PubMed Health⌕ Search

Biomedical subjects

Ching-Jen Wang

Publications and source records attributed to Ching-Jen Wang.

71 records · Page 4Linked to original sources
PubMed2002

Supracondylar fractures of the femur above total knee arthroplasties with cortical allograft struts.

Ten supracondylar fractures of the femur above a total knee arthroplasty were treated with open reduction and internal fixation using a metal plate and cortical allograft struts. Failure with nonunion of previous operative treatments was seen in 5 patients. The other 5 patients had either severe osteopenia or comminution of the fracture above the knee prosthesis. At an average of 38 months' follow-up, all the fractures healed with an average union time of 17.6 weeks. The postoperative knee alignment averaged 5.1 degrees valgus. Infection occurred in 1 patient, which resulted in a poor outcome. The remaining 9 patients were functioning well at the most recent follow-up examination. The use of cortical allograft struts combined with a compression plate provided satisfactory results for supracondylar fractures above knee prostheses with severe osteopenia or loss of bone stock after initial failure of internal fixation.

Aged↗
PubMed2002

The often poor clinical outcome of infected total knee arthroplasty.

The clinical outcomes of various options of treatment in 26 infected total knee arthroplasties (TKAs) with successful eradication and no recurrence of infection for at least 2 years were compared. There were 20 women and 6 men with an average age of 67.7 years. The average follow-up time was 48 months (range, 24-83 months). The evaluation parameters included pain score, knee score, functional score, and radiograph of the knee. The TKAs with acute infection showed significantly better outcome and clinical results when compared with noninfected TKAs. The clinical outcome of chronic infection was less favorable. Arthrodesis achieved better pain relief, whereas reimplantation TKA showed better function. No significant difference in knee scores was observed, however, between reimplantation TKA and arthrodesis. Approximately 50% of reimplantation TKAs had mild-to-moderate knee pain.

Acute Disease↗
PubMed2002

Normocalcemic primary hyperparathyroidism with fractures.

Normocalcemic primary hyperparathyroidism is an uncommon condition usually found among patients with urinary stones. To the best of our knowledge, this is the first case of a patient with normocalcemic primary hyperparathyroidism presenting with bilateral femoral neck fracture. A 45-year-old man had pain both hip joints and limping in for several months. Vertical fractures of bilateral femoral necks were found by radiographs. Laboratory findings showed a normal value of total serum calcium but elevated serum ionized calcium. Serum parathyroid hormone and alkaline phosphatase levels were elevated. The patient was treated with subtrochanteric valgus osteotomy fixed with a dynamic hip screw and total parathyroidectomy. Histopathologic examination showed hyperplasia of the parathyroid glands. At 1-year follow-up, the patient was doing well clinically.

Alkaline Phosphatase↗
PubMed2002

Early diagnosis of deep vein thrombosis in female patients who undergo total knee arthroplasty with measurement of P-selectin activation.

BACKGROUND: Deep vein thrombosis (DVT) remains a leading cause of postoperative morbidity and mortality in patients who undergo total knee arthroplasty (TKA). Although patients with previous thrombotic episodes are inherently at a higher risk for subsequent episodes of DVT, it remains difficult to predict such an occurrence and to make a diagnosis in early stages. One potentially useful assay that can be used in the determination of changes of coagulation among patients who undergo arthroplasty is platelet activation. The goal of this study was to establish a predictive value for DVT with measurement of P-selectin levels that could help in planning appropriate perioperative management strategies for patients at high risk for DVT. METHODS: A total of 52 patients who underwent TKA with general anesthesia underwent contrast venography on the 5th postoperative day. Platelet activation before and after operation was measured with platelet surface expression of P-selectin with flow cytometry in these two groups of patients for TKA. None of the patients underwent any anticoagulation therapy. RESULTS: Nineteen of the 52 patients for TKA showed radiologic evidence of DVT, whereas 33 patients for TKA had no radiologic signs of DVT. There was no difference in platelet activation at baseline, which was 1 hour before induction of anesthesia, between the two groups (P >.05) as measured with P-selectin assays. Differences were noted between the two groups on the 5th day after operation, wherein P-selectin was expressed in only 2.72% +/- 0.9% (mean +/- standard deviation) of platelets in patients for TKA with healthy venogram results. This differed significantly from platelets in patients for TKA with DVT, who had P-selectin expression of 6.56% +/- 3.1% (mean +/- standard deviation; P <.01). Sensitivity for the diagnosis of DVT with P-selectin assay was calculated to be 74%, and specificity was found to be 94%. CONCLUSION: The findings showed that radiologically confirmed DVT in patients for TKA surgery with general anesthesia is associated with an elevated number of activated platelets. Perioperative assessment of P-selectin may predict the early onset of DVT in patients who undergo high risk surgical procedures like TKA. This laboratory assay may help prevent the occurrence of the fatal events caused by DVT with use of early therapeutic intervention, such as heparinization.

