Orthopedic Surgery

In the "Kobe City Municipal Medical Center Orthopedic Surgery Specialized Training Program", our hospital will be the core facility, and the Kobe City Municipal Medical Center Nishi Municipal Hospital and Nishi Kobe Medical Center will be partner facilities. In addition to these three hospitals, the National Hospital Organization Himeji Medical Center, Hyogo Prefecture Amagasaki General Medical Center, Toyooka Public Hospital Association Toyooka Hospital, Social Medical Corporation Shinko Memorial Association Shinko Memorial Hospital, and Kyoto University are joint facilities. join the program.

Our department deals with many acute and chronic diseases including trauma. Each case is jointly handled by a Senior Resident in charge and a doctor in charge of each field, and it is possible to accumulate a wealth of experience.

We are planning to hold a special training program information session on June 3, 2022.

Introduction of 2017 Senior Resident Surgery Surgery Achievements

Impressions of Senior Resident about Orthopedic Surgery training

Senior Resident A

You can experience multiple injuries unique to tertiary emergency. I also feel that I can grow in a well-balanced manner after experiencing chronic diseases such as artificial joints and spine.

Senior Resident B

I feel that it is a privileged environment to experience many severe cases under the kind guidance of staff members who are well versed in their respective specialties. There are some difficult cases, but I am spending fulfilling days while being blessed with the same period and being encouraged. I actively participate in academic conferences and lectures, and have gained valuable experience. I would like to continue to devote myself to the training and put my feet on the ground.

Senior Resident C

At our hospital, we are able to experience a wide range of cases from the acute stage to the chronic stage under the backup of senior doctors. In particular, there are many complicated cases of trauma regardless of the body part, and I think that there are many cases that are very valuable as training because it is not only a simple procedure, but also training to make a solid preoperative plan. Also, regarding artificial joint surgery, you can be involved in surgery from an early stage, and you can gain experience in implant placement and cement procedures. Postoperative management also needs to be done in a responsible position as the attending physician, and I can feel that I am involved with the patient comprehensively. Therefore, I need to update my knowledge of not only Orthopedic Surgery but also other departments to some extent, which may be a little burdensome, but I think I am in an environment where I can grow as a doctor comprehensively. Senior doctors can equally handle duty and standby duty, so it is possible to devote holidays to your own time, and it is an environment that makes it easy to participate in seminars and academic conferences. I am full of gratitude to Director Yasuda and the other senior medical staff for providing me with training in an environment where I can learn both in classrooms and in practice at a high level.

Senior Resident D

I started my new post in October 2015. The specialized training at our clinic is still short, about 5 months, but I would like to write about two features of the training at our clinic.

The first is the ability to touch various wounds. Since our hospital focuses on emergency care, we will be in charge of various trauma cases. I thought I had experienced all kinds of injuries at the hospitals I worked at, but there were many cases that I had never experienced or that were difficult to treat.

The second is that you can learn about various specialized fields. Various cases have been introduced from Kobe City and surrounding areas. For example, during the 5 months of training, I had the experience of operating about 15 cases of THA. Among them, there are many difficult cases such as CDH and after Chiari surgery, and I am able to accumulate treatment experience that I can use in the future.

What makes this possible is that we have experts in each field who provide guidance and backup. I think it's wonderful to be able to do specialized training in such an environment. It's easy, but I wrote about the characteristics of the specialized training at our clinic.

We perform surgeries for hip osteoarthritis, femoral head necrosis, acetabulum dysplasia, hip labrum injury, etc.
Hip replacement surgery for hip osteoarthritis and femoral head necrosis can reduce pain in the hip joint and allow more freedom of activity and movement. In addition, if there is a difference in the length of the left and right legs, the length of the left and right can be almost the same, so the burden on the knees and lower back can be reduced, and the gait (walking) can be improved considerably. After surgery, some people enjoy swimming, walking, golf, cycling, light mountain climbing, and tennis. However, complications include postoperative infection and dislocation. The incidence rate is about 1% for both cases, but we pay close attention to its prevention and countermeasures.

Acetabuloplasty and acetabular rotation osteotomy for acetabulum dysplasia, femoral head rotation osteotomy for femoral head necrosis, and hip arthroscopic surgery for hip labrum injury. both have achieved good results.

