Search PubMed⌕ Search

Biomedical subjects

H N Shih

Publications and source records attributed to H N Shih.

At least 37 records · Page 2Linked to original sources
PubMed1996

Ankle arthrodesis with cross screw fixation. Good results in 36/40 cases followed 3-7 years.

Tibiotalar arthrodesis by an anterior approach, using internal compression with cancellous crews, offers wide exposure, good possibilities of correcting deformities, and good bony apposition. From 1987 to 1991, we used this technique in 42 ankle joints (40 patients). The indications were posttraumatic arthrosis, sequelae of septic arthritis, necrosis of the talus and failed ankle arthrodesis. In 13 ankles with severe deformity, a bone graft was also used. 38 patients (40 ankle joints) were available for follow-up after 4 (3-7) years. Solid union was achieved in 38 ankles after an average of 13 weeks. The clinical result was good-to-excellent in 36 ankles. We conclude tha this is a simple and effective method for ankle arthrodesis in both low-risk and, coupled with bone grafting, in properly selected high-risk patients.

Adult↗
PubMed1996

Treatment of giant cell tumor of long bone.

From 1981 to 1991, sixty-eight patients with giant cell tumors of their long bones were treated and followed-up at Chang Gung Memorial Hospital. Thirty-three males and thirty-five females between the ages of 14 and 76 (average, 32 years) were followed for an average duration of 3.5 years (range, 2.5 years to 7.3 years). Forty-five primary lesions and 23 cases of recurrent lesions were diagnosed. Seventeen patients were classified as grade II while 51, as grade III. Surgical procedures included intralesional curettage and wide resection. The local recurrent rate following surgery was 13% (9/68). The overall outcome was 85% (58/68) good or excellent results. Complications included one superficial infection, 9 local recurrences and 3 fractures of fixation devices. In addition, one patient with a lung metastasis was noted. In the primary lesion group, there were 9 grade II and 10 grade III lesions treated by curettage and grafting. Of these 4 grade II and 5 grade III patients had local recurrences. The recurrent rate was 47% (9/19) following intralesional curettage with cancellous bone graft (8/16) or bone cement (1/3). The average period before local recurrence was 10.4 months. Seven of the 9 recurrent patients received radical resections and allograft reconstruction with good results at short-term follow-up. The other two patients were lost in follow-up. The cases in the curettage group had shown low recurrent rate (1/10) after 1989 and high recurrent rate (8/9) before 1989 (p < 0.001). The most important factor for local recurrence appeared to be inadequate curettage with similar recurrence rates regardless of the type of bone graft used. A careful approach to the surgical margin including use of a dental burr and local adjuvant treatment with phenol, the rate of local recurrence may be decreased. There were no recurrences in the wide resection group. Although radical resection yield a best chance for cure, the sacrifice of the joint with subsequent arthroplasty resulted a compromise of the joint function.

Adolescent↗
PubMed1996

Distal chevron osteotomy with intra-articular lateral soft-tissue release for treatment of moderate to severe hallux valgus deformity.

We retrospectively reviewed the results of 32 patients (38 feet), with hallux valgus angles between 35 degrees and 60 degrees, who were treated by standard distal chevron osteotomy and intra-articular lateral soft tissue release. The average follow-up period was 5.2 years (4-7 years). The preoperative intermetatarsal angle averaged 14.4 degrees, and the postoperative angle averaged 7.7 degrees. The preoperative hallux valgus angle averaged 42.7 degrees, and the postoperative angle averaged 18.8 degrees. Subjectively, the satisfaction rate in terms of symptom improvement, cosmetic appearance and function was over 90%. Avascular necrosis of the first metatarsal head was not found in our series, which indicated that additional lateral soft tissue release is not contraindicated in combination with chevron osteotomy. Based on the level of satisfaction in our series, we conclude that the combination of distal chevron osteotomy and intraarticular lateral soft tissue release has broader application than the chevron osteotomy alone for patients with hallux valgus deformity.

Hallux Valgus↗
PubMed1995

Surgical indications in low lumbar burst fractures: experiences with Anterior Locking Plate System and the reduction-fixation system.

