Biomedical subjects

Chi-Chuan Wu

Publications and source records attributed to Chi-Chuan Wu.

At least 19 recordsLinked to original sources

PubMed2007

Femoral supracondylar malunions with varus medial condyle and shortening.

Femoral supracondylar malunions associated with varus deformity of the medial femoral condyle and shortening are rare, and all techniques for treatment of this complication reported to date have limitations. A one-stage antegrade locked intramedullary nailing technique to concomitantly treat these combined disorders was performed in 19 consecutive patients. The following procedures were performed: removal of previous implants, supracondylar corrective osteotomy, one-stage lengthening on a fracture table, antegrade static locked intramedullary nail stabilization, and corticocancellous bone grafting. Seventeen patients with malunions received regular followup for a median of 2.4 years (range, 1.1-5.2 years). Sixteen malunions healed with a union rate of 94.1% (16 patients) and a median union period of 4.5 months (range, 3-7 months). Only one nonunion associated with nail breakage occurred (5.9%; one patient) and one deep infection recurred (5.9%; one patient). Both patients recovered after appropriate treatment. All patients had improved knee alignment and function. Antegrade locked intramedullary nailing is an effective technique for one-stage treatment of combined disorders in patients with femoral supracondylar malunions. Complications can be avoided if patients and surgeons are careful during the treatment course. Protected weightbearing until fracture healing is crucial to successful treatment.

Adult↗

PubMed2006

Plating treatment for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions.

INTRODUCTION: The load tolerance of conventional plate treatment for bicondylar tibial plateau fractures with the buttress and the tension band positions was compared from biomechanical viewpoints. MATERIALS AND METHODS: Fourteen left synthetic tibiae divided into two groups were tested. T-plates in the buttress group were placed on the medial tibial subcondyle and T-plates in the tension band group were placed on the lateral tibial subcondyle. All specimens were evaluated with a Material Testing System (MTS) machine. A linear variance displacement transducer gauge was placed on the medial tibial subcondyle. The anatomic axis of the synthetic femur and the tibia was maintained at 6 degrees varus in the frontal plane. The MTS actuator was set to increase displacement at 3 mm/min. All specimens were evaluated to failure. The relative motion and the ultimate failure load (UFL) between both groups were compared. RESULTS: The buttress group had significantly less displacement than the tension band group following the incrementally increased loading (p < 0.001). At failure, the buttress group also had a higher UFL (p < 0.001) and less displacement (p = 0.009) than the tension band group. CONCLUSION: All medial tibial condylar fragments achieved improved stabilization from the medial aspect of the proximal tibia by conventional plates. When conventional plates cannot be placed medially due to skin ailments, lateral placement of conventional plates may have the insufficient stability. Protected weight bearing should be followed strictly.

Biomechanical Phenomena↗

PubMed2006

Salvage of proximal tibial malunion or nonunion with the use of angled blade plate.

INTRODUCTION: Single buttress plating laterally was sometimes performed by a few orthopedists to treat complex tibial plateau fractures with medial compartment involvement. However, we might encounter cases with medial compartment collapse due to such treatment. The causes of failure, the technique of the revision surgery, and the methods of prevention were investigated retrospectively. The purpose of this study was to report our clinical results of a retrospectively followed series of patients treated with blade plate fixation for proximal tibial metaphyseal nonunions and malunions which were treated with unilateral plating. MATERIALS AND METHODS: Twenty-eight patients with failed treatment of complex tibial plateau fractures due to single buttress plating laterally underwent the revision surgeries. Removal of the buttress plate, proximal tibial corrective osteotomy, and insertion of an angled blade plate medially were performed. Postoperatively, exercise of the range of motion of the knee was encouraged as early as possible. RESULTS: Twenty-five patients were followed-up for a median of 4.8 years (range, 1.2-6.8), and all fractures healed at a median of 4.0 months (range, 3.0-6.0). The proximal medial tibial angle (PMTA) was corrected to the acceptable range (80-99 degrees ) in all 25 patients (P<0.001) and knee function improved in 22 out of 25 patients (P<0.001). CONCLUSION: For clinical and biomechanical considerations, single buttress plating laterally was unsuitable for complex tibial plateau fractures with medial compartment involvement due to relatively huge compressive loads on the medial compartment. The stability provided by a few screws of the buttress plate laterally was normally insufficient. An angled blade plate could be a useful armament in the management of metaphyseal nonunion and malunions of the proximal tibia. Its better stabilization could normally provide a high success rate.