Osteoarthritis of the hip

Surgery using your own bone

Since articular cartilage has poor self-repair ability, the surgical method differs depending on whether the articular cartilage remains undegenerated or degenerated and worn out. If articular cartilage remains, surgery to preserve the bones and joints, such as acetabuloplasty and acetabular rotation osteotomy, is the mainstay. It was found that young people up to the age of 25 had better long-term results in acetabuloplasty (shelfoplasty) than older people. Acetabuloplasty improves the fit of the hip joint in younger people. However, it is not performed when cartilage wear has progressed to some extent. We believe that acetabuloplasty is indicated for people under the age of 25 who do not have articular cartilage degeneration. On the other hand, we believe that rotation acetabular osteotomy is indicated for people up to the age of 50, when joint compatibility improves when the hip joint is opened outward, even if cartilage degeneration has begun (Fig. 1). ). In both cases, the hospitalization period is 1 to 1.5 months, and it is necessary to wait about 3 months after the operation until bone union is obtained before returning to light work.

total hip arthroplasty

If the cartilage degeneration progresses and wears out, and the hip joint has poor movement or the length of the leg is shortened, surgery to replace it with an artificial hip joint is indicated. The hospital stay is about 2 weeks. Continuing rehabilitation after surgery. Depending on each person's living environment and preoperative conditions, you will be able to lead a normal life in about 1 to 2 months. There is no strict age limit, as people in their 20s can undergo surgery if there is no other way to improve function other than total hip replacement surgery, and people over 80 can undergo surgery if there are no serious complications. We have excellent staff in all clinical departments, so we have established a system where even patients with various complications can undergo surgery with peace of mind. Also, by collecting the blood that bleeds after surgery and returning it to the patient, there is no need to store your own blood before surgery. The operation is a combination of general anesthesia and continuous epidural anesthesia, so you can spend almost no pain for 2 days after the operation. Another feature of our facility is that there are many excellent physical therapists in charge of rehabilitation. Standing and walking training begins the day after surgery. Physical therapists on duty are basically in charge of rehabilitation on Saturdays and Sundays. After about two weeks, some patients are able to walk with a cane and can go home, while others are transferred to other hospitals and continue their rehabilitation. If you live alone or it seems that it will take time to adjust to your daily life, we will make a reservation to transfer to a partner hospital before surgery.

The artificial joint to be used is determined according to the condition of each patient's hip joint.

After the artificial joint surgery, you will have regular follow-up visits to monitor your progress.

Revision hip arthroplasty (replacement surgery)

Approximately 20% of cases require replacement surgery 20 years after surgery due to loosening of the joint between the artificial joint and the bone. The two-week hospitalization is almost the same as the first artificial joint surgery, so it can be said that the burden on the patient has been greatly reduced compared to before. However, revision surgery is by no means a simple operation. The patient is older than the initial surgery, and there are concerns about deterioration of cardiopulmonary function and various systemic complications, as well as bone fragility, bone loss, muscle atrophy, scar formation from the initial surgery, and changes in anatomical structure. Various difficulties and problems must be resolved. In particular, it is a big problem that fixation tends to be insufficient due to bone defects. We have a bone bank at -80°C in our hospital in preparation for allogeneic bone grafting for bone defects (Fig. 3). Although some hospitals called artificial joint centers do not have a bone bank, in most of the revision surgeries we perform, allogeneic bone grafting is performed from a bone bank (Fig. 4). Even if the patient is elderly, since our hospital is a general hospital, a specialist intensive care doctor is always present in the intensive care unit, and high-risk patients are treated in cooperation with other departments such as cardiology and respiratory medicine. You can also accept Reoperation allows you to return to your normal life, so you will never be in a wheelchair if the artificial joint loosens.

Regarding knee joints, we treat knee joint dysfunction caused by osteoarthritis and rheumatoid arthritis, and meniscal and anterior cruciate ligament injuries caused by sports injuries.