A study of 14 surgically treated patients with low lumbar burst fractures (L3 to L5) is reported. Initially, 13 patients presented with incomplete neurologic deficits below the level of injury. The follow-up period ranged from 24 to 40 months, with an average of 30 months. In group 1, seven patients underwent one-stage anterior decompression, fusion, and Anterior Locking Plate System (ALPS) fixation. In Group 2, seven patients had posterior surgery with decompression, portero-lateral fusion, and a short segment fixation, one above and one below the injuried level, with the reduction-fixation transpediculate system. Indications for one-stage anterior surgery consisted of patients with incomplete neurologic deficits, segmental kyphotic deformity caused by loss of anterior vertebral height (< 50%), or canal encroachment < 50%. When there is significant radiologic evidence of lamina fractures, displaced or greenstick type, or injuries that occurred at the L5 level, the posterior approach was undertaken initially. This may be followed by anterior surgery if satisfactory vertebral height restoration or canal clearance was not achieved. Five dura tears (36%) were noted during surgery: two tears in group 1 and three tears in group 2. There were two patients in group 2 (29%) who had screws broken; however, none in group 1 demonstrated implant failure. In the low lumbar region, the step-off ALPS plate is preferable to the straight plate because of the increasing size of the vertebral body toward the caudal area. A low profile and easy application were its advantages. However, the ALPS could not be distracted or compressed anteriorly.

Adolescent↗
PubMed1995

Posterior tibial tendon tear combined with a fracture of the accessory navicular: a new subclassification?

A 58-year-old woman with a diagnosis of a tear of the posterior tibial tendon associated with the os accessory navicular fracture was treated surgically. We believe that the dysfunction of the posterior tibial tendon was associated with an os accessory navicular fracture. This case is proposed as a new subclassification that was separate from the traditional classification of the tear of the posterior tibial tendon.

Female↗
PubMed1995

Ewing's sarcoma.

Explore the source record for details and available documents.

Antineoplastic Agents↗
PubMed1995

Salmonella psoas abscess--a case report.

The clinical presentation of psoas abscess is often non-specific and insidious that may mislead the diagnosis and treatment. The abscess often extends beyond the retroperitoneum and pelvis before its diagnosis, and leads to serious complications. Many diseases have the similar signs and symptoms and must be ruled out. Computed tomogram is the most useful and reliable diagnostic tool. Only a few cases of salmonella psoas abscess were reported in the literature, and were usually associated with spinal osteomyelitis or septic hip. We present a case of salmonella psoas abscess in a patient with diabetes mellitus. The patient had the history of cholecystitis with sepsis due to salmonella infection 4 years before and cholecystectomy had been done. No associated lesion was found to be associated with the abscess, and we believed the abscess being the result of recurrent bacteremic attack. High index of suspicion, early diagnosis, adequate drainage and effective antibiotic treatment are the key points in managing the disease.

Aged↗
PubMed1995

Treatment of an adult with neglected congenital pseudoarthrosis of the tibia with acute fracture: a case report.

Treatment of congenital pseudoarthrosis of the tibia is very difficult. Numerous surgical procedures have been used including bone grafting, fixation, pulsed electromagnetic field, vascularized fibular bone grafting and lengthening devices. Previous studies, often reporting unsatisfactory results, are limited to children and adolescents. In adults, the following factors need to be considered: leg length discrepancy, leg deformity, soft tissue problems, lack of potential for growth and difficulties in healing. We reported a case of untreated congenital pseudoarthrosis of the tibia with fracture in a 32-year-old man. Conventional treatments used included excision of the pseudoarthrosis, correction of the deformity, intramedullary fixation, bone grafting and soft tissue transplantation for lengthening and coverage. These procedures led to good bony union and a satisfactory outcome.

Acute Disease↗
PubMed1994

Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach.

Intercondylar fractures of the distal humerus in adults are rare and notoriously difficult to treat. The goals of open reduction are to preserve the articular surface and restore elbow function. We treated 20 patients by open reduction with dual-plate internal fixation and routine anterior subcutaneous transposition of the ulnar nerve. The follow-up period ranged from 15 to 35 months. The fractures were classified according to Muller's system. The results were evaluated using the Cassebaum rating system and subjective functional status. Excellent or good results were achieved in 15 elbows (75%), two had a fair result, and three, poor. A clearer understanding of fracture patterns, rigid dual-plate internal fixation, and early rehabilitation are needed to improve the results from this vexing injury. We recommended routine ulnar nerve anterior subcutaneous transposition using a posterior approach. Compared with published reports, our preliminary results demonstrated no postoperative ulnar nerve compression syndrome at follow-up. Routine anterior subcutaneous transposition of the ulnar nerve to avoid the postoperative ulnar nerve compression syndrome is required.

Adult↗
PubMed1993

Squamous cell carcinoma arising in chronic osteomyelitis--clinical analysis of 7 cases.

Retrospectively, we analyzed 7 cases of chronic osteomyelitis complicated with squamous cell carcinoma (SCC), who had been treated consecutively in Chang Gung Memorial Hospital from April 1983 to Jan. 1991. There were 6 males and one female, with the age between 43 and 80 years (average 57 years). The distribution of these lesions was 5 in the lower legs and 2 in the thighs; one had another hip lesion. The duration of discharging sinus presented before malignant change was from 4.5 years to 50 years (average 30 years). The pathological findings were all well-differentiated squamous cell carcinoma. Amputation was performed in 5 of them. Limb salvage procedure was selectively done in one case. Chemotherapy and regional irradiation without surgery was given in the remaining case. Follow up examination showed that the short term results were satisfactory in all cases. Six cases had at least one year of follow-up; the longest follow-up was 8 years.

