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Biomedical subjects

S M Hou

Publications and source records attributed to S M Hou.

At least 19 recordsLinked to original sources
PubMed2007

Skin and soft tissue infection caused by non-tuberculous mycobacteria.

SETTING: A medical centre in Taipei, Taiwan. OBJECTIVE: To investigate the trend and characteristics of patients with non-tuberculous mycobacteria (NTM) related skin and soft tissue infection. DESIGN: A total of 63 patients with culture-proven diseases were identified from January 1997 to December 2004. The medical records of all patients were reviewed. RESULTS: Twenty-seven patients were infected with rapidly growing mycobacteria (RGM), 19 with Mycobacterium marinum, six with M. avium complex (MAC), five with M. kansasii and six with other species. Most patients presented with a protracted cutaneous lesion without systemic symptoms, and two thirds of the patients had a history of exposure. Seventy-three per cent of the lesions involved the extremities. Underlying illness with suppressed immunity was documented in 30.2% of the patients, and was most prevalent in patients with MAC (100%) and M. kansasii (60%). Of the patients, 62% underwent at least one surgical intervention, and 77.8% received treatment with different antimicrobial combinations. Most patients (86%) recovered completely. Granulomatous inflammation was found in 88.9% of biopsied tissue associated with M. marinum infection, 31.8% with RGM and 25.0% with MAC. CONCLUSION: A combination of surgery and antimicrobials cured most patients with microbiologically proven localised NTM skin and soft tissue infection.

Adolescent↗
PubMed2002

Embolisation of a renal artery pseudoaneurysm in a patient with renal malrotation and chronic aortic dissection.

INTRODUCTION: Renal artery pseudoaneurysms may arise as a complication of percutaneous nephrolithotomy (PCNL). Prompt recognition and treatment is essential to arrest haemorrhage which may be life threatening. CLINICAL PICTURE: A patient with chronic aortic dissection and malrotated right kidney underwent PCNL for right renal calculus. He developed delayed gross haematuria. TREATMENT: Angiography showed a pseudoaneurysm arising from one of two right renal arteries, which in turn arose from the false lumen of the aortic dissection. The supplying artery was successfully embolised. CONCLUSION: Renal artery pseudoaneurysms can be successfully treated with prompt angiography and embolisation, even in the presence of renal malrotation and aortic dissection.

Adult↗
PubMed2001

Glutathione S-transferase T1-null genotype interacts synergistically with heavy smoking on lung cancer risk.

We studied the influence of genotype for glutathione S-transferase T1 (GSTT1) on susceptibility to lung cancer among 184 Swedish lung cancer patients (88 never-smokers and 96 ever-smokers) and 162 matched population controls (79 never-smokers and 83 ever-smokers), with special emphasis on gene-environment interactions. Cases had significantly lower frequency of the GSTT1-null genotype than that of controls among never-smokers (4.6 vs. 16.5%, P = 0.02), whereas the frequencies were very close to each other among smokers (7.4 vs. 7.2%). Cases with high packyears of smoking, however, had a significantly higher frequency of the GSTT1-null genotype compared to that of cases with low packyears (18.3 vs. 5.6%, P = 0.005). Adjusted for age and gender, the GSTT1-null genotype appeared to be protective against lung cancer among never-smokers (odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.07-0.7), although it was associated with an increased risk for lung cancer among smokers (OR = 2.1, 95% CI = 0.8-5.9), mainly attributed to the group of heavy smokers (>23 packyears; OR = 3.5, 95% CI = 0.7-17.3). Heavy smoking conferred a threefold increased risk for lung cancer (OR = 2.6, 95% CI = 1.3-5.0) among GSTT1-positive individuals, but a ninefold increased risk when combined with the GSTT1-null genotype (OR = 9.3, 95% CI = 1.9-46.3, relative to GSTT1-positive light smokers). This joint effect was further demonstrated by a positive interaction between the GSTT1-null genotype and packyears of smoking. The risk of lung cancer increased steeply with increasing packyears among GSTT1-null smokers, whereas no such effect was seen among GSTT1-positive smokers. We conclude that the GSTT1-null genotype may strengthen the effect of heavy smoking on lung cancer risk.

Adult↗
PubMed2001

An osteomyocutaneous transplantation model on the rat.