As Japan transitions to an aging society, the number of patients suffering from knee osteoarthritis is increasing year by year. For knee osteoarthritis, rheumatoid arthritis, and intra-articular osteonecrosis of the knee, total knee arthroplasty (TKA) may be recommended if the pain worsens despite drug therapy such as joint injections, making daily activities difficult. , unicompartmental arthroplasty (UKA), and high tibial osteotomy (HTO).

knee osteoarthritis

The smooth and elastic articular cartilage that covers the surfaces of the femur, tibia, and patella of the knee joint degenerates due to aging, obesity, trauma, etc., and the cartilage gradually wears away. will result in osteoarthritis of the knee. When you bend or straighten your knee, when you walk, or when you go up or down stairs, you may experience pain, and it becomes difficult to bend and straighten your knee. The function of the knee joint gradually deteriorates, making it difficult to perform daily activities, and the joint deforms. Also, when the symptoms are severe, fluid may accumulate in the joint. Rheumatoid arthritis also destroys the cartilage and bones of the knee joints due to inflammation, causing pain, deformation, and functional disorders, which interferes with activities of daily living.

total knee arthroplasty

For knee osteoarthritis, do not perform conservative surgery such as exercise therapy such as quadriceps femoral muscle training, topical agents such as poultices and ointments, oral anti-inflammatory analgesics, and intra-articular injection of hyaluronic acid. Treat first. If the knee joint dysfunction still does not improve, a total knee arthroplasty (TKA) is performed. TKA is also performed when functional impairment due to rheumatoid arthritis is severe. TKA is a surgical procedure in which a damaged joint is removed and replaced with an artificial joint. It is a very good surgery with a great pain-relieving effect because it removes everything that causes pain in the joints. In addition, TKA corrects deformities (bow legs and bow legs), resulting in straight knees (Figs. 1 and 2). However, even if you undergo TKA, it is difficult to bend your knees enough to sit straight, but there is no problem in your daily life other than sitting straight. Light exercise such as walking, swimming, and cycling on flat ground is possible. You cannot participate in strenuous sports such as running or soccer.

Artificial knee joints are made of materials such as titanium alloys and high molecular weight polyethylene. After surgery, there is no problem with MRI examination. Once the surgery is performed, in most cases, the artificial knee joint will not need to be replaced for the rest of its life.

The hospital stay is about 2 weeks. Continuing rehabilitation after surgery. After 2 to 3 months, you will be able to lead a normal daily life. If there are no serious complications, the operation can be performed even if the patient is over 80 years old, and there is no strict age limit. We have excellent staff in all clinical departments, so we have a system in place that allows even patients with various complications to undergo surgery. Also, because hemostats are used during surgery, the chance of transfusion is less than 3%. The operation is a combination of general anesthesia and block injection, so you can spend two days after the operation without feeling much pain. The operation takes about 2 to 3 hours, and walking training begins the day after the operation, and on the 3rd day after the operation, the patient is able to go to the toilet by himself in a wheelchair. You can walk with a cane in 2 weeks. Two weeks after surgery, the patient was transferred to a rehabilitation hospital for rehabilitation purposes. After about one month of rehabilitation treatment (gait training, leg strength training, knee range of motion training) at a rehabilitation hospital, the patient will be discharged.

High tibial osteotomy (HTO)

High tibial osteotomy is recommended for relatively young people with bow leg deformity, intra-articular osteonecrosis of the knee, active people, and those who do sports or heavy work. Unlike TKA, heavy work and sports are possible after surgery. It is a surgery to reduce the burden on the inside of the knee joint due to the bow leg by correcting the bow leg by cutting the tibia. A wedge-shaped osteotomy is performed on the inner side of the proximal tibia, and artificial bone is implanted and fixed with a titanium alloy plate and screws. A tibial osteotomy corrects the bow leg to a normal bow leg. Wheelchair movement is possible from the day after surgery. About 2 weeks after the operation, full-weight walking will start, and about 3 weeks after the operation, you will be discharged from the hospital with walking sticks. Light exercise such as hiking and golf can be resumed after 3 to 4 months, and heavy work and sports such as running can be resumed after 9 to 12 months. The fixation bracket is removed approximately one year after surgery (Fig. 3).

Unicompartmental knee arthroplasty (UKA)

Unicompartmental knee arthroplasty is performed for osteonecrosis of the knee joint and medial knee deformity (Fig. 4). Since only the inner joint is replaced with an artificial joint, the scar is smaller than TKA, and postoperative pain is mild. Good postoperative results and postoperative rehabilitation are similar to TKA. Postoperative exercise is similar to TAK.

meniscus injury

The meniscus is a fibrous tissue between the femur and tibia. The medial meniscus is C-shaped and the lateral meniscus is semicircular. Involved in knee joint load distribution, support stability function, and joint movement. Meniscal injuries are common during the late teens and early twenties when people are physically active, including playing sports. The meniscus is often damaged during imbalanced movements such as soccer and basketball. After the age of 40, age-related degeneration of the meniscus can lead to tearing, even without trauma.

The meniscus does not show up on x-rays. Therefore, MRI examination is necessary to make a diagnosis of meniscal injury. MRI examinations are harmless and painless. An MRI scan can show the condition of the meniscus and ligaments.

For meniscal injuries, we first monitor the progress with analgesics, topical agents, intra-articular injections, etc. Arthroscopic surgery is done if the pain does not improve, or if MRI reveals a significant tear. Since the camera is inserted into the joint during the surgery, the scar is small. Depending on the type of tear, a meniscal tear is excised if it cannot be sutured, and sutured if sutured.

The surgery is performed under spinal anesthesia (lower body anesthesia). If resection is performed, hospitalization is about 2 to 4 days, walking is possible from the next day, and the return to heavy work is about 2 to 3 months. If suturing is performed, the patient will need to be hospitalized for about 1 to 2 weeks and be immobilized in a cast for about 3 to 4 weeks, and it will take about 4 to 6 months before returning to heavy work.

anterior cruciate ligament injury

Anterior cruciate ligament injuries are among the most common knee sports injuries. It occurs during sports such as jump landings, takeoffs, sudden stops, and sudden changes in direction. It can also occur in contact sports, such as rugby and judo, when the knee is twisted in contact with an opponent.

Diagnosis of anterior cruciate ligament injury is made by interview, examination findings, and MRI examination.

If an anterior cruciate ligament (ACL) injury occurs, it will not only be difficult to return to sports if left untreated, but it will also lead to repeated knee flexion and secondary osteoarthritis in the future. Therefore, it is often treated with surgery. The anterior cruciate ligament cannot be repaired by suturing the rupture. In our department, we perform arthroscopic anterior cruciate ligament reconstruction using knee flexor tendons (semitendinosus, gracilis). It is performed under general anesthesia and the hospital stay is about 1-2 weeks. Jogging is possible in about 4 months, and full return to sports is about 8 to 12 months later (Fig. 5).

There are a wide variety of spinal diseases, and along with recent advances in spinal surgery, there are various options for actual treatment methods. At our clinic, we focus on making an accurate diagnosis and selecting the appropriate treatment for it. The principle of treatment is conservative treatment, and if there is no movement disorder or significant pain in the limbs, outpatient drug therapy, nerve block treatment, rehabilitation treatment, etc. are performed (outpatient rehabilitation is difficult at our hospital, so appropriate at the facility). However, if the symptoms cannot be resolved without surgery, surgical treatment should be considered.

Spine surgery performed at our hospital includes surgery for degenerative diseases such as aging and rheumatism, and surgery for trauma such as falls and traffic accidents. For spinal metastasis of cancer, we perform surgical treatment for the purpose of relieving symptoms such as early social reintegration and paralysis and pain. In order to perform optimal and safe treatment, we have introduced a computer navigation system at our hospital, which enables accurate placement of implants even in cervical spine instrumentation surgery and cases of advanced spinal deformity (Fig. 1). ). In addition, the number of patients with various complications is increasing with the aging society. It is possible to have surgery with peace of mind.

At our hospital, we treat most spinal diseases other than intramedullary tumors, but the typical diseases are as follows.

Lumbar spinal stenosis

It is a condition in which the spinal canal, which is the passageway for nerves in the lower back, narrows due to aging (Fig. 2). Symptoms include sluggishness and heaviness in the lower extremities and lower back when walking or standing. A typical symptom is intermittent claudication. Intermittent claudication is a symptom in which the leg becomes painful or unable to walk due to numbness or weakness after a while after the first time walking, and is able to walk again after resting by squatting or sitting. When it gets worse, it may become difficult to walk for 2 to 3 minutes. As symptoms worsen, symptoms such as muscle weakness and difficulty passing urine and stools may occur.

Diagnosis includes CT, MRI, myelography, and nerve root blocks that paralyze certain nerves. For foraminal stenosis and extraforaminal stenosis, which are difficult to diagnose, we perform accurate diagnosis using 3D MRI, nerve root block, and contrast-enhanced CT.

