Biomedical subjects

Kuo-Yao Hsu

Publications and source records attributed to Kuo-Yao Hsu.

8 recordsLinked to original sources

PubMed2006

Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases.

PURPOSE: This investigation arthroscopically assesses the frequency of soft tissue injury in tibial plateau fracture according to the severity of fracture patterns. We hypothesized that use of arthroscopy to evaluate soft tissue injury in tibial plateau fractures would reveal a greater number of associated injuries than have previously been reported. METHODS: From March 1996 to December 2003, 98 patients with closed tibial plateau fractures were treated with arthroscopically assisted reduction and osteosynthesis, with precise diagnosis and management of associated soft tissue injuries. Arthroscopic findings for associated soft tissue injuries were recorded, and the relationship between fracture type and soft tissue injury was then analyzed. RESULTS: The frequency of associated soft tissue injury in this series was 71% (70 of 98). The menisci were injured in 57% of subjects (56 in 98), the anterior cruciate ligament (ACL) in 25% (24 of 98), the posterior cruciate ligament (PCL) in 5% (5 of 98), the lateral collateral ligament (LCL) in 3% (3 of 98), the medial collateral ligament (MCL) in 3% (3 of 98), and the peroneal nerve in 1% (1 of 98); none of the 98 patients exhibited injury to the arteries. No significant association was noted between fracture type and incidence of meniscus, PCL, LCL, MCL, artery, and nerve injury. However, significantly higher injury rates for the ACL were observed in type IV and VI fractures. CONCLUSIONS: Soft tissue injury was associated with all types of tibial plateau fracture. Menisci (peripheral tear) and ACL (bony avulsion) were the most commonly injured sites. A variety of soft tissue injuries are common with tibial plateau fracture; these can be diagnosed with the use of an arthroscope. LEVEL OF EVIDENCE: Level III, diagnostic study.

Adult↗

PubMed2006

Arthroscopic reconstruction of the posterior cruciate ligament with use of a quadruple hamstring tendon graft with 3- to 5-year follow-up.

PURPOSE: This study prospectively evaluated 20 patients treated consecutively to determine patient outcomes, efficacy, and complication potential of arthroscopically assisted posterior cruciate ligament (PCL) reconstruction performed with hamstring tendon grafts. METHODS: Twenty patients (15 men and 5 women), each with an isolated PCL injury, underwent PCL reconstruction with hamstring tendon autograft and were enrolled in this prospective study. Average age at time of surgery was 29 years (range, 20 to 57 years). Average time from injury to surgery was 4 months (range, 3 to 12 months). Average follow-up period was 40 months (range, 36 to 50 months). Patients underwent regular follow-up after clinical and radiographic preoperative and postoperative evaluation. Follow-up examinations comprised the Lysholm Knee Score, the Tegner Activity Score, the International Knee Documentation Committee (IKDC) score, thigh muscle assessment, and radiographic evaluation. RESULTS: Mean preoperative Lysholm score for 20 knees was 63 +/- 10 (range, 48-73); mean postoperative Lysholm score was 93 +/- 9 (range, 77-100). Eighteen of 20 patients (90%) showed good or excellent results at final assessment. Mean preinjury and preoperative Tegner scores were 7 +/- 1.5 (range, 5-9) and 3 +/- 1.9 (range, 2-5), respectively; mean postoperative Tegner score for 20 knees was 6.3 +/- 2.4 (range, 4-9). In final IKDC ratings, 85% of patients (17 of 20) were assessed as normal or near normal (grade A or B). A statistically significant improvement was seen in thigh girth difference, extensor strength ratio, and flexor strength ratio before and after reconstruction at a minimum of 3 years of follow-up. CONCLUSIONS: After follow-up for longer than 36 months, analytical results showed satisfactory function after PCL reconstruction with the use of hamstring tendon autografts. We suggest that the hamstring tendon autograft is a safe, effective, and acceptable choice for PCL reconstruction, and that it affords good ligament reconstruction. LEVEL OF EVIDENCE: IV, therapeutic case series.

Adult↗

PubMed2005

Evaluating hip labral tears using magnetic resonance arthrography: a prospective study comparing hip arthroscopy and magnetic resonance arthrography diagnosis.

