THRITIS OF THE SHOULDERYasumoto Matsui,a Yasuhide Kanayama,b Takaaki Omachi,c Hi-roaki Kachi,c Dept of Orthop Surg, Chubu National Hospital,aDept of Reumatology, Toyohashi Municipal Hospital,b Dept ofOrthop Surg, Toyohashi Municipal Hospitalc

Case 1. An 81-year-old female of adhesive capsulitis lost jointspace on X-ray during 6 months with marked cysts in humeral headand glenoid indentation on MRI. Total arthroplasty resulted JOAscore 89 1 year post-op, compared to 43 pre-op.

Case 2. An 80-year-old male with sudden severe right omalgiaand ROM limitation 9 months ago. Rehabilitation under continuousepidural block brought marked destruction on X-ray and MRI.Possibility of infection led to conservative treatment.

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Case 3. A 92-year-old demented female with large bony defectsof humeral head and glenoid in 3 months. Rapid destructiveshoulder arthritis can happen in aged people with porotic bone.

● EFFECT OF RECOMBINANT BASIC FIBROBLASTGROWTH FACTOR (bFGF) ON FIBROBLAST-LIKE CELLSFROM ROTATOR CUFF TENDONS. Takahashi, MD, N. Miyakoshi, MD, M. Kobayashi, MD, I.Wakahashi, MD, H. Minagawa, MD, E. Itoi, MD, Dept of Ortho-pedic Surgery, Akita University

Purpose. To investigate the effect of bFGF on fibroblast-like cellsfrom the rotator cuff tendon (RCC).

Materials and methods. RCC were maintained for 10 days in�-MEM supplemented with 10% FBS and bFGF.

Results. The proliferation was promoted by bFGF in a dose-dependent manner. Maximal responses were obtained at around 1ng/mL. The administration of bFGF suppressed the secretion ofcollagens and SDS-PAGE showed that most predominant collagenwas type I.

Conclusion. bFGF has a stimulatory effect on the proliferation ofRCC; however, the administration of bFGF suppressed the secre-tion of collagens in a dose-dependent manner.

● NIGHT PAIN IN SHOULDERS WITH ROTATOR CUFFTEARS: A QUESTIONNAIRE ON NIGHT PAIN AND THE MEA-SUREMENT OF SUBACROMIAL BURSA PRESSUREN. Yamamoto, MD, K. Okamura, MD, T. Takiuchi, MD, K. Keiko,MD, T. Hirose, MD, R. Nagasawa, MD, Dept of Orthopaedic Surg,Sapporo Med Univ. School of Med, Sapporo

We obtained information through a questionnaire on 62 shoul-ders with rotator cuff tears and investigated the relationship be-tween night pain and the subacromial bursa by measuring itspressure. The pressure on the bursa of 18 shoulders was measuredin the three positions (standing, supine, and lateral decubitus).Night pain was related to the position of the body. However, therewas no relation between night pain and the position of the upperlimbs. In shoulders that experienced night pain, the pressure sig-nificantly increased, and we believe that this increase in the pres-sure may be the cause of night pain.

● ROTATOR CUFF TEAR WITH AXILLARY NERVE PALSYM. Nagoshi, MD,a H. Hashizume, MD,b Nagoshi OrthopaedicClinic,a Dept of Orthop Surg, Okayama Univ Med School,bOkayama, Japan

We report on four rotator cuff tears with axillary nerve palsy.Four cases injured anterior dislocations by high energy (all men,age: 46-52). In all cases rotator cuff tears were repaired afterconfirming improvement sign of nerve palsy by electromyography.The average follow-up period was 27.2 months. The average JOAscore improved from 37.5 to 81.2 points. Differential diagnosisfrom brachial plexus injury is important. Cuff tear should be re-paired after confirming improvement of nerve palsy.