Adult↗
PubMed1991

Dedifferentiated chondrosarcoma arising from osteochondromatosis. A case report.

Multiple hereditary osteochondromata has a higher incidence (5%-25%) of malignant change into chondrosarcoma than solitary osteochondroma (1%-2%); but only less than 10% of all chondrosarcomas may undergo dedifferentiated change into fibrosarcoma or malignant fibrous histiocytoma. We have a case presented here with osteochondromatosis who was found to have dedifferentiated chondrosarcoma arising from pelvic osteochondroma. Radical extra-compartmental resection was done and followed by chemotherapy and radiotherapy. Recurrence was found 3 months later. Early recognition of malignant change and adequate surgical resection with adjuvant therapy may prevent local recurrence and increase the survival rate.

Adult↗
PubMed1990

Lower extremity compartmental syndrome following snake-bite envenomation--one case report.

Acute compartmental syndrome develops when the intracompartmental pressure rises rapidly, even if only for a short duration. Loss of function and/or viability of the intracompartmental muscles may occur within a short period. Consequently early recognition and management are essential. We report a case where a young child with severe snake bite envenomation who and acute compartmental syndrome who had complete functional recovery following emergent fasciotomy and delayed primary closure.

Compartment Syndromes↗
PubMed1989

Femoral shaft fracture treated with Hoffmann external skeletal fixator in young teens.

External skeletal fixation has been proved to be an effective method in treating complex femoral shaft fracture in adult patients with multiple trauma, extensive soft tissue injury or vascular injury which need reconstructive procedures. This method has the advantages of less extensive surgical exposure, easy wound access, and early ambulation. Twenty-two cases of femoral shaft fracture, between the ages of 10 and 15, were treated with the Hoffmann external skeletal fixator in Chang Gung Memorial Hospital from 1981 to 1985. The average time for union and removal of fixator was 72 +/- 8 days (from 44 to 150 days). The average leg length discrepancy was 0.6 +/- 0.3 cm. There was no deep wound infection, nonunion, rotationary deformity in closed fracture. All patients regained their range of motion of knee within 3 months after removal of the Hoffmann apparatus. The advantages of simple technique, less extensive surgical exposure, early ambulation, easy nursing care, patient comfort and no significant complications make it a good alternative method for treatment of femoral shaft fracture in young teens.

Adolescent↗
PubMed1989

Acute femoral neck fracture in children--preliminary report.

Nineteen children, aged 3-15 years, with acute femoral neck fracture were treated. The follow-up period ranged from 2 years to 6 years, 9 months (avg. 54.8 +/- 14.5 months). The clinical and radiological assessments were carried out according to the assessment system of Ratliff. Undisplaced fractures and all intertrochanteric fractures were treated conservatively and displaced ones by reduction and multiple pinning. The outcomes reveal 14 (79%) with good results, 2 (10.5%), fair and 3 (15.8%), poor. Four hips (21%) developed avascular necrosis with 2 requiring secondary surgical procedures. Both of them also had leg length discrepancy. Another 3 hips (15.8%) developed coxa vara, one of them had mild leg length discrepancy.

Acute Disease↗
PubMed1989

Treatment of femoral shaft fractures with the Hoffmann external fixator in prepuberty.

Twenty-two children with femoral shaft fractures, between the age of 10 and 14 years, were treated with the Hoffmann external fixation apparatus from 1980 to 1985. This method of treatment is very simple. It requires less surgical exposure and allows earlier ambulation and easy nursing care. In addition, it makes patients comfortable in multiple trauma conditions. The average time to union and removal of fixators was 72 days (range, 44 to 80 days). There were no deep wound infections, nonunions, or rotationary deformities. On followup, all patients regained the range of motion of knee joints in 3 months without significant leg length discrepancy or radiographic evidence of growth disturbance. The device may serve as an alternative method for femoral shaft fractures in prepuberty, especially in areas of tropical climate.

Adolescent↗
PubMedDate not supplied

One-stage combined operation of congenital dislocation of the hips in older children.

From 1977 to 1983, 17 patients with 20 long-standing congenitally dislocated hips were treated with a one-stage combined operation and then followed for more than 3 years by our institution. The growth of the proximal femur after femoral osteotomy was studied. The average neck-shaft angle was 111 degrees immediately after operation, and 128 degrees at follow-up. The outcome was largely independent of either age at operation or bilateral involvement. Our findings revealed 30% good and 50% excellent results in our patients.

Child↗