Biomedical subjects

Chun-Hsiung Shih

Publications and source records attributed to Chun-Hsiung Shih.

36 records · Page 2Linked to original sources

PubMed2003

Treatment of early cut-out of a lag screw using a trochanter supporting plate: 11 consecutive patients with unstable intertrochanteric fractures.

INTRODUCTION: Superior cut-out of a lag screw remains a serious complication in the treatment of intertrochanteric fractures. It is related to the stability of fracture reduction. We describe the application of a trochanter supporting plate (TSP) to restore the fracture stability after early cut-out of a lag screw in unstable intertrochanteric fractures. MATERIALS AND METHODS: A total of 11 consecutive patients with superior cut-out of the lag screw of a dynamic hip screw (DHS) or a gamma nail in an unstable intertrochanteric fracture occurring within 6 months after surgery were included in the present study. They underwent repeat surgery for placement of a DHS and a laterally mounted TSP of our design. All patients were monitored for at least 6 months (median 15 months; range 6-28 months). RESULTS: There was no repeated cut-out of a lag screw, and 10 patients (91%) achieved bony union within 5 months. At the last follow-up, all patients could walk with or without aids. CONCLUSION: It reveals that a TSP, as an adjuvant to a lag screw placed inferiorly, is an easy and safe solution for the treatment of early cut-out of a lag screw in unstable intertrochanteric fractures.

Aged↗

PubMed2003

Fixation strength of three different graft types used in posterior cruciate ligament reconstruction.

Surgical reconstruction is generally recommended for PCL and associated ligament injuries. A variety of graft choices exist for PCL reconstruction surgery. This study evaluated the initial fixation strength of three grafts using in PCL reconstruction in a porcine model. Twenty fresh porcine knees were harvested and randomly assigned to four groups: bone-patellar tendon-bone graft, quadruple tendons graft, Achilles tendon graft, and normal PCL. After reconstruction the knee was tested on an MTS testing machine by translating the tibia posteriorly until failure at 30 degrees of flexion, neutral rotation, and anatomical vertical alignment. Biomechanical parameters including maximal failure load, stiffness, and failure modes, were analyzed and compared. In the maximal failure load, the four-strand tendon group was significantly greater than the other two grafts. However, it had greatest translation. There were no significant differences between the three grafts in stiffness. All three of these commonly used grafts had weaker initial fixation strength and stiffness than normal PCL. Graft failure occurred mainly at the tendon-bone junction and tendon-suture sites. The Patellar tendon group had significantly least translation during continuing loading.

Animals↗

PubMed2003

Double-bundle posterior cruciate ligament reconstruction with quadriceps and semitendinosus tendon grafts.

This study presents a novel arthroscopic technique for double-bundle reconstruction of the posterior cruciate ligament. A quadriceps tendon-patellar bone autograft is used to reconstruct the major anterolateral bundle. An additional double-stranded semitendinosus tendon is used to reconstruct the posteromedial bundle. In 70 degrees of flexion and full extension with anterior drawer force, the quadriceps tendon graft and semitendinosus tendon graft are fixed inside the anterior aspect of the single tibial tunnel, respectively. An anatomic reconstruction can be achieved by using these 2 autografts.

Arthroscopy↗

PubMed2003

Finite element analysis of the cervico-trochanteric stemless femoral prosthesis.

OBJECTIVE: To investigate the biomechanical performance of a newly designed cervico-trochanteric stemless prosthesis by comparing the stress distribution with that of the traditional stem-type porous-coated anatomic prosthesis. DESIGN: Three-dimensional finite element models were created for the intact femur, cervico-trochanteric implanted femur and porous-coated anatomic implanted femur. The stress distributions on the femur and the implant were compared. The effects of using two or three screws fixation for the cervico-trochanteric implanted femur were also investigated. BACKGROUND: Local bone loss after implantation of traditional stem-type prostheses remains an unsolved problem during the long-term application of total hip replacement. The stress shielding effect and osteolysis were thought to be the two main factors that result in local bone loss after prosthesis implantation. In order to eliminate the mechanical and the biological causes of bone loss after total hip arthroplasty, a newly designed stemless femoral prosthesis was investigated. METHODS: Three-dimensional finite element models were created for the intact, cervico-trochanteric (with two or three fixation screws), and porous-coated anatomic implanted femora with the geometry of a standardized composite femur. Analysis was performed for a loading condition simulating the single-legged stance. The von Mises stress distributions of each model were analyzed and compared. RESULTS: The results can be summarized as follows: (1) Von Mises stress in the proximal, medial femur for the cervico-trochanteric implanted model was higher than that of the intact model and the porous-coated anatomic implanted model; (2) stress-shielding effect of the cervico-trochanteric models (with two or three fixation screws) were eliminated as compared with the porous-coated anatomic model; (3) no obvious difference in von Mises stress distribution for the cervico-trochanteric implanted model with two or three fixation screws. CONCLUSIONS: The cervico-trochanteric femoral prosthesis may reduce the stress-shielding effect of the proximal femur and achieve a more physiological stress distribution on the proximal femur than that of the porous-coated anatomic prosthesis. RELEVANCE: The new concept of cervico-trochanteric stemless prosthesis has proven to possess several advantages based on the current results, and may be an alternative for traditional stem-type prostheses in future clinical applications.