● MR ARTHRO- AND BURSOGRAPHY FOR DIAGNOSISOF INCOMPLETE ROTATOR CUFF TEARTakayuki Sugihara, MD, Dept of Orthopaedic Surgery, TokyoMedical and Dental University

The purpose of this study is to determine the diagnostic perfor-mance of MR arthro- and bursography for incomplete rotator cufftears. Seven shoulders of surgically proved incomplete rotator cufftears were studied. After an injection of urografin into the gleno-humeral joint and subacromial bursa, MR images were obtainedpreoperatively. A comparative study between the findings of pre-operative MR arthro- and bursography and the surgical findingswas performed. MR arthro- and bursography revealed adequate

diagnosis in bursal side tears and intratendinous tears. However, itre vealed inadequate diagnosis in articular side tears.

● THE USEFULNESS OF HELICAL COMPUTED TOMOG-RAPHY WITH ARTHROGRAPHY TO DIAGNOSE ROTATORCUFF TEARS MORE ACCURATELYH. Kakoi, MD, Y. Fujii, MD, S. Komiya, MD, Dept of OrthopaedicSurgery, Kagoshima University, Kagoshima, Japan

Purpose. We evaluated rotator cuff tears (RCT) with the recon-structed coronal and sagittal view after arthrographic helical CT(arthro-HCT) to improve the diagnosis.

Methods. 15 cases, including 10 cases with RCT. We per-formed a comparative study to evaluate the precise size andposition of RCT with arthroscopic examination.

Results. Arthro-HCT nearly showed the exact condition of theRCT in 7 RCT cases. In the other 3 cases, only bursographic HCTshowed a bursal-side partial tear. Arthro-HCT combined with bur-sography showed the exact RCT in all RCT cases.

Conclusion. Arthro-HCT is one of the most useful examinations toevaluate the RCT.

● THE FREQUENCY OF THE MUSCLAR FATTY DEGENER-ATION IN THE COMPLETE ROTATOR CUFF TEAR: EVALUA-TION BY CT SCANK. Hori, MD, G.-I. Yoshikawa, MD, M. Murakami, MD, S. Hiraoka,MD, Y. Matsusue, MD, Dept of Orthopaedic Surgery, Shiga Univof Med Sci, Shiga, Japan

We examined fatty degeneration in 28 patients (average age60.7 years) with a complete rotator cuff tear using CT images.Degeneration frequency was 66.7%, 35.7%, and 23.1% in theinfraspinatus, supraspinatus, and subscapularis tendon, respec-tively. Postoperative results might be inferior when fatty degenera-tion has occurred and surgery should be performed prior to itsappearance. Further, since fatty degeneration may be more prev-alent with rupture of the infraspinatus tendon, the operation shouldbe performed as early as possible.

● INTRAOSSEOUS GANGLION OF THE SCAPULAM. Egawa, MD, G.-I. Yoshikawa, MD, K. Hori, MD, Y. Matsusue,MD, Dept of Orthopaedic Surgery, Shiga Univ of Med Sci, Shiga,Japan

A 49-year-old man presented to our institute with left shoulderpain for 2 months. Plain radiographs of the left shoulder showed anosteolytic lesion with sclelotic margin. CT scans showed density ofgas in the multilobular lesions. Curettage followed by packing ofthe defect with �-TCP was performed. The histological diagnosis ofintraosseous ganglion was made. Intraosseous ganglion are rarelesions. Gas (vacuum phenomenon) in the lesion was documentedon CT scan in this case.

● OPEN REDUCTION FOR DISLOCATION OF THE TEN-DON OF THE LONG HEAD OF THE BICEPS: A CASE REPORTY. Gotoh, J. Etoh, Dept of Orthopedic Surg, Municipal SagaeHospital, Sagae, Yamagata, Japan

A 44-year-old-man injured his right shoulder taking his childrunning into his arms. His shoulder was forced into extension. Therewas a tenderness on the lesser tuberosity and pain with a click onthe bicipital groove during Yergason test’s maneuver. CTA and MRIshowed a medial displacement of LHB from the bicipital groove. Anoperation was performed. The subscapularis tendon was partiallytorn horizontally and LHB was dislocated inside the subscapularistendon. A reduction of LHB and a repair of the subscapularistendon were performed. At 9 months after the operation, there waspain and swelling on the bicipital groove.