Adult↗

PubMed2005

Low success rate of non-intervention after breakage of interlocking nails.

We followed 12 patients with nailed femoral shaft fractures in which breakage of the static locked nail occurred during fracture treatment. Only two fractures united. The remaining ten fractures had to be treated with exchange nailing after a median of 10 (4-14) months. Nine fractures healed after a median of 5 (4-7) months and one was lost to follow-up. Although breakage of a proximal static reamed femoral locked nail may imitate the effect of dynamisation, the success rate is low. Early exchange nailing is a more successful option to achieve fracture union.

Adult↗

PubMed2005

Treatment of femoral shaft aseptic nonunion associated with broken distal locked screws and shortening.

BACKGROUND: This retrospective study investigated the treatment of femoral shaft aseptic nonunions associated with broken distal locked screws and shortening. METHODS: In this study, 11 femoral shaft aseptic nonunions associated with both broken distal locked screws and shortening in 11 consecutive adult patients were treated. All nonunions were associated with at least 1.5 cm (range, 1.5-3.5 cm) shortening. These nonunions were treated by removal of locked nails, one-stage femoral lengthening, static locked nail stabilization, and corticocancellous bone graft supplementation. Postoperatively, ambulation with protected weightbearing was encouraged as early as possible. RESULTS: Ten nonunions were followed up for a median of 4.1 years (range, 1.8-5.5 years), and nine fractures healed at a median of 4 months (range, 3-6 months). The nonunion case had broken locked screws again at 5 months and was treated with exchange nailing. The fracture healed uneventfully at 4 months. No other complications occurred. CONCLUSIONS: The key to removal of broken screws is withdrawal of the nail slightly to release the incarcerated broken screw end. The screw end then is pushed out with a used Knowles' pin or a smaller screwdriver under image intensifier guidance. Concomitant one-stage femoral lengthening to treat nonunion with shortening has a high success rate.

Adult↗

PubMed2005

A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan.

OBJECTIVES: To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan. DESIGN: Randomized experimental design. SETTING: A 3,800-bed medical center in northern Taiwan. PARTICIPANTS: Elderly patients with hip fracture (N=137) were randomly assigned to an experimental (n=68) or control (n=69) group. INTERVENTION: An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning. MEASUREMENTS: Demographic and outcome variables were measured. Outcome variables included service utilization, clinical outcomes, self-care abilities, health-related quality-of-life (HRQOL) outcomes, and depressive symptoms. RESULTS: Subjects in the experimental group improved significantly more than those in the control group in the following outcomes: ratio of hip flexion 1 month after discharge (P=.02), recovery of previous walking ability at 1 month (P=.04) and 3 months (P=.001) after discharge, and activities of daily living at 1 month (P=.01) and 2 months (P=.001) after discharge. Three months after discharge, the experimental group showed significant improvement in peak force of the fractured limb's quadriceps (P=.04) and the following health outcomes: bodily pain (P=.03), vitality (P<.001), mental health (P=.02), physical function (P<.001), and role physical (P=.006). They also had fewer depressive symptoms (P=.008) 3 months after discharge. CONCLUSION: This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes, self-care abilities, and HRQOL and by decreasing depressive symptoms within 3 months after discharge.

Activities of Daily Living↗

PubMed2004

Predictors of functional recovery for hip fractured elders during 12 months following hospital discharge: a prospective study on a Taiwanese sample.