To replace the complex and time-consuming procedure of limb transplantation, we developed a new osteomyocutaneous model that excluded the function but retained all the tissue components of the limb. Ten vascularized grafts from five donor hindlimbs were contralaterally transplanted to 10 syngeneic recipients' inguinal region. The graft of this model is composed of complete tibia and fibula and partial muscle and skin of the crus. The operative time was 145.3 +/- 9.1 minutes with the harvesting time of 49.7 +/- 5.8 minutes and the warm ischemia time of 65.4 +/- 6.0 minutes. The transplantation procedure of this model takes significantly less time and is less stressful to the animals than the previous whole limb transplantation model. This model is suitable for the studies of limb or composite tissue transplantation if functional recovery is not the main concern.

Animals↗
PubMed2001

Implementation and evaluation of a multifunctional telemedicine system in NTUH.

In this article, we proposed a multifunctional telemedicine system supporting both telediagnosis and teleconsultation services. We attempted not only to insure that the implementation of this system satisfied most requirements, but also to evaluate the impact of the system. With regard to system architecture, we designed a unified multimedia database to store all types of data and used two kinds of network (ATM and ISDN) for different possible applications. As for data transmission, the REFRESH and PREFETCH mechanisms were implemented to enhance data transfer efficiency. A total of 1107 consultations employing the telemedicine system were performed during the past 3 years. This technology was used most frequently for radiology consultation (32.7%, n = 362) and ultrasonic examination (19.5%, n = 216). An evaluation of the impact on diagnosis (507 valid cases) indicated that the diagnosis in 80 cases (15.78%) were altered on the basis of second opinions from a medical center; and the number of patients transferred to the medical center was reduced from 24 (4.7%) to eight cases. Most of the rural-site physicians (97%) thought that they did benefit from specialists' experience and knowledge via the telemedicine system. Based on 431 valid questionnaires, the number of the patients with confidence in the telemedicine system at their local healthcare center increased from 72.6% to 87.5%. Overall, more than 90% of patients and physicians believed that the system was valuable and provided satisfactory services.

Adolescent↗
PubMed2001

Mutational spectrum induced by acetaldehyde in the HPRT gene of human T lymphocytes resembles that in the p53 gene of esophageal cancers.

As the primary metabolite of alcohol, acetaldehyde (AA) may be responsible for many pathological effects related to consumption of alcohol, such as esophageal cancer. The spectrum of p53 mutations in esophageal tumors is indicative of the involvement of exogenous agents, such as tobacco smoke. There is, however, no experimental proof for the involvement of alcohol as data on mutational spectrum induced by AA in human genes is completely lacking. The aim of this study is to investigate whether AA leaves mutational fingerprint in the HPRT reporter gene in human peripheral T cells. Pre-existing in vivo HPRT mutants were removed from PHA-stimulated T lymphocytes before in vitro treatment with 2.4 mM AA for 24 h. Following cell growth to allow mutation expression, independent 6-thioguanine-resistant mutants were selected from large numbers of subcultures showing a 3-fold induction of mutant frequency on average. A total of 73 induced and 36 spontaneous mutants were found to carry a missense, nonsense, frameshift or splice mutation. Base substitutions were identified in the coding or splicing sequences of 55 induced and 26 control mutants. The induced base changes were mainly G > A transition (40%, G on non-transcribed strand) followed by A > T transversions (14.5%, A on non-transcribed strand). The control mutants had significantly (P = 0.04) less G > A transition (15.4%) and completely lacked A > T transversions. We also identified 5'-AGG-3' or 5'-AAG-3' as potential target sequences for AA-induced G > A transitions. This specific mutational spectrum induced by AA is consistent with the known formation and persistency of N(2)-ethyl-2'-guanosine adduct and with the predominance of G > A transitions and mutations at A:T base pairs in the p53 gene of esophageal tumors. We conclude that AA may be involved in the pathogenesis of esophageal cancer.

Acetaldehyde↗
PubMed2001

XPD exon 10 and 23 polymorphisms and DNA repair in human skin in situ.