Aged↗
PubMed2002

Shockwave therapy for patients with plantar fasciitis: a one-year follow-up study.

The effect of shockwave therapy was investigated in 79 patients (85 heels) with plantar fasciitis with one-year follow-up. There were 59 women and 20 men with an average age of 47 (range, 15-75) years. Each patient was treated with 1000 impulses of shockwave at 14 kV to the affected heel. A 100-point scoring system was used for evaluation including 70 points for pain and 30 points for function. The intensity of pain was based on a visual analogue scale from 0 to 10. The overall results were 75.3% complaint-free, 18.8% significantly better, 5.9% slightly better and none unchanged or worse. The effect of shockwave therapy seemed cumulative and was time-dependent. The recurrence rate was 5%. There were no device-related problems, systemic or local complications. Shockwave therapy is a safe and effective modality in the treatment of patients with plantar fasciitis.

Adolescent↗
PubMed2002

Periacetabular osteotomy through a modified ollier transtrochanteric approach for treatment of painful dysplastic hips.

BACKGROUND: Elimination of abnormally high joint-loading resulting in excessive contact stresses may prevent or reduce the onset of osteoarthrosis in a dysplastic hip. A number of periacetabular osteotomies have been shown to be effective in restoring normal hip-joint mechanics. We treat acetabular dysplasia with a periacetabular osteotomy performed through a modified Ollier transtrochanteric approach. In this report, we describe the operative technique and the clinical and radiographic results. METHODS: Thirty-six patients (thirty-eight hips) in whom a painful dysplastic hip had been treated with a periacetabular osteotomy between March 1991 and June 1999 were included in the study. There were thirty-five female patients and one male patient with a mean age (and standard deviation) at the operation of 29.42 +/- 9.1 years. The technique utilizes a u-shaped skin incision, and a routine osteotomy of the greater trochanter with distal transfer if needed, and allows excellent visualization enabling the surgeon to perform the periacetabular osteotomy without penetrating the joint. RESULTS: At a mean of five years and six months postoperatively, the mean modified Harris hip score had improved from 59.1 +/- 15.8 points preoperatively to 87.97 +/- 14.3 points. Radiographically, the degree of osteoarthrosis had decreased in eleven hips, remained unchanged in twenty-four, and worsened in three. The mean anterior center-edge angle had increased from 22.0 degrees +/- 12.9 degrees to 36.1 degrees +/- 12.3 degrees, the mean lateral center-edge angle had increased from -2.7 degrees +/- 14.4 degrees to 26.6 degrees +/- 14.1 degrees, the mean acetabular index angle had improved from 23.4 degrees +/- 6.6 degrees to 12.7 degrees +/- 4.6 degrees, and the mean acetabular head index had increased from 48.2% +/- 12.7% to 73.1% +/- 16.0%. The Shenton line was restored in eleven hips. Thirty patients (thirty-two hips; 84%) had a satisfactory result. A poor preoperative functional score was associated with an unsatisfactory outcome (p = 0.00191). Complications included prolonged limping (eleven hips); numbness in the distribution of the lateral femoral cutaneous nerve (four); osteonecrosis of the rotated acetabular fragment (two); and acetabulofemoral impingement, heterotopic ossification, and a defect on the rotated ilium (one hip each). CONCLUSIONS: Painful dysplastic hips should be treated before function becomes seriously impaired. We believe that periacetabular osteotomy through a modified Ollier approach, which allows osseous cuts to be made under direct vision, can be learned readily. It provides improved femoral head coverage and relief of symptoms in most painful dysplastic hips in adolescents and young adults.