PURPOSE: To evaluate the sensitivity and accuracy of magnetic resonance arthrography (MRA) with true sagittal scout image mapped radial reformation in localizing hip labral tears. TYPE OF STUDY: Case series. METHODS: Thirty patients were examined with hip MRA because of suspected labral tears. Every patient underwent normal hip arthrography and MR examinations using a 1.5-T scanner with a 3D-FLASH pulse sequence. Multiplanar reformation using double oblique technique produced radial reformatted rotation images with 10 degrees increment on the acetabular rim. Labral tears were annotated as anterior-superior (AS), anterior-inferior (AI), posterior-superior (PS), and posterior-inferior (PI) quadrant based on the cranial-caudal axis in true sagittal reformatted scout localizing image. Patients with positive MRA findings were counseled to have the arthroscopic hip procedure. RESULTS: Five patients showed no MRA indication of labral tear. Of 25 patients who had MRA evidence of labral tear, 17 underwent arthroscopic hip surgery. One patient had only synovial process in the hip joint near the suspected MRA area. The remaining 16 operated patients had labral tears with a total of 21 quadrant lesions on arthroscopy (distributed as AS, 14; AI, 3; PS, 2; and PI, 2). Radial reformatted images revealed accurate mapping with arthroscopic findings in 21 of the 22 quadrant lesions. The sensitivity and accuracy of MRA for the diagnosis of hip labral tear were 100% and 94%, respectively, and the sensitivity and accuracy of radial reformatted MRA for mapping the tear location were 100% and 96%, respectively. CONCLUSIONS: MRA using radial reformatted images with a true sagittal localizer may achieve superior success rates in diagnosing hip labral lesions and in guiding the arthroscopist in portal selection, thus rendering location of hip labral tears simpler in surgery. It supplied detailed preoperative information to the surgeon, avoiding unnecessary surgery for patients if the diagnosis was unconfirmed. LEVEL OF EVIDENCE: Level III.

Acetabulum↗

PubMed2004

Total knee arthroplasty in patients with liver cirrhosis.

BACKGROUND: Patients with liver cirrhosis have an increased risk of surgical morbidity and mortality. We are aware of no study that has investigated the risks and outcomes of elective orthopaedic procedures in these patients. The purposes of the present study were to review the results of total knee arthroplasty in patients with cirrhosis and to identify risk factors leading to poor results. METHODS: Fifty-one patients with cirrhosis who had undergone sixty total knee arthroplasties for osteoarthritis were studied. The medical records and laboratory data were collected retrospectively. All data were compared with those for matched patients without cirrhosis. Forty-two patients (fifty-one knees) with complete follow-up were evaluated with regard to complications, mortality, and factors leading to poor results. RESULTS: Total knee arthroplasty was associated with significantly more blood loss, a longer hospital stay, more complications, and a higher mortality rate in patients with cirrhosis as compared with control patients (p </= 0.006 for all). Twenty-six complications occurred in twenty patients (twenty-two knees). Logistic regression analysis showed that a history of hepatic decompensation or variceal bleeding was an independent predictor of complications. Infection was the most common complication (prevalence, 21%). Age, platelet count, and hepatitis-B-related cirrhosis were independent predictors of infection. There were no perioperative deaths. Fifteen patients died at a mean of forty-three months after total knee arthroplasty; two deaths were related to the procedure. The presence of a hepatoma was found to be a significant predictor of mortality (p < 0.001). CONCLUSIONS: The rate of complications after total knee arthroplasty was significantly higher in patients with cirrhosis than in control patients (p < 0.001). We believe that total knee arthroplasty should not be performed in patients with a history of hepatic decompensation or variceal bleeding. The risk of infection was high in older patients, patients with a low platelet count, and patients in whom the cirrhosis was related to the hepatitis-B virus. Aggressive prophylaxis against infection should be performed. Patients with Child class-A cirrhosis without these risk factors may do well following a total knee arthroplasty. The benefit of total knee arthroplasty should be cautiously weighed against its potential risks in patients with cirrhosis.

Aged↗

PubMed2004

Concurrent scaphoid fracture with scapholunate ligament rupture.

