Biomedical subjects

Fang-Yao Chiu

Publications and source records attributed to Fang-Yao Chiu.

At least 19 recordsLinked to original sources

PubMed2007

Reconstruction of juxta-articular huge defects of distal femur with vascularized fibular bone graft and Ilizarov's distraction osteogenesis.

BACKGROUND: We evaluate the effect of reconstructing huge defects (mean, 15.8 cm) of the distal femur with Ilizarov's distraction osteogenesis and free twin-barreled vascularized fibular bone graft (TVFG). METHODS: We retrospectively reviewed a consecutive series of five patients who had cases of distal femoral fractures with huge defects and infection that were treated by the Ilizarov's distraction osteogenesis. After radical debridement, two of the five cases had free TVFG and monolocal distraction osteogenesis, and another two cases had multilocal distraction osteogenesis with knee fusion because of loss of the joint congruity. The other case with floating knee injury had bilocal distraction osteogenesis and a preserved knee joint. The mean defect of distal femur was 15.8 cm (range, 14-18 cm) in length. RESULTS: The mean length of distraction osteogenesis by Ilizarov's apparatus was 8.2 cm. The mean length of TVFG was 8 cm. The average duration from application of Ilizarov's apparatus to achievement of bony union was 10.2 months (range, 8-13 months). At the end of the follow-up, ranges of motion of three knees were 0 to 45 degrees, 0 to 60 degrees, and 0 to 90 degrees. Two cases had knee arthrodesis with bony fusion because of loss of the joint congruity. There were no leg length discrepancies in all five patients. In addition, three patients had pin tract infections and one case had a 10 degree varus deformity of the femur. CONCLUSIONS: Juxta-articular huge defect (>10 cm) of distal femur remains a challenge to orthopedic surgeons. Ilizarov's technique provides the capability to maintain stability, eradicate infection, restore leg length, and to perform adjuvant reconstructive procedure easily. In this study, we found that combining Ilizarov's distraction osteogenesis with TVFG results in improved patient outcome for patients with injuries such as supracondylar or intercondylar infected fractures or nonunion of distal femur with huge bone defect.

Adolescent↗

PubMed2006

Experience in the use of the long Gamma nail for 16 femoral shaft fracture that have occurred following initial Asian Pacific Gamma nail fixation for pertrochanteric fractures.

From January 1993 to September 2002, 931 patients suffered from intertrochanteric fracture and subrochanteric fracture received open reduction and internal fixation with APGN in our institute. Among these patients, 16 patients (1.7%) developed a femoral shaft fracture after the initial fixation with APGN. Removal of the APGN, closed reduction and fixation with long Gamma nail (LGN) was performed in all the 16 patients. The patients were followed for 12-60 months (average, 39.8 months). The union time of fracture was 12-24 weeks (average, 18.5 weeks) for femoral shaft fractures and 12-20 weeks (average, 16 weeks) for peritrochanteric fractures. Two early complications were noted, including one superficial (6%) infection and one deep (6%) infection. Two malunions (12.5%) developed with no definite functional impairment. The functional results using the Harris hip score were good to excellent. In conclusion, closed reduction and internal fixation with a LGN is very effective in the management of a femoral shaft fracture, a complication of a previous APGN that had been initially used for stabilisation of a pertrochanteric fracture.

Aged↗

PubMed2006

The native femoral sulcus as the guide for the medial/lateral position of the femoral component in knee arthroplasty: Normal patellar tracking in 690/700 knees--a prospective evaluation.

BACKGROUND: There are no simple guidelines for the medial/lateral positioning of the femoral component in knee arthroplasty (TKA). I therefore conducted a prospective study to evaluate the use of the native femoral sulcus as a guide for the medial/lateral positioning. PATIENTS AND METHODS: Between 1997 and 2001, 700 primary TKAs (Nexgen Zimmer, cruciate retaining prostheses) were performed in 508 patients with the femoral component positioned according to the native femoral sulcus. Intraoperatively, no thumb technique was used to check the patellar tracking. The median follow-up period was 4.5 (4.0-5.5) years. RESULTS: Intraoperatively, lateral retinacular release was performed in 3 knees. In the postoperative radiographic evaluation of patellar tracking, 10 knees (1.4%) had lateral tilting of the patella. The postoperative HSS scores were 93 (85-98). INTERPRETATION: The native femoral sulcus may be used as an effective and simple guide for the medial/lateral femoral component position.

Aged↗

PubMed2005

Native femoral sulcus as a guide for the position of the femoral component in primary total knee arthroplasty: a prospective comparative study of 420 knees.

