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Papers by Wene Yang

Formosan Journal of Musculoskeletal Disorders

ABSTRACT Background/PurposeSpastic hip displacement is a common musculoskeletal problem in cerebr... more ABSTRACT Background/PurposeSpastic hip displacement is a common musculoskeletal problem in cerebral palsy (CP), leading to further complications in daily life. Deformities of the proximal femur were regarded as a factor in hip displacement, and therefore, femoral osteotomy is often recommended. This study aims to identify the relationship between hip displacement and femoral deformities.Methods We retrospectively collected preoperative radiography and three-dimensional computed tomography (3D-CT) images from 19 nonambulatory CP children with unilateral hip displacement (average age: 8.4 years; range: 4.4–13.6). The 3D image of femur was reconstructed for measuring the femur anteversion angle (FAA) and true femoral neck-shaft angle (NSA). The association among migration percentage (MP), acetabular index (AI), FAA, and NSA between nondisplaced and displaced hips was analyzed by paired t test and its correlations were identified.ResultsThe FAA and AI are significantly greater in displaced hips (42.7° vs. 36.3° and 32.8° vs. 22.7°, respectively, p < 0.001). However, the NSA is similar between displaced and nondisplaced hips. The AI and FAA have significantly positive correlations with MP between nondisplaced hips and displaced hips (0.69 and 0.57, respectively).Conclusion Using reconstructed 3D-CT images we can directly measure and prove these femoral deformities. We found that AI has a positive correlation with MP (0.69), which is consistent with the results of previous studies. The displaced side has greater femur anteversion (42.7° vs. 36.3°), and coxa valga is common in these nonambulatory patients, irrespective of whether or not these patients underwent hip displacement. In addition, the severity of AI and anteversion angle will be affected by the MP.

Chang Gung Medical Journal, 2010

Background: Tuberculous osteomyelitis of the long bone in children is often neglected, and establ... more Background: Tuberculous osteomyelitis of the long bone in children is often neglected, and established transphyseal bone lesions are common. The purpose of this study was to evaluate the clinical outcomes of these patients. Methods: Between January 1990 and December 2008, 19 patients (10 boys and 9 girls) with sustained tuberculous osteomyelitis of the long bone accompanied by physeal involvement were treated at our institute. The average age was 23.8 months (range, 10-58 months). All patients received surgical treatment and antituberculosis therapy for at least 6 months. The final radiographic and functional results were analyzed. Results: All patients were followed up for an average of 61.8 months (range, 14-123 months). The most common site of infection was the distal femur (8 patients, 42.1%), followed by the proximal tibia (5 patients, 26.3%) and the distal tibia (3 patients, 15.8%). Most of the lesions were osteolytic, round to oval in shape, and showed marginal sclerosis. Some lesions were expanding or multiloculated. The periosteal reaction was minimal. Even in cases with extensive surgical curettage through the physis, the growth plate maintained its function and gradually remodeled. Clinical symptoms improved within 4-6 weeks. All bone lesions decreased in size in 3-6 months. Further, physeal bar formation was observed, but the extent was minimal. All transphyseal lesions healed gradually over a period of several years. Good remodeling of skeletal lesions was noted. Conclusions: The diagnosis of tuberculous osteomyelitis of the long bone should be considered in every child with unexplained chronic limb pain or swollen limbs. The lesions are usually located in the metaphysis and easily cross the growth plate to the epiphysis. Surgical debridement is beneficial in both diagnosis and treatment. In patients with growth plate involvement, careful surgical debridement is recommended to eradicate infection since the risk of permanent physeal damage is minimal. The physis can heal gradually, and full range of motion of the adjacent joints can be maintained.

Chang Gung Medical Journal, Jun 1, 2002

Background: The cementless fixation technique in total hip arthroplasty (THA) was developed to so... more 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.

Chang Gung Medical Journal, 2005

Background: The optimal treatment for femoral fractures in children is controversial. The purpose... more Background: The optimal treatment for femoral fractures in children is controversial. The purpose of this study was to compare the results of Rush pin fixation with those of conservative treatment, and to evaluate the sequels of growth plate injury by internal fixation. Methods: Eighteen femoral shaft fractures in 17 children who had concomitant head injury or multiple traumas were treated surgically. The mean age at operation was 9 years 3 months (range, 7 years 5 months to 11 years 1 month). One Rush pin was inserted from the tip of the greater trochanter, without reaming, to fix the fracture. Another 20 age-matched children treated by traction and casting were the control subjects. Results: All the fractures united without consequences. In addition to a decrease in hospital stay with the use of the Rush pin (10 days vs. 27 days, p<0.05), fewer leg length discrepancies (4.2 mm vs. 7.1 mm, p<0.05) were also noted, compared with conservative treatment. The growth of the proximal femur after Rush pin fixation was evaluated after an average of 59 months. No femur shortening, coxa valgus, or hip dysplasia was noted. Conclusions: Intramedullary Rush pin fixation for femoral shaft fracture in children older than 7 years is a simple and reliable alternative. One narrow and non-reaming pin inserted from greater trochanter did not demonstrate femoral growth inhibition.