To examine the longitudinal changes in overall and individual physical activities of daily living (PADLs) and instrumental activities of daily living (IADLs), at 1, 3, 6, and 12 months after hospital discharge in elderly subjects, 110 hip fractured elders (mean+/-SD age, 79.4+/-7.5; 60.9% females) were enrolled in a prospective study. At 12 months following hospital discharge, 56.1% subjects had recovered their overall PADLs, 37.9% had recovered their overall IADLs, and 74.2% could walk independently or with the aide of a cane. When analyzed by generalized estimating equations (GEE), for individual PADL, bathing and climbing stairs had consistently improved at every time point throughout the 1-year follow-up period, while transferring, toileting, and walking ability only improved significantly in the first 3 months after discharge. For individual IADL, the proportion of recovery for mobility appeared to increase significantly during the first 6 months post-discharge, and the remaining IADLs appeared to be stable. These results indicated that the recovery rate is varied for performance of different activities according to the complexity and the involvement of the lower extremities. We also found that less concomitant diseases, and a shorter hospital stay could predict a better recovery trend of overall and of most individual PADLs. These findings may be applicable to other countries with Chinese populations, and could provide a reference for health care providers to develop specific interventions for Chinese hip fractured elders.

Activities of Daily Living↗

PubMed2004

One-stage lengthening using a locked nailing technique for distal femoral shaft nonunions associated with shortening.

OBJECTIVE: To assess the effectiveness of a one-stage lengthening using a locked nail technique for the treatment of distal femoral shaft nonunions associated with shortening. DESIGN: Retrospective. SETTING: University hospital. PATIENTS AND METHODS: During a 6-year period, 36 distal femoral shaft nonunions associated with shortening (>1.5 cm) were treated by the one-stage lengthening technique. Indications for this technique were distal femoral shaft aseptic or quiescent infected nonunions, 1.5-5 cm shortening, and a fracture level suitable for the insertion of two distal locked screws. The surgical technique involved skeletal traction using the femoral condyle, local débridement, lengthening by <or=4 cm aided by a laminar spreader, insertion of a static locked nail, and grafting of corticocancellous bone. Mize's classification for clinical function was used for final patient evaluation. RESULTS: A total of 32 nonunions were followed-up for at least 1 year (median 3.8 years; range 1.2-6.9 years), and 29 fractures healed. The median union period was 4.5 months (range 3-6 months). Three fractures persistently failed to heal. One was treated successfully with exchange nailing, and the remaining two patients were followed annually and had no symptoms. At the latest follow-up, all 32 patients had achieved a satisfactory outcome. The average lengthening was 2.5 cm (range 1.5-3.5 cm). CONCLUSIONS: One-stage lengthening using the locked nailing technique to treat distal femoral shaft nonunions associated with shortening can achieve a high success rate and low complication rate. The key to successful treatment is the patient's complete cooperation with strictly protected weight bearing until the fracture has healed.

Adult↗

PubMed2004

Environmental barriers and mobility in Taiwan: is the Roy adaptation model applicable?

This study tested Roy's adaptation model by exploring the relationship between environmental stimuli, specifically barriers, and the mobility, and instrumental behaviors of hip-fractured elderly persons after surgery in Taiwan. A prospective study was conducted 3 months after hospital discharge with 87 elderly persons with hip fracture who had received surgery at a medical center in northern Taiwan. After controlling for prefracture conditions, subjective environmental barriers significantly diminished the walking ability, self-care ability, and role performance of hipfractured elderly persons. The findings of this study lend to suggestions for intervening with hip-fractured elderly persons after surgery.

Activities of Daily Living↗

PubMed2004

The influence of iliotibial tract on patellar tracking.

Thirty patients with 49 snapping hips and patellar malalignment underwent surgical release of the iliotibial tract contracture over the trochanteric area. Minimal follow-up was 2 years (average 4.6 years, range: 2-9 years). Eight patients underwent computed tomography (CT) preoperatively and 1 month postoperatively to investigate the patellar location in the patellofemoral articulation with knee bending at 0 degrees, 20 degrees, 45 degrees, 60 degrees, and 90 degrees. Significant improvements in the congruence angle and lateral patellofemoral angle were noted on Merchant radiograph for all knees (P<.01). On CT, at 20 degrees and 45 degrees knee bending, all congruence, lateral patellofemoral, and patellar tilt angles significantly improved postoperatively in 8 knees (P<.01). Iliotibial tract affects patellar tracking and dominates lateral patellar supporting structures.