A prospective randomized study was conducted to evaluate the effects of using the native femoral sulcus as a guide for the positioning of the femoral component in primary total knee arthroplasty (TKA), especially for patellar tracking. Between 2000 and 2002, 420 cases of primary TKA were collected. All the TKAs were performed with the same approach. The cases were randomly separated into two groups. In group 1 (consisting of 202 knees), the femoral insertion of the posterior cruciate ligament and the midline of the lateral-medial femoral condyles were used as a guide for the midline position of the femoral component; while in group 2 (consisting of 218 knees), the native femoral sulcus was used as the guide for the femoral component. Intraoperatively, no thumb technique was used to check the patellar tracking. In group 1, 16 knees (7.9%) received lateral retinacular releases, while none received lateral retinacular release in group 2 (P<0.0001). The average (range) follow-up period was 40 (30-56) months. In postoperative radiographic evaluation, two knees (1%) of lateral tilting of the patella were noted in group 1; while two knees (0.91%) of lateral tilting of the patella were noted in group 2 (P=0.751). In conclusion, native femoral sulcus could be a very effective and simple guide for the medial-lateral position of the femoral component, especially for patellar tracking. The prostheses used in this series were all Nexgen LPS-FLEX PCL Substituting (Zimmer, Warsaw) prostheses.

Aged↗

PubMed2005

Interlocking nails for displaced metaphyseal fractures of the distal tibia.

Metaphyseal fractures of the distal tibia near the ankle joint are difficult to manage. Poor soft tissue coverage and comminution of the fracture complicate open reduction. This prospective study aims to evaluate the practicability of using interlocking nails to treat such fractures. Using the method of closed reduction and internal fixation with a shortened tibial interlocking nail, 20 consecutive cases of distal tibial metaphyseal fractures within 4 cm of the ankle joint line were enrolled from 1997 to 2001. All patients received regular post-operative radiographic check-up and the ankle function was evaluated with the Iowa Ankle-Evaluation rating system. Our result was satisfactory and all of the fractures united solidly with a mean union time of 17.2 weeks. No major complication occurred. We conclude that tibial interlocking nailing is a reliable and safe method for managing metaphyseal fractures of the distal tibia near the ankle joint.

Adult↗

PubMed2005

Operative treatment of intra-articular distal radius fractures using the small AO external fixation device.

BACKGROUND: A retrospective group study was done to evaluate the effect of the small AO external fixator in the management of acute intra-articular fractures of the distal radius. METHODS: Between January 1995 and December 1996, 70 consecutive patients with articular fractures of the distal radius were treated by closed reduction and external fixation with small AO external fixators. The mean age at the time of surgery was 58.9 years (range, 14-87 years). There were 58 Colles' Barton's fractures and 12 Smith's Barton's fractures. The follow-up period was 104 months (range, 92-118 months). RESULTS: All fractures united in a mean of 5.8 weeks (range, 4-10 weeks). At the final follow-up, the average range of motion was 56.3 +/- 11.6 degrees in flexion, 58.6 +/- 10.7 degrees in extension, 21.5 +/- 4.2 degrees in ulnar deviation, 9.1 +/- 2.9 degrees in radial deviation, 71.5 +/- 8.5 degrees in pronation, and 67.3 +/- 9.2 degrees in supination. Compared with the normal side, the average grip force was 87 +/- 6%. The overall clinical and functional outcomes, according to the scoring system of Gartland and Werley, showed that 22 patients (31.4%) had excellent results, 36 (51.4%) had good results, 9 (12.9%) had fair results, and 3 (4.3%) had poor results. CONCLUSION: Closed reduction and external fixation with the small AO external fixator is useful and effective in the management of displaced comminuted articular fractures of the distal radius.

Adolescent↗

PubMed2005

Treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone graft.

BACKGROUND: This study was conducted to evaluate the treatment of aseptic nonunion of the humeral shaft with a dynamic compression plate (DCP) and cancellous bone graft. METHODS: One hundred and five cases of nonunion of a humeral shaft fracture between 1982 and 2001 were analyzed retrospectively. The study population comprised 66 males and 39 females with an average age of 46.2 years (range, 17-81 years). Sixty-seven fractures were defined as atrophic nonunion, and 20 as hypertrophic nonunion, whereas 18 could not be defined clearly. All the fractures were managed by open reduction and internal fixation with DCP and cancellous bone graft. The mean follow-up period was 20 months (range, 14-28 months). RESULTS: All nonunion fractures united within an average of 16 weeks (range, 10-26 weeks). Complications included 4 patients with temporary radial-nerve palsies, and 3 patients with wound infections. At the final follow-up, shoulder and elbow functions of the operated limbs were all satisfactory. CONCLUSION: Fixation by DCP with supplemental cancellous bone graft is a reliable and effective treatment for nonunion of a humeral shaft fracture.