Biomechanical Phenomena↗

PubMed2003

Enveloping the tendon graft with periosteum to enhance tendon-bone healing in a bone tunnel: A biomechanical and histologic study in rabbits.

PURPOSE: Fixing and incorporating the tendon graft within the bone tunnel is a major concern when using grafts for ligament reconstruction. The periosteum contains multipotent stem cells and has the potential to form osteogenic and chondrogenic tissues. This study uses histologic and biomechanical analyses to examine the effect of periosteum on tendon-bone healing within a bone tunnel. TYPE OF STUDY: Experimental study in an animal model. METHODS: In this study, 36 adult New Zealand White rabbits were used. The long digitorum extensor tendon was transplanted into a bone tunnel of the proximal tibia. The periosteum from the proximal tibia was sutured on the surface of the tendon portion. The tendon was pulled through a drill-hole in the proximal tibia and attached to the medial aspect of the tibia. Histologic examination of the tendon-bone interface and biomechanical test for maximal pullout load were evaluated at 4, 8, and 12 weeks after operation. RESULTS: Histologic analysis of the tendon-bone interface showed a fibrous layer formed between the tendon and the bone by the periosteum. This layer became progressively integrated with the tendon and bone surface during the healing process. At 4 weeks, the cancellous bone lining in the bone tunnel was interdigitated with the fibrous interface tissue. At 8 weeks, progressive new bone grew into the interface fibrous layer. At 12 weeks, collagen fibers anchored to the bone and organization with fibrocartilage formation developed between the tendon and bone. Biomechanical testing revealed higher maximal pullout strength in the periosteum-enveloped group at all time points, with a statistically significant difference at 8 and 12 weeks. The periosteum-treated group had a higher interface strength-to-length ratio and significant increase at 8 weeks and 12 weeks. CONCLUSIONS: The histologic and biomechanical studies demonstrated that, if periosteum was sutured on the tendon that was transplanted within a bone tunnel, it resulted in a superior healing process and better healed strength. When doing ligament reconstruction with a tendon graft, the periosteum can be sutured to the graft to enhance tendon-bone healing.

Animals↗

PubMed2003

A modified periacetabular osteotomy with use of the transtrochanteric exposure.

BACKGROUND: Periacetabular osteotomies are technically demanding surgical procedures. We developed a modified technique that uses a transtrochanteric approach. Our goal was to facilitate surgical exposure without compromising the results of surgery. The purpose of the present study was to review the early results in our initial group of patients who had this procedure. METHODS: We retrospectively reviewed the results of a modified periacetabular osteotomy in thirty-eight consecutive patients (forty-six hips) at an average duration of follow-up of 4.2 years. The average age of the patients was thirty-one years (range, eighteen to fifty-eight years) at the time of surgery. We evaluated the results with use of serial radiographs and the Merle d'Aubigné and Postel hip-scoring system. RESULTS: All osteotomies healed. Preoperatively, the average lateral center-edge angle was 3 degrees (range, -15 degrees to 12 degrees ), the anterior center-edge angle was 0 degrees (range, -20 degrees to 5 degrees ), the acetabular angle of Sharp was 57 degrees (range, 50 degrees to 68 degrees ), and the femoral head coverage was 53% (range, 40% to 66%). Postoperatively, the average lateral center-edge angle was 35 degrees (range, 23 degrees to 45 degrees ), the anterior center-edge angle was 32 degrees (range, 20 degrees to 55 degrees ), the acetabular angle of Sharp was 40 degrees (range, 37 degrees to 45 degrees ), and the femoral head coverage was 92% (range, 85% to 100%). The average amount of medialization of the femoral head was 6 mm. At the latest follow-up examination, improvement in the grade of osteoarthritis was noted in eight hips, while progression of osteoarthritis was seen in five hips. Functionally, the average Merle d'Aubigné and Postel hip score improved from 13.2 points preoperatively to 17.0 points postoperatively. No patient had a neurovascular complication. CONCLUSION: Our early experience with a modified periacetabular osteotomy showed encouraging results in terms of the technical ease of the technique and the outcome in our patients.

