Biomedical subjects

Tain-Hsiung Chen

Publications and source records attributed to Tain-Hsiung Chen.

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

Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study.

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVES: To compare the results of fusion versus nonfusion for surgically treated burst fractures of the thoracolumbar and lumbar spine. SUMMARY OF BACKGROUND DATA: The operative results of surgically treated burst fractures with short segmental fixation have been well documented. There is no report comparing the results of fusion and nonfusion. METHODS: Fifty-eight patients were included in this study, with the inclusion criteria as follows: neurologically intact spine with a kyphotic angle > or = 20 degrees, decreased vertebral body height > or = 50% or a canal compromise > or = 50%, incomplete neurologic deficit with a canal compromise 50%, complete neurologic deficit, and multilevel spinal injury or multiple traumas. All patients were randomly assigned to fusion or nonfusion groups, and operative treatment with posterior reduction and instrumentation was carried out. Posterior fusion with autogenous bone graft was performed for the fusion group (n = 30), and no fusion procedure was done for the nonfusion group (n = 28). The average follow-up period was 41 months (range, 24-71 months). RESULTS: The average loss of kyphotic angle was not statistically significant between these 2 groups. The radiographic parameters were statistically significantly better in the nonfusion group, including angular change in the flexion-extension lateral view (4.8 degrees vs. 1.0 degrees), lost correction of decreased vertebral body height (3.6% vs. 8.3%), intraoperative estimated blood loss (303 mL vs. 572 mL), and operative time (162 minutes vs. 224 minutes). The scores on the low back outcome scale were not statistically significant for these 2 groups. CONCLUSIONS: The short-term results of short segmental fixation without fusion for surgically treated burst fractures of the thoracolumbar spine were satisfactory. The advantages of instrumentation without fusion are the elimination of donor site complications, saving more motion segments, and reducing blood loss and operative time.

Adult↗

PubMed2006

Comparison of idiopathic, post-trauma and post-surgery frozen shoulder after manipulation under anesthesia.

Manipulation under anesthesia (MUA) has been used to speed up the recovery of frozen shoulder, which is said to be a self-limiting process. We would like to elucidate the short- and long-term results of the treatment of frozen shoulders by manipulation under anesthesia and compare the results of idiopathic, post-trauma and post-surgery frozen shoulders. We applied an adjusted Constant score (Constant score after excluding the 25 points allocated for the assessment of muscle strength) to assess all patients. In our series, 47 cases with 51 frozen shoulders were collected and evaluated retrospectively. The adjusted Constant score at pre-manipulation was on average 22.8+/-4.9 (10-31) points. The score from the 3-week follow-up was 52.6+/-9.2 (31-67) points on average. The score from the averaged 82-month follow-up was on average 70.1+/-6.2 (54-75) points, with 23 shoulders scored for a maximum point number of 75. The score at the early and late follow-ups was significantly lower for the post-surgery group (63.2+/-6.7) when compared to the other two groups (P<0.001). Our results revealed that manipulation under anaesthesia is a very simple and noninvasive procedure for shortening the course of an apparently self-limiting disease and can improve shoulder function and symptoms within a short period of time. However, we found less improvement in post-surgery frozen shoulders, especially in residual pain and limited range of motion (ROM), which may be influenced by the initial injury or initial surgery. Although less improvement in pain and ROM was noted, manipulation is still a good and simple way to treat post-surgery frozen shoulders.

Adult↗

PubMed2006

Synovial chondromatosis presented as knocking sensation of the knee in a 14-year-old girl.

Knee joint is the most common site of synovial chondromatosis with the prevalence in middle-aged male. The following is the description of a 14-year-old girl presented with a knocking sensation during the motion of her joint, which is a less common occurrence at her age. Loose bodies in the left knee joint were excised as much as possible with arthroscopy. The patient was asymptomatic when moving her knee after arthroscopic synovialectomy and removal of the loose bodies. In spite of the less possibility of malignant transformation of synovial chondromatosis, long-term follow-up is still recommended in this 14-year-old girl due to the supposed genetic abnormalities.

Adolescent↗

PubMed2006

Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features.