Conservative treatment includes oral medication and nerve block therapy. Surgery may be necessary if conservative treatment fails to improve symptoms. In the case of normal spinal canal stenosis only, we use the minimally invasive spinal process splitting method, which is performed under a microscope with an approach that minimizes damage to the muscles of the lower back. The skin incision is small, about 4 cm, and the patient is usually able to walk the next day (Fig. 2). If there is misalignment of the lower back bones (lumbar spondylolisthesis), if there is scoliosis, or if foramen stenosis is suspected, spinal fusion may be added. A metal implant is used for fixation, but depending on the case, a percutaneous pedicle screw is used to make it less invasive (Fig. 3).

OLIF: A minimally invasive lumbar fusion surgery that is becoming popular in Japan, in which a cage is inserted between the vertebral bodies through a skin incision of approximately 5 cm from the flank. It is effective in correcting degenerative scoliosis and spinal misalignment (Fig. 3).

Lumbar disc herniation

Symptoms improve in most cases with oral treatment and nerve block therapy. If there is muscle weakness or significant pain, or if early rehabilitation is required, surgical treatment is selected. Microscopic herniectomy is performed using a skin incision of approximately 3-4 cm.

cervical myelopathy

It is a condition caused by the compression of the spinal cord by the cervical vertebrae. Symptoms include difficulty in fine hand movements and difficulty in walking.

At our hospital, the surgical method is selected according to the symptoms and condition of the patient. More than half of the patients undergo laminoplasty to remove pressure on the nerve from the back of the neck. It adopts a double-opening type that opens the vertebral arch to the left and right. You will be able to walk while wearing a collar from the early postoperative period. In addition, we perform anterior cervical decompression fixation when there is a pressure element of the spinal cord in front (Fig. 4).

The area around the cervical spine contains not only the spinal cord but also large blood vessels such as the vertebral arteries, so extreme caution is required. At our hospital, we perform blood vessel evaluation with contrast-enhanced CT before surgery as necessary, and perform safe and accurate surgery using a computer navigation system during surgery.

After surgery on the cervical spine, the whole body is managed in the intensive care unit, and after confirming that there are no problems, the patient is sent back to the ward.

Atlantoaxial subluxation/instability

It may occur in rheumatoid arthritis, etc., and the 1st and 2nd bones of the cervical vertebrae are out of alignment. Headache, numbness, and gait disturbance may occur. In surgery, we perform surgery to fix the first and second bones (Fig. 5) and surgery to fix the skull and cervical vertebrae.

surgery for trauma

Treatment for fractures and dislocations of the spine, as well as associated nerve damage (cervical spinal cord injury, thoracic spinal cord injury, etc.). Depending on the degree of paralysis and the state of the fracture, emergency surgery is also supported. Evidence-based scaling is used to determine whether surgery is necessary, comprehensively including the general condition. Especially in the case of the elderly, early ambulation is necessary to prevent postoperative complications.

Surgery for metastatic spinal tumors

When a malignant tumor such as cancer metastasizes to the spine, it compresses the spinal cord and causes paralysis. If the life prognosis is long and the progression of paralysis is minor, the paralysis can often be improved by releasing the spinal cord pressure and immobilizing it. In addition, when the metastatic focus is solitary, tumor resection may be performed for the purpose of radical intellectual treatment.

Minimally Invasive spine Stabilization (MISt)

In spinal surgery, we aim to perform minimally invasive surgery as much as possible to achieve early rehabilitation, less bleeding, and less postoperative pain. At our hospital, we apply MISt surgery not only to normal spinal surgery, but also to surgery for metastatic spinal tumors and spinal trauma. Compared to conventional incision surgery, it has been proven that the amount of bleeding during and after surgery is less. Since there is little burden on the body, early rehabilitation after surgery is possible.

In today's world of computers and mobile phones, hands are indispensable for daily life, and if the functions of the hands are impaired, human life will be greatly restricted. In addition, since the hand is useful only when it is linked to the movement of the shoulder and elbow joints, it is important to treat disorders and diseases of the entire upper extremity in a well-balanced manner in hand surgery.

Since the hand is an anatomical structure with a dense collection of various tissues such as bones, cartilage, ligaments, tendons, nerves, blood vessels, and skin, even a seemingly simple injury such as a cut with a kitchen knife can damage nearby tissues. In many cases, the treatment requires specialized knowledge and techniques such as microsurgery. In addition, endoscopic techniques are becoming more important in the treatment of shoulders and elbows in order to perform treatments based on less invasive and more accurate diagnoses. Our hospital's upper extremity surgery department aims to provide integrated treatment with three major pillars: the general hand surgery department, the micro-reconstruction department, and the shoulder and elbow sports department. We introduce typical upper extremity surgical diseases treated in our department.

carpal tunnel syndrome

When the median nerve is compressed in the space called the carpal tunnel on the palm side of the wrist, you will become aware of numbness in your fingertips. In a typical example, numbness often wakes up at night, and as it progresses, the muscle at the base of the thumb weakens, making fine movements difficult.

As a treatment, conservative treatment such as a night brace is performed first, but if there is no effect or if it progresses, surgery to remove the pressure in the carpal tunnel (carpal tunnel release) is performed.

There are two types of surgery, direct open surgery and arthroscopic open surgery using a 4 mm diameter arthroscope, and the surgical method is determined according to the patient's wishes. Arthroscopic treatment is often performed because the scar is relatively small and there is little postoperative pain (Fig. 1). Both methods require local anesthesia and the operation takes about 10 to 20 minutes, so it is possible to undergo the procedure as a day surgery.

Distal radius fracture

The radius is the bone on the thumb side of the two bones in the forearm (between the elbow joint and the wrist joint), and fractures near the wrist joint occur frequently when a person falls and falls on the hand, especially in elderly women. It is a common fracture in people with osteoporosis. Leaving a large dislocation at the fracture site not only causes pain in the wrist joint, but also causes functional disorders in parts other than the wrist joint, such as restricted supination and supination of the forearm. will be left. As a treatment, if the dislocation is small, immobilization with a cast is performed, but if there is a large dislocation or if the fracture is unstable even after manual reduction, surgery is required. In recent years, due to the growing awareness of healthy life expectancy, many elderly patients are choosing surgical treatment so as not to impair the original movement of the wrist joint as much as possible. Surgery mainly involves internal fixation using a palmar locking plate. The locking plate, which has been developed in recent years, has a structure in which the plate and screw are integrated, providing strong fixing force and enabling early return to society (Fig. 2). The operation is conducted under conduction anesthesia (injection into the base of the arm, anesthesia for only the upper extremities undergoing surgery), and the operation takes about an hour. It is possible to receive it in hospital for 1 night and 2 days, and the skin incision is only about 6 cm. In order to allow the patient to return to normal life as soon as possible, we try to plan the surgery within a few days as long as the operating room is available.

Finger Amputation/Microsurgery

Since the world's first successful reattachment of a mother's finger for complete amputation in Japan in 1965, Japanese microsurgery and hand surgery techniques have been highly regarded overseas. Surgery to restore blood flow to an amputated finger requires urgency and requires specialized knowledge and skills due to the combined damage to bone, tendons, nerves, blood vessels, and skin. The first re-attachment surgery in our hospital was performed in 1972, which is already nearly half a century old. Amputation finger treatment requires not only medical equipment such as operating microscopes, but also the cooperation of the emergency department, operating room, and Anesthesiology. Although there was a time when we could not accept patients due to changes in the medical treatment system, we currently perform about 30 amputation finger reattachments every year based on our original philosophy of practicing 24-hour emergency medicine, and accept patients not only from Hyogo Prefecture but also from other prefectures as much as possible (Fig. 3). We perform about 90 microsurgeries a year, including not only amputated fingers but also free tissue grafts and peripheral neuropathies using microscopes.

Shoulder joint endoscopic treatment

In recent years, endoscopic treatment has become indispensable for improving diagnostic accuracy and treatment outcomes in shoulder surgery. The main diseases for which endoscopic treatment is performed include shoulder rotator cuff tear and shoulder joint dislocation (labrum injury).

A rotator cuff tear is a disease that causes symptoms such as pain in the shoulder joint and inability to raise the arm. A torn rotator cuff can make your shoulders weak, make it difficult to put on and take off your clothes, and keep you from sleeping because of the pain. Basically, we aim to cure without surgery such as rehabilitation and injections, but surgery may be performed depending on the severity of symptoms and the duration of illness. Although postoperative immobilization rehabilitation is required, we aim to improve pain by smoothing the movement of the shoulder joint, which requires three-dimensional movement. Endoscopic labrum suture has become the standard treatment for recurrent shoulder joint dislocations. Anterior braking with bone grafting may be performed, but endoscopic treatment is performed with as little burden as possible.

shoulder prosthesis treatment

Until now, the theme of artificial shoulder joints was how to reproduce the three-dimensional three-dimensional movement unique to the shoulder while maintaining the anatomical structure. is happening. Indications are limited to the elderly, where reconstruction is more difficult, but it has become reasonably successful in osteoarthritis of the shoulder with large rotator cuff tears and comminuted humeral fractures with difficult osteosynthesis. rice field. At our hospital, we give priority to endoscopic treatment and try to preserve the joint as much as possible.