Forty-four Finnish volunteers who were previously studied with regard to the repair rate of UV-specific cyclobutane pyrimidine dimers in the skin were genotyped for XPD polymorphisms at codons 312 (exon 10 G-->A, Asp-->Asn) and 751 (exon 23 A-->C, Lys-->Gln). The repair rate was measured at 24 h for two different cyclobutane dimers. The data did not show consistent XPD genotype-specific differences in DNA repair rates among all subjects. The combined exon 10 AA and exon 23 CC genotype was associated with an approximately 50% depression of repair rate but this was of borderline statistical significance. However, the exon 23 C allele was associated with depressed repair among subjects aged 50 years or older and the result was consistent with both dimers.

Base Sequence↗
PubMed2001

Bending strength and holding power of tibial locking screws.

The bending strength and holding power of two types of specially designed tibial locking devices, a both-ends-threaded screw and an unthreaded bolt, were studied and compared with four types of commercially available tibial interlocking screws: Synthes, Howmedica, Richards, and Osteo AG. To test bending strength, the devices were inserted into a high molecular weight polyethylene tube and loaded at their midpoint by a materials testing machine to simulate a three point bending test. Single loading yielding strength and cyclic loading fatigue life were measured. To test holding power, the devices were inserted into tubes made of polyurethane foam, and their tips were loaded axially to measure pushout strength. The devices were tested with two different densities of foam materials and two different sizes of pilot holes. Insertion torque and stripping torque of the screws were measured first. Pushout tests were performed with each screw inserted with a tightness equal to 60% of its stripping torque. Test results showed that the yielding strength and the fatigue life were related closely to the inner diameter of the screws. The stripping torque predicted the pushout strength more reliably than did the insertion torque. All tested devices showed greater holding power in the foam with the higher density and with the smaller pilot holes. The both-ends-threaded screw had the highest pushout strength and a satisfactory fatigue strength. The unthreaded bolt had the highest fatigue strength but only fair holding power. Clinical studies of the use of these two types of locking devices are worthwhile.

Bone Screws↗
PubMed2001

Unreamed locked tight-fitting nailing for acute tibial fractures.

OBJECTIVES: Treatment of tibial fractures by unreamed locked nailing with loose-fitting nails has previously been shown to be associated with a low union rate and high implant failure rate. This report describes the authors' experience in using tight-fitting nails that were relatively larger than loose-fitting nails. DESIGN: Prospective cohort study. SETTING: University medical center. PATIENTS: Forty-eight consecutive patients with fifty-two tibial fractures (excluding open IIIC fractures and those with bone loss) were studied: thirty-four men and fourteen women, with a mean age of 38 years. There were twenty-five closed fractures, nine Type I, eight Type II, four Type IIIA, and six Type IIIB open fractures. INTERVENTION: Unreamed nailing with tight-fitting nails using the Russell-Taylor system. OUTCOME MEASURES: Union rate, time to union, complication rate, and functional recovery, as well as nailing time, hospital time, and crutch-walking time were recorded. RESULTS: Union occurred in forty-eight of fifty-two fractures (92%) with a mean time to union of 18.2 weeks. Compartment syndrome occurred in three patients. Deep infection occurred in one Type II and one Type IIIB open fracture. Four fractures required additional exchange nailing or bone grafting to achieve union: one Type II, one Type IIIA, and two Type IIIB open fractures. Three malalignments resulted from operative technical error. The rate of both intraoperative bony split and screw breakage was 3.8% (2 of 52), but neither complication interfered with fracture healing. Recovery of joint motion was essentially normal in those patients without knee or ankle injury. CONCLUSIONS: Unreamed locked nailing with tight-fitting nails can produce satisfactory clinical results for acute tibial fractures. It has the advantages of technical simplicity and an acceptable risk of implant failure.

Acute Disease↗
PubMed2001

Differential interactions between GSTM1 and NAT2 genotypes on aromatic DNA adduct level and HPRT mutant frequency in lung cancer patients and population controls.