STUDY DESIGN: We retrospectively compared magnetic resonance images (MRIs) of tuberculous (TB) spondylitis and pyogenic spondylitis. OBJECTIVE: To identify differences between the diseases. SUMMARY OF BACKGROUND DATA: Clinical and imaging findings of the 2 diseases are hard to distinguish. MRI may show important differences and aid in early diagnosis and treatment. METHODS: We compared 22 MRI parameters in 33 patients with TB spondylitis (average age, 66 years) and in 33 patients with pyogenic spondylitis (average age, 65 years). RESULTS: Seventeen parameters significantly differed between the groups. The most important were local and heterogeneous enhancement of the vertebral body in all patients with TB spondylitis, diffuse and homogeneous enhancement of the vertebral body in 94% of patients with pyogenic spondylitis, vertebral intraosseous abscess with rim enhancement (TB vs. pyogenic, 79% vs. 0%), disc abscess with rim enhancement (9% vs. 64%), and well-defined paraspinal abnormal signal intensity (82% vs. 18%). CONCLUSIONS: Most parameters occurred in both diseases. Distinctive findings were a pattern of bone destruction with relative disc preservation and heterogeneous enhancement for TB spondylitis and a diskitis pattern (disc destruction) with peridiscal bone destruction and homogeneous enhancement for pyogenic spondylitis. These MRI parameters may facilitate the differential diagnosis of these diseases.

Adult↗

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

Comparison of two interbody fusion cages for posterior lumbar interbody fusion in a cadaveric model.

Although the Brantigan cage and Bagby and Kuslich (BAK) cage have different geometrical characteristics, clinical observations suggest that they are equally effective in restoring disc height and stability across the involved spinal segments. This study was designed to compare their performance as posterior lumbar interbody fusion devices at two levels in fresh ligamentous cadaver lumbar spines (L2-S1). After mounting in a testing frame, the three-dimensional load-displacement behaviour of each vertebra was quantified using the Selspot II Motion Measurement System for; the intact state, posterior decompression, and stabilisation, using a pair of Brantigan or BAK cages across L4-S1, additional stabilisation using Isola spinal instrumentation across L4-S1, and cyclic loading in flexion/extension. In the "cage-only" state, the Brantigan cage did not restore the stability in right axial rotation, whereas the BAK cage not only restored stability in all six directions but also improved lateral bending. After implanting the posterior instrumentation, both groups exhibited similar stability, and cyclic loading did not alter this. Although the Brantigan cage appears less effective than the BAK cage, implantation of posterior instrumentation significantly improves stability and reduces the differences between them. This underscores the need to use posterior instrumentation to achieve a higher initial stability.

Aged↗

PubMed2006

Alpha-smooth muscle actin expression and structure integrity in chondrogenesis of human mesenchymal stem cells.

The expression of alpha-smooth muscle actin (SMA) by human mesenchymal stem cells (hMSCs) during chondrogenesis was investigated by the use of pellet culture. Undifferentiated hMSCs expressed low but detectable amounts of SMA and the addition of transforming growth factor beta1 (TGF-beta1) to the culture medium increased SMA expression in a dose-dependent manner. Differentiation in pellet culture was rapidly induced in the presence of TGF-beta1 and was accompanied by the development of annular layers at the surface of the pellet. These peripheral layers lacked expression of glycosaminoglycan and type II collagen during early differentiation. Progress in differentiation increased the synthesis of glycosaminoglycan and type II collagen and the expression of SMA in these layers. Double-staining for type II collagen and SMA by immunofluorescence demonstrated the differentiation of hMSCs into cells positive for these two proteins. The addition of cytochalasin D, a potent inhibitor of the polymerization of actin microfilaments, caused damage to the structural integrity and surface smoothness of the chondrogenic pellets. The SMA-positive cells in the peripheral layers of the chondrogenic pellets mimic those within the superficial layer of articular cartilage and are speculated to play a major role in cartilage development and maintenance.

Actins↗

PubMed2006

Comparison between F-18-FDG positron emission tomography and histology for the assessment of tumor necrosis rates in primary osteosarcoma.

BACKGROUND: The purpose of this prospective study was to identify if F-18-fluorodeoxy-D-glucose positron emission tomography (F-18-FDG PET) was a reliable noninvasive surrogate of histologic response in determining the efficacy of neoadjuvant chemotherapy before surgical resection in primary osteosarcoma. METHODS: Between January 2003 and December 2003, 10 patients with primary osteosarcomas were examined using F-18-FDG PET before neoadjuvant chemotherapy and surgery. The mean age at the time of first intervention was 19 years (range, 4-47 years). Positive prognostic significance was defined as more than 90% tumor necrosis response following neoadjuvant chemotherapy. The parameters of FDG uptake were correlated with histologic findings. The intraclass correlation coefficient was used to validate the tumor necrosis rates determined by PET and histology. RESULTS: The tumor necrosis rate determined by PET was comparable with that determined histologically. The mean standardized uptake value before and following neoadjuvant chemotherapy were 8.2 and 4.4, respectively. The average tumor necrosis rate determined by PET was 22%. However, the mean tumor necrosis rate determined histologically was 54.5%. According to the intraclass correlation coefficient models, the intraclass correlation coefficient equaled O. The relationship of tumor necrosis rates determined by F-18-FDG PET and histology seems to be statistically insignificant. CONCLUSION: In this preliminary study, FDG PET did not seem to be a promising tool for evaluating the response of primary osteosarcoma to neoadjuvant chemotherapy.

Adolescent↗

PubMed2005

Neocartilage from human mesenchymal stem cells in alginate: implied timing of transplantation.

Previous reports have demonstrated the suitability of alginate microencapsulation for chondrogenesis of human mesenchymal stem cells (MSCs) in vitro. This study examined the MSCs-alginate constructs that were transplanted beneath the dorsal skin of nude mice for 8 weeks after a variety of in vitro culture periods. The in vitro culture had great effects on gross morphology and histological characteristics of transplants. The integrity of alginate of transplants increased as the in vitro culture period increased. Transplants were characterized by an opaque and yellowish color, fair burnish, a firm to elastic texture, but without any evidence of calcification spots. Histological findings agreed with the clinical determination of hyaline cartilage, characterized by isolated cells with basophilic ground substance positive in Safranin-O staining and collagen type II immunohistochemistry. Transplants with exposure to TGF-beta1 for more than 2 weeks before transplantation, lost burnish, were flexible in texture, and had an increased formation of calcification spots. Accordingly, 1-week exposure to TGF-beta1 in vitro before transplantation is appropriate for neocartilage formation of human MSCs in alginate. These findings suggested that regeneration using cell therapy or tissue engineering should assist in ascertaining the optimal timing of transplantation.

Alginates↗

PubMed2005

Can povidone-iodine solution be used safely in a spinal surgery?

UNLABELLED: Intra-operative incidental contamination of surgical wounds is not rare. Povidone-iodine solution can be used to disinfect surgical wounds. Although povidone-iodine is a good broad-spectrum disinfecting agent, it has occasionally been reported to have a negative effect on wound healing and bone union. Therefore, its safety in a spinal surgery is unclear. A prospective, single-blinded, randomized study was accordingly conducted to evaluate the safety of povidone-iodine solution in spinal surgeries. Ascertained herein was the effect of wound irrigation with diluted povidone-iodine solution on wound healing, infection rate, fusion status and clinical outcome of spinal surgeries. MATERIALS AND METHODS: From January 2002 to August 2003, 244 consecutive cases undergoing primary instrumented lumbosacral posterolateral fusion due to degenerative spinal disorder with segmental instability had been collected and randomly divided into two groups: the study group (120 cases, 212 fusion levels) and the control group (124 cases, 223 fusion levels). Excluded were those patients with a prior spinal surgery, spinal trauma, malignant tumor, infectious spondylitis, rheumatoid arthritis, ankylosing spondylitis, metabolic bone disease, skeletal immaturity or with an immunosuppressive treatment. In the former group, wounds were irrigated with 0.35% povidone-iodine solution followed by normal saline solution just before the bone-grafting and instrumentation procedure. However, only with normal saline solution in the latter. All the operations were done by the same surgeon with a standard technique. All the patients were treated in the same postoperative fashion as well. Later on, wound healing, infection rate, spinal bone fusion and clinical outcome were evaluated in both groups. RESULTS: A significant improvement of back and leg pain scores, modified Japanese Orthopedic Association function scores (JOA) and ambulatory capacity have been observed in both groups. One hundred and seven patients in the study group and one hundred and nine in the control group achieved solid union. There was no infection in the study group but six deep infections in the control group. Wound dehiscence was noted in one group 1 and two group 2 patients. A subsequent statistical analysis revealed higher infection rate in the control group (P<0.05), but no significant difference in fusion rate, wound healing, improvement of pain score, function score and ambulatory capacity between the two groups. CONCLUSION: Diluted povidone-iodine solution can be used safely in spinal surgeries, and it will not influence wound healing, bone union and clinical outcome.