Adolescent↗

PubMed2002

Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption.

BACKGROUND: Surgical reconstruction is usually indicated for distal clavicle fractures with coracoclavicular ligament disruption due to a high rate of nonunion and delayed union. We report the outcome of a surgical technique for this type of fracture. METHODS: The procedures consist of coracoclavicular reconstruction with a Mersilene tape, repair of torn coracoclavicular ligament, and wire fixation of the fracture fragments. From 1993 through 1998, this technique has been used on 13 patients with distal clavicle fracture and associated coracoclavicular ligament disruption. Eleven patients with at least 18 months of complete postoperative follow-up were included for functional and radiographic evaluation. RESULTS: After 18 to 48 months' follow-up, the clinical outcome has been encouraging. Solid union of the fracture could be achieved at 3 months after operation in 10 patients. The remaining one fracture achieved bony union at 6 months. Ten patients could return to the same or a higher level of preinjury activity. Good and excellent results were obtained in 10 patients. CONCLUSION: The advantages of this technique include that the disrupted coracoclavicular articulation is rigidly restored and then the fracture site can be easily reduced and fixed with a wire. This technique allows for stable fixation with early mobilization and early return to work and sports.

Adult↗

PubMed2002

Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon graft: a double fixation method.

BACKGROUND: Surgical reconstruction is indicated for posterior cruciate ligament (PCL) reconstruction for a grade III or IV injury, combined ligament or meniscus injuries, and chronic symptomatic posterior instability. Considerable controversy continues over the choice of graft tissues. Hamstring tendon has been popular in recent years. The purpose of this study is to prospectively assess the outcomes of PCL reconstruction using quadruple hamstring tendon autograft with a double-fixation technique at minimal 2-year follow-up. METHODS: Only patients who received PCL reconstruction without combined associated posterolateral injury reconstruction were included in the series. A hamstring tendon graft is composed of a quadruple-stranded semitendinosus tendon and gracilis tendon 10 cm in length. An arthroscopic technique using a two-incision method and a double-fixation technique were used. Clinical assessments were performed for 30 patients, of which 27 were available for final outcome analysis. Clinical review of patients included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle assessment, and radiographic evaluation. RESULTS: On the Lysholm knee rating, 89% of the patients demonstrated good or excellent results in the final assessment. In the IKDC rating analyses, 56% of the patients revealed 3- to 5-mm ligament laxity. Four patients (15%) had grade II laxity. For the IKDC final rating, 26% were normal and 55% were nearly normal. Seventy-eight percent of the patients had less than a 10-mm difference in thigh girth between their reconstructed and opposite limbs. CONCLUSION: Arthroscopic PCL reconstruction with quadruple hamstring tendon autograft appears to produce acceptable results at a minimal 2-year follow-up. The four-stranded hamstring tendon graft is adequate in graft size and associated with minimal harvesting morbidity. The double-fixation method for the graft could provide a rigid fixation. We believe that this technique could afford good ligament function after reconstruction and could be a reasonably acceptable choice for PCL injury.

Adult↗

PubMed2002

Periacetabular osteotomy through a modified ollier transtrochanteric approach for treatment of painful dysplastic hips.