Formosan Journal of Musculoskeletal Disorders, 2012

We report the case of a patient in whom the use of monolateral double-row Trauma-Fix lengthener w... more We report the case of a patient in whom the use of monolateral double-row Trauma-Fix lengthener was successful for femur lengthening after initial difficulty in lengthening by using the single-row lengthener. Problem and case report: A girl 12 years of age presented with a leg-length discrepancy (LLD) of 8 cm and left genu valgum deformity due to a trauma-induced left distal femur physial lesion during her infancy. The patient's weight and height were 38 kg and 148 cm, respectively, and the mechanical axis was 16 degrees of valgus at the time of operation. The lengthening procedure was initiated on postoperative day 7 after the initial correction of the genu valgum deformity. However, no distraction was observed at the osteotomy site, and a convergent angulation deformity developed at the pin-clamp joint. Method and outcome: This problem was resolved successfully with the addition of another row of the Trauma-Fix lengthening device, which was linked via the previously applied pins. A final lengthening of 7.5 cm was achieved in 3 months by using the double-row lengthener without pin tract infection or breakage. The monolateral frame of the Trauma-Fix lengthener was removed in the 11th postoperative month after a solid union of the femur was achieved. The postoperative mechanical axis of the knee was 4 degrees varus. The monolateral double-row lengthener device that showed high efficiency and improved the strength of the ball joints were used along the single-row lengthener, and it may serve as a good alternative for augmentation of insufficient ball joints during limb lengthening.

BioMed Research International, 2015

Pin site infection is a common complication after fracture fixation and bone lengthening, and dai... more Pin site infection is a common complication after fracture fixation and bone lengthening, and daily pin site care is recommended. Weather is a strong environmental factor of infection, but few articles studied the issue of weather and pin site infection. We performed a prospective comparative study of 61 children with supracondylar humeral fractures treated by closed reduction and percutaneous pinning. The patients were divided into high-temperature season or low-temperature season by the months they received surgery. The patients within each season were further allocated to 2 groups by the different postoperative pin site care methods of daily care or noncare. The infection rate per patient was significantly higher in the high-temperature season compared to low-temperature season (45% versus 19%,P= 0.045). In the high-temperature season, the infection rate per patient was significantly higher in the daily care group versus the noncare group (70% versus 20%,P= 0.001). In the low-tem...

Journal of orthopaedic surgery (Hong Kong), 2000

One hundred and sixty-six cementless primary total hip arthroplasties were performed in 133 patie... more 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.

Changgeng yi xue za zhi / Changgeng ji nian yi yuan = Chang Gung medical journal / Chang Gung Memorial Hospital, 1998

Os trigonum tarsi is found in 7% of the world adult population. However, it rarely causes symptom... more Os trigonum tarsi is found in 7% of the world adult population. However, it rarely causes symptoms. The majority of patients with os trigonum tarsi are found incidentally. This condition is often found in ballet dancers, javelin throwers and soccer players. It rarely produces symptoms in normally active adults. The etiology of os trigonum syndrome is impingement of an unfused ossicle or a fractured posterior lateral tubercle of talus over the posterior rim of tibial plafond. We present a case of os trigonum syndrome in a young man. His posterior heel pain was due to tophaceous gout around the os trigonum tarsi, instead of the common pathogenesis of repeated hyperflexion of the ankle joint. Pictures of the specimen showed marked giant cell reaction which resulted in pseudotumor formation. We reviewed the clinical characteristics of os trigonum tarsi and gout and present the treatment of our patient.

Journal of Pediatric Orthopaedics B, 2015

Radiographic parameters for evaluating hip development are altered by Salter osteotomy, and their... more Radiographic parameters for evaluating hip development are altered by Salter osteotomy, and their prognostic value require further validation. A total of 63 patients who underwent open reduction and Salter osteotomy for unilateral hip dysplasia were evaluated with Severin classification 10.8 years later. The initial first-year postoperative acetabular index, c/b ratio, head-teardrop distance, and head coverage were compared with the final outcome of Severin classification. Greater c/b ratio was significantly associated with later Severin class III hip. Using receiver operating characteristics curve, a c/b ratio greater than 0.72 at 6 months and 1 year postoperatively can predict the possibility of a class III hip in 30 and 60% of patients, respectively.