When rheumatoid arthritis destroys joints, it causes pain, swelling, and dysfunction. Surgery may be needed to restore joint function.

hip joint

Contracture and ankylosis associated with hip joint destruction, femoral head necrosis or similar lesions, femoral neck stress fracture, acetabulum protrusion, etc. When hip joint lesions occur due to rheumatoid arthritis, the ability to walk is significantly reduced, so hip replacement surgery is necessary to improve hip joint pain and dysfunction. However, since rheumatoid arthritis has poor bone quality and fragile soft tissues, accurate surgical techniques and prevention of complications are essential. In particular, for bone defects due to acetabulum protrusion, various measures are required, and the acetabulum is reconstructed using an acetabulum reconstruction plate. (Figure 1)

Knee joint

When knee joint lesions occur due to rheumatoid arthritis, deformation, contracture, instability, etc. associated with knee joint destruction occur, and walking ability is significantly reduced. You will need replacement surgery. (Figure 2)

ankle joint

When ankle lesions occur due to rheumatoid arthritis, deformity occurs due to ankle joint destruction and walking ability is significantly reduced. I have. (Fig.3)

elbow joint

When elbow joint lesions occur due to rheumatoid arthritis, deformation, contracture, instability, etc. associated with elbow joint destruction occur, making it difficult to eat, etc. To improve elbow joint pain and joint dysfunction You will need an elbow joint replacement. (Fig.4)

others

We also perform finger, wrist, shoulder and foot surgery.

Our hospital was the first emergency medical center to be certified in Japan, and for four consecutive years since 2014, we have been ranked No. Currently, we accept more than 10,000 emergency cases per year. Half of Orthopedic Surgery surgeries (approximately 800 in 2017) are temporary or emergency surgeries, and are characterized by an extremely large number of trauma cases associated with life-saving emergencies. There are many cases of serious injuries, and the range of injuries is wide-ranging, including spine, joints, hand surgery cases requiring microsurgery, and complex tissue injuries requiring soft tissue reconstruction. Depending on the case, specialists in each field work together to provide medical care with the goal of restoring function and returning to social life. Some of the characteristic trauma cases in our department are shown below.

There are many cases of serious injuries, and the range of injuries is wide-ranging, including spine, joints, hand surgery cases requiring microsurgery, and complex tissue injuries requiring soft tissue reconstruction. Depending on the case, specialists in each field work together to provide medical care with the goal of restoring function and returning to social life. Some of the characteristic trauma cases in our department are shown below.

pediatric fracture

Pediatric fractures are mainly seen around the elbow joint, often in the forearm and also in the lower extremities. In principle, in cases with dislocation, internal fixation surgery is performed on the same day. In 2017, we performed 29 surgeries for fractures in children under 15 years of age (Figures 1-3).

open fracture

It occurs most often in the tibia, but can also occur in the forearm and femur. Since the risk of infection is high and early cleaning and debridement are required, emergency surgery is performed. There are many cases with extensive skin and soft tissue defects, and we are consistently working on reconstruction. In 2017, we performed 13 surgeries for open tibia fractures alone (Figures 4 and 5).

spinal trauma

It ranges from dislocated fractures associated with high-energy trauma to non-bone traumatic spinal cord injuries. Some cases require emergency measures such as reduction, fixation and decompression. (See spine surgery section)

intra-articular fracture

There are many fracture cases with destruction of not only the normal diaphyseal shaft but also the articular surface due to high-energy trauma. Perform anatomical reduction whenever possible. (Figures 6-8)

pelvic fracture

There are about 50 cases of emergency transportation per year. The initial response is to perform arterial embolization very early, showing a good survival rate. With an emphasis on functional prognosis, we perform surgical treatment for approximately 30 cases of dislocation and instability per year. (Figures 9 and 10)

The paper ``Association of preoperative variables of ipsilateral hip abductor muscles with gait function after total hip arthroplasty: a retrospective study. Arthroplasty 2022; Contest of Arthroplasty, 2020 The Hyogo Prefecture Medical Association Medical Research Award.