We have studied the influence of GSTM1 and NAT2 genotypes on aromatic DNA adduct level (AL) and HPRT mutant frequency (MF) in smokers with newly diagnosed lung cancer and matched population controls. AL was analyzed in relation to genotypes in 170 cases and 144 controls (113 current/recent smokers and 201 former/never smokers), and MF in 157 cases and 152 controls (155 ever smokers and 154 never smokers). Both genotypes exhibited the a priori expected effects on AL and MF among controls only, especially among smoking controls [significantly lower pack-years (a pack-year is defined as 1 pack of cigarettes/day for 1 year) than among cases]. Among the 42 currently smoking controls, the NAT2 slow genotype [odds ratio (OR), 7.5; 95% confidence interval (CI), 1.5-38.4], in particular in combination with the GSTM1 null genotype (OR, 19.3, 95% CI, 1.1-338.6 for null/slow versus positive/rapid) was strongly associated with high AL. The null/slow combination was also significantly associated with high MF among ever smokers (cases and controls pooled) with lower pack-years (OR, 3.7; 95% CI, 1.3-10.7 versus all of the other genotypes; OR, 5.1; 95% CI, 1.2-22.4 versus positive/rapid). In contrast, an antagonistic gene-gene interaction was seen among smoking cases for both AL and MF. Only currently smoking cases with the combined GSTM1 null and NAT2 rapid genotype showed a positive correlation between InAL and InMF (r, 0.64; P = 0.1), and an increase of AL with both age and daily cigarette use. This genotype combination was also associated with high MF among ever-smoking cases (OR, 4.0; 95% CI, 0.9-17.7 versus positive/rapid). There was a significant interaction between NAT2 genotype and pack-years of smoking among cases, so that the rapid genotype was associated with high MF among ever-smoking cases diagnosed at higher pack-years, whereas the slow genotype was associated with high MF at lower pack-years. These findings suggest that the influence of NAT2 genotype on AL and MF and its interaction with GSTM1 genotype may be dose dependent. The NAT2 slow genotype, in particular when combined with the GSTM1 null genotype, may confer increased susceptibility to adduct formation, gene mutation, and lung cancer when the smoking dose is low.

Adult↗
PubMed2001

Extra-articular deformity in distal radial fractures treated by external fixation.

OBJECTIVE: To determine the radiographic outcome in fractures of the distal radius treated with closed reduction and external fixation. DESIGN: A retrospective study. SETTING: The orthopedic department of National Taiwan University Hospital. PATIENTS: Eighty-five consecutive patients (36 female, 49 male), average age 48 years, with fractures of the distal radius seen between March 1995 and June 1998. INTERVENTIONS: Closed reduction and external fixation of fractures, followed up by good-quality posteroanterior and lateral radiographs to evaluate healing. MAIN OUTCOME MEASURES: Radial height, radial inclination and volar tilt were measured on radiographs obtained initially, immediately postoperatively and at the time of removal of external fixation. Data were analyzed by the t-test. RESULTS: Immediately after reduction and fixation, there was a significant improvement in the measurements of radial height and radial inclination. This improvement was gradually lost and height and inclination were significantly decreased at the time the external fixation device was removed. External fixation did not improve the volar tilt. CONCLUSION: External fixation is a popular method to improve the reduction of osseous deformity but cannot effectively protect comminuted distal radial fractures from loss of reduction, which may be associated with shortening and redisplacement.

Congenital Abnormalities↗
PubMed2000

Hydrogen peroxide induced mutations at the HPRT locus in primary human T-lymphocytes.

Reactive oxygen species (ROS) produced by intracellular metabolism are believed to contribute to spontaneous mutagenesis in somatic cells. Hydrogen peroxide (H(2)O(2)) has been shown to induce a variety of genetic alterations, probably by the generation of hydroxyl radicals via the Fenton reaction. The kinds of DNA sequence alterations caused by H(2)O(2) in prokaryotic cells have been studied extensively, whereas relatively little is known about the mutational spectrum induced by H(2)O(2) in mammalian genes. We have used the T-cell cloning assay to study the ability of H(2)O(2) to induce mutations at the hypoxanthine guanine phosphoribosyltransferase (HPRT) locus in primary human lymphocytes. Treatment of cells for 1 h with 0.34-1.35 mM of H(2)O(2) caused a dose dependent decrease of cell survival and increase of the HPRT mutant frequency (MF). After 8 days of expression time, the highest dose of H(2)O(2) caused a 5-fold increase of MF compared to the untreated control cells. Mutant clones were collected and the genomic rearrangements at the T-cell receptor (TCR) gamma-locus were studied to identify independent mutations. RT-PCR and DNA sequencing was used to identify mutations in the HPRT coding region. Due to a relatively high frequency of sibling clones, only six independent mutations were obtained among the controls, and 20 among the H(2)O(2) treated cells. In both sets, single base pair substitutions were the most common type of mutation (5/6 and 13/20, respectively), with a predominance of transitions at GC base pairs, which is also the most common type of HPRT mutation in T-cells in vivo. Among the single base pair substitutions, five were new mutations not previously reported in the human HPRT mutation database. Overall, the kinds of mutation occurring in T-cells in vivo and H(2)O(2) treated cells were similar, albeit the number of mutants was too small to allow a meaningful statistical comparison. These results demonstrate that H(2)O(2) is mutagenic to primary human T-lymphocytes in vitro and induces mutations of the same kind that is observed in the background spectrum of HPRT mutation in T-cells in vivo.