Journal of Pediatric Orthopaedics, 2014

Osteonecrosis of the femoral head is a major complication in the treatment of developmental dyspl... more Osteonecrosis of the femoral head is a major complication in the treatment of developmental dysplasia of the hip (DDH). Redislocation and secondary surgeries were regarded as risk factors of osteonecrosis. This study aims to clarify whether prior failed closed reduction is a risk factor of osteonecrosis in subsequent surgery. We retrospectively studied 124 patients treated by open reduction and pelvic osteotomy for unilateral DDH before 3 years old. Twenty-five patients had failed closed reduction before the surgery (secondary surgery group), and the other 99 patients had the same surgery as the first treatment (primary surgery group). Osteonecrosis was defined by broadening of femoral neck and fragmentation of epiphysis in the first 3 years after operation. The background data and rate of osteonecrosis were compared between the 2 groups using t test and χ test. Age at surgery and Tönnis grade were not significantly different between the 2 groups. Broadening of the femoral neck was observed in 63 of the 99 hips (63.6%) in the primary surgery group and 7 of the 25 hips (28.0%) in the secondary surgery group (P=0.001). Rate of epiphyseal fragmentation was 34% in primary surgery group and 24% in secondary surgery group (P=0.323). Soft tissue tension could be reduced by previous closed reduction, and redislocation would not carry a greater risk of osteonecrosis in the subsequent open reduction. Therapeutic study: level III.

Archives of Orthopaedic and Trauma Surgery, 2014

Pin site infection is a critical issue for patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; safe... more Pin site infection is a critical issue for patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; safety in skeletal fixation using percutaneous pins or wires. Closed reduction and percutaneous Kirschner wires fixation are the mainstay of treatment in pediatric supracondylar humeral fractures. Little information is available in the literature about the optimal regimen of pin site care in children. We performed a prospective comparative study of 61 children with supracondylar humeral fractures between June 2011 and March 2013 after approval by the institutional review board. They were allocated into two groups of different postoperative pin site care methods by the emergency department arrival date and received fracture fixation within 24 h. Postoperatively, 30 children underwent pin site cleaning every day whereas the other 31 patients did not have the pin sites cleaned until the pins removal 4-6 weeks later. Demographic data were not significantly different between the two groups. The infection rate was significantly higher in patients who underwent daily pin site care (90.3 vs. 53.3 %, p = 0.001). Of the 144 pin sites, infection occurred at 42 (57.5 %) pin sites in the daily care group and at 19 (26.8 %) pin sites in the non-care group. The number of telephone consultations for postoperative care was significantly higher in the daily care group (1.0 vs. 0.27 call/case, p = 0.007). Daily pin site care was associated with a higher infection rate and greater stress in postoperative care that required more telephone consultations. The study results could not support daily pin site care. Careful observation of pin sites was recommended in the treatment of pediatric supracondylar humeral fractures.

The Journal of Trauma: Injury, Infection, and Critical Care, 2004

Two-stage reconstruction is a well-recognized treatment for deep infection of hip joint implants.... more Two-stage reconstruction is a well-recognized treatment for deep infection of hip joint implants. The purpose of the study was to report the results of our treatment using a standardized protocol. Forty-two consecutive patients with deep infection of the hip prosthesis were treated according to a prospective, two-stage resection/reimplantation protocol. Between stages, a custom-made, antibiotic-loaded, cement prosthesis was implanted as an interim spacer. Infection was eradicated in 41 patients after the first-stage operation. Thirty-six patients remained with the ability to walk with the interim cement pros-thesis. For 40 patients who underwent reimplantation, recurrence of infection was observed in only 1 patient at an average of 55.2 months&amp;amp;amp;amp;amp;amp;#39; follow-up. We have found that our two-stage treatment protocol is a reliable approach for the management of infected hip prostheses. It is effective for eradicating infection and for providing a mobile and functional joint through the treatment course.