Acetabulum↗
PubMed2002

Total knee arthroplasty for arthritis of the knee with extra-articular deformity.

BACKGROUND: Simultaneous corrective osteotomy of angular deformity and total knee arthroplasty has been considered the treatment of choice for patients with arthritis of the knee associated with ipsilateral extra-articular deformity. However, this procedure is technically demanding, and the functional outcome of the total knee arthroplasty may be jeopardized if the osteotomy fails. This retrospective study was performed to evaluate the clinical results of total knee arthroplasty combined with intra-articular bone resection, without osteotomy, in patients with extra-articular deformity and arthritis of the knee. METHODS: Fifteen patients with arthritis of the knee and extra-articular deformity underwent total knee arthroplasty with bone resection and soft-tissue balancing. All deformities had resulted from fracture malunion. There were ten uniplanar, three biplanar, and two triplanar deformities. The deformity was in the tibia in eight patients and in the femur in seven. The average angle of the femoral deformities was 15.1 degrees in the coronal plane and 8.1 degrees in the sagittal plane. Two femora had a rotational deformity, consisting of 20 degrees of internal rotation in one and 10 degrees of external rotation in the other. The average angle of the tibial deformities was 19 degrees in the coronal plane. RESULTS: The duration of follow-up averaged thirty-eight months. The average Knee Society knee score improved from 22.3 points preoperatively to 91.7 points at the time of the last follow-up, and the average Knee Society function score improved from 28.0 points preoperatively to 87.3 points at the time of the last follow-up. The average arc of knee motion improved from 77.7 degrees preoperatively to 103.7 degrees postoperatively. The average mechanical axis of the knee improved from 22.7 degrees of varus preoperatively to 0.3 degrees of varus at the time of the last follow-up. Two patients had an unsatisfactory clinical result, which was not related to the total knee arthroplasty. There were no complications such as infection, ligament instability, or component loosening. CONCLUSIONS: Total knee arthroplasty in conjunction with intra-articular bone resection is an effective procedure for patients with arthritis of the knee and extra-articular varus deformity of <20 degrees in the femur or 30 degrees in the tibia in the coronal plane.

Aged↗
PubMed2002

Injuries to the posterior cruciate ligament and posterolateral instabilities of the knee.

Unlike anterior cruciate ligament (ACL) injury, disability from isolated posterior cruciate ligament (PCL) injury varies from no interference with life style to severe impairment of daily activities. Therefore, management of isolated PCL injuries remains controversial. High-energy vehicular accidents often cause more-serious PCL injuries, while less-severe injuries result from low-energy trauma including sports. The natural history and prognosis of PCL injury are correlated with the type and extent of instability and the development of degenerative changes in the knee. Indications for surgery include pain and instability of the knee. Arthroscopic single-bundle PCL reconstruction improved the function and stability of the knee with 77.4% satisfactory results in medium-term follow-up. Complete restoration of ligament stability was achieved in only 52% of knees, while 1/3 of the knees showed mild and 9.7% showed moderate residual ligament laxity. The incidence of degenerative changes was 52%, and the rate was correlated with duration of injury and severity of ligament laxity. Therefore, the significance of PCL injury has been overly simplified, and the functional disability of knees with PCL injury underestimated. Early surgical reconstruction of knees with grade III PCL injury is recommended. PCL injury is frequently associated with multiple ligamentous injuries. Combined PCL and posterolateral instabilities are serious knee injuries and frequently result in severe functional disability due to pain, instability, and degenerative changes in the knee. Unlike isolated PCL injury, there is a consensus of opinion that surgical reconstruction is indicated in knees with combined PCL and posterolateral instabilities. Commonly employed methods of reconstruction of the posterolateral corner include popliteus reconstruction, lateral collateral reconstruction or advancement, and a combination of the two. Combined arthroscopic PCL reconstruction and posterolateral reconstruction achieved 64% satisfactory (24% excellent and 40% good) and 36% unsatisfactory (24% fair and 12% poor) results over an average of 32 months of follow-up. Complete restoration of ligament stability was noted in only 44% of knees. The incidence of degenerative changes was 44%, and the rate was correlated with duration from injury to surgery and severity of ligament laxity. Despite the fact that currently employed surgical techniques only achieve modest success in restoration of ligament stability, early surgical reconstruction in knees with combined PCL and posterolateral instabilities achieved the best clinical results and a high rate of patient satisfaction.