Cell Division↗
PubMed2000

Mutational spectra at the hypoxanthine-guanine phosphoribosyltransferase (HPRT) locus in T-lymphocytes of nonsmoking and smoking lung cancer patients.

Molecular analysis of mutations at the hypoxanthine-guanine phosphoribosyltransferase (HPRT) locus in peripheral blood T-lymphocytes can provide information on mechanisms of somatic in vivo mutation in populations exposed to exogenous carcinogens and in individuals with inherent susceptibility to cancer and other diseases. To study possible mutational changes associated with smoking as a risk factor for lung cancer, we analyzed HPRT mutations in T-cells of newly diagnosed, nonsmoking and smoking lung cancer patients before treatment. Reverse transcriptase polymerase chain reaction (RT-PCR) and DNA sequencing methods were used to identify 146 independent mutations, 73 each from 32 nonsmoking and 31 smoking cases. In 35 T-cell mutants, the HPRT cDNA showed loss of an entire exon, indicating a splicing mutation. Among the remaining 111 fully characterized mutations in the coding region, single base pair (bp) substitutions predominated with 79% (48/61) in nonsmokers and 90% (45/50) in smokers. Frameshift and small deletion (1-24 bp) mutations were found in 18 mutants. The distribution of base pair substitutions was nonrandom, with significant clustering at previously identified hotspot positions 143, 197 and 617 in the HPRT coding sequence (P< or =0.008). One additional hotspot, GC-->TA at position 606, was observed only in smokers (P=0.006). The frequency of GC>TA transversions was higher in smokers (13%) than in nonsmokers (6%). Conversely, smokers had a lower frequency of GC>AT transitions (24%) than nonsmokers (35%). This smoking-associated shift of the HPRT mutational spectrum, although not statistically significant, is consistent with the in vitro mutagenicity of benzo(a)pyrene (BaP), a prominent carcinogen of tobacco smoke, and with known differences in the TP53 mutational spectrum in lung tumors of smokers and nonsmokers. Among nonsmokers, the HPRT mutational spectra in healthy population controls and lung cancer patients were similar, but there was a marginally significant difference (P=0.07) in the distribution of base pair substitutions between smoking controls and patients. These results suggest that (i) general mechanisms of somatic mutagenesis in individuals with possible predisposition to cancer (e.g. nonsmoking lung cancer patients) are not different from those in normal healthy individuals, and (ii) the HPRT gene in T-cells is a useful reporter locus for smoking-associated somatic in vivo mutations occurring early in lung cancer development.

Adult↗
PubMed2000

In vivo kinematic study of normal wrist motion: an ultrafast computed tomographic study.

OBJECTIVE: To quantify in vivo carpal kinematics of a normal wrist in a dynamic continuous model. DESIGN: The instantaneous changes in the radiocarpal and midcarpal joints during normal wrist motion were analyzed using ultrafast computed tomography (CT). BACKGROUND: Wrist injuries account for a considerable and growing proportion of work-related disorders and disability. However, little is known about normal wrist kinematics. METHODS: Ten uninjured subjects were studied using ultrafast CT to measure the continuous motion of the wrist from full flexion to full extension. Sagittal plane scanning was performed mediolaterally at six different locations as the wrists were moved slowly and repeatedly from full flexion to full extension. The data were printed to X-ray film and transferred to an independent work station with a video camera. The motion of the radiocarpal, midcarpal and wrist joints was determined by an image analyzing system. RESULTS: Wrist motion was expressed as a ratio of capitate-lunate (C-L) (midcarpal) motion and radio-lunate (R-L) (radiocarpal) motion. In the volar flexion of normal wrists, the contribution of the radiocarpal joint and midcarpal joint were approximately equal; while dorsal flexion of the normal wrist occurred mainly at the midcarpal joint. CONCLUSIONS: In normal wrists, the radiocarpal joint and midcarpal joint contribute equally to volar flexion, while the midcarpal joint is more important in dorsal flexion. RELEVANCE: In this study, we demonstrated the suitability of using two-dimensional computed tomographic images in a quantitative study of flexion/extension kinematics of the normal wrist.