リハビリテーション部と行った共同研究成果を発表した論文「Alterations in deep tissue temperature around the knee after total knee arthroplasty: its association with knee motion recovery in the early phase」が、日本理学療法士学会第10回優秀論文表彰優秀賞を受賞しました。

We have been certified as a specialist training facility by the Japanese Society for Surgery of the Hand（JSSH）.
August 2011 lucky day

We have been certified as a Board Certified Surgeon training facility for spine and spinal cord surgeons The Japanese Society for Spine Surgery and Related Research.
Auspicious day of April 2020

In the "Kobe City Municipal Medical Center Orthopedic Surgery Specialized Training Program", our hospital will be the core facility, and the Kobe City Municipal Medical Center Nishi Municipal Hospital and Nishi Kobe Medical Center will be partner facilities. In addition to these three hospitals, the National Hospital Organization Himeji Medical Center, Hyogo Prefecture Amagasaki General Medical Center, Toyooka Public Hospital Association Toyooka Hospital, Social Medical Corporation Shinko Memorial Association Shinko Memorial Hospital, and Kyoto University are joint facilities. join the program.

Our department deals with many acute and chronic diseases including trauma. Each case is jointly handled by a Senior Resident in charge and a doctor in charge of each field, and it is possible to accumulate a wealth of experience.

We are planning to hold a special training program information session on May 28, 2021.

Introduction of 2017 Senior Resident Surgery Surgery Achievements

Impressions of Senior Resident about Orthopedic Surgery training

Senior Resident A

You can experience multiple injuries unique to tertiary emergency. I also feel that I can grow in a well-balanced manner after experiencing chronic diseases such as artificial joints and spine.

Senior Resident B

I feel that it is a privileged environment to experience many severe cases under the kind guidance of staff members who are well versed in their respective specialties. There are some difficult cases, but I am spending fulfilling days while being blessed with the same period and being encouraged. I actively participate in academic conferences and lectures, and have gained valuable experience. I would like to continue to devote myself to the training and put my feet on the ground.

Senior Resident C

At our hospital, we are able to experience a wide range of cases from the acute stage to the chronic stage under the backup of senior doctors. In particular, there are many complicated cases of trauma regardless of the body part, and I think that there are many cases that are very valuable as training because it is not only a simple procedure, but also training to make a solid preoperative plan. Also, regarding artificial joint surgery, you can be involved in surgery from an early stage, and you can gain experience in implant placement and cement procedures. Postoperative management also needs to be done in a responsible position as the attending physician, and I can feel that I am involved with the patient comprehensively. Therefore, I need to update my knowledge of not only Orthopedic Surgery but also other departments to some extent, which may be a little burdensome, but I think I am in an environment where I can grow as a doctor comprehensively. Senior doctors can equally handle duty and standby duty, so it is possible to devote holidays to your own time, and it is an environment that makes it easy to participate in seminars and academic conferences. I am full of gratitude to Director Yasuda and the other senior medical staff for providing me with training in an environment where I can learn both in classrooms and in practice at a high level.

Senior Resident D

I started my new post in October 2015. The specialized training at our clinic is still short, about 5 months, but I would like to write about two features of the training at our clinic.

The first is the ability to touch various wounds. Since our hospital focuses on emergency care, we will be in charge of various trauma cases. I thought I had experienced all kinds of injuries at the hospitals I worked at, but there were many cases that I had never experienced or that were difficult to treat.

The second is that you can learn about various specialized fields. Various cases have been introduced from Kobe City and surrounding areas. For example, during the 5 months of training, I had the experience of operating about 15 cases of THA. Among them, there are many difficult cases such as CDH and after Chiari surgery, and I am able to accumulate treatment experience that I can use in the future.

What makes this possible is that we have experts in each field who provide guidance and backup. I think it's wonderful to be able to do specialized training in such an environment. It's easy, but I wrote about the characteristics of the specialized training at our clinic.

Recruiting Orthopedic Surgery Senior Resident for 2024

An information session for the Kobe City Medical Center Orthopedic Surgery Specialty Training Program will be held from 6:00 PM on May 10, 2024.