BACKGROUND: Elimination of abnormally high joint-loading resulting in excessive contact stresses may prevent or reduce the onset of osteoarthrosis in a dysplastic hip. A number of periacetabular osteotomies have been shown to be effective in restoring normal hip-joint mechanics. We treat acetabular dysplasia with a periacetabular osteotomy performed through a modified Ollier transtrochanteric approach. In this report, we describe the operative technique and the clinical and radiographic results. METHODS: Thirty-six patients (thirty-eight hips) in whom a painful dysplastic hip had been treated with a periacetabular osteotomy between March 1991 and June 1999 were included in the study. There were thirty-five female patients and one male patient with a mean age (and standard deviation) at the operation of 29.42 +/- 9.1 years. The technique utilizes a u-shaped skin incision, and a routine osteotomy of the greater trochanter with distal transfer if needed, and allows excellent visualization enabling the surgeon to perform the periacetabular osteotomy without penetrating the joint. RESULTS: At a mean of five years and six months postoperatively, the mean modified Harris hip score had improved from 59.1 +/- 15.8 points preoperatively to 87.97 +/- 14.3 points. Radiographically, the degree of osteoarthrosis had decreased in eleven hips, remained unchanged in twenty-four, and worsened in three. The mean anterior center-edge angle had increased from 22.0 degrees +/- 12.9 degrees to 36.1 degrees +/- 12.3 degrees, the mean lateral center-edge angle had increased from -2.7 degrees +/- 14.4 degrees to 26.6 degrees +/- 14.1 degrees, the mean acetabular index angle had improved from 23.4 degrees +/- 6.6 degrees to 12.7 degrees +/- 4.6 degrees, and the mean acetabular head index had increased from 48.2% +/- 12.7% to 73.1% +/- 16.0%. The Shenton line was restored in eleven hips. Thirty patients (thirty-two hips; 84%) had a satisfactory result. A poor preoperative functional score was associated with an unsatisfactory outcome (p = 0.00191). Complications included prolonged limping (eleven hips); numbness in the distribution of the lateral femoral cutaneous nerve (four); osteonecrosis of the rotated acetabular fragment (two); and acetabulofemoral impingement, heterotopic ossification, and a defect on the rotated ilium (one hip each). CONCLUSIONS: Painful dysplastic hips should be treated before function becomes seriously impaired. We believe that periacetabular osteotomy through a modified Ollier approach, which allows osseous cuts to be made under direct vision, can be learned readily. It provides improved femoral head coverage and relief of symptoms in most painful dysplastic hips in adolescents and young adults.

Acetabulum↗

PubMed2002

Conditions before collapse of the contralateral hip in osteonecrosis of the femoral head.

BACKGROUND: Osteonecrosis of the femoral head is a disease which may cause rapid femoral head collapse in relatively young patients. Clinical results of prosthesis replacement in osteonecrosis patients are generally poorer than in age-matched patients with other diagnoses. The ultimate goal in treating these patients is therefore to preserve not replace the involved femoral head. The purposes of this study were to analyze outcomes by examining osteonecrotic hips before collapse and to justify the role of early surgical intervention for osteonecrosis of the femoral head. METHODS: Between 1993 and 1997, there were 275 consecutive patients with osteonecrosis of the femoral head who received joint replacement on 1 side. Among these patients, 100 contralateral hips with evidence of osteonecrosis in the stage before collapse were included in this study. Demographic information, laboratory data, and radiographs were reviewed and compared between patients whose collapse time was less than 1 year, between 1 and 2 years, and more than 2 years, and those who had no collapse at the latest follow-up. RESULTS: At the final follow-up, the overall collapse rate was 78%, and the collapse time was generally within 2 years. Patients with younger age (less than 50 years old), higher activity levels, and higher serum triglyceride levels were at higher risk of rapid collapse. CONCLUSION: In conclusion, we found that the disease progression rate is high in patients who have bilateral femoral head involvement. Early surgical intervention to preserve the femoral head should be adopted to prevent early femoral head collapse in these patients. In addition, risk factors such as high activity levels and abnormal lipid metabolism should also possibly be addressed in the therapeutic modality.

Adult↗

PubMed2002

Primary total hip arthroplasty without the use of bone cement: a 10-year follow-up of 157 hips.

BACKGROUND: The cementless fixation technique in total hip arthroplasty (THA) was developed to solve clinical problems such as aseptic loosening and osteolysis which were thought to be associated with the use of bone cement. This retrospective study reports our mid-term results with cementless THA. METHODS: A series of 173 consecutive, unselected cementless THA procedures using the Omnifit prosthesis was performed by a single surgeon. Sixteen hips were excluded from the study because of insufficient follow-up evaluation. One hundred and fifty-seven THAs with an average follow-up period of 10.2 (range, 5-12) years were retrospectively reviewed. RESULTS: The overall revision rate was 7.0%. Ninety-five percent of unrevised hips achieved a Merle D'Aubigne hip score of 16 points or above. Radiographically, bone ingrowth occurred in all unrevised cups, and in 95% of unrevised stems. Osteolytic lesions, seen on 28.1% of femora and 8.9% of pelvises, appeared at an average of 3.8 years postoperatively. Femoral osteolytic lesions were confined to the proximal Gruen zones 1 and 7. The mean annual polyethylene wear rate was 0.15 mm. Approximately 1/3 of the hips were noted to have excessive wear. CONCLUSION: These results suggest that cementless Omnifit THA provides stable fixation for as long as 12 years after implantation. Of significant concern is the high incidence of excessive polyethylene wear and associated osteolysis. Our experience also indicates that a femoral stem with a circumferential porous coating in the proximal region can protect the femur from distal osteolysis.