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● ISOKINETIC PROFILE AND SUGGESTION FOR THE RE-COVERY OF THROWING SHOULDER INJURIES OF HIGHSCHOOL BASEBALL PLAYERST. Yoshimatsu, MD,a S. Yoshimatsu, MD,b K. Fukushima,a S. Mo-tojima, MD,a K. Mashima, MD,c A. Saito, MD,a J. Ryu, MD,a Deptof Orthop Surg, Nihon Univ Sch of Med, Tokyo, Japan,a Dept ofOrthop Surg, Koushoku Chuo Hosp, Nagano, Japan,b Dept ofOrthop Surg, Tokyo Jikeikai Med School, Tokyo, Japanc

150 shoulders of uninjured and 115 shoulders in patients withthrowing injuries were examined by isokinetic evaluation of shoul-der rotational strength and endurance strength to investigate theappropriate time for the patient to return to pitching. Returning topitching was found to be highly possible when the patients hadcorrected the imbalance of internal and external rotationalstrengths and their endurance strength was above 70% measuredby the concentric endurance strength test. Correction of the imbal-ance of shoulder rotational strength and the improvement of endur-ance strength are considered to be necessary to judge the appro-priate time for returning to pitching.

● FORCED SHOULDER ABDUCTION AND ELBOW FLEX-ION TEST: DIAGNOSTIC TEST FOR SLAP LESIONS INTHROWING SHOULDERShigeto Nakagawa,a Toru Komuro,b Sunao Fukushima,c MasanoriObata,c Yoshio Miyazaki,c Minoru Yoneda,c Dept of Orthop Surg,Osaka Prefectural Hosp,a Com Prehabilitation Center,b Dept ofSports Med, Osaka Kosei-nenkin Hosp,c Osaka, Japan

The purpose of this study was to investigate the efficacy ofseveral diagnostic methods to detect superior labrum injuries inthrowing shoulder. Fifty-four throwing athletes were prospectivelystudied. There were 24 superior labrum injuries. Efficacy of preop-erative diagnostic methods was investigated comparing with ar-throscopic findings. Our original forced shoulder abduction andelbow flexion test was diagnosed as positive, when pain at pos-terosuperior aspect of the shoulder in forced maximal abductionwas reduced or diminished in elbow flexion. As results, this test wasmost effective, and the sensitivity, specificity, and accuracy were73%, 69%, and 70%, respectively.

● CLINICAL OUTCOMES OF EPIPHYSEAL SEPARATIONIN THE PROXIMAL HUMERUS CAUSED BY SPORTS ACTIVITYH. Hashiguchi, MD, H. Ito, MD, Y. Banzai, MD, Dept of Ortho-paedic Surgery, Nippon Medical School

We report the clinical outcomes of 47 patients with the epiph-yseal separation in the proximal humerus due to sports activities.X-ray images revealed partial separation of the lateral epiphysis in36 patients, full separation in 7, and slipping in 4. All patients weresubjected to conservative treatments. Complete improvement of theseparated epiphysis was observed in all patients. 46 patients couldreturn to their previous sports. All patients had motion limitation ofinternal rotation due to posterior tightness of the shoulder joints.Therefore, the posterior tightness may be one of the causes of theepiphyseal separation.

● MIDTERM CLINICAL RESULTS AFTER ARTHROSCOPICREMOVAL OF PAINFUL BENNETT OSSIFICATION INTHROWING ATHLETESShigeto Nakagawa,a Minoru Yoneda,b Sunao Fukushima,b Masa-nori Obata,b Yoshio Miyazaki,b Kenji Hayashida,c Dept of OrthopSurg, Osaka Prefectural Hospital,a Dept of Sports Med, OsakaKosei-nenkin Hospital,b Dept of Orthopaedic Surg, HoshigaokaKosei-nenkin Hospital,c Osaka, Japan

The purpose of this study was to clarify the midterm clinicalresults after arthroscopic removal of painful Bennett ossification inthrowing athletes. Thirteen baseball players were retrospectivelystudied. Tenderness, throwing pain, recovery of throwing ability,

return to playing baseball, and patient’s satisfaction were investi-gated. As results, no tenderness was seen. Throwing pain disap-peared in 8 shoulders and was improved in 5 shoulders. Ninepatients returned to baseball completely, while 3 patients returnedpartially and one patient could not return. No recurrence was seenincluding one case of re-ossification. In conclusion, the midtermclinical result was almost favorable and persisted unchanged.

