Biomedical subjects

Chi-Chuan Wu

Publications and source records attributed to Chi-Chuan Wu.

26 records · Page 2Linked to original sources

PubMedDate not supplied

Ipsilateral femoral neck and shaft fractures treated with Russell-Taylor reconstruction intramedullary nails.

BACKGROUND: Ipsilateral femoral neck and shaft fractures are rare injuries and the treatment is complicated and versatile. No single device has been considered absolutely superior to others. METHODS: Fifteen combined fractures in 15 patients were treated with Russell-Taylor reconstruction intramedullary nails (recon nails). Twelve surgeries were performed within 24 hours of trauma and the other 3 were delayed for 4-7 days due to associated life-threatening injuries. Postoperatively, protected weight bearing was permitted as early as possible. RESULTS: The median operating time was 250 minutes (range 125-430 min) and median blood loss was 300 ml (range 100-600 ml). Thirteen patients were followed-up for a median of 22 months (range 13-45 months). The union rates for neck and shaft fractures were 84.6% and 69.2% respectively. The median union times were 3.0 months for neck fractures and 8.5 months for shaft fractures. CONCLUSIONS: Recon nails are alternative acceptable devices to treat combined fractures. However, the stability of neck fixation may be insufficient and restriction of vigorous activity is suggested to avoid fixation failure.

Adult↗

PubMedDate not supplied

Surgical treatment of acute complete acromioclavicular dislocation: comparison of coracoclavicular screw fixation supplemented with tension band wiring or ligament transfer.

BACKGROUND: Treatment of acute complete acromioclavicular (AC) dislocation is still controversial. Both non-surgical and surgical methods have been reported with similar results. In addition, once surgical treatment is chosen, a satisfactory surgical technique has not been developed yet. METHODS: Sixty consecutive patients who sustained 60 acute complete AC dislocations were treated using coracoclavicular (CC) screw fixation supplemented with tension band wiring for the AC joint (n = 30) or coracoacromial (CA) ligament reconstruction (n = 30), respectively. The operating times, functional outcomes, and complications were compared. RESULTS: Twenty-nine patients with tension band wiring (group 1) and 27 patients with CA ligament reconstruction (group 2) were followed-up for 12-47 (mean, 23.6) months. The operating time was 34-57 (mean, 46.3) minutes in group 1 verse 52-93 (mean, 83.4) minutes in group 2 (p < 0.001). The percentage of satisfactory outcomes was 86.2% in group 1 verse 88.9% in group 2 (p = 0.30). Loss of reduction of the AC joint was 13.8 % (4/29) in group 1 verse 3.7% in group 2 (1/27, p = 0.17). Patients who received tension band wiring treatment had a higher rate of unsatisfactory outcomes when loss of reduction of the AC joint occurred (p = 0.01). CONCLUSIONS: Once surgical methods are chosen in patients with acute complete AC dislocation, CC screw fixation supplemented with tension band wiring for the AC joint or CA ligament reconstruction achieved similar satisfactory rates. However, patients who received the former had relatively shorter operating times.

Acromioclavicular Joint↗

PubMedDate not supplied

Indirect reduction with sliding compression screw stabilization for subtrochanteric fractures.

BACKGROUND: Subtrochanteric fractures possess unique characteristics, and no single device used in their treatment is considered absolutely superior to others. Use of sliding compression screws (SCSs) is technically simple. The feasibility of SCS stabilization was evaluated using indirect reduction of fracture fragments. METHODS: One hundred and thirty-one acute subtrochanteric fractures without extensive shaft involvement were treated using this technique, and they were classified into 4 groups to evaluate the success rate. After the lag screw was inserted into the femoral head, the side plate was applied onto the distal fragment without exploring the fracture site. At least 4 cortical screws were used to stabilize the distal fragment. Postoperatively, ambulation with protected weight bearing was encouraged at as early a time as was possible. RESULTS: One hundred and thirteen fractures were followed-up for 12 to approximately 38 (mean, 22) months. The union rate was 94.7% (107/113), and the time period until union occurred was 2.5 to approximately 8 (mean, 3.8) months. No statistical difference was noted among the individual groups. Complications included 6 nonunions (5.3%), which were associated with infection in 1 case (0.9%) and implant failure in 2 cases (1.8%). CONCLUSIONS: Compared to other techniques, indirect reduction with SCS stabilization is a feasible method for treating acute subtrochanteric fractures. However, because plate insertion normally requires a large dissecting wound and biomechanically the tension band principle might not be applicable, there may be greatly increased complications with extensively comminuted fractures. Accordingly, if this technique is used for carefully selected fractures, a high success rate can be expected.

Adolescent↗

PubMedDate not supplied

A biomechanical comparison of unlocked or locked reamed intramedullary nails in the treatment of mid-third simple transverse femoral shaft fractures.

BACKGROUND: Despite that a mid-third simple transverse femoral shaft fracture has been traditionally treated with an unlocked reamed intramedullary nail, recently a static locked reamed intramedullary nail has been favored by some orthopedists to avoid missing extended fracture lines. A prospective comparison of both nails was conducted to investigate the superiority between the nails from biomechanical viewpoints. METHODS: Seven pairs of fresh healthy cadaver femora underwent mid-third transverse osteotomy. Consequently, all seven left femora were stabilized using Kuntscher nails and all seven right femora, static Russell-Taylor locked nails. Finally, all 14 femora were tested using a Material Testing System (MTS) machine to investigate the sustained mechanical loads, the maximal failure load, and the relative fragment displacement. RESULTS: The locked nails produced the larger mechanical loads (p = 0.02). The unlocked nails had the larger fragment displacement (p = 0.02) and the higher maximal failure load (6090 verse 5590 newtons, p = 0.02). All tests ended due to basal neck oblique fractures. CONCLUSIONS: Biomechanically, an unlocked nail, being a load-sharing device, is superior to a static locked nail, being a load-bearing device, in the treatment of a mid-third simple transverse femoral shaft fracture. Clinically, careful investigation of the fracture types and adequate selection of the nail type should be performed in treating these types of fractures.