Adolescent↗

PubMed2005

Surgical treatment of open diaphyseal fractures of both the radius and ulna.

BACKGROUND: This study was designed to determine the effects of surgical treatment of acute, open and displaced diaphyseal fractures of both the radius and ulna by early debridement, reduction and internal fixation with a dynamic compression plate (DCP). METHODS: From 1991 to 2003, data from 25 patients with acute, open and displaced diaphyseal fractures of both the radius and ulna were collected and evaluated retrospectively. Twenty-four patients were managed with early surgical debridement, open reduction and internal fixation with a DCP, and 1 fracture was reduced and fixed 3 days after the initial injury. The mean follow-up period was 74.7 months (standard deviation [SD], 38.6 months; range, 16-150 months). All patients had complete functional and radiographic assessments. RESULTS: Twenty-four patients (96%) achieved normal union in a mean of 20.2 weeks (SD, 3.8 weeks; range, 12-24 weeks). One patient with an open type I fracture had nonunion. Functional outcomes showed that 15 patients had excellent results, 8 had satisfactory results, 1 had an unsatisfactory result, and there was 1 failure. There was 1 delayed superficial wound infection. CONCLUSION: Early meticulous debridement, good open reduction and internal fixation with a small DCP proved very effective in the management of type I and II open fractures of both the radial and ulnar diaphyses.

Adult↗

PubMed2005

Treatment of complex subtrochanteric fracture with the long gamma AP locking nail: a prospective evaluation of 64 cases.

BACKGROUND: Complex subtrochanteric fractures are uncommon injuries and challenging to manage. We elucidate the role of the Long Gamma AP Locking Nail (LGAPN) in the management of such fractures in the acute stage. METHODS: Between 1992 and 2002, 64 consecutive cases with nonpathologic complex subtrochanteric fractures managed with the LGAPN were enrolled in this study. Associated injuries were present in 16 cases. The average follow-up period was 68 months. RESULTS: Mean time to union was 14 weeks. There were two complications (one wound infection and one delayed union). The time to union and functional results were not statistically different between different ages (below 50 years old, or older than 50 years) and the number of distal locking screws used (one or two). Longer time to union is noted in patients with a longer operation time and a more comminuted fracture pattern by the AO classification. CONCLUSION: Closed reduction and internal fixation with the LGAPN were proven to be safe and effective in the treatment of complex traumatic subtrochanteric fractures in all age groups, and one distal locking screw is sufficient for distal fixation.

Adult↗

PubMed2005

The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results.

BACKGROUND: We would like to define the results of treatment of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus. METHODS: Between 1988 and 1998, 19 consecutive aged patients (older than 65 years old) with displaced comminuted articular fractures of the distal humerus were treated by open reduction and internal fixation with AO reconstruction plate. The age at the time of injury was 71.9 (65-79) years old. According to the AO classification, 15 patients had type C2 and four had type C3 injury. No patient had inflammatory arthritis of the elbow. The period of follow up is 97.2 (60-174) months. RESULTS: All fractures united with union time of 14.6 (11-20) weeks. No implant failure was found. In final follow up, the average flexion contracture was 16.8 degrees with a range of 0-40 degrees , the average active flexion was 128.4 degrees with a range of 115-140 degrees , the average pronation was 80 degrees with a range of 60-90 degrees , and the average supination was 78 degrees with a range of 60-90 degrees . According to the elbow motion classification of Cassebaum, eight (42.1%) patients were graded as very good elbow motion, eight (42.1%) as good, three (15.8%) as fair, and none as poor. The functional results showed that 15 (79%) patients had excellent results, four (21%) had good results, and none had fair or poor results, according to Mayo elbow performance score. The radiographic evaluation in final follow up showed that four patients (21%) had no osteoarthritic (OA) change, 11 (58%) had grade 1 OA, four (21%) had grade 2 OA, and none had grade 3 OA (the scale of Knirk and Jupiter). Fifteen (79%) patients reported no pain and four (21%) had mild pain. All patients were satisfied with their results. However, There were two early post-operative complications, including one (5.3%) superficial wound infection and one (5.3%) iatrogenic ulnar nerve injury. CONCLUSIONS: Open reduction and internal fixation with appropriate surgical technique is effective in the treatment of displaced fractures of the distal humerus in elderly patients.