Adult↗

PubMed2001

One-incision endoscopic technique for posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft.

Quadriceps tendon-patellar bone autograft is an alternative graft choice for posterior cruciate ligament (PCL) reconstruction. A 2-incision technique with outside-in fixation at the femoral condyle is generally used. In this article, we describe a 1-incision endoscopic technique for PCL reconstruction with quadriceps tendon-patellar bone autograft. The graft consists of a proximal patellar bone plug and central quadriceps tendon. The bone plug is trapezoidal, 20 mm long, 10 mm wide, and 8 mm thick. The tendon portion is 80 mm long, 10 mm wide, and 6 mm thick, including the full-thickness of the rectus femoris and partial thickness of the vastus intermedius. Three arthroscopic portals, including anteromedial, anterolateral, and posteromedial, are used. All procedures are performed in an endoscopic manner with only 1 incision at the proximal tibia. At the femoral side, the bone plug is fixed by an interference screw. At the tibial side, the tendon portion is fixed by a suture to a screw on the anterior cortex and an interference bioscrew in the posterior tibial tunnel opening. Quadriceps tendon autograft has the advantages of being self-available, allowing for easier arthroscopic technique, and providing comparable graft size. The 1-incision technique provides a simple reconstruction method for PCL insufficiency without a second incision at the medial femoral condyle.

Journal Article↗

PubMed2000

Cementless total hip arthroplasty using the omnifit system: An 8.2 year follow-up study of 166 hips.

One hundred and sixty-six cementless primary total hip arthroplasties were performed in 133 patients with porous coated Omnifit prosthesis. The average age was 49.7 years. The mean follow-up period was 8.2 years with a minimum of 5 years. Good to excellent clinical results were achieved in 93% of patients. The overall revision rate was 5.4%. Radiographically, bone ingrowth occurred in all unrevised cups, and in 95% of unrevised stems. Osteolytic lesions appeared at an average of 3.8 years postoperatively. Femoral and pelvic osteolysis were seen in 21% and 4% of the surviving hips respectively. All femoral osteolytic lesions were found in the proximal Gruen zones 1 and 7. The mean annual polyethylene wear rate was 0.15 mm. Approximately one-third of the hips were observed to have excessive wear. Our experience with cementless Omnifit total hip prosthesis is encouraging. Of significant concern is the high incidence of excessive polyethylene wear and osteolysis.

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↗

PubMedDate not supplied

Enveloping of periosteum on the hamstring tendon graft in anterior cruciate ligament reconstruction.

Tendon-bone incorporation of a tendon graft within the bone tunnel is a major concern when using tendon graft for ligament reconstruction. Periosteum consists of multipotent mesodermal cells to form all varieties of connective tissue, including osteogenic and chondrogenic tissues. From our histologic and biomechanical studies in animals, a superior healing process and stronger healing strength can be achieved when periosteum is sutured onto the tendon inserted within a bone tunnel. We applied this idea to anterior cruciate ligament reconstruction to enhance tendon-bone healing. A quadruple-stranded hamstring tendon graft is used. A piece of periosteum, 3 x 3 cm, harvested from the anterior cortex of proximal tibia, is split into 2 rectangle flaps (1.5 x 3 cm each). The periosteum flaps are wrapped and sutured around the tendon graft at the portions near the femoral and tibial tunnel openings. The cambium layer is faced outside to the bone tunnel. Periosteum is easy to harvest from proximal tibia, where is a routine incision for harvesting hamstring tendons. Besides the potential for enhancement of tendon-bone healing, periosteum may be able to seal off the intra-articular opening in a very early period to avoid synovial fluid reflux into the tunnel.

Animals↗

PubMedDate not supplied

Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft.

