Biomedical subjects

W H Lo

Publications and source records attributed to W H Lo.

At least 55 records · Page 3Linked to original sources

PubMed1998

Os supratrochlear dorsale of the elbow: a report of two cases.

The os supratrochlear dorsale, an accessory ossicle of the elbow, has rarely been described in the literature. Rather than being caused by trauma, it is subject to trauma by elbow extension with secondary chondrometaplasia, resulting symptomatology. The aim of this report is to remind readers that its presence is crucial for both diagnostic and therapeutic purposes. Arthroscopic removal may be required to relieve persistent pain, catching and limited range of motion.

Adolescent↗

PubMed1998

Computerized tomography in the diagnosis of subluxation of the distal radioulnar joint.

BACKGROUND: The diagnosis of distal radioulnar joint (DRUJ) subluxation is difficult. Routine radiographs are imprecise in clinical analysis. However, the anatomy and dynamic configuration of this articulation have been clearly defined utilizing computerized tomography (CT). Three CT criteria for the evaluation of DRUJ subluxation have been reported: Mino's criteria, the epicenter method and the congruity method. Previous reports discussed these criteria in the analysis of symptomatic DRUJ, but no clear conclusion has been reached. The purpose of this study is to investigate accurate criteria of CT in defining subluxation of the DRUJ. METHODS: Eighty distal radioulnar joints in 40 patients with suspected DRUJ subluxation underwent CT scans of both symptomatic and asymptomatic wrists. The CT scan was obtained through the DRUJ with the forearm in neutral rotation, active full supination and active full pronation. Three CT criteria were used to assess the DRUJ in all positions of unstable and normal wrists. RESULTS: Overall, 54 wrists were included in the final analysis. Seventeen symptomatic wrists had frank DRUJ instability diagnosed from true lateral radiographs, and 11 were reconfirmed from intraoperative pathology. The other 37 wrists had normal DRUJ. Among the three methods, the epicenter method had similar sensitivity to Mino's criteria and the congruity method. However, the epicenter method had much better specificity than Mino's criteria and the congruity method. CONCLUSIONS: For accurate diagnosis of subluxation of the DRUJ, CT scan through the symptomatic DRUJ in neutral rotation, active full supination, active full pronation and analysis with the epicenter method are recommended.

Adolescent↗

PubMed1997

Another pedigree with pure autosomal dominant spastic paraplegia (AD-FSP) from Tibet mapping to 14q11.2-q24.3.

The mutant in a family with autosomal-dominant spastic paresis in Northern Tibet was mapped by linkage analysis with several microsatellite markers to a gene locus at 14q11.2-q24.3, an area to which a few mutants leading to a condition with similar clinical signs have previously been mapped. The mutant observed in this pedigree probably arose de novo. Gene loci at 2p21-p24 and 15q, which have been found for other pedigrees with dominant spastic paresis, were excluded. The data in this pedigree do not contradict the hypothesis proposed by another group that there might be anticipation.

Adult↗

PubMed1997

One-stage reconstruction of skin defect and patellar tendon rupture after total knee arthroplasty. A new technique.

A case is presented herein in which infected total knee arthroplasty associated with a skin defect and patellar tendon rupture was reconstructed with lateral gastrocnemius-Achilles tendon complex after infection was controlled. The results were satisfactory, and the technique proposed herein is highly promising for treating such complicated circumstances after total knee arthroplasty, as not reported previously.

Aged↗

PubMed1997

Closed humeral shaft fractures: a prospective evaluation of surgical treatment.