● ARTHROSCOPIC TREATMENT OF ROTATOR CUFF IN-JURIES IN THROWING ATHLETESJ. Ide, MD, S. Maeda, MD, K. Takagi, MD, Dept of OrthopaedicSurgery, Kumamoto Univ Sch of Med, Kumamoto, Japan

Between 1993 and 2000, 61 throwing athletes (4 women, 57men, mean age, 28) with rotator cuff injuries were treated arthro-scopically, 47 patients were baseball players. We performeddebridement of torn cuff (articular side partial tear; n � 41), repairof torn cuff (n � 6), subacromial decompression (n � 15), debride-ment of torn labrum (n � 22), repair of SLAP type 2 (n � 12). 17patients (28%) had excellent results, 27 (44%) good, 17 (28%)poor. Internal impingement was a major mechanical cause ofrotator cuff injuries in throwing athletes. Partial cuff tears involving50% or greater of the tendon substance should be repaired.

● ACTIVITY LEVELS OF PATIENTS WITH SHOULDER DIS-LOCATION: QUANTITATIVE ASSESSMENT WITH USE OFPHYSICAL ACTIVITY SCOREMoto Kobayashi, MD, Eiji Itoi, MD, Hiroshi Minagawa, MD, IkukoWakabayashi, MD, Dept of Orthopedic Surgery, Akita UniversitySchool of Medicine, Japan

Purpose. Patient’s physical activity level has been thought to beone of the crucial factors affecting recurrence of shoulder disloca-tion. We assessed activity levels of shoulder patients quantitativelyusing physical activity scores (PAS).

Patients and methods. 209 subjects were enrolled in this study.There were 50 patients with recurrent shoulder dislocation and 159normal controls.

Results. Among PAS, values for job and sports/recreation ofdislocation patients showed significantly higher values than thecontrols (P � .0001). Logistic regression analysis revealed that thejob and sports/recreation scores had significant effect on recur-rence (P � .0001).

Conclusion. Patients with recurrent dislocations showed highphysical activity.

● RISK FACTORS FOR NONUNION AND DELAYEDUNION OF DIAPHYSEAL FRACTURES OF THE CLAVICLEK. Fujii, MD, Department of Orthopaedic Surgery, Health Insur-ance Naruto Hospital

The purpose of this study was to investigate the risk factors fornonunion and delayed union of diaphyseal fractures of the clavicle.225 fractures were treated from August 1987 to August 2000. Allfractures with bony contact healed uneventfully. Two fractures ofnonunion and three fractures of five delayed unions were displacedmore than 20 mm and their ages except one were 50 years ormore. The other two delayed unions were refractures. In this study,displacement more than 20 mm, age of 50 years or more, andrefracture were associated with poor prognosis of union.

● POSTERIOR FRACTURE-DISLOCATION OF THE SHOUL-DER JOINTSatoshi Maeda, MD, Junji Ide, MD, Katsumasa Takagi, MD, Deptof Orthopaedic Surgery, Kumamoto University School of Medicine

Posterior fracture-dislocation of the shoulder joint is an uncom-mon and frequently missed injury. We describe three cases with

4 J Shoulder Elbow SurgMarch/April 2003

this injury. 1: A 21-year-old man involved in a rugby game. Theaxillary radiograph showed a two-part posterior fracture-disloca-tion of the anatomical neck. 2: A 70-year-old woman involved in amotorcycle accident. The computed tomography showed a two-part posterior fracture-dislocation of the greater tubercle. 3: A44-year-old man involved in an epileptic seizure. The computedtomography showed a two-part posterior fracture-dislocation of thelesser tubercle. All cases have favorable outcome after open reduc-tions and internal fixations.

● OPEN REDUCTION AND INTERNAL FIXATION FORFOUR-PART FRACTURES OF THE PROXIMAL HUMERUS BYINTRAMEDULLARY PIN AND WIREY. Nakagawa, MD, M. Oshima, MD, T. Mondori, MD, Dept ofOrthop Surg, Haibara General Hospital, Nara, Japan

Purpose. The purpose is to introduce our method and to evalu-ate the postoperative results for four-part fractures.

