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Biomedical subjects

W H Lo

Publications and source records attributed to W H Lo.

At least 73 records · Page 4Linked to original sources
PubMed1996

Ender nail in unstable closed tibial fractures.

BACKGROUND: This retrospective study aims to evaluate the effect of Ender nail in management of unstable closed tibial fractures. METHODS: From January 1985 to May 1992, 99 cases of unstable closed tibial shaft fractures (with fibular fractures) were collected for retrospective study. All the 99 tibiae were fixed with Ender nails. The mean follow up period was 80 (26-115 months). RESULTS: The clinical results were evaluated with special charts. The average blood loss was 126 ml. Operation time was 45 minutes. Hospital day was 10.2 days. Union time was 16.8 weeks for Winquist-Hansen (WH) type I-II fractures and 20.5 weeks for VVH type III-V fractures. Student t test revealed statistically significant differences between the clinical results of WH type I-II cases and those of WH type III-V cases. The postoperative complications included superficial infection in 1 case (1%), nail protrusion in 13 (13%), malunion in 10 (10%), aseptic nonunion in 2 (2%) and infected nonunion in 1 (1%) (overall 18% in the 99 cases). CONCLUSIONS: Ender nail is no doubt effective in treatment of less comminuted unstable tibial shaft fractures, but should be used carefully for more comminuted unstable tibial shaft fractures.

Adolescent↗
PubMed1996

Anterior tibia spine fracture in children: follow-up evaluation by biomechanical studies.

BACKGROUND: The treatment of anterior tibial spine (ATS) fracture in children is in controversy. Previous studies have shown that most of the children who sustained ATS fractures have objective evidence of the anterior cruciate ligament (ACL) laxity at follow-up, but detailed biomechanical analysis of the knee joint has seldom been performed. METHODS: Eight ATS fractures in children at a mean age of 12 years were treated from 1989 to 1994. Two were of Meyer's classification type I, 3 were of type II, and 3 were of type III. The treatment varied from casting to open reduction & internal fixation (ORIF) by pulling through suture or biofix absorbable screw. Patients were followed with radiological, clinical and biomechanical analysis. KT 1000 knee arthrometer was used to evaluate the laxity of ACL. Cybex isokinetic machine was used to evaluate knee extensor and flexor strength. RESULTS: During an average follow-up period of 47 months, all fractures showed to unite well on X-ray except 1 untreated type I fracture who had malunion. Only one had subjective complaint of instability, but 3 had clinical signs of instability. Objective evidence of laxity, determined by KT-1000 arthrometer, was noted in 4 patients. Decreased muscle strength, determined by Cybex isokinetic machine, was more prominent in hamstrings than in quadriceps. CONCLUSIONS: Patients with milder ATS fracture (type I & II), if treated inappropriately, may still result in ACL laxity and knee muscle strength deficiency. Type III ATS fractures, if treated well by ORIF, tend to recover nearly normal ACL function and muscle strength.

Adolescent↗
PubMed1996

Lunate and perilunate dislocation.

BACKGROUND: Perilunate dislocation is an uncommon injury of the wrist due to hyperextension. The factors affecting its prognosis are still controversial. The aim of the present study was to review its fracture types, associated injuries, timing of surgery, different fixation methods and prognostic factors. METHODS: Fourteen patients with perilunate dislocation or fracture dislocation were treated by open reduction and internal fixation, and were followed for at least 12 months. A functional scoring system and X-ray findings were used for follow-up evaluation. RESULTS: Two patients had excellent results, six patients had good results, and four had fair results. Only two patients had poor results. Treatment delayed over one month, transscaphoid perilunar fracture dislocation, or fixation of the transscaphoid fracture with Kirschner wire was associated with poorer results. CONCLUSIONS: Early diagnosis of perilunate dislocation, prompt open reduction and rigid fixation for fracture combined with ligament repair can give more promising results.

Accidents, Traffic↗
PubMed1996

Acute monteggia fractures in children.

BACKGROUND: Monteggia fracture rarely occurs in children. If it occurs, type I fracture is most commonly seen. We study the functional results of nonsurgical management in acute cases. METHODS: From July, 1988 through October, 1994, we encountered 15 cases of acute Monteggia fractures, accounting for 2.3% of forearm fractures. Twelve were males and three were females, at an average age of 7 years and 10 months. Nine fractures occurred on left non-dominant side, six occurred on right dominant side. There were eleven type I (73.3%), no type II, three type III (20%), and one type IV (6.7%) fractures. All of these patients received closed reduction with long arm casting, and the most stable position of fracture was supination of the forearm and flexion of the elbow. RESULTS: After follow-up for an average of 45.9 months, all fractures were found to unite without residual deformity of ulna or dislocation of the radial head. The functional results were excellent. Posterior interosseous nerve palsy occurred in one patient before treatment, and recovered spontaneously. CONCLUSIONS: Unlike adults, children with Monteggia fractures can get excellent results from closed reduction with long arm casting.