Biomechanical Phenomena↗
PubMed2002

Premature closure of the physeal plate after treatment of a slipped capital femoral epiphysis.

BACKGROUND: Treatment of a slipped capital femoral epiphysis (SCFE) should stabilize the epiphysis and prevent complications. Attempting to obtain physeal closure is still controversial. The purpose of this study was to evaluate the clinical results and complications after treatment of SCFE. METHODS: From 1989 to 2000, 12 patients (14 hips) underwent pinning for treatment of SCFE. For acute and acute-on-chronic slippage, longitudinal traction was attempted for reduction. Patients with chronic slippage received fixation in situ. All patients were available for follow-up for an average of 63 months. RESULTS: Nine of the 14 hips had excellent or good functional results, and 5 had fair results. One hip developed avascular necrosis of the femoral head with a fair result. There was no chondrolysis or osteoarthritis of the joint at the most recent follow-up. Physeal closure in 9 hips occurred at an average of 16 months. The change in articulotrochanteric distance averaged 5.4 mm. CONCLUSION: Although most functional results were not adversely influenced after premature closure of the physeal plate of consideration should be given to the device, such as a dynamic screw, that stabilizes the epiphysis and prevents premature physeal closure in patients who have significant growth potential. To understand the influence of growth disturbance of the proximal femur and the effect of dynamic screw fixation, long-term follow-up is mandatory.

Adolescent↗
PubMed2001

Treatment of focal articular cartilage lesions of the knee with autogenous osteochondral graftsA 2- to 4-year follow-up study.

A retrospective study of 15 patients with 16 knees who underwent osteochondral autografts for focal full thickness articular cartilage defects of the knee with 2- to 4-year follow-up showed 80% good or excellent clinical results. There was no correlation of the clinical results with the underlying diagnoses, including osteonecrosis, osteochondritis dessicans and traumatic cartilage defect, or a size of the lesion smaller than 600 mm(2). However, cartilage lesions larger than 600 mm(2) were associated with increasing fibrous tissue formation and fissuring between the grafts and the host tissues and poor results. The improvement in symptoms appeared time-dependent, ranging from 6 to 16 weeks, suggesting that postoperative protection of the graft is warranted. There was no radiographic progression of degenerative changes of the knee on the medium-term follow-up. Therefore, an autogenous osteochondral graft is considered a good method in the treatment of knees with moderately sized articular cartilage defects.

Adult↗
PubMed2000

Periprosthetic fracture of the femur after hip arthroplasty: The clinical outcome using cortical strut allografts.

Between 1993 and 1998, 15 patients with periprosthetic fractures of the femur after hip arthroplasty were treated using deep-frozen cortical strut allografts as an adjunct support after internal fixation or revision arthroplasty. According to the Vancouver classification system, there were 7 type B1, 2 type B2, 4 type B3 and 2 type C fractures. Seven patients had severe osteopenia, 10 patients had bone defects between 2 to 7 cm and 2 were associated with infection. Nine patients had internal fixation of the fracture using a compression plate, and 6 had revision arthroplasty using a long-stemmed femoral prosthesis. The average length of the allograft was 13.9 cm. At an average follow-up of 31 months, all the patients had a satisfactory functional result except one who had a leg length discrepancy of 4 cm due to multiple operations. There were no non-unions, malunions or infections. The fractures healed between 10 to 24 weeks (average, 15.6 weeks). In conclusion, a cortical strut allograft associated with internal fixation can be an effective method of treating periprosthetic fractures of the femur after hip arthroplasty.