OBJECTIVE: We tried to define the roles of the rigid dynamic compression plate (DCP) and the semi-rigid Ender nail (EN) in the treatment of closed humeral shaft fractures. DESIGN: A prospective, randomized clinical study was performed with detailed comparison parameters. MATERIALS AND METHODS: Ninety-one closed humeral shaft fractures were treated. Randomly, 30 humeri were treated with open reduction and internal fixation with DCP and no bone grafting (BG), 29 were treated with the same procedure but with BG, and 32 were treated with closed reduction and internal fixation with Ender nails. The average follow-up period was 32 months (range, 13-54 months). MEASUREMENTS AND MAIN RESULTS: In the group with DCP without BG, the average blood loss was 270 mL, operation time was 92 minutes, hospital length of stay was 6.5 days, and union time was 12.5 weeks. In the group with DCP with BG, the average blood loss was 325 mL, operation time was 108 minutes, hospital length of stay was 6.9 days, and union time was 9.4 weeks. In the EN group, the average blood loss was 114 mL, operation time was 54 minutes, hospital length of stay was 5.6 days, and union time was 9.9 weeks. Analysis of variance and Fisher's exact test were used to evaluate the statistical significance. CONCLUSION: In our experience, for humeral shaft fractures fixed surgically, EN is better than DCP without BG. When DCP is chosen for the means of fixation, prophylactic BG is recommended, especially in cases with more comminution.

Analysis of Variance↗

PubMed1997

Segmental tibial fractures treated with interlocking nails. A retrospective study of 33 cases.

We treated 33 segmental tibial fractures with interlocking nails between 1986 and 1991. All fractures were managed with calcaneal traction, closed reduction, reaming and fixation with a Grosse-Kempf interlocking nail. The patients were followed for at least 15 months. The mean duration to union was 17 (12-20) weeks for the distal fractures and 20 (12-34) weeks for the proximal ones. There were only 3 cases of delayed union of the proximal fracture, 2 of which united after dynamization by removal of distal screws and 1 after autogenous bone grafting. There were 2 cases of deep infection, which were diagnosed after the fractures were united. The infection was treated with removal of the nail, reaming, and antibiotic treatment intravenously for 2 weeks and orally for 4 weeks. All patients returned to their previous activity level. We conclude that segmental tibial fractures can be treated with an interlocking nail and have a high rate of union and a low complication rate.

Adolescent↗

PubMed1997

Giant-cell tumor of bone around the knee.

BACKGROUND: In most of the reported series, almost half of the giant-cell tumors involved the knee region. The characteristics of the lesions were usually benign but often locally aggressive and easily recurrent neoplasms. Some surgeons performed intralesional excision combined with local adjunctive chemical coagulant, and bone grafting or methylmethacrylate cement packing. These methods could both decrease local recurrence and retain the function of joint. METHODS: From January, 1984 to December, 1994, a review was made of the results for eighteen patients who had been managed consecutively at the Veterans General Hospital-Taipei for giant-cell tumor of bone around the knee. Fourteen instances had occurred in the proximal tibia and four, in the distal femur. According to the classification of Campanacci, nine lesions were Stage II and nine, Stage III. Eleven patients had been managed with intralesional excision of the tumor with local adjunctive application; the other seven had en bloc resection and reconstructive procedures. RESULTS: All patients had been followed for a mean of fifty-six months (range 22 to 125 months). The overall recurrence rate was 11% (2/18). The intralesional excision had 18% (2/11) recurrence; there was no recurrence in the en bloc resection (0/7). The complication rate was 16% (4/18); 9% (1/11) for intralesional excision and 42% (3/7) for en bloc resection, respectively. The mean functional score was 28 points (range, 22 to 30) in the intralesional excision group and 21 points (range, 11 to 30) in the en bloc resection group. CONCLUSIONS: En bloc resection with reconstruction had a lower rate of recurrence, but a higher rate of complication and poor functional results. Intralesional excision, combined with a local adjunctive application and packed with bone grafting or methylmethacrylate cement, was an acceptably good method with satisfactory results, which either decreased local recurrence or retained the function of the joint.

Adolescent↗

PubMed1997

Surgical treatment of seat belt type injury of the thoracolumbar spine.

BACKGROUND: Seat belt type injury of thoracolumbar spine is an uncommon injury characterized by disruption of the posterior elements of the spine. The fracture has long been treated conservatively, but progressive kyphotic deformity developed frequently. METHODS: From January, 1991 through December, 1992, 10 cases of seat belt type injury of the thoracolumbar spine were encountered at our hospital with an incidence of 8% in overall spinal fractures. Of these patients, eight patients were male and two were female, average age 30.7 years old. The causes included motor-vehicle accident in five patients, fall from height in four, and stricken by a falling electric pole in one. None of the victims of motor vehicle accidents wore seat belt. All of them received open reduction, posterior internal fixation and posterior fusion. RESULTS: After follow-up for an average of 42.2 months, the average kyphotic angulation was 5.7 degrees. Back pain and function of these patients were all rated good. None of them suffered from neurologic deficit. One patient with breakage of transpedicular screws was encountered during follow-up, but there was no complaint. CONCLUSIONS: In treating seat belt type injuries of spinal column, benefits of operation outweigh the risks. Besides, the clinical result is satisfactory and more aggressive surgical approach should be encouraged.

Accidents, Traffic↗

PubMed1997

Intraosseous epidermoid cyst in distal phalanx of finger: a case report.

Bone tumor in distal phalanx of finger is rare. Differential diagnosis includes glomus tumor with bone erosion, enchondroma, osteomyelitis, aneurysmal bone cyst and metastasis. We herein present a case with intraosseous epidermoid cyst in distal phalanx which has rarely been reported.

Bone Diseases↗

PubMed1997

Core decompression in treating ischemic necrosis of the femoral head.

BACKGROUND: The application of core decompression in the treatment of ischemic necrosis of femoral head (INFH) is to preserve the joint at early stage of the disease. Although excellent results have been obtained in many series, its effectiveness is questionable because of high rates of failure. This study is to evaluate the effectiveness of this technique in our patients with INFH receiving core decompression as the sole treatment. METHODS: Although 91 patients were treated with core decompression in Veterans General Hospital-Taipei from 1980 to 1993, only 71 were considered as the valid cases after having been followed for 24 to 165 months (mean 56.7 months). Of 84 hips treated, 49 hips were steroid induced, 20 idiopathic, 14 alcohol related, and one related to trauma. Twenty-five hips were at Steinberg stage I, 32 at stage II, nine at stage III, 17 at stage IV, and one at stage VI. RESULTS: The results were poor in 22 (26.19%) hips since the patients required hip prosthesis. Fair results were rated in 37 (44.05%) hips since progressive collapse occurred in the femoral head and the patients suffered from moderate hip pain. Good results were found in nine (10.71%) hips since the lesion showed no progression and the patients had only occasional pain. Excellent results were obtained in 16 (19.05%) hips since the patients had no pain and the lesion had no progressive change. The satisfactory rate in the nonsteroid-related hips (33% or 12/35) was significantly higher than in the steroid-related hips (27% or 13/49). The overall satisfactory result was only 30%. CONCLUSIONS: Although core decompression may not be effective in preventing progression of INFH, it may relieve temporary pain and delays the need for hip arthroplasty in some patients.

Adolescent↗

PubMed1996

Fractures of posterior wall of acetabulum.

Fractures of the posterior wall of the acetabulum form a special group in acetabular fractures. This study aims to evaluate the results in the management of such fractures. Thirty-two patients with fractures of posterior wall of acetabulum were reviewed retrospectively. The follow-up period was 7 (range 3-10) years. Twenty-four were associated with initial posterior dislocations. Twenty-seven were managed with open reduction and internal fixation, while the remainder were managed conservatively. Reductions were rated as congruent in 30 cases and as noncongruent in 2. The functional results were excellent in 16 cases, good in 10, fair in 2, and poor in 4. Two early complications were met, namely 1 iatrogenic sciatic nerve injury and 1 superficial wound infection. Sixteen late complications were noted, including 10 heterotopic ossifications, 3 avascular necroses of femoral head, and 3 symptomatic arthritides. The incidence of late complications was high, but the functional results were generally satisfactory. Congruent reduction was the key in obtaining satisfactory results in the management of these fractures.

Acetabulum↗

PubMed1996

Undisplaced femoral neck fracture in the elderly.

The results and the related conditions of 250 undisplaced femoral neck fractures managed by percutaneous Knowles pinning were evaluated. All of the patients were over 59 years old, and the protocol of management and follow-up was determined prospectively. The duration from injury to management was 3.0 (range 1-12) days, the operation time was 20 (range 10-44) min, and most of the patients were discharged without hospitalization. The follow-up period was 74 (range 24-138) months. The final results showed 226 (90.4%) fractures with smooth course of union (mean union time: 24 weeks), 15 (6.0%) fractures with nonunion, and 9 (3.6%) fractures with implant problems. Eighteen (7.2%) hips developed avascular necrosis of femoral head after union. The analysis showed that the rate of complications was higher in elderly persons with undisplaced femoral neck fractures.

Age Factors↗

PubMed1996

Percutaneous pinning in undisplaced subcapital femoral neck fractures.

Three hundred and five undisplaced subcapital femoral neck fractures managed by pinning in situ with Knowles' pins were evaluated to elucidate the role and effect of such treatment. The protocol of management and follow up, and evaluation, both radiographically and functionally, were set up prospectively. The duration from injury to management was 3.5 (1-14) days, the operation time was 22 (9-48) min and most of the patients were discharged without hospitalization. The follow-up period was 75 (28-136) months. The final results showed 282 (92.5 per cent) fractures united without complications (mean union time: 20 weeks), 14 (4.6 per cent) limbs with non-union, and 9 (2.9 per cent) had implant problems. Twenty-two (7.2 per cent) developed avascular necrosis after union. Percutaneous pinning of undisplaced subcapital femoral neck fractures as day cases is a simple, safe, effective and economic method.

Adult↗

PubMed1996

Unstable closed tibial shaft fractures: a prospective evaluation of surgical treatment.

OBJECTIVE: To define the roles of the rigid interlocking nail and the semirigid Ender nail in the treatment of closed unstable tibia] shaft fractures. DESIGN: Randomized, clinical, prospectively study with detailed comparison of parameters. MATERIALS AND METHODS: Data on 116 unstable closed tibial shaft fractures were collected. Randomly, 60 tibiae were fixed with interlocking nails and 56 tibiae were fixed with Ender nails. The follow-up period was 24 (16-32) months. MEASUREMENTS AND MAIN RESULTS: In the interlocking nail group, the average blood loss was 189 cc, operation time was 51 minutes, length of hospital stay was 7 days, and union time was 14.2 weeks. In the Ender nail group, the average blood loss was 95 cc, operation time was 30 minutes, length of hospital stay was 5.0 days, and union time was 16.9 weeks. Student's t test was used for statistical significance. CONCLUSIONS: For more comminuted unstable tibial shaft fractures, an interlocking nail is undoubtedly a better choice, but an Ender nail still is effective in some aspects of treatment in the less comminuted unstable tibial shaft fractures.

Adolescent↗

PubMed1996

Treatment of unstable tibial fractures with interlocking nail versus Ender nail: a prospective evaluation.

BACKGROUND: For unstable tibial fractures, there are many methods of surgical treatment. The efficacy of the Ender nail and the interlocking nail in the treatment of such fractures is examined. METHODS: One hundred and seven cases of unstable tibial shaft fractures were collected for the prospective study. Randomly, 61 tibia were fixed with interlocking nails and 46, with Ender nails. The mean follow-up period was 30.5 (23 to 40) months. The results of the different treatments were compared. RESULTS: In the group with interlocking nails, the average blood loss was 265 cc; operation time was 61 minutes; hospital days were 10.4; and union time was 15.1 weeks for closed fractures and 17 weeks for Winquist-Hansen type III and IV fractures. In the group with Ender nails, the average blood loss was 135 cc, operation time was 32 minutes, hospital days were 8.3 days, and union time was 17.6 weeks for closed fractures and 22.5 weeks for Winquist-Hansen type III and IV fractures. Student t-test revealed statistically significant difference between the groups in all of the data described above. However, treatment with the different nails showed no significant difference in results for open type I and II fractures. CONCLUSIONS: Ender nail still has its superior usefulness in some aspects of treatment of less comminuted unstable tibial shaft fractures, but for the more comminuted unstable tibial shaft fractures, the interlocking nail is undoubtedly better used.

Adolescent↗

PubMed1996

Treatment of open tibial fracture with Ender nail.

BACKGROUND: This retrospective study aims to evaluate the effect of Ender nail in management of open type I and II unstable tibial fractures. METHODS: From 1984 to 1993, 30 cases of open unstable tibial shaft fracture (with fibular fracture) were collected in the retrospective study. All were fixed with Ender nails. The followup period was 99 (24-135) months. RESULTS: The average of blood loss was 140 cc, operation time 45 minutes, hospital day 10 days, and union time 20.5 weeks. Student t-test revealed statistically significant difference between open type I cases and type II cases in some parameters described above. CONCLUSIONS: Ender nail is effective in the treatment of open type I and II unstable tibial shaft fractures, but it should be used carefully, especially in cases with more comminution.

Adult↗

PubMed1996

Patellar dislocation after total knee arthroplasty.

BACKGROUND: Patellar problem is an important cause of nonseptic failure of the current condylar design of total knee arthroplasties. Patellar dislocation after total knee arthroplasty is infrequent but can cause disabling symptoms. METHODS: From March, '84 to July, '92, 1652 total knee arthroplasties were performed at this Hospital. Of these 1100 knees in 978 patients were available to be followed up regularly at the Outpatient Department. Eleven cases of patellar dislocation after total knee arthroplasty were encountered during follow-up. Among these patients, nine patients had received operation at this Hospital; the other two patients had been referred here by the other hospitals. All 11 patients had been treated with surgical methods: proximal realignment of the quadriceps alone in 6 knees, lateral retinacular release combined with revision of the malaligned components in 2 knees, combined proximal and distal realignment in 2 knees and patellar tendon transfer in 1 knee. RESULTS: After an average follow-up of 21.8 months, from April, '84 to April, '93, there was one redislocation, unfortunately caused by trauma. Using the average knee rating scale of the Hospital for Special Surgery, New York, USA, the results of 90.5 were satisfactory and encouraging. CONCLUSIONS: Patellar dislocation after total knee arthroplasty can cause disabling symptoms, including pain, weakness, limited range of motion, extension lag and difficulty when climbing up or down stairs. The cause of patellar dislocation after total knee arthroplasty was error in surgical technique in this series. Revision of the component should be performed in those with malaligned component. Proximal realignment is recommended in those with quadriceps imbalance. Distal realignment is recommended only when proximal realignment alone has failed to restore proper patellar tracking, this should be carried out with great caution due to the potential for serious complications.

Aged↗

PubMed1996

Complications in surgical treatment of undisplaced femoral neck fracture.

BACKGROUND: Percutaneous Knowles' pinning is a well accepted treatment of undisplaced femoral neck fracture, but there are some complications that have seldom been discussed. METHODS: One hundred and eighty two patients with undisplaced femoral neck fractures, at a mean age of 67 years, were treated by percutaneous Knowles' pinning between 1983 to 1989, and followed for an average of 102 months. The clinical results and complications were evaluated. The data were collected on the basis of age and bone density. Student's t-test was used to evaluate the significance of the results. RESULTS: The mean union time was 20 weeks. In all the patients, 85.8% had good results, 3.8% patients had acceptable results and 10.4% patients had poor results. Old age (> or = 65 years) and osteoporosis (Singh index < or = 3) were two factors of the poor result. Thirty-two cases (17.6%) developed complications. The incidence of nonunion or implant problems was apparently higher in the older or osteoporosis group, but avascular necrosis of femoral head correlated little with old age or osteoporosis. CONCLUSIONS: Although percutaneous Knowles' pinning is simple, safe, economic and reasonably effective for the treatment of undisplaced femoral neck fractures, we should pay more attention to the uncooperative, old, and osteoporotic patients.

Adult↗