Materials and methods. Their average age was 64.0 years. Thehumeral head and shaft were fixed by two intramedullary Enderpins through the rotator cuff. The rotator cuff and humeral shaftwere fixed by a wire extramedullary.

Results. Nine of 11 fractures healed without avascular necrosis.Necrosis occured in one case; prosthetic replacement was per-formed for re-fracture in one case.

Conclusion. Our method is advantageous to revasculization ofthe humeral head and very useful for the four-part fractures of theproximal humerus.

● COMPLEX INJURY PATTERNS OF THE SHOULDER GIR-DLE: THREE- OR FOUR-SITE INJURYM. Oshima, MD, Y. Nakagawa, MD, T. Mondori, MD, Dept ofOrthop Surg, Haibara General Hospital, Nara, Japan

Purpose. We classified the complex injury patterns of the shoul-der girdle and report the clinical results of three- or four-site injury.

Materials and methods. Complex injuries are classified with thecombination of the injuries as follows: (1) injury around acromio-clavicular ligament, (2) injury around coracoclavicular ligament,(3) scapular neck fracture, (4) mid-clavicular fracture.

Results. There were seven cases with three or four sites of injury.We did surgical management in 6 cases.

Conclusion. In the case of significantly displaced three- orfour-site injury, surgical reconstructions of at least two injury sitesare required.

● DIAGNOSTIC ASSESSMENT OF THE STRESS VIEW INTHE SHOULDER JOINTSYasuaki Nakagawa, MD, Takashi Suzuki, MD, Shuzo Okudaira,MD, Takashi Nakamura, MD, Department of Orthopaedic Sur-gery, Faculty of Medicine, Kyoto University

Purpose. We evaluated the diagnostic value of the stress viewin the shoulder joints.

Materials and methods. We performed the stress view in theshoulder joints using Telos shoulder positioning device from 2000to 2002. There were 18 patients and 36 shoulders. We dividedthem into three groups: group A (recurrent anterior shoulder dislo-cation), group B (multidirectional instability of the shoulder), andgroup C (throwing shoulder).

Results. The mean of anterior stress in group A was 35.9% inthe operated side and 48.2% in the other. It was significantdifference.

Conclusion. This stress view in the shoulder joints had diagnosticvalue.

●ARTHROSCOPIC BANKART REPAIR USING SUTURE

ANCHORS IN ATHLETES: PATIENT SELECTION AND RESULTSJ. Ide, MD, S. Maeda, MD, K. Takagi, MD, Dept of OrthopaedicSurgery, Kumamoto Univ Sch of Med, Kumamoto, Japan

32 patients (8 women, 24 men; mean age, 20 years) with adiscrete Bankart lesion, no bilateral multidirectional instability,and no large Hill-Sachs or bony anterior glenoid defect wererepaired arthroscopically using suture anchors. 28 patientswere excellent and 4 good by Rowe after a mean of 36 (24-48)months’ follow-up. The mean loss of ER arm at side was 4degrees and that in abduction was 2 degrees. One (3%) hadrecurrence. There was no complication. Arthroscopic Bankartrepair for our selected patients restored stability of the shoulderand led to a favorable outcome in the overhead and contactathletes.

●THE OPERATIVE RESULTS OF ARTHROSCOPIC BAN-

KART REPAIR PROCEDURE FOR TRAUMATIC ANTERIOR IN-STABILITY OF THE SHOULDER JOINTSYu Mochizuki, MD, Kenji Kashiwagi, MD, Kazuhiko Kikugawa,MD, Kouji Natsu Kouji, MD, Mitsuo Ochi, MD, Dept of Orthopae-dics, Faculty of Medicine, Hiroshima University, Hiroshima, Japan

The purpose of this study was to evaluate the operative results ofarthroscopic Bankart repair (Caspari’s procedure [TG group] andsuture anchor procedure [SA group]). TG group were 35 cases andSA group were 23 cases. The clinical evaluation was performedusing the JSS Shoulder Instability Score. Using 3DCT image, weinvestigated the shape of the glenoid. The SA group showed betterresults than the TG group. In 91% of all cases, we found the bonydefect at the injured site comparing with the healthy site using the3DCT.

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