Adult↗

PubMed2005

Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery.

STUDY DESIGN: Prospective, single-blinded, randomized study. OBJECTIVES: To evaluate the efficacy of dilute betadine irrigation of spinal surgical wounds in prevention of postoperative wound infection. SUMMARY AND BACKGROUND: Deep wound infection is a serious complication of spinal surgery that can jeopardize patient outcomes and increase costs. Povidoneiodine is a widely used antiseptic with bactericidal activity against a wide spectrum of pathogens, including methicillin-resistant Staphylococcus aureus. The aim of this study was to evaluate the efficacy of dilute betadine solution in the prevention of wound infection after spinal surgery. METHODS: Four hundred and fourteen patients undergoing spinal surgery were randomly assigned to two groups. In group 1 (208 patients), surgical wounds were irrigated with dilute betadine solution (3.5% betadine) before wound closure. Betadine irrigation was not used in group 2 (206 patients). Otherwise, perioperative management was the same for both groups. RESULTS: Mean length of follow-up was 15.5 months in both groups (range, 6-24 months). No wound infection occurred in group 1. One superficial infection (0.5%) and six deep infections (2.9%) occurred in group 2. The differences between the deep infection rate (P = 0.0146) and total infection rate (P = 0.0072) were significant between the two groups. CONCLUSIONS: Our report is the first prospective, single-blinded, randomized study to evaluate the clinical effectiveness of dilute betadine solution irrigation for prevention of wound infection following spinal surgery. We recommended this simple and inexpensive measure following spinal surgery, particularly in patients with accidental wound contamination, risk factors for wound infection, or undergoing surgery in the absence of routine ultraviolet light, laminar flow, and isolation suits.

Adult↗

PubMed2005

Thermal effects after anterior cruciate ligament shrinkage using radiofrequency technology: a porcine cadaver study.

The effects of thermal energy on an anterior cruciate ligament (ACL) are unknown. This study was undertaken to know the immediate and direct effects of thermocoagulation on normal ACL. Thermocoagulation was generated by monopolar radiofrequency (RF) at 67 degrees C and 40 W of energy and applied with use of a commercial jig in a porcine cadaveric model, and biomechanical and histological changes were evaluated immediately. Thermocoagulation caused significant shrinkage of ACL without immediate effects on ligament biomechanical properties, including stiffness and maximal failure force. However, histological analysis demonstrated a decrease in number of dense elongated cells and blood vessels within the epiligamentous tissue, loss of areolar spaces, decrement in the periodicity of collagen waveform, and shortening and pyknotic nuclear changes of cells within the fascicular region. RF-generated thermocoagulation resulted in ACL shortening with significant changes on histological findings but not on initial biomechanical properties.

Animals↗

PubMed2005

Open Bankart repair with suture anchors for traumatic recurrent anterior shoulder instability: comparison of results between small and large Bankart lesions.

This retrospective study was to demonstrate the clinical outcome of open Bankart repair with suture anchors for recurrent anterior shoulder instability, and to compare surgical results of small (<3 clock units) and large (>3 clock units) Bankart lesions. With an average follow-up of 55.6 months (2-8 years), there were 82 patients (60 right, 22 left shoulders) with the mean age of 27 years accepting open Bankart repair with suture anchors and capsular shift procedure by the same team. According to surgical findings, these patients were grouped into small (<3 clock units) and large (>3 clock units) Bankart lesions. Subjective outcomes were recorded according to the Bankart scoring system of Rowe. Rowe scores averaged 85.9+/-12.9 (range 25-100). The patients, 92-7 %, had objectively excellent or good results. Twenty nine patients (35.4%) had small Bankart lesions and 53 patients had large Bankart lesions. The Rowe scores in small Bankart lesions were better than that in large Bankart lesions (93.5+/-6.8 vs. 81.8+/-13.6, Wilcoxon rank sum test, P<0.001). Mean scores of stability (Wilcoxon rank sum test, P=0.043), motion (Wilcoxon rank sum test, P=0.037), and function (Wilcoxon rank sum test, P<0.001) in small lesions also had superior outcomes than in large lesions. Four patients (4.9%) got fair results and two (2.4%) patients got poor results at the end of follow-up. The average loss of external rotation is 10 degrees . Open Bankart repair with the aid of suture anchors still got satisfactory results in the treatment of traumatic recurrent anterior instability of the shoulder. The size of the Bankart lesion was a factor affecting surgical outcome. Small Bankart lesions usually got better results than large Bankart lesions.

Adolescent↗

PubMed2005

Giant cell tumors of the knee: subchondral bone integrity affects the outcome.

From January 1992 to July 2001, we treated 38 patients with giant cell tumour in the knee region. Seventeen tumours were located in the distal femur and 21 in the proximal tibia . Twenty patients were classified as Campanacci grade II, 15 as grade III, and three as grade I. Patients' mean age was 34.5 (19-65) years, and the mean follow-up was 52 (24-134) months. Operative procedures were chosen according to the extent of bone and soft-tissue involvement. In 28 patients, intralesional curettage and bone grafting was performed and in ten patients a wide resection. We defined subchondral bone of the knee to be affected when the distance to the tumour was less than 3 mm. We then measured the area of affected subchondral bone radiographically using plain radiographs, CT, and MRI. In patients initially treated with curettage and bone grafting, the mean area of initially affected subchondral bone was 18.6 (0-81)%. The mean Enneking functional score at follow-up was 88 (66.6-100). There was a linear trend showing that the larger the area of affected subchondral bone, the worse the functional score. Among patients initially treated with wide resection, the mean area of affected subchondral bone was 68.2 (41-100)%. There was, however, no significant association between affected subchondral bone area and functional score.

Adult↗

PubMed2005

Posterior instrumentation reduces differences in spine stability as a result of different cage orientations: an in vitro study.

STUDY DESIGN: A multisegmental cadaveric spine model was used to quantify the load-displacement behavior of intact spine specimens, specimens injured and stabilized using Bagby and Kuslich (BAK) cages as lumbar interbody fusion devices with or without posterior instrumentation across two levels. OBJECTIVES: To compare the stabilities imparted by the cages placed using an oblique and conventional posterior approaches and to determine the effects of supplementary posterior instrumentation. SUMMARY OF BACKGROUND DATA: The BAK cage as posterior lumbar interbody fusion (PLIF) has been used to restore disc height, reduce morbidity, provide immediate stability to the patients, and enhance fusion rates. The obliquely inserted BAK cage has the advantages of reducing exposure and precise implantation. The biomechanical efficacy of this procedure is sparse, especially in comparison to the PLIF with and without posterior instrumentation. METHODS: Nine fresh human ligamentous spines (L2-S1) were affixed within a testing frame for determining their load-displacement behaviors. Load testing in clinically relevant modes was performed sequentially for the intact and the following procedures across the L4-S1 segment: posterior destabilization, stabilization using two parallel BAK cages (CBAK group) or one oblique BAK cage (OBAK group), further stabilization with posterior instrumentation, and finally cyclic loading in flexion-extension. Spatial positions of the LEDs attached to vertebral bodies were recorded using a three-dimensional motion measurement system. RESULTS: When used alone to restore stability, the orientation of the cage affected the outcome. In flexion OBAK orientation and in extension CBAK orientation provided better stability (decrease in motion with respect to intact case), compared with the other orientation. In lateral bending, CBAK orientation was found to be better than OBAK. In axial mode, CBAK orientation was effective in both directions while OBAK was effective only in right axial rotation. With the supplementary posterior fixation, the differences in stability resulting from the orientations were not noticeable at all, both before and after cyclic tests. CONCLUSIONS: Owing to the differences in the surgical approach and the amount of dissection, the stability for the cages when used alone as a function of cage orientation was different. These subtle differences were reduced by the use of posterior fixation device, underscoring the importance of using instrumentation when cages are used as PLIFs. However, the oblique insertion may be more favorable since it requires less exposure, enables precise implantation, and is less expensive, especially when used with supplementary instrumentation.

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↗