Aged↗

PubMed2004

Surgical treatment of displaced fractures of posterior column and posterior wall of the acetabulum.

We evaluated the results of open reduction and internal fixation of displaced posterior wall and posterior 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 interfragmentary screws and reconstruction plates. Data on 11 patients treated by open reduction (all via Kocher-Langenbech approach)/internal fixation with interfragmentary screws and reconstruction plates were collected. The follow-up period was 61 (18-102) months. Reduction with a fracture gap of less than 2mm without articular stepping was achieved in all 11 cases. Postoperative complications developed in five patients, including subcutaneous haematoma in one, avascular necrosis of the femoral head (AVNFH) in one and heterotopic ossification (HO) in three. All but the patient with AVNFH, had anatomic radiological reduction, and good to excellent functional results. Open reduction and internal fixation with interfragmentary screws and reconstruction plates is the treatment of choice in displaced posterior wall and posterior column fractures of the acetabulum.

Accidents, Traffic↗

PubMed2004

Surgical treatment of acute displaced fractures of adult distal humerus with reconstruction plate.

We evaluated the results of the use of AO reconstruction plates in the open reduction and internal fixation of acute displaced fractures of the adult distal humerus. This was a retrospective study of such patients where the main surgical strategy was open reduction and internal fixation with AO reconstruction plates. From 1992 to 1998, 40 patients were included. Average follow-up was 98 (60-127) months. All the fractures united with the union time of 11.7 (9-16) weeks. Early post-operative complications developed in four patients (10%), including wound infection in two (5%) and iatrogenic ulnar neuropathy in another two (5%). At follow-up, 24 (60%) patients developed grade 1 osteoarthritis and eight (20%) developed grade 2 osteoarthritis. Thirty-five patients (87.5%) got good to excellent functional results and 35 cases (87.5%) were satisfied with their surgical results. In conclusion, open reduction and internal fixation with AO reconstruction plate is very useful and effective in the treatment of displaced fractures of the adult distal humerus.

Adolescent↗

PubMed2004

Transacromial Knowles pin in the treatment of Neer type 2 distal clavicle fracturesA prospective evaluation of 32 cases.

BACKGROUND: The high rate of non-union makes surgical intervention necessary for a distal clavicle fracture. This report presents the outcome of a simple surgical method using a transacrominal Knowles pin for this unstable fracture. METHODS: In this study, 32 patients with Neer type 2 distal clavicle fractures were treated using a single transacromial Knowles pin without repair of the torn ligament. All 32 patients were studied prospectively and followed up for a mean of 80 months (range, 12-132 months). The clinical outcome was evaluated with the UCLA score, and the fracture union was judged roentgenographically. RESULTS: All the patients showed excellent results with solid union. The mean union time was 6.8 weeks (range, 4-12 weeks). No major complication was noted, and only one asymptomatic acromioclavicular arthrosis developed. CONCLUSIONS: Single transacrominal Knowles pin fixation offers a simple and safe method for treating patients with displaced Neer type 2 distal clavicle fractures.

Accidental Falls↗

PubMed2004

Treatment of unstable pelvic fractures: use of a transiliac sacral rod for posterior lesions and an external fixator for anterior lesions.

BACKGROUND: This study sought to define the role of transiliac sacral rods used in combination with an external fixator for the management of unstable pelvic fractures. METHODS: This retrospective study evaluated cases in which the surgical strategy was open reduction and internal fixation of posterior lesions with two transiliac sacral rods and closed reduction and external fixation of anterior lesions with an AO external fixator. The data for 65 cases were analyzed. Comprehensive Classification (AO) identified 42 C1 cases, 21 C2, cases and 2 C3 cases. Fractures with iliac bone involvement that impeded the application of an external fixator or transiliac sacral rods were excluded. The follow-up period was 85 months (range, 24-140 months). RESULTS: All the fractures/dislocations healed well. The complications involved 17 cases (26.2%) of persistent posterior pain, 16 cases (24.6%) of irreversible neurologic deficit, 2 cases (3.1%) of posterior wound infection, 3 cases (4.6%) of pin tract infection, and 4 cases (6.2%) of irreversible urologic deficit. The functional results showed that the surgical results were satisfactory in 42 cases (64.6%) and unsatisfactory in 23 cases (35.4%). CONCLUSIONS: For type C pelvic fractures without significant iliac bone involvement, surgical management with posterior transiliac fixation using sacral rods and anterior external fixation yields good radiologic results. The functional results correlated primarily with avoidance of complications and not necessarily with the radiologic results.