Journal Article↗
PubMedDate not supplied

Pathogenesis of partial tear of the rotator cuff: a clinical and pathologic study.

This prospective study investigated the clinical and pathologic results in 66 patients with partial tears of the rotator cuff from January 1996 to December 1998. The pathologic change in the rotator cuff was graded from the magnetic resonance images by using the criteria described by Zlatkin and Iannotti. A modified grading system from Ozaki and Panni was used for pathologic grading of the anterior acromion. The functional score of Constant and Murley was used for clinical assessment. The pathologic change in the rotator cuff revealed by the magnetic resonance imaging study was more severe in patients with articular side tears compared with patients who had bursal side tears. On the contrary, the pathologic changes in the acromion were significantly milder in patients with articular side tears compared with bursal side tears. These observations indicate that articular side tears of the rotator cuff are mainly associated with intrinsic pathologic changes of the rotator cuff, whereas bursal side tears are associated with subacromial impingement on an underlying milder pathologic change of the rotator cuff.

Acromion↗
PubMedDate not supplied

Shock wave-enhanced neovascularization at the tendon-bone junction: an experiment in dogs.

The purpose of the research was to study the phenomenon of neovascularization at the Achilles tendon-bone junction after low-energy shock wave application. The study was performed on eight mongrel dogs. The control specimens were obtained from the medial one-third of the right Achilles tendon-bone unit before shock wave application. Low-energy shock waves of 1000 impulses at 14 kV (equivalent to 0.18 mJ/mm2 energy flux density) were applied to the right Achilles bone-tendon junction. Biopsies were taken from the middle one-third of the Achilles tendon-bone junction at 4 weeks and from the lateral one-third at 8 weeks, respectively, after shock wave application. The features of microscopic examination included the number of new capillaries and muscularized vessels, the presence and arrangements of myofibroblasts, and the changes in bone. New capillary and muscularized vessels were seen in the study specimens which were obtained in 4 weeks and in 8 weeks after shock wave application, but none were seen in the control specimens before shock wave application. There was a considerable geographic variation in the number of new vessels within the same specimen. Myofibroblasts were not seen in the control specimens. Myofibroblasts with haphazard appearance and intermediate orientation fibers were seen in all study specimens obtained at 4 weeks and predominantly intermediate orientation myofibroblast fibers at 8 weeks. There were no changes in bone matrix, osteocyte activity, and vascularization within the bone. Two pathologists reviewed each specimen and concurrence was achieved in all cases. The results of the study suggested that low-energy shock wave enhanced the phenomenon of neovascularization at the bone-tendon junction in dogs.

Achilles Tendon↗
PubMedDate not supplied

Effects of knee position, graft tension, and mode of fixation in posterior cruciate ligament reconstruction: a cadaveric knee study.

PURPOSE: Many knees exhibit residual ligament laxity after posterior cruciate ligament (PCL) reconstruction, which is believed to be technique related. The purpose of this study was to investigate the optimal graft tension, the best angle of knee flexion, and the mode of fixation in PCL reconstruction. TYPE OF STUDY: Anatomic biomechanical study. METHODS: A testing apparatus with frictionless bearing that allows other degrees of freedom except for flexion and extension of the knee joint was designed. The normal PCL tension at different angles of knee flexion was measured with a force transducer, and the optimal tension of the PCL graft that allows full range of knee motion was studied with a tensiometer in 12 cadaver knees. The modes of fixation failure between interference screw fixation and post fixation were studied with an Instron (Canton, MA) machine in 8 cadaver knees. RESULTS: The lowest PCL tension in normal knees was noted at 20 degrees to 30 degrees of knee flexion and the highest at 90 degrees. The optimal tension of PCL graft, which allows full range of knee motion, was 15 lb (68 N). The average load of graft failure was 417 (179-730) N with interference screw fixation and 367 (149-701) N with post fixation when the patellar bone-tendon-bone graft was tested. There was no statistical difference in the failure load between interference screw fixation and post fixation (P =.753); however, the modes of failure differ. The sites of failure for interference screw fixation were 25% caused by rupture of ligament substance and 75% bone plug pullout; those of post fixation were 25% caused by rupture of ligament substance, 37.5% caused by fracture, and 37.5% as a result of suture breakage. CONCLUSIONS: The results of this study suggested that a 15-lb tension to the graft at 20 degrees to 30 degrees of knee flexion is optimal in PCL reconstruction. There was no statistical difference in the failure load between interference fixation and post fixation despite different modes of fixation failure.

Biomechanical Phenomena↗
PubMedDate not supplied

Shock wave therapy for patients with lateral epicondylitis of the elbow: a one- to two-year follow-up study.

BACKGROUND: The results of both nonoperative and surgical treatments for lateral epicondylitis of the elbow have been inconsistent. Shock wave therapy has been shown to have a favorable short-term effect in treating this condition. HYPOTHESIS: Shock wave therapy is an effective treatment for patients with lateral epicondylitis of the elbow and long-term results will be as favorable as short-term ones. STUDY DESIGN: Case series. METHODS: The effect of shock wave therapy was investigated in 57 patients with lateral epicondylitis of the elbow. Forty-three patients (24 men and 19 women with an average age of 46 years) with 1 to 2 years of follow-up were included in this study. In addition, six patients were treated with a sham procedure as a control group. Each patient was treated with 1000 impulses of shock wave therapy at 14 kV to the affected elbow. A 100-point scoring system was used for evaluating pain, function, strength, and elbow range of motion. RESULTS: Twenty-seven elbows (61.4%) were free of complaints, 13 (29.5%) were significantly better, 3 (6.8%) were slightly better, and 1 (2.3%) was unchanged. In the control group, the results were unchanged in all six patients. There were no device-related problems and no systemic or local complications. CONCLUSIONS: Shock wave therapy is a safe and effective modality in the treatment of patients with lateral epicondylitis of the elbow.

Adult↗
PubMedDate not supplied

Shock wave therapy for calcific tendinitis of the shoulder: a prospective clinical study with two-year follow-up.

BACKGROUND: Shock wave therapy is a new modality that has shown efficacy in the treatment of various orthopaedic disorders. PURPOSE: To determine the effectiveness, at 2- to 3-year follow-up, of shock wave therapy for calcific tendinitis of the shoulder. STUDY DESIGN: Prospective clinical study. METHODS: Thirty-seven patients (39 shoulders) with calcific shoulder tendinitis were treated with shock wave therapy (1000 impulses at 14 kV) and observed for 24 to 30 months. The control group, which underwent sham treatment with a dummy electrode, consisted of 6 patients (6 shoulders) with an average follow-up of 6 months. Evaluation included use of the 100-point Constant score system and shoulder radiographs. RESULTS: The overall results in the study group were 60.6% excellent (20 of 33 shoulders), 30.3% good (10), 3.0% fair (1), and 6.1% poor (2), and those of the control group were 16.7% fair (1 of 6 shoulders) and 83.3% poor (5). The symptom recurrence rate in the study group was 6.5%. Dissolution of calcium deposits was complete in 57.6% of the study group, partial in 15.1%, and unchanged in 27.3%. Fragmentation was seen in 16.7% of the control group patients; in 83.3% deposits were unchanged. No recurrence of calcium deposits was observed during the 2 years that the study group was followed. CONCLUSIONS: Shock wave therapy is a safe and effective noninvasive treatment for patients with calcific tendinitis of the shoulder.

Adult↗