Adult↗

PubMedDate not supplied

Exchange nailing for aseptic tibial shaft nonunion: emphasis on the influence of a concomitant fibulotomy.

BACKGROUND: Exchange nailing is reported to have a high success rate for aseptic tibial nonunions. However, sample sizes in all series in the literature were small, and the influence of a concomitant fibulotomy was not evaluated. METHODS: Fifty-four aseptic tibial shaft nonunions for 1.2 approximately 4.3 (mean, 2.4) years were treated with exchange nailing. Indications for this technique included an aseptic nonunion of the tibial shaft with an inserted intramedullary nail and < 2 cm of shortening. A fibulotomy was performed in a nonunion with poor shaft alignment, which concomitantly required manipulation to correct. The success rate of exchange nailing was determined, and whether a concomitant fibulotomy affected the success rate was evaluated. RESULTS: Forty-seven nonunions were followed-up for 1.1 approximately 6.9 (mean, 3.8) years, and all nonunions healed. The union rate was 100% (47/47), and the average period required to achieve union was 4.7 (3.0 approximately 7.5) months. The average union periods between the fibulotomy and non-fibulotomy groups did not statistically differ (4.6 vs. 4.8 months, p = 0.61). There were no significant complications in either group. CONCLUSIONS: Exchange nailing is an excellent technique to treat aseptic nonunions of the tibia. It can be considered the treatment of choice for all indicated cases. A concomitant fibulotomy has minimal influence on the success rate. It can be performed when the shaft alignment needs correction.

Adult↗

PubMedDate not supplied

Treatment of long-bone fractures, malunions, and nonunions: experience at Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Long-bone fractures are common in the field of orthopedic trauma and require careful treatment to avoid refractory disabilities. Through advancements of modern medicine and technology, many excellent techniques and devices are continually being invented. Currently, the success rates of treatment have markedly increased while complication rates have been greatly lowered. Even so, complications of failed fracture treatment still occasionally occur. Among these complications, malunions and nonunions are relatively common and disturbing. However, both complications can be reduced if the principles of fracture treatment are strictly followed. All fractures may be treated with nonoperative or operative methods according to individual advantages and disadvantages. In principle, nonoperative methods should be given priority. In this article, principles of treatment of long-bone fractures, malunions, and nonunions are clarified. Current practices which have been published and which are representative of treatment of these issues at the author's institution are reported. Inconsistencies of important viewpoints concerning fracture-related treatment between the author's institution and published articles are discussed. The aims of this study were to assess the academic level of fracture treatment at the author's institution. Then, improved techniques for fracture treatment might be continually developed. Some studies at the author's institution have revealed that the success rates are comparable to those of articles with the highest success rates in the world.

Femoral Fractures↗

PubMedDate not supplied

Osteoblastic differentiation of rabbit mesenchymal stem cells loaded in A carrier system of Pluronic F127 and Interpore.

BACKGROUND: Ideally, bone tissue engineering products should have the ability of osteoconduction and osteoinduction. According to the tissue engineering principle, mesenchymal stem cells (MSCs) combined with an appropriate scaffold can be used as a bone substitute for bone defects. Here we used Interpore as a scaffold loaded with MSCs mixed in hydrogel (Pluronic F127). In order to demonstrate the osteogenic ability of MSCs in the hydrogel, cell/hydrogel scaffold constructs were cultured in an induction medium to elicit an osteoblastic response. METHODS: MSCs aspirated from rabbit bone marrow were cultured in induction medium. MSCs were then loaded into scaffold Interpore with the aid of hydrogel (Pluronic F127). After culture for 7 and 14 days, osteoblastic differentiation ability was tested using Alizarin Red S stain, reverse transcription polymerase chain reaction (RT-PCR), measurement of calcium and alkaline phosphatase levels, and scanning electron microscopy (SEM). RESULTS: Calcium and alkaline phosphatase levels both increased after 7 and 14 days incubation. Alizarin Red S staining revealed MSCs could survive and differentiate to osteoblasts in the cell/hydrogel scaffold. RT-PCR showed mRNA expression of osteopontin and Core binding factor alpha 1 (Cbfa1). SEM revealed growth of osteoblast-like cells on ceramic pores. CONCLUSIONS: Osteoconductive bone substitute (Interpore) has been used clinically for a long time. This study showed that MSCs could be held on Interpore with the aid of hydrogel (Pluronic F127) and that they could differentiate to osteoblasts.

Alkaline Phosphatase↗

PubMedDate not supplied

Treatment of volar Barton's fractures: comparison between two common surgical techniques.

BACKGROUND: Volar Barton's fractures are not uncommon but more convincing treatment methods are still controversial. Currently, open reduction with buttress plating or closed reduction with external fixation and percutaneous Kirschner wire fixation have achieved most support. METHODS: Twenty-three consecutive volar Barton's fractures treated with either open reduction and buttress plate fixation (12 cases) or closed reduction with external fixation and percutaneous Kirschner wire fixation (11 cases) were compared retrospectively. The fractures were followed-up for a mean of 30 months (range, 24-50 months). RESULTS: All 23 fractures healed without major complications. The wrist function was satisfactory in all plating patients (12 out of 12) and nine out of 11 external fixation patients (p = 0.22). CONCLUSION: Both the above mentioned surgical techniques give a high success rate. Despite the fact that each technique has advantages and disadvantages, the results from the plating treatment seem to be superior.

Adolescent↗