Various patterns of traumatic carpal injury have been described in the literature. Although the combination of scaphoid fracture and scapholunate ligament rupture in the same injury has been reported and these lesions can no longer be considered mutually exclusive, little information is available on management methods and the long-term results of such seemingly paradoxical complex injuries. This study reviews 11 previously described cases and reports an additional two cases of concurrent scaphoid fracture with scapholunate ligament rupture. This concurrent injury has two presentations; namely perilunate fracture-dislocation, which is the most common presentation, and complex scaphoid fracture. No single mechanism of injury exists that accounts for these complex injuries. High-energy trauma was the only characteristic common to all these cases. Most cases had unsatisfactory radiographic results including scaphoid nonunion, avascular necrosis of the lunate or the proximal pole of the scaphoid and arthrotic wrist changes at an average follow-up of 11 months. Managing these difficult problems needs critical recognition and repair of both bony and ligamentous damage. Early proximal row carpectomy or four-corner midcarpal fusion is another option when these injuries preclude stable reduction and fixation.

Adult↗

PubMed2002

Arthroscopic extraction of a drainage tube: solution for a troublesome problem.

We present a case of a foreign body retained in the knee joint after a hemovac tube was broken during removal at bedside. The foreign body was successfully extracted arthroscopically. Arthroscopy provides an excellent alternative in the management of this troubling complication, minimizing hospitalization and delay in recovery.

Arthroplasty↗

PubMed2002

Reconstructing humerus defects after tumor resection using an intramedullary cortical allograft strut.

BACKGROUND: The humerus is a frequent involvement site of benign bone lesions. Various reconstruction methods have been adopted to restore the defect after excavating the lesion and/or to treat associated pathological fractures. In this study, we reviewed the clinical outcomes of using allogenous cortical struts to the treatment of patients with large humeral defects resulting from benign bone lesions, and investigated the mid-term fate of implanted allografts. METHODS: From 1988 through 1997, 29 patients with space-occupying humeral lesions were treated by eradication of the tumor and reconstruction with an intramedullary allogenous cortical strut. No additional internal fixation was needed for support. Clinical data were recorded, and functional and radiographic results were evaluated. RESULTS: The sizes of defects after eradication of the lesions ranged from 61 to 122 ml (mean, 92 ml). The patients were followed for a mean of 8.8 years. One local recurrence was noted and was successfully treated by repeating the procedure. All patients achieved good to excellent functional results. Follow-up radiographs showed complete healing of the defects, with partial to complete incorporation of the allografts into the host bones. Children had a better chance of complete allograft incorporation than adults. CONCLUSION: Intramedullary allogenous cortical struts act as internal splint mechanically and bone graft material biologically. The combined use of intramedullary allogenous cortical struts and chipped cancellous bone grafts provided good stability and healing probability for large osseous defects in the humerus without the need for implant fixation. Allograft incorporation occurred slowly in adults and might not achieve complete incorporation in adults.

Adolescent↗

PubMedDate not supplied

Complications of hip arthroscopy: analysis of seventy three cases.

BACKGROUND: Hip arthroscopy is recognized as a highly effective means of treating joint disorders. Complications in hip arthroscopy, including neurovascular traction injury, compression injury to the perineum and scope trauma, have been reported. We report our experience with 73 hip arthroscopy procedures and complications at Chang Gung Memorial Hospital. METHODS: Seventy-two patients with 73 hips with severe hip pain were enrolled in this prospective study. The average age of the patients was 42 years (range, 22-61 years). The average follow-up period was 16 months (range, 12-36 months). Surgical indications for hip arthroscopy were labral tears (54 cases, 73.9%); painful dysplastic hips (7 cases, 9.5%); osteoarthritis (5 cases, 6.8%); synovitis (3 cases, 4.1%); ligament teres tears (2 cases, 2.8%); chondromatosis (1 case, 1.4%); and avascular necrosis of the femoral head (1 case, 1.4%). With the patient in the supine position with the involved leg in traction, 2 or 3 portals (anterior, anterolateral or posterolateral) were made. Intraoperative and postoperative arthroscopic complications were recorded and prospectively analyzed. RESULTS: The average operative time was 67 minutes (range, 30-190 minutes) and the average traction time was 58 minutes (range, 30-150 minutes). During surgery, 12 of 73 (16.4%) patients had mild scope trauma to the femoral head, which did not affect their excellent outcomes. Five (7%) patients had transient sciatic nerve neuropraxia and achieved complete recovery within 2 weeks after surgery. CONCLUSION: No major complications of hip arthroscopy were noted in this series. The most frequent complication was mild scope trauma to the femoral head. With experience in the technique and good hip arthroscopic instrumentation, hip arthroscopy complications can be minimized. We suggest that hip arthroscopy is a safe technique, providing an additional valuable tool for hip surgery.

Adult↗