Casts, Surgical↗
PubMed1996

Wraparound injury of posterior interosseous nerve on the unreduced radial head: a case report.

Injury in radial nerve, especially its deep branch, posterior interosseous nerve (PION), is the most common nerve complication associated with Monteggia fracture. According to the reports by Boyd and Spinner, 100% of these injuries recovered spontaneously. Permanent or chronic radial nerve palsy caused by an unreduced radial head is very rare; the optimal treatment is still uncertain. Here a case of chronic PION injury in Monteggia fracture with unreduced radial head is reported.

Adult↗
PubMed1995

Surgical correction of muscular torticollis in older children.

BACKGROUND: Children with muscular torticollis treated before the age of 1 year respond well to conservative treatment. Surgical correction is indicated only in resistant cases. Nevertheless, there is still controversy about the results and the type of operation in the management of neglected older children. METHODS: Seventeen patients, at a mean age of 9 years and 5 months, with muscular torticollis were surgically treated between 1986 to 1991. The average follow-up period was 3 years and 4 months. months. Combined approach with open tenotomy at mastoid and clavicular level was the choice of procedure. The outcome for these older children and young adults were evaluated with function and cosmesis. RESULTS: Our results showed that the best results can be expected in children before 12 years of age. Late releases give acceptable results, although facial asymmetry and some residual upper dorsal scoliosis remain. Adequate surgical release and intensive postoperative physical therapy are the keystones to a good result. CONCLUSIONS: Surgical correction of muscular torticollis in the older children is of benefit for functional and cosmetic recovery, but facial asymmetry is irreversible after 12 years of age.

Adolescent↗
PubMed1995

Surgical treatment of extensive discovertebral destruction in ankylosing spondylitis: a report of two cases.

Extensive discovertebral destruction in ankylosing spondylitis is rare and difficult in diagnosis and management. We present two such cases who were treated with anterior decompression, autogenous strut iliac bone graft and fixed with anterior locking plate system (ALPS) instrumentation. After operation the patients' symptoms improved and the spinal deformities were corrected. Our experiences in these two patients emphasize the importance of early recognition, early detection and aggressive surgical treatment in the lesion.

Adult↗
PubMed1995

Total hip arthroplasty in patients with ankylosing spondylitis: longterm followup.

OBJECTIVE: To evaluate the longterm functional effects of total hip arthroplasty (THA) on 46 patients. METHODS: Clinical and radiographic examinations were performed on 46 patients (74 THA) with ankylosing spondylitis (AS). The mean followup period was 100 months (range 37-174 months); 32 hips were followed for more than 10 years. RESULTS: Significant benefit was obtained in pain control (all but 2) and function (mean improvement in range of motion 128 degrees) in the early stage so that patients could be gainfully employed. An average 100 months after THA, the overall functional results were rated excellent in 21 hips, good in 28, fair in 7, and poor in 18. Only 6 hips (8%) in our series developed clinically significant (Class III or IV) heterotopic ossification. Seventeen hips needed a 2nd operation because of loosening (11 hips), deep infection (3), malposition of acetabular component (2), and prosthetic failure (1). Another 6 hips showed definite loosening on radiographs and needed to be revised. The total incidence of failure was 31% (23 hips). The average time from the index operation to loosening was 9.5 years (range 4-13 years). Factors contributing to component loosening were young age, short stature, and decreased postoperative range of motion. CONCLUSION: Total hip arthroplasty can be very important and beneficial to patients with AS, but the patients, being young and active, and with their rigid spines, do not treat their prostheses gently and are very dependent upon their mobility. They must be kept under supervision long after THA, probably for the rest of their lives, to identify possible longterm complications.

Adult↗
PubMed1995

Nonvascularized proximal fibular autograft to treat giant-cell tumor of the distal radius.

BACKGROUND: The Distal end of the radius is the third most common site where giant-cell tumors occur. High recurrent rate was reported after curettage. To manage such aggressive tumors, wide resection is the best treatment and nonvascularized proximal fibular autograft has been widely used for reconstruction. METHODS: Eight patients were treated here with this method from April, 1988 to April, 1992. Patients' average age was 40 years, and all had grade III. Of the four males and females, six tumors were over the dominant hands and the other two, over the nondominant ones. They were treated primarily with wide resection and reconstruction with osteochondral proximal fibular autograft, from either the ipsilateral or contralateral side. Bone anastomotic site was fixed with dynamic compression plate. The soft tissue was directly repaired in six patients and reinforced with extensor carpi radialis longus tendon in two. RESULTS: Patients were regularly followed from 14-60 months, for an average of 25 months. The average grip strength of the affected hands was 77% that of the unaffected sides. There were four distal radioulnar joint diastasis, one ulnar deviation of the wrist, one volar tilt of the carpal bones and one transient peroneal palsy over the donor site. No recurrence or metastasis was found up to the last follow-up. The average total range of motion of the affected wrist (supination, pronation, dorsiflexion and palmar flexion) was 185 degrees. All Patients were satisfied with the results. CONCLUSIONS: Using proximal fibular autograft to reconstruct the bony defect and joint after wide excision for distal radial giant-cell tumor gives satisfactory results. It is a widely accepted good method, though there are many problems still unresolved.

Adult↗
PubMed1994

Management of avulsion injury of the PCL with reattachment.

Twenty-eight cases of avulsion injury of the posterior cruciate ligament (PCL) treated by reattachment were followed up to evaluate the results. Evaluation was based on appropriate functional and dynamic criteria: the results are classified as good, fair or poor. The interval between injury and repair ranged from 3 days to 2 months with a mean 4 weeks. The follow-up period ranged from 3 to 10 years with a mean of 5 years. The evaluation revealed 27 (96 per cent) good, one (4 per cent) fair and no poor results. It is apparent that operative reattachment is the treatment of choice for avulsion injury of the PCL, especially in early cases.

Adolescent↗
PubMed1994

IgD multiple myeloma with thoracic spine compression due to epidural extra-osseous tumour spread.

On initial presentation of a patient with IgD multiple myeloma there were no features to suggest an unusual variant. Two months later she developed spinal cord compression due to an IgD plasmacytoma. This complication of IgD myeloma has rarely been reported. During the course of the disease and using the routine laboratory protocol for investigating and identifying paraproteins, including IgD, the patient's results became indistinguishable from those in Bence-Jones proteinuria myeloma.

Acute Disease↗
PubMed1994

Surgery for old ankle fracture. 13 cases followed for 9 (5-15) years.

Between 1978 and 1988, we treated 13 cases of neglected ankle fractures by open reduction and internal fixation or osteotomy 11 (2-36) months after the accident. Having been followed for 9 (5-15) years, the results were evaluated. All the patients were improved, even though restoration of the anatomy of the joint often was difficult. Those operated on after less than 6 months had better function than those with longer delays.

Adolescent↗
PubMed1994

A new approach to gene diagnosis of Duchenne/Becker muscular dystrophy--amplified fragment length polymorphisms.

Four (CA)n repeats, located in introns 44, 45, 49 and 50 of the dystrophin gene, were evaluated in Chinese. These loci are highly polymorphic, with polymorphism information contents of 0.872, 0.772, 0.870 and 0.718, respectively. All four loci can be easily amplified and labelled using two duplex PCR reactions with alpha-32P-dCTP and can be detected by denaturing polyacrylamide gel electrophoresis. Using these four loci and the two polymorphic (CA)n repeats located at the 5' and 3' ends of the dystrophin gene, we have developed a new PCR-based procedure--Amp-FLP (amplified fragment length polymorphism) linkage analysis for the gene diagnosis of DMD/BMD. This method can detect intragenic recombination rapidly and efficiently and greatly improves the success rate of carrier detection and prenatal diagnosis in non-deletion DMD/BMD families. All of the loci used in this procedure are intragenic. In addition, the loci in introns 44, 45, 49 and 50 are located in the deletion-prone region of the dystrophin gene, making them valuable and useful in the identification of deletion mutations. Here we report one case of deletion detection using these four loci.

Base Sequence↗
PubMed1994

Delayed treatment of ankle fracture.

BACKGROUND: Cases of old ankle fractures with different delayed treatments in different conditions were collected and evaluated to determine which treatments were optimal for individual type of fractures. METHODS: Sixteen cases of old ankle fractures were managed by open reduction and internal fixation, osteotomy, or removal of loose fragment according to the condition of the fractures between 1977 and 1987. The follow-up period was from 5 to 15 years with mean 7.9 years. The final result was evaluated by a modified performance index. RESULTS: All the 12 patients treated with open reduction and internal fixation for malposition got improved with the mean performance score rising from 37 before operation to 76 after operation. Improvement was also noted in all the 3 patients treated with osteotomy for malunion without significant arthritis, rising from 44 to 88. One patient had painful non-united fragment of medial malleolus, and removal of the loose fragment was done to improve the score from 58 to 96. CONCLUSIONS: Management of old ankle fractures can be effective and beneficial when appropriate treatments are given according to the different conditions of the fracture and joint.

Adult↗
PubMed1994

Management of insufficiency of posterior cruciate ligaments.

BACKGROUND: This study aims to evaluate the role of different methods in management of insufficiency of posterior cruciate ligament (PCL) that were used in VGH-Taipei. METHODS: 129 cases with insufficiency of PCL were collected to evaluate, according to functional and dynamic criteria, the results of different managements which were graded as good, fair, or poor. The patients were divided into 3 groups, i.e. group 1 with conservative rehabilitation therapy, group II with surgical reattachment, and group III with surgical ligament reconstruction that had 3 subgroups including IIIa reconstruction with medial head of gastrocnemius, IIIb with patellar tendon and IIIc with artificial ligament. The artificial ligaments used were Leeds-Keio ligament (group IIIcl), Dacron ligament (group IIIc2) and Goretex ligament (group IIIc3). The duration from injury to treatment varied from 3 days to 12 years with mean 45 weeks. The followup period was from 38 months to 112 months with mean 62 months. RESULTS: The results revealed 6 cases of good grade (25%) and 18 cases of fair grade (75%) in group 1, 20 cases of good grade (95%) and 1 case of fair grade (5%) in group II, 14 cases of good grade (40%), 10 cases of fair grade (29%) and 11 cases of poor grade (31%) in group IIIa, 3 cases of good grade (100%) in group IIIb, 13 cases of good grade (82%) and 3 cases of fair grade (18%) in group IIIcl, 19 cases of good grade (83%), 3 cases of fair grade (12%) and 1 case of poor grade (4%) in group IIIc2, and 3 cases of good grade (43%), 3 cases of fair grade (43%), and 1 case of poor grade (14%) in group IIIc3. CONCLUSIONS: Conservative intervention could be satisfactory in some cases with PCL insufficiency, especially in cases with isolated PCL injury, while surgical methods is mandatory in the others, especially in cases with chronic symptomatic PCL insufficiency.

Adolescent↗
PubMed1994

Bateman bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures. Uncemented versus cemented.

Four hundred forty-seven patients with 451 displaced fractures of the femoral neck were treated with Bateman bipolar hemiarthroplasty (190 cemented and 261 uncemented) between 1985 and 1990 in the authors' institution. During a follow-up period of at least two years, the authors found less thigh pain (13% versus 46.2%) and higher Harris hip scores (86 versus 79) in the cemented group in comparison with the uncemented group. Radiographic examination showed less radiolucent zones and subsidence in the cemented group. Heterotopic ossification was more common in the cemented group. Despite the fact that the cemented group had longer operative times (average, 20 minutes) and more blood loss (average, 160 ml) during the operation, there was no significant difference in the early mortality rate observed between these two groups. The cemented prostheses provided better functional and radiographic results and fewer failures in the early stage. In addition, the cemented prostheses did not lead to more complications and higher mortality rates. Thus, for elderly patients who need early ambulation and functional recovery, the cemented Bateman bipolar prosthesis appears to be a better choice than the uncemented Bateman prosthesis.

Aged↗
PubMed1993

Limb salvage surgery for locally aggressive and malignant bone tumors.

Since 1983, 77 patients have had limb salvage surgery for locally aggressive or malignant bone tumor of the limbs or pelvis. Twenty-nine patients had locally aggressive lesions with giant cell tumors the most prevalent, and 48 patients had malignant lesions, of which osteosarcomas predominated. Resection with a wide margin could be achieved in most of the patients. A mobile joint reconstruction was performed in 57 patients and an arthrodesis in 14 patients. At follow-up, 14 patients have died of disease, 7 patients have survived with disease, and 56 patients (73%) have survived without disease. Local recurrences were encountered in 4 patients (5%). The overall functional results were classified as excellent in 11 patients, good in 45 patients, and fair in 9 patients. Twelve patients had poor results because of failure of the reconstruction or amputation due to complications. Twenty-seven complications were encountered, among which infection was the most serious. Careful selection of patients and consideration of procedure chosen to reconstruct the defect are important for a successful outcome. This decision is based on a number of factors related to the tumor and the patient. Presently, major neurovascular involvement, displaced pathological fracture, inappropriate biopsy incision, extreme youth of the patient, and infection were considered to be contraindications to resection in our institution. Although various procedures promise functional restoration, the reconstructive procedure should be individualized and designed to meet the needs of the patient.

Adult↗