PURPOSE: Considerable controversies remain on the graft choice and fixation methods in the posterior cruciate ligament (PCL) reconstruction. The purpose of this study was to compare, at minimal 2-year follow-up, the outcomes of PCL reconstruction between using quadriceps tendon autograft and using quadruple hamstring tendon autograft. TYPE OF STUDY: Case series. METHODS: All patients received only PCL reconstruction without combined severe associated posterolateral instability. From 1996 to 1998, there were 24 patients who had a quadriceps tendon autograft, and 30 patients with hamstring tendon autograft. Twenty-two of the quadriceps tendon group and 27 of the hamstring tendon autograft group with 2 more years of complete follow-up were included for final analyses. Clinical assessments consisted of Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle girth and strength, and radiographic evaluation. RESULTS: On the Lysholm knee rating, 86% of patients showed good or excellent results in the quadriceps tendon group and so did 89% of patients in the hamstring tendon group. Fifty-nine percent of the quadriceps tendon group and 56% of the hamstring tendon group revealed a 3- to 5-mm ligament laxity. Two patients with quadriceps tendon grafts and 4 patients with hamstring tendon grafts revealed grade II laxity. The IKDC rating showed no significant difference between the 2 groups in terms of activity level, ligament laxity, and final rating. In the thigh girth side-to-side difference, 82% of the quadriceps tendon group and 78% of the hamstring tendon group had less than a 10-mm difference. CONCLUSIONS: Comparable satisfactory results between the 2 surgical groups were shown at a minimal 2 years follow-up. We suggested that both grafts could afford good ligament reconstruction likelihood and that they are reasonably acceptable graft choices for PCL reconstruction.

Adult↗

PubMedDate not supplied

Extension splint for trigger thumb in children.

Sixty-two reducible trigger thumbs in 50 children with age from 0 to 4 years (mean, 1 year 11 months) were reviewed to study the effect of splinting. Thirty-one thumbs in 24 children received splinting for a mean of 11.7 weeks. The other 31 thumbs in 26 children were only observed. The results were categorized as cured, improved, or nonimproved. Follow-up was conducted after a mean of 20 months (age, 43 months). Result in the splinted group showed cured in 12 thumbs, improved in 10 thumbs, and nonimproved in 9 thumbs, whereas in the observed group, result showed 4, 3, and 24, respectively. Splinting results in 71% trigger thumbs cured or improved that is better than observation alone. The subsequent surgical release for the nonimproved trigger thumbs after splinting still had excellent results. Because surgical release for trigger thumb is not urgent, we suggest extension splinting to be a treatment option before the elective surgery.

Child, Preschool↗

PubMedDate not supplied

Complications of hip arthroscopy: analysis of seventy three cases.

BACKGROUND: Hip arthroscopy is recognized as a highly effective means of treating joint disorders. Complications in hip arthroscopy, including neurovascular traction injury, compression injury to the perineum and scope trauma, have been reported. We report our experience with 73 hip arthroscopy procedures and complications at Chang Gung Memorial Hospital. METHODS: Seventy-two patients with 73 hips with severe hip pain were enrolled in this prospective study. The average age of the patients was 42 years (range, 22-61 years). The average follow-up period was 16 months (range, 12-36 months). Surgical indications for hip arthroscopy were labral tears (54 cases, 73.9%); painful dysplastic hips (7 cases, 9.5%); osteoarthritis (5 cases, 6.8%); synovitis (3 cases, 4.1%); ligament teres tears (2 cases, 2.8%); chondromatosis (1 case, 1.4%); and avascular necrosis of the femoral head (1 case, 1.4%). With the patient in the supine position with the involved leg in traction, 2 or 3 portals (anterior, anterolateral or posterolateral) were made. Intraoperative and postoperative arthroscopic complications were recorded and prospectively analyzed. RESULTS: The average operative time was 67 minutes (range, 30-190 minutes) and the average traction time was 58 minutes (range, 30-150 minutes). During surgery, 12 of 73 (16.4%) patients had mild scope trauma to the femoral head, which did not affect their excellent outcomes. Five (7%) patients had transient sciatic nerve neuropraxia and achieved complete recovery within 2 weeks after surgery. CONCLUSION: No major complications of hip arthroscopy were noted in this series. The most frequent complication was mild scope trauma to the femoral head. With experience in the technique and good hip arthroscopic instrumentation, hip arthroscopy complications can be minimized. We suggest that hip arthroscopy is a safe technique, providing an additional valuable tool for hip surgery.

Adult↗