Adult↗

PubMed2003

Ununited ipsilateral femoral neck and shaft fractures: treatment of 16 patients.

INTRODUCTION: Ununited ipsilateral femoral neck and shaft fractures are very rare, and their treatment is very complicated. Until now, no single treatment method has been recommended in the literature. MATERIALS AND METHODS: Eighteen patients sustained femoral shaft fractures, which were treated with reamed intramedullary nails but remained ununited. Concomitant, ipsilateral femoral neck fractures were neglected for 2-16 months (median 4 months). The neck fractures were treated by subtrochanteric valgus osteotomy with sliding compression screw stabilization, and the shaft fractures by dynamic compression plating with supplementary cancellous bone grafting. Postoperatively, ambulation with protected weight-bearing was encouraged as early as possible. RESULTS: Sixteen patients were followed up for at least 2 years (range 2-7 years), and all fractures healed. The neck fracture healed at 3.7+/-0.6 months ( p<0.001), the osteotomy site at 5.3+/-0.9 months, and the shaft fracture at 5.6+/-1.0 months ( p=0.07). All patients could walk without aids. Complications included one osteonecrosis of the femoral head (6.3%), which was followed up regularly without further treatment. CONCLUSION: The described technique provided a high union rate with a low complication rate. In addition, the surgical procedure was relatively simple. Therefore, it might be considered for all indicated cases.

Adult↗

PubMed2003

Changes in quality of life among elderly patients with hip fracture in Taiwan.

To examine the longitudinal change in health related quality of life (HRQoL) during 1 year following hospital discharge in elderly subjects, 110 hip fractured subjects (age, mean+/-SD: 79.3+/-7.4 years) were enrolled in a prospective study. Face-to-face interviews with the patients were conducted, using Short Form 36 (SF-36) at 1, 3, 6, and 12 months after they were discharged from the hospital. The GEE approach was employed to evaluate changes in the variables of interest among different time points. Subjects in this study appeared to have lower scores in most dimensions of SF-36, with physical function and role limitation being the lowest due to physical problems (mean+/-SD=10.97+/-16.19; 6.32+/-20.60) during the 1st month after hospital discharge, compared to community dwelling subjects (mean+/-SD=77.5+/-20.5; 63.8+/-45.30). Most of the dimensions of SF-36, except general health (6th month versus 3rd month=57.56+/-21.90 versus 61.75+/-23.46, P>0.05) improved significantly from the 1st month to the 3rd month (range of means of improved scores from 12.81 to 30.76, P<0.01). After the 3rd month after discharge, physical functions kept improving significantly until 6 months after hospital discharge (3rd month versus 6th month=25.18+/-23.66 versus 40.30+/-25.94, P<0.05). Role limitation due to physical problems reached a plateau between the 3rd and 6th month, and then again improved significantly during the 6th month and the 1st year after hospital discharge (6th month versus 1st year=17.69+/-31.78 versus 32.22+/-44.47, P<0.05). The rest of the dimensions of SF-36 remained stable from the 3rd month to 1 year after discharge. These results indicated that different aspects of SF-36 recovered differently for the hip fractured patients in Taiwan. Similar studies may be helpful for health-care providers in other countries with Chinese populations to develop specific intervention programs.

Aged↗

PubMed2003

Posttraumatic contracture of elbow treated with intraarticular technique.