Adult↗
PubMed2000

GSTM1 and NAT2 polymorphisms in operable and non-operable lung cancer patients.

We have genotyped 657 Norwegian men, including 282 lung cancer patients (147 non-operable and 135 operable) and 375 healthy referents (210 smokers and 165 non-smokers), to study the possibility that glutathione S-transferase M1 (GSTM1)-null and/or N-acetyl transferase 2 (NAT2)-slow genotypes confer susceptibility towards lung cancer in smokers. Compared with smoking referents, there was a significant over-representation of the GSTM1-null genotype among patients with squamous cell carcinoma (SQ) [odds ratio (OR) = 1.7, 95% confidence interval (95%CI) = 1.1-2.7], and the NAT2-slow genotype among patients with large cell carcinoma or mixed histological diagnosis (LM) (OR = 2.5, 95%CI = 1.0-6.1). In contrast to operable patients, non-operable patients showed a clear over-representation of slow genotypes if they were younger (</= 63 years; versus older: OR = 3.9, 95%CI = 1.7-8.8) or younger light smokers [</= 30 pack-years (PY); versus heavy smokers: OR = 5.7, 95%CI = 1.4-23.3]. Among younger light smokers, the slow genotype appeared to be associated with an increased risk of developing non-operable tumours only (OR = 6.3, 95%CI = 1.9-20.4), especially other types of tumours than SQ (OR = 10.8, 95%CI = 1.4-83.9). The null genotype (OR = 3.9, 95%CI = 1.1-13.5) and the null/slow combination (OR = 4.5, 95%CI = 1.5-13.8) seemed to increase the risk for non-operable SQ only. These results are supported by logistic regressions of patients allowing interactions between tumour type (or treatment) and PY (or age), and indicate that the GSTM1-null genotype could be an important susceptibility factor for SQ while the NAT2-slow genotype may have an impact on other types of lung cancer. Individuals with the GSTM1-null and/or NAT2-slow genotypes may constitute susceptible groups with increased risk to contract non-operable lung cancer at younger age and lower smoking dose.

Adult↗
PubMed2000

Treatment of humeral shaft delayed unions and nonunions with humeral locked nails.

OBJECTIVE: To report experience with use of humeral locked nails in treating humeral delayed unions and nonunions. The following techniques yielded encouragingly good results: static locking, short-to-long segment nailing, bone grafting, fracture compression, and minimal surgical trauma. DESIGN AND METHODS: A total of 41 consecutive patients with 13 delayed unions and 28 nonunions were treated with humeral locked nails. Delay from trauma to surgery averaged 4.2 months for delayed union and 15.5 months for nonunion. The average age of patients was 50.2 years; average follow-up time was 23.2 months. There were 7 proximal-third fractures, 21 middle-third fractures, and 13 distal-third fractures. The antegrade approach was used for 13 fractures and retrograde for 28. Open nailing was performed in 39 fractures and closed nailing in 2. If the fracture motion was still present after nail insertion, axial compression of the fracture site was specially applied. Bone grafting was performed in the fractures with open nailing. Thirty-four fractures were nailed with 8-mm nails, and 7 fractures were nailed with 7-mm nails. RESULTS: With a single operation, all but two patients achieved osseous union in, on average, 5.6 months. One of these two patients eventually gained union after another surgery with fracture compression along the original nail and concurrent bone grafting. The second patient, undergoing hemodialysis for chronic renal failure, had persistent nonunion. At follow-up, for patients with antegrade nailing, all but four patients had less than 20 degrees limitation of shoulder abduction. For patients with retrograde nailing, all but two had less than 10 degrees limitation of elbow motion. Only the patient with persistent nonunion had continual pain and significant impairment of arm function. CONCLUSIONS: Humeral locked nailing seems to be effective for humeral delayed unions or nonunions. It may be an acceptable alternative for fractures unsuited for plate fixation, such as those with comminution, osteoporosis, or a severely adhered radial nerve.

Adult↗