Search PubMed⌕ Search

Biomedical subjects

C H Shih

Publications and source records attributed to C H Shih.

At least 127 records · Page 7Linked to original sources
PubMed1992

A simpler surgical technique to treat aseptic nonunion-associated femoral length discrepancy.

In a prospective study from December 1986 to August 1989, 17 consecutive patients with femoral shortening due to aseptic nonunion of femoral shaft fractures were treated with limitedly open Gross-Kempf locking nailing with a lengthening procedure. Patients were followed up for at least 1 year (average 25 months). There was a 88.2% union rate with an average union period of 5.2 months. Average lengthening was 2.4 cm (1.0 approximately 3.0 cm), and average operation time 90 min (70 approximately 130 min). The blood loss was slight (average 200 ml). Complications (11.8%) were 5.9% implant failure and 5.9% nonunion which were not difficult to manage. No neurovascular complications were noted. We conclude that for 5 cm shortening or less in femoral aseptic nonunion, this treatment constitutes the simplest technique and can achieve a very satisfactory result.

Adult↗
PubMed1992

A small effect of weight bearing in promoting fracture healing.

We treated 66 consecutive type IV comminuted femoral shaft fractures with static Grosse-Kempf interlocking nails and followed them up for at least 1 year (median 27 months). Although the effect of weight bearing was completely lost, 60 fractures healed primarily without dynamization. We conclude that weight bearing contributes only an auxiliary role in promoting fracture healing, and that the most decisive role is adequate mechanical stability with sufficient nutrition.

Adolescent↗
PubMed1992

Treatment of femoral supracondylar unstable comminuted fractures. Comparisons between plating and Grosse-Kempf interlocking nailing techniques.

A prospective study was done of 66 consecutive unstable comminuted supracondylar femoral fractures in adults, fixed with either plates (28 cases) or Grosse-Kempf interlocking nails (38 cases). Patients were followed up for at least 1 year (average 44 months). Interlocking nails led to a higher union rate and more satisfactory functional results. Nevertheless, the first distal transverse screw hole took a potential risk of breakage due to stress concentration. The authors conclude that for a cooperative patient, a closed static interlocking nail with strict non-weight-bearing should be the treatment of choice, and for an uncooperative patient, a closed static interlocking nail should be supplemented with a cast brace to reduce the complication rate.

Adolescent↗
PubMed1992

Biomechanical analysis of the mechanism of interlocking nail failure.

From December 1986 to May 1989, 412 patients with 274 femoral and 144 tibial fractures were treated with Grosse-Kempf interlocking nails at our hospital. 324 cases (78.6%) were followed-up for at least 1 year (average 23 months). There were 13 breakages in the locking nails in femora and none in tibiae. The recorded incidence of breakage in the femur is therefore 4.7% (13/274). The mechanisms of locking nail failure are stress concentration around screw hole and nail slot, nicking of the nail during drilling of the screw holes, too close proximity of the screw hole to the fracture, and larger loading over the proximal femur. The incidence of failure is 4.9% in the upper third, 1.9% in the mid-third, and 8.2% in the distal third (P greater than 0.05, chi 2 test). The site most at risk is the first screw hole of the distal third, especially if it is near the fracture site. Prevention of failure involves using a nail of larger diameter and sufficient length, improving the surgical drilling technique, and allowing only protected weight bearing. Management of nail breakage by insertion of a new implant and supplementary cancellous bone grafting can gain satisfactory results.

Adolescent↗
PubMed1992

Necrotizing fasciitis of the extremities.

Necrotizing fasciitis is a limb- and life-threatening soft-tissue infection. Eighteen patients with necrotizing fasciitis of the extremities were reviewed. These infections occurred most commonly after minor trauma. Associated chronic debilitating diseases were present in 13 patients. All but two infections were polymicrobial. The overall mortality rate was 33%. Death was caused by persistent wound sepsis in three and systemic septic complications in spite of apparent local infection control in three. At the admission physical examination the condition may resemble a benign, low-grade cellulitis. Three of four patients died because of a delay in surgical debridement for more than 24 hours after admission. Multiple radial debridements of the involved skin, fat, and fascia are essential to control progressive necrosis. Our results suggest that early diagnosis and prompt surgical debridement of necrotizing fasciitis are essential for survival.

Adult↗
PubMed1992

Simultaneous bilateral femoral shaft fractures.

Simultaneous bilateral femoral shaft fractures are unusual injuries caused by severe force and are usually associated with multiple injuries. There are few reports in the literature. From December 1986 to April 1989, there were 21 consecutive adult (greater than 16 years old) bilateral femoral shaft fracture cases treated at our hospital. The incidence was 2.0% (21/1,065). The associated multiple injuries (42 sites; 2.0 sites per case) markedly influenced the prognosis. There were two deaths, one bilateral above-knee amputation, and 15 cases followed for at least 1 year (average, 25 months). The individual fracture union rate was 80.0% (24/30) and the union period, 5.1 +/- 1.7 months. Complications (26.7%, 8/30) included nonunion, 20.0% (6/30); chronic osteomyelitis, 3.3% (1/30); and, limb shortening, 3.3% (1/30). All complications were in the open method treatment group: 40.0% (8/20) (p less than 0.05). We conclude that bilateral femoral shaft fractures indicate severe systemic and local injuries necessitating aggressive management, and the femoral shaft fracture itself should be treated with a closed nailing technique.

Adolescent↗
PubMed1992

Treatment of 84 cases of femoral nonunion.

Eighty-four femoral nonunions were treated with Küntscher nailing, Grosse-Kempf locked nailing, plating, and Huckstep nailing, and were followed-up for a median of 34 months. Küntscher nailing and locked nailing were superior, with fewer complications, less operation time, and less blood loss. A Küntscher nail was preferred for the isthmic region when there was no shortening of the bone, and a locked nail was preferred above or below this region or when lengthening was indicated.

Adolescent↗
PubMed1992

Management of infected tibial plate osteosynthesis using a staging system for infected fractures.

Osteomyelitis following plate osteosynthesis of a tibial shaft fracture was managed in 23 patients through a staging system and prospective treatment protocol. The staging system, which is arranged in an upstaging disease progression and downstaging treatment protocol, is composed of the status of osseous continuity (Type I to II) and the dead space created by the debridement surgery (Classes A to D). The follow-up period ranged from 20 to 48 months (average, 31.5 months). Staphylococcus aureus (35.5%) and Pseudomonas aeruginosa (29%) were the most commonly involved organisms. Twenty-two infections were initially arrested by one debridement, and one infection was arrested by three sequential debridements. There were seven Stage IA, one Stage IB, seven Stage IIA, two Stage IIB, three Stage IIC, and three Stage IID fractures in this study. The average number of surgical procedures were 1, 2, 2.1, 4, 4.7 and 6, respectively. The difficulty of treatment increased with the severity of the disease. The average time to bone union for Stage IIA, IIB, IIC and IID fractures were 11, 9, 20.3 and 21.5 months, respectively. A tibial osseous defect longer than 4 cm is a major prognostic factor for prolonged disability time. Important complications were nonunion one, bone graft stress fractures (two), and recurrence (three).

Adolescent↗
PubMed1992

Management of infected tibial intramedullary nailing using an organized treatment protocol.

Twenty cases of osteomyelitis, following intramedullary nailing of tibial shaft fractures, were managed with a prospective treatment protocol, comprising intramedullary reaming debridement, antibiotic-bead depot, external skeletal fixation, microvascular muscle flap and early cancellous bone grafting. The follow-up period ranged from 25 to 48 months (average, 34.3 months). Pseudomonas aeruginosa (37.5%) and Staphylococcus aureus (20.8%) were the organisms most commonly involved. There were eight united and 12 ununited fractures after reaming debridement surgery. Nineteen infections were initially arrested by one debridement. One infection was arrested by two Sequential debridements. All 12 ununited fractures were stabilized by Hoffmann unilateral external fixation until the fracture healed. The time spent in external fixation ranged from three to seven months (average, 5.2 months). Early cancellous bone grafting was successfully accomplished for nine ununited fractures with major debridement bone loss. The average union time of the nine fractures with bone grafting was 6.5 months (range, from six to eight months). We believe that this treatment protocol gives a predictable and rapid recovery. The complications were infection recurrence in two cases at the old tibial shaft fracture sites, minor Hoffmann pin tract infection in two cases and stiffness in two ankles and one knee.

Adolescent↗
PubMed1992

Treatment for nonunion of the shaft of the humerus: comparison of plates and Seidel interlocking nails.

From July 1986 to November 1989, fractures of the humeral shaft in 35 adults who had nonunion of the fracture were managed by plate fixation (19 patients) or antegrade nailing of the fracture fragments with the Seidel interlocking nail (16 patients) together with cancellous bone grafting. The follow-up period ranged from 12 to 52 months. Of the patients who had plate fixation, 89.5% had fracture union within 4.5 +/- 1.7 months; of the patients whose fracture was managed with the Seidel interlocking nail, 87.5% had fracture union within 4.4 +/- 1.8 months. The range of shoulder motion was improved with both techniques. Patients who had plate fixation had more complications than those whose fracture was managed by interlocking nailing (21% v. 12%). The authors prefer interlocking nailing because it is a relatively simpler technique, resulting in fewer complications. It may replace plating in the treatment of nonunion of humeral shaft fractures. However, rotatory instability with interlocking nailing cannot be disregarded, and if this is evident plate fixation should be done.

Adult↗
PubMed1992

Brachial plexus injury with erect dislocation of the shoulder.

Luxatio erecta, or inferior dislocation of the glenohumeral joint, is an extremely uncommon variety of shoulder dislocation. Several types of neurovascular injuries may be associated with luxatio erecta. Concomitant fracture of the coracoid, clavicle, acromion, greater tuberosity, and humeral head may also be noted. A case of luxatio erecta associated with a fracture of the greater tuberosity and transient mixed brachial plexus injuries is presented.

Adult↗
PubMed1992

Osteofibrous dysplasia (ossifying fibroma of long bones). A report of four cases and review of the literature.

Osteofibrous dysplasia (ossifying fibroma of long bones) is a rare fibroosseous lesion. Only about 64 cases have been reported in the English literature. It is most commonly found in the tibia and fibula of a child ten years of age or younger. Of the four cases reported in this study, however, only one patient was younger than ten years of age. In two cases, the lesions were unusually located in the radius and ulna respectively. The other two cases had the usual tibial involvement. The last case had two recurrences after curettage before the patient was ten years of age. The other three patients who were treated after the age of 18 years had uneventful healing, one after wide resection and two after curettage. Extensive histologic examination and immunostaining for keratin were performed in all cases. No epithelioid cells were found. Because of a high recurrence rate after curettage, the treatment of this disease in a child should be conservative if the diagnosis is confirmed by biopsy. Only curettage with bone grafting is necessary for those patients older than 15 years of age with symptomatic lesions.

Adolescent↗
PubMed1992

Posterior transpediculate Zielke instrumentation in spondylolisthesis.

Between July 1987 and June 1989, 82 patients with spondylolisthesis (degenerative in 49, isthmic in 33) underwent Zielke posterior transpediculate instrumentation. One-level fusion was performed in 42 patients, two-level fusion in 32 patients, and three-level fusion in 8 patients. A supplemental allograft using frozen femoral heads was implanted in seven of the patients who underwent three-level fusion. The follow-up period ranged from 1.3 to 3 years (average, 1.7 years). Overall, 90.2% of the patients achieved solid fusion, and 85.4% had a good to excellent clinical result. Complications included nerve injury (one patient), rod breakage (four patients), nut loosening (11 patients), screw loosening (two patients), and screw breakage (three patients). The high incidence of instrumentation-related complications indicated that this technique must be further modified and refined.

Adult↗
PubMed1991

Biomechanical analysis of the dynamic hip screw in the treatment of intertrochanteric fractures.

A prospective study was performed in 148 elderly patients (over 60 years old) whose intertrochanteric fractures were caused by moderate trauma. The patients were treated with dynamic hip screws and followed up for at least 2 years (average 34 months). The lag screw was placed as the biomechanical analysis favored. Follow-up showed that the majority achieved good union and were without mechanical failure. The authors conclude that a lag screw should ideally be placed inferiorly toward the medial margin in the frontal plane and centrally in the sagittal plane. The length of the lag screw should be such as to extend from 1.0 cm beneath the subchondral bone to the lateral femoral cortex. At least four cortical screws (piercing the cortex at eight points) should be inserted on the distal femoral fragment.

Aged↗
PubMed1991

Replication-defective missense mutations within the terminal protein and spacer/intron regions of the polymerase gene of human hepatitis B virus.

We have analyzed 11 independent mutations located at various domains of the polymerase gene (pol) of human hepatitis B virus. Surprisingly, one of the two missense mutants within the spacer/intron region appears to be lethal. This result further defines the N-terminal limit of the reverse transcriptase domain. Alternatively, it suggests the potential existence of a novel domain with an unknown function. Two missense mutations within the terminal protein (TP) domain appear to be replication-defective as well, suggesting a functionally essential role of the TP domain in DNA replication.

Blotting, Northern↗
PubMed1991

Subtrochanteric fractures treated with interlocking nailing.

In a prospective study of 31 subtrochanteric fractures treated with Grosse-Kempf interlocking nails with a followup period of at least 1 year, there was a 87.1% (27/31) union rate, and a union period of 4.2 +/- 1.8 months. Knee range of motion in 28 acute traumatic cases was on average 127.5 +/- 23.0 degrees. The significant complications included: nail breakage, 3.2% (1/31); nonunion without nail breakage, 9.7% (3/31); neglected femoral fracture with malunion, 3.2% (1/31). The interlocking nailing has the advantages of: a) closed method, b) weight-sharing principle, c) shortening prevention, d) non-rigid fixation. From the theoretical and clinical comparison among the various implants, we conclude that closed interlocking nailing is one of the better instruments for subtrochanteric fracture treatment, and moreover, the most reasonable of all. However, for the higher level subtrochanteric fractures, reconstruction-style locking nails should be chosen.

Adolescent↗
PubMed1991

Distal femoral nonunion treated with interlocking nailing.

From December 1986 to September 1989, 24 consecutive cases of distal femoral nonunion in adults were treated with Grosse-Kempf interlocking nailing and prospectively followed for an average of 32 months. The union rate was 91.7% (22/24) with a union period of 4.5 +/- 1.8 months. Complications occurred in two patients (8.3%), who suffered nonunion because of implant failure. A cast brace is very useful in promoting ambulation and reducing early overactivity. The potential for implant failure is a result of a concentration of stress over the nail hole, with the most stress occurring near the fracture site (p less than 0.05).

Adolescent↗