BACKGROUND: Posttraumatic contracture of the elbow (either flexion or extension) is sometimes very disabling. However, an absolutely convincing surgical technique has not yet been defined in the literature. We developed an intraarticular technique to concomitantly treat both intraarticular and extraarticular lesions with one posterior incision. METHODS: Twenty consecutive adult patients were treated. After the olecranon was osteotomized, all intraarticular pathologies and the anteroposterior capsule were corrected completely. The olecranon was then stabilized with the modified tension band wiring technique. Immediately postoperatively, continuous passive movement was performed, and range-of-motion exercise of the elbow was encouraged continuously. RESULTS: All 20 patients were followed up for a median of 3.8 (range 2.1-6.6) years. The satisfactory rate was 95% (19 of 20, p<0.001). The flexion contracture improved from an average of 42 to 13 deg (p<0.001), and the maximal flexion improved from an average of 89 to 131 deg (p<0.001). The arc of motion improved from an average of 47 to 118 deg (p<0.001). The sole unsatisfactory patient still had 20-110 deg of arc of motion. There were no evident complications noted. CONCLUSION: Compared with other techniques, we recommend this one due to its high satisfactory rate and low complication rate.

Adult↗

PubMed2003

Tibial lengthening: technique for speedy lengthening by external fixation and secondary internal fixation.

BACKGROUND: The conventional Ilizarov technique for tibial lengthening is frequently time-consuming, causes suffering, and is associated with many complications. This study takes a retrospective approach to investigate the outcome of applying a slightly speedier procedure using an Ilizarov apparatus and secondary internal fixation. METHODS: Twelve adult patients displaying tibial shortening (median, 4.0 cm; mean, 4.6 cm; range, 3.0-12.0 cm) with various causes were treated with or without tibial osteotomy and stabilized using an Ilizarov lengthening apparatus. Postoperatively, lengthening of 1 to 1.5 mm/day was performed until the desired length was achieved. External fixation was then converted to internal fixation and either pure autogenous bone graft, or a mixture of autogenous and allogenous bone graft was supplemented. Postoperatively, protected weight bearing was advised until bony union was achieved. RESULTS: Eleven patients were followed up for a median of 3.4 years (mean, 4.0 years; range, 2.1-6.7 years) and solid union was achieved in all cases. Median external fixation occurred after 1.8 months (mean, 1.9 months; range, 1.2-4.5 months) and the median time until union after internal fixation was 4.5 months (mean, 4.8 months; range, 4-6 months). Two patients with rigid equinus feet required concomitant Achillis tendon lengthening. No other significant complications were noted. Classification of the results revealed that improvement from an unsatisfactory to a satisfactory outcome was achieved in all patients (p < 0.001). CONCLUSION: The described technique shortens the external fixation period and reduces patient suffering. Moreover, a high union rate and a low complication rate are achieved. Subjectively and objectively, patients can achieve satisfactory outcomes. Consequently, the described technique may be considered as an alternative to conventional techniques when indicated.

Adult↗

PubMed2002

Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis.

Methods for the treatment of tuberculous spondylitis still are controversial. The authors treated 32 consecutive patients with a two-stage surgical technique combined with antituberculous chemotherapy for 1 year. After anterior debridement, fusion with autogenous anterior iliac tricortical strut bone graft was done, and in a second stage, posterior instrumentation and fusion with autogenous posterior iliac corticocancellous bone graft was done 11 days (range, 4-22 days) later. Postoperatively, patients were encouraged to ambulate with brace protection as early as possible. Twenty-nine patients were followed up for a minimum of 2 years (median, 4.7 years; range, 2-10 years) of whom 28 patients achieved solid fusion (97%). All patients had improvement of back pain including the only patient with pseudarthrosis. Neurologic deficits completely recovered in 84% (16 of 19) of patients after 3 months. Kyphotic deformity improved in all 29 patients (34.6 degrees versus 17.3 degrees ) with the average correction angle of 17.3 degrees. Clinically, 27 patients had achieved a satisfactory outcome (93%). There were no evident surgical complications. The authors, therefore, recommend a two-stage surgical technique combined with antituberculous chemotherapy to treat patients with severe vertebral body destruction attributable to tuberculosis because of its high success rate and a low complication rate.

Adolescent↗

PubMed2002

Aseptic nonunion of a femoral shaft treated using exchange nailing.

BACKGROUND: There are many methods for treating femoral shaft aseptic nonunions of which exchange nailing is the simplest technique. However, the reported success rate varies. Therefore, a prospective study was conducted to further clarify the role of exchange nailing. METHODS: From October 1994 through December 1999, 40 femoral shaft aseptic nonunions in 39 patients were treated using exchange nailing. The indications for this technique included a femoral shaft aseptic nonunion with a previously inserted intramedullary nail, less than 1 cm shortening, a radiolucent line of the nonunion, and no segmental bony defects. The surgical technique consisted of close removal of the previously inserted intramedullary nail, reaming the intramedullary canal as widely as possible (1 or 2 mm oversized), and re-insertion of a stable unlocked or locked intramedullary nail. RESULTS: Thirty-six femoral shaft aseptic nonunions in 35 patients were followed-up for at least 1 year (median, 2.9 years; range, 1.1-6.0 years) and 33 nonunions healed. The union rate was 91.7% (33/36) and the union period was median 4 months (range, 3-8 months). No major surgical complications were noted. The other three patients with persistent nonunions were continuously followed-up due to their reluctance for further operations. CONCLUSION: Although exchange nailing is a relatively simple surgical technique, it can still achieve a high union rate with a low complication rate. Despite that factors to induce a persistent nonunion are still unclear, clinically, exchange nailing should be used as the first choice in the treatment of an indicated femoral shaft aseptic nonunion.

Adolescent↗

PubMed2000

A revised protocol for more clearly classifying a nonunion.

Classifying a nonunion solely on the extent of callus formation on a radiograph is insufficient. We have conducted a study with a revised protocol to classify a nonunion more clearly, which uses both radiographic observation and fixation stability. 47 consecutive femoral shaft nonunions were studied using this protocol and 42 nonunions were followed up for at least one year after discovery (range, 1-3 years). 40 nonunions healed after treatment with a union rate of 95.2% (40/42) and a union period of 4.7 plus or minus 0.9 months. The 2 cases of failure were due to implant failure and both healed after reoperation. We recommend this revised protocol as a pretreatment assessment for all nonunions because of its integrity and effectiveness.

Journal Article↗

PubMed1997

New concepts -- biomechanical studies of a newly designed femoral prosthesis (cervico-trochanter prosthesis).

OBJECTIVE: A newly designed stemless (cervico-trochanter) prosthesis was developed for the purpose of reducing the incidence of the stress-shielding effect caused by the traditional stem-type prosthesis. DESIGN: Both mechanical test and three-dimensional finite element analysis were performed for comparing the differences of strain and stress distributions between the intact, C-T and PCA prosthetic femora. BACKGROUND: The stress-shielding effect and polyethylene (PE) wear debris were thought to be the main factors that resulted in local bone loss after the implantation of stem-type prostheses. In this study, we developed the new C-T prosthesis, which aimed to resolve the above-mentioned problems. METHODS: Six pairs of femora taken from human male cadavers were used to compare the strain magnitudes of intact (n = 12), C-T (n= 12) and PCA (n = 4) prosthetic femora in specific positions. Failure load tests of C-T (n = 8) and PCA (n = 12) prosthetic femora were also carried out from the load-displacement curve. The analysis of variance (ANOVA) test was used for statistical analysis. In addition, three-dimensional finite element stress analyses were performed using a commercial package, ANSYS, on a Convex 3810 computer. RESULTS: Both mechanical test and finite element results showed that the C-T prosthetic femora has a lower stress-shielding tendency than the PCA prosthetic femora (P < 0.001). The C-T prosthetic femora also withstood an average bearing load of 6312 N, which is greater than that of the PCA prosthesis at 5358 N (P < 0.01). CONCLUSIONS: The C-T prosthetic femur could withstand a higher failure load than the PCA prosthesis, which effectively reduced the incidence of the stress-shielding effect. Moreover, the particular design of the C-T prosthesis also reduced localized osteolysis because of the overall coverage of the neck-trochanteric area.

Journal Article↗