Journal of Orthopaedic Trauma, 2013

The purpose of this study was to report the efficacy of the Kapandji technique performed in the p... more The purpose of this study was to report the efficacy of the Kapandji technique performed in the prone position for humeral supracondylar fractures in children. Retrospective. Level I trauma center. We retrospectively reviewed 34 children with Gartland type III supracondylar humerus fractures. There were 22 boys and 12 girls with a mean age of 5.2 years (range, 1-12.7 years). Closed reduction and the Kapandji technique were performed in the prone position for all patients. The mean follow-up was 17.4 months (range, 13.2-24.8 months). We assessed preoperative and postoperative radiographs to evaluate the quality of the reduction. The clinical outcome was assessed according to the criteria of Flynn. All operations were performed in a closed manner, no cases required open reduction. Loss of reduction after K-wire fixation was identified in 2 patients. There were no pin-related nerve injuries. The mean range of elbow motion was 139.6 degrees. The clinical outcome was excellent in 31 patients, good in 2 patients (97% excellent or good), and fair in 1 patient. This technique is an effective and safe option to treat type III supracondylar humerus fractures in children. In patients with severe soft tissue swelling, unstable fracture reduction, or unable to achieve acceptable reduction, this technique could facilitate fracture reduction and avoid unnecessary open reduction. The disadvantage of this technique is that the prone position is less desirable for airway management. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Journal of Arthroplasty, 2009

Studies comparing the minimally invasive surgery with 2-incision technique (MIS-2) technique with... more Studies comparing the minimally invasive surgery with 2-incision technique (MIS-2) technique with the conventional transgluteal technique are lacking in the literatures. We compared the clinical outcomes in a series of 166 hips, including 83 MIS-2 total hip arthroplsty (THA) (group I) and another 83 matched-pair series (group II) using conventional transgluteal approach. Demographic data, hospital course, radiographic data, and functional outcome (Western Ontario and McMaster University Osteoarthritis Index and Harris hip score [HHS]) were investigated. The 2 groups significantly differed in 3 and 6-month HHS with a higher HHS in MIS-2 group. But the MIS-2 group had longer operation time, increased blood loss, and more complications. The current study indicates that the benefit of MIS-2 technique was only short-term with quicker functional recovery and shorter duration use of nonsteroid antiinflammatory drugs postoperatively.

The Journal of Arthroplasty, 2008

Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthropla... more Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthroplasty. Between September 2003 and July 2004, 2-incision total hip arthroplasties were done in 18 hips with and another 18 hips without the use of fluoroscopy. In group 1, the anterior skin incision was initially limited to 5 cm. Fracture or instability was checked by fluoroscopy first and then the incision was enlarged to 8 cm for visualization. In group 2, incisions were made long enough to expose the surgical field. There were 2 femoral neck fractures in the fluoroscopy group. The fractures were linear in the anteromedial femoral neck and could not be detected by fluoroscopy. Such linear fractures if overlooked could result in serious complications such as fracture displacement or implant instability. Surgeons should not rely on intraoperative fluoroscopy to check implant stability, and visualization of the surgical field should not be compromised when doing minimally invasive approach for total hip arthroplasty.

The Journal of Arthroplasty, 2008

Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthropla... more Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthroplasty. Between September 2003 and July 2004, 2-incision total hip arthroplasties were done in 18 hips with and another 18 hips without the use of fluoroscopy. In group 1, the anterior skin incision was initially limited to 5 cm. Fracture or instability was checked by fluoroscopy first and then the incision was enlarged to 8 cm for visualization. In group 2, incisions were made long enough to expose the surgical field. There were 2 femoral neck fractures in the fluoroscopy group. The fractures were linear in the anteromedial femoral neck and could not be detected by fluoroscopy. Such linear fractures if overlooked could result in serious complications such as fracture displacement or implant instability. Surgeons should not rely on intraoperative fluoroscopy to check implant stability, and visualization of the surgical field should not be compromised when doing minimally invasive approach for total hip arthroplasty.

Journal of Pediatric Orthopaedics B, 2013

Formosan Journal of Musculoskeletal Disorders

ABSTRACT Background/PurposeSpastic hip displacement is a common musculoskeletal problem in cerebr... more ABSTRACT Background/PurposeSpastic hip displacement is a common musculoskeletal problem in cerebral palsy (CP), leading to further complications in daily life. Deformities of the proximal femur were regarded as a factor in hip displacement, and therefore, femoral osteotomy is often recommended. This study aims to identify the relationship between hip displacement and femoral deformities.Methods We retrospectively collected preoperative radiography and three-dimensional computed tomography (3D-CT) images from 19 nonambulatory CP children with unilateral hip displacement (average age: 8.4 years; range: 4.4–13.6). The 3D image of femur was reconstructed for measuring the femur anteversion angle (FAA) and true femoral neck-shaft angle (NSA). The association among migration percentage (MP), acetabular index (AI), FAA, and NSA between nondisplaced and displaced hips was analyzