Biomedical subjects

F Y Chiu

Publications and source records attributed to F Y Chiu.

At least 19 recordsLinked to original sources

PubMed2001

Avascular necrosis of femoral head after gamma-nailing for unstable intertrochanteric fractures.

We reported on 7 cases of avascular necrosis of the femoral head after treatment of an unstable intertrochanteric fracture with the Asian Pacific gamma-nail. The incidence was about 1.16% (7 of 604) in our series. Good reduction and good implant position were achieved in all 7 men. Avascular necrosis was found about 6 months to 3 years after the initial operation, and all the fractures were solidly united at the final diagnosis. The possible etiologies were initial high energy trauma and combining basal neck fracture and iatrogenic damage of the blood supply to the femoral head.

Adult↗

PubMed2001

Cerclage wiring in displaced both-column fractures of the acetabulum.

We evaluated the effect of cerclage wiring in the open reduction and internal fixation of displaced both-column fractures of the acetabulum. This was a prospective clinical evaluation of such cases where the main surgical strategy was open reduction and internal fixation with cerclage wire and supplemental reconstruction plates. Data on 35 cases treated by open reduction (all via the triradiate approach)/internal fixations with cerclage wire and reconstruction plates were collected. The follow-up period was 40 months (18-69). Reduction with a fracture gap of less than 2 mm without articular stepping was achieved in all 35 cases. Postoperative complications developed in seven cases, including subcutaneous haematoma in two, wound infection in two and heterotopic ossification in three. All the complications had no adverse effect on the clinical outcome, and all the cases had good to excellent final results. Cerclage wiring is very useful and effective in the reduction and fixation of displaced both-column fractures of the acetabulum, and supplemental fixation with reconstruction plates and screws is necessary.

Acetabulum↗

PubMed2001

Cefuroxime-impregnated cement at primary total knee arthroplasty in diabetes mellitus. A prospective, randomised study.

We have performed a prospective single-blinded randomised study to evaluate the role of antibiotic-impregnated cement in the prevention of deep infection at primary total knee arthroplasty (TKA) in patients with diabetes mellitus. We studied prospectively 78 arthroplasties performed for osteoarthritis in such patients. They were randomly separated into two groups. In group 1 (41 knees), cefuroxime-impregnated cement was used while in group 2 (37 knees) cefuroxime was not added to the cement. The preoperative, intraoperative and postoperative management was the same for both groups. The mean follow-up was 50 months (26 to 88). There were no cases of deep infection in group 1, but five (13.5%) occurred in group 2 (p = 0.021). We conclude that cefuroxime-impregnated cement is effective in the prevention of deep infection at primary TKA in patients with diabetes mellitus.

Aged↗

PubMed2000

Treatment of acute closed humeral shaft fractures with Ender nails.

The effect of semirigid Ender nails (EN) in the treatment of closed humeral shaft fractures was reviewed and analyzed. Clinical study was set retrospectively with detailed parameters. One hundred and eighteen closed humeral shaft fractures, treated with closed reduction and internal fixation with ENs, were collected. The follow-up period was 78 (24-175) months. The average operation blood loss was 105 cc, operation time was 57 min, hospital stay was 6.5 days, and union time was 10.5 weeks. The postoperative complications included three superficial infections, one iatrogenic radial nerve palsy, eight nail backouts, and eight nonunions. In our experience, for closed humeral shaft fractures fixed surgically, EN is a good choice for its simplicity and efficacy, but the fracture gap should be minimized after fixation and postoperative care should be closely observed.

Adolescent↗

PubMed2000

Ipsilateral hip and distal femoral fractures.

We tried to find the trauma mechanism and treatment rationale of ipsilateral concomitant hip and distal femoral fractures involving the articular surface. Between 1988 and 1995, 15 cases of ipsilateral hip (confined to neck or trochanteric areas of the femur) and distal (confined to supra- and intercondylar area of the femur) femoral articular fractures were collected. The hip fractures consisted of 10 trochanteric fractures and five neck fractures, which were managed with reduction and fixation in 14 (Knowles' pin in eight, DHS in four and standard Gamma nail in two), and primary bipolar hemiarthroplastry in one. The distal femoral articular fractures were open in 11; these were managed with radical debridement, implantation of Septopal chains and immediate internal fixation, followed by prophylactic autogenous bone grafting 6 weeks later in the recent six cases (five Judet plates, four dynamic condylar screws and two condylar plates). The other four closed distal femoral fractures were managed with early reduction and internal fixation (two Judet plate, one dynamic condylar screw and one condylar plate). The union time was 20.3 (12-48) weeks for proximal fractures and 23.7 (12-36) weeks for distal fractures. Early infection developed in three cases. Nonunion of a femoral neck fracture developed in one case. The other complications were implant failure in one, coxa vara in one, refracture in one, delayed union in one and knee stiffness in one.

Adult↗

PubMed2000

Surgical treatment of displaced acetabular fractures - 72 cases followed for 10 (6-14) years.

Seventy-two displaced acetabular fractures managed surgically were evaluated retrospectively. The follow-up period was 10 (6-14) yr. The commonest fractures were posterior wall (28) and both columns (10). The surgical approaches were Kocher-Langenbeck (47), ilioinguinal (19) and extended iliofemoral (6). No neural monitoring was used in operations and no preventive agents for heterotopic ossification or thromboembolism were used perioperatively. Reduction was rated congruent in 59 (81.9%) and noncongruent in 13 (18.1%). The early postoperative complications were 1 vascular injury, 1 iatrogenic sciatic nerve injury, 1 deep vein thrombosis and 2 wound infections. The late complications were heterotopic ossification in 20 patients, avascular necrosis of the femoral head in 4 and symptomatic arthritis in 10. Functional outcomes were rated as excellent in 31, good in 23, fair in 7 and poor in 11. Our results show that traditional management is effective enough for displaced acetabular fractures.

Acetabulum↗

PubMed2000

The effect of posterior capsulorrhaphy in primary total hip arthroplasty: a prospective randomized study.

Between 1994 and 1997, 180 cases of primary total hip arthroplasty (THA) were performed with the posterior (Moore) approach for a variety of indications and studies prospectively. The cases were separated randomly into 2 groups to evaluate the effect of posterior capsulorrhaphy in the prevention of postoperative dislocation. In group 1 (96 cases), closure of the arthroplasty was performed with a posterior capsulorrhaphy; in group 2 (84 cases), closure was performed without capsulorrhaphy. The follow-up period was 38 months (range, 12-60 months). No dislocations occurred in group 1, whereas 2 dislocations (2.3%) occurred in group 2. Although the factors affecting dislocation in primary THA are many, a posterior capsulorrhaphy may be helpful in the prevention of posterior dislocation of primary THA performed with a posterior approach.

Arthroplasty, Replacement, Hip↗

PubMed2000

Sudomotor abnormalities in reflex sympathetic dystrophy.

BACKGROUND: Intractable pain and sweating dysfunction can occur in patients with reflex sympathetic dystrophy (RSD). We, therefore, investigated autonomic function by measuring sympathetic skin response (SSR) in these patients. This method provides useful information regarding the pathophysiologic changes in and clinical evaluation of RSD. METHODS: Twenty-six RSD patients and 22 age-matched normal subjects were involved in our investigation. Three significant stages of RSD were classified through three-phase bone scanning of the wrist, carpal and metacarpal bones. There were 11 patients in stage I RSD, nine in stage II and six in stage III. SSRs were recorded from the bilateral palms of each subject simultaneously using electrical stimulation of the median nerve in the wrist. Latency and amplitude side ratios were calculated and compared with the control group. RESULTS: The affected/normal (A/N) hand amplitude ratios were significantly lower in stage I RSD, and stage II RSD patients exhibited significantly higher A/N amplitude ratios compared with the control group. A/N amplitude and A/N latency ratios in stage III RSD did not change significantly. The A/N latency ratios in stage I RSD were significantly higher than those of the control group and those of stage II RSD. In one stage I patient and three stage III patients, SSRs were bilaterally unobtainable. CONCLUSIONS: It appears that abnormal SSRs may be associated with autonomic disturbance in RSD patients.

Adult↗

PubMed2000

Treatment of acetabular fractures: 10-year experience.

BACKGROUND: Acetabular fracture is a controversial and difficult fracture to manage. We retrospectively evaluated the outcome of the traditional management of acetabular fractures. METHODS: From 1987 to 1996, 112 cases of acetabular fracture presented at the Taipei Veterans General Hospital and were managed surgically in 73 cases and nonsurgically in 39 cases. The follow-up period was 90 (36-140) months. RESULTS: In the nonsurgically managed group, congruent reduction was achieved in 29 cases (74.3%) and good to excellent functional results were achieved in 25 cases (64.1%). In the surgically managed group, congruent reduction was achieved in 60 cases (82.2%) and good to excellent functional results were achieved in 57 cases (74.3%). In 51 (45.5%) cases, early or late complications developed after management, including one femoral artery perforation, one screw penetration, three wound infections, one iatrogenic sciatic nerve injury, one deep vein thrombosis, 21 heterotopic ossifications, two chondrolyses, three avascular necroses of the femoral head and 18 cases of symptomatic traumatic arthritis. CONCLUSIONS: The functional results correlated well with the final congruity of the joints and the severity of the complications.

Acetabulum↗

PubMed1999

Aerobically generated CO(2) stored during early exercise.

Previous studies have shown that a metabolic alkalosis develops in the muscle during early exercise. This has been linked to phosphocreatine hydrolysis. Over a similar time frame, the femoral vein blood pH and plasma K(+) and HCO(-)(3) concentrations increase without an increase in PCO(2). Thus CO(2) from aerobic metabolism is converted to HCO(-)(3) rather than being eliminated by the lungs. The purpose of this study was to quantify the increase in early CO(2) stores and the component due to the exercise-induced metabolic alkalosis (E-I Alk). To avoid masking the increase in CO(2) stores by CO(2) released as HCO(-)(3) buffers lactic acid, the transient increase in CO(2) stores was measured only for work rates (WRs) below the lactic acidosis threshold (LAT). The increase in CO(2) stores was evident at the airway starting at approximately 15 s; the increase reached a peak at approximately 60 s and was complete by approximately 3 min of exercise. The increase in CO(2) stores was greater, but the kinetics were unaffected at the higher WR. Three components of the change in aerobically generated CO(2) stores were considered relevant: the carbamate component of the Haldane effect, the increase in CO(2) stores due to increase in tissue PCO(2), and the E-I Alk. The Haldane effect was calculated to be approximately 5%. Physically dissolved CO(2) in the tissues was approximately 30% of the store increase. The remaining E-I Alk CO(2) stores averaged 61 and 68% for 60 and 80% LAT WRs, respectively. The kinetics of O(2) uptake correlated with the time course of the increase in CO(2) stores; the size of the O(2) deficit correlated with the size of the E-I Alk component of the CO(2) stores. We conclude that a major component of the aerobically generated increase in CO(2) stores is the new HCO(-)(3) generated as phosphocreatine is converted to creatine.

Adult↗

PubMed1999

Salmonella infection in total hip replacement--report of successful reimplantation and review of the literature.

A case of Salmonella enteritidis group C infection following total hip replacement was treated by resectional arthroplasty and appropriate antibiotics. Total hip replacement with reimplantation of an antibiotic-impregnated cemented hip prosthesis was performed five months later. The postoperative course was smooth and hip function was good, without any sign of infection recurrence throughout 10 years of follow-up. The treatment protocol and clinical results are discussed along with a review of the literature.

Arthroplasty, Replacement, Hip↗

PubMed1998

Acute closed humeral shaft fractures treated with dynamic compression plate.

BACKGROUND: To define the efficacy of dynamic compression plates (DCPs) for the treatment of closed humeral shaft fractures. METHODS: A total of 165 patients with closed humeral shaft fractures were studied retrospectively. There were 120 patients who underwent open reduction and internal fixation with DCPs and no bone grafting (BG). Forty-five patients received the same procedures with BG. The mean follow-up period was 93 months. RESULTS: In the DCP without BG group, the average blood loss was 350 ml, operation time was 105 minutes, hospital stay was 8.5 days and fracture union time was 13.5 weeks. In the DCP with BG group, the average blood loss was 525 ml, operation time was 115 minutes, hospital stay was 7.9 days and fracture union time was 9.2 weeks. CONCLUSIONS: In our experience, DCPs are effective for surgical fixation of humeral shaft fractures. Prophylactic BG is recommended for cases with more comminution.

Adolescent↗

PubMed1997

Closed humeral shaft fractures: a prospective evaluation of surgical treatment.

OBJECTIVE: We tried to define the roles of the rigid dynamic compression plate (DCP) and the semi-rigid Ender nail (EN) in the treatment of closed humeral shaft fractures. DESIGN: A prospective, randomized clinical study was performed with detailed comparison parameters. MATERIALS AND METHODS: Ninety-one closed humeral shaft fractures were treated. Randomly, 30 humeri were treated with open reduction and internal fixation with DCP and no bone grafting (BG), 29 were treated with the same procedure but with BG, and 32 were treated with closed reduction and internal fixation with Ender nails. The average follow-up period was 32 months (range, 13-54 months). MEASUREMENTS AND MAIN RESULTS: In the group with DCP without BG, the average blood loss was 270 mL, operation time was 92 minutes, hospital length of stay was 6.5 days, and union time was 12.5 weeks. In the group with DCP with BG, the average blood loss was 325 mL, operation time was 108 minutes, hospital length of stay was 6.9 days, and union time was 9.4 weeks. In the EN group, the average blood loss was 114 mL, operation time was 54 minutes, hospital length of stay was 5.6 days, and union time was 9.9 weeks. Analysis of variance and Fisher's exact test were used to evaluate the statistical significance. CONCLUSION: In our experience, for humeral shaft fractures fixed surgically, EN is better than DCP without BG. When DCP is chosen for the means of fixation, prophylactic BG is recommended, especially in cases with more comminution.

Analysis of Variance↗

PubMed1996

Fractures of posterior wall of acetabulum.

Fractures of the posterior wall of the acetabulum form a special group in acetabular fractures. This study aims to evaluate the results in the management of such fractures. Thirty-two patients with fractures of posterior wall of acetabulum were reviewed retrospectively. The follow-up period was 7 (range 3-10) years. Twenty-four were associated with initial posterior dislocations. Twenty-seven were managed with open reduction and internal fixation, while the remainder were managed conservatively. Reductions were rated as congruent in 30 cases and as noncongruent in 2. The functional results were excellent in 16 cases, good in 10, fair in 2, and poor in 4. Two early complications were met, namely 1 iatrogenic sciatic nerve injury and 1 superficial wound infection. Sixteen late complications were noted, including 10 heterotopic ossifications, 3 avascular necroses of femoral head, and 3 symptomatic arthritides. The incidence of late complications was high, but the functional results were generally satisfactory. Congruent reduction was the key in obtaining satisfactory results in the management of these fractures.

Acetabulum↗

PubMed1996

Undisplaced femoral neck fracture in the elderly.

The results and the related conditions of 250 undisplaced femoral neck fractures managed by percutaneous Knowles pinning were evaluated. All of the patients were over 59 years old, and the protocol of management and follow-up was determined prospectively. The duration from injury to management was 3.0 (range 1-12) days, the operation time was 20 (range 10-44) min, and most of the patients were discharged without hospitalization. The follow-up period was 74 (range 24-138) months. The final results showed 226 (90.4%) fractures with smooth course of union (mean union time: 24 weeks), 15 (6.0%) fractures with nonunion, and 9 (3.6%) fractures with implant problems. Eighteen (7.2%) hips developed avascular necrosis of femoral head after union. The analysis showed that the rate of complications was higher in elderly persons with undisplaced femoral neck fractures.

Age Factors↗

PubMed1996

Percutaneous pinning in undisplaced subcapital femoral neck fractures.

Three hundred and five undisplaced subcapital femoral neck fractures managed by pinning in situ with Knowles' pins were evaluated to elucidate the role and effect of such treatment. The protocol of management and follow up, and evaluation, both radiographically and functionally, were set up prospectively. The duration from injury to management was 3.5 (1-14) days, the operation time was 22 (9-48) min and most of the patients were discharged without hospitalization. The follow-up period was 75 (28-136) months. The final results showed 282 (92.5 per cent) fractures united without complications (mean union time: 20 weeks), 14 (4.6 per cent) limbs with non-union, and 9 (2.9 per cent) had implant problems. Twenty-two (7.2 per cent) developed avascular necrosis after union. Percutaneous pinning of undisplaced subcapital femoral neck fractures as day cases is a simple, safe, effective and economic method.

Adult↗

PubMed1996

Unstable closed tibial shaft fractures: a prospective evaluation of surgical treatment.

OBJECTIVE: To define the roles of the rigid interlocking nail and the semirigid Ender nail in the treatment of closed unstable tibia] shaft fractures. DESIGN: Randomized, clinical, prospectively study with detailed comparison of parameters. MATERIALS AND METHODS: Data on 116 unstable closed tibial shaft fractures were collected. Randomly, 60 tibiae were fixed with interlocking nails and 56 tibiae were fixed with Ender nails. The follow-up period was 24 (16-32) months. MEASUREMENTS AND MAIN RESULTS: In the interlocking nail group, the average blood loss was 189 cc, operation time was 51 minutes, length of hospital stay was 7 days, and union time was 14.2 weeks. In the Ender nail group, the average blood loss was 95 cc, operation time was 30 minutes, length of hospital stay was 5.0 days, and union time was 16.9 weeks. Student's t test was used for statistical significance. CONCLUSIONS: For more comminuted unstable tibial shaft fractures, an interlocking nail is undoubtedly a better choice, but an Ender nail still is effective in some aspects of treatment in the less comminuted unstable tibial shaft fractures.

Adolescent↗

PubMed1996

Treatment of unstable tibial fractures with interlocking nail versus Ender nail: a prospective evaluation.

BACKGROUND: For unstable tibial fractures, there are many methods of surgical treatment. The efficacy of the Ender nail and the interlocking nail in the treatment of such fractures is examined. METHODS: One hundred and seven cases of unstable tibial shaft fractures were collected for the prospective study. Randomly, 61 tibia were fixed with interlocking nails and 46, with Ender nails. The mean follow-up period was 30.5 (23 to 40) months. The results of the different treatments were compared. RESULTS: In the group with interlocking nails, the average blood loss was 265 cc; operation time was 61 minutes; hospital days were 10.4; and union time was 15.1 weeks for closed fractures and 17 weeks for Winquist-Hansen type III and IV fractures. In the group with Ender nails, the average blood loss was 135 cc, operation time was 32 minutes, hospital days were 8.3 days, and union time was 17.6 weeks for closed fractures and 22.5 weeks for Winquist-Hansen type III and IV fractures. Student t-test revealed statistically significant difference between the groups in all of the data described above. However, treatment with the different nails showed no significant difference in results for open type I and II fractures. CONCLUSIONS: Ender nail still has its superior usefulness in some aspects of treatment of less comminuted unstable tibial shaft fractures, but for the more comminuted unstable tibial shaft fractures, the interlocking nail is undoubtedly better used.

Adolescent↗