Adolescent↗

PubMed2003

Posterior dislocation after posterior stabilization TKA.

Posterior dislocation after primary total knee arthroplasty is a rare but serious complication. The authors described an 85-year-old man receiving bilateral total knee arthroplasty, which achieved good flexion arc immediately. Posterior dislocation occurred on right knee one month after operation, which was treated by close reduction and casting. Dislocation recurred in combination with infection. The mechanism of dislocation was checked under vision when performing open reduction and debridement. The tibial spine escaped from femoral cam in slight flexion and external rotation due to flexion laxity and biceps tethering. On the way to pursuit higher flexion angle, which is beyond the ordinary daily demand, excessive soft tissue release and bone resection seems to b e compromised. Flexion instability alsooccurs out of purpose, accompanied with increased risk of dislocation.

Aged↗

PubMed2003

Injuries during a massive tug-of-war game.

"Tug-of-war" may cause a variety of sports injuries, which has rarely been reported previously. This report described an uncommon case of a previously fit 64-year-old male who presented with abrupt onset of loss of consciousness after falling down in a game of massive tug of war including 1,500 participants as the rope snapped apart. Computed tomography (CT) scan of his abdomen revealed liver and spleen rupture. Spinal cord injury due to traumatic herniation of intervertebral disc at C5-6 level and bilateral brachial plexus injury were also noted after exploratory laparotomy with primary repair of liver and spleen. He then received diskectomy over C5-6 and C6-7 and neurolysis for the right brachial plexus. Multiple neurological complications including paraplegia, severe neuralgia over bilateral C5 dermatome and spasticity over bilateral lower extremities developed. After two-year comprehensive rehabilitation programs, the patient recovered to ambulate with assistive device, and resumed partially dependent daily living activities.

Athletic Injuries↗

PubMed2003

The combination of systemic antibiotics and antibiotics impregnated cement in primary total knee arthroplasty in patients of rheumatoid arthritis--evaluation of 60 knees.

BACKGROUND: We evaluated the effect of combination of systemic antibiotics and antibiotics-impregnated cement in prevention of deep infection in primary total knee arthroplasty (TKA) in patients of rheumatoid arthritis (RA). METHODS: Between 1993-2000, primary TKA were performed for 60 RA patients. Systemic antibiotics with cefazolin and gentamycin were applied in all the patients. Cefuroxime-impregnated cement was used for fixation of tibial and patellar components in all the patients; femoral component was fixed noncementedly in 45 patients (hybrid TKA) and cementedly in 15 patients (cemented TKA). The preoperative, intraoperative and postoperative courses were evaluated in detail. The mean follow-up period was 61 months (range: 24-108 months). The effect of cefuroxime-impregnated cement in the prevention of postoperative deep infection in primary TKA in cases of RA was evaluated. RESULTS: Except 1 (1.6%) superficial infection, no other complication was noted. There was no deep infection, either. CONCLUSIONS: Cefuroxime-impregnated cement combining with systemic antibiotics seems to be effective in the prevention of early or intermediate deep infection in primary TKA in patients of RA.

Adult↗

PubMed2002

The comparison of electrophysiologic findings of traumatic brachial plexopathies in a tertiary care center.

This study was undertaken to demonstrate the distribution of causative factors of brachial plexopathy (BP), to assess the association between the mechanism of injuries and the predominant level of the brachial plexus involved in the injuries, and to characterize the extent and degree of severity of injury in patients with BPI. It consisted of a cross-sectional, retrospective review of electrophysiological data of 5547 patients with 117 patients being identified as having BPI, of whom 86 patients were recruited into the study. The patients were divided into six subgroups according to the mechanism of the damage. The injury was subdivided according to the brachial plexus levels predominantly affected, and each component of the four major anatomical plexus levels-root, trunk, cord and nerve levels was analyzed. The affiliation between the type of injuries and the specified brachial plexus levels was calculated via a two-tailed Fisher's exact test. These findings demonstrated that the type of brachial plexus injury (BPI) is significantly related to the brachial plexus level involved. The motorcycle and birth injury groups were affected at the trunk level, the fall group at the nerve level, the automobile group at the cord level, and the blunt injury group at the cord or nerve level. Moreover, the majority of patients in the motorcycle, fall, and pedestrian groups suffered from severe, incomplete lesions, while the neurophysiological results of the other groups varied.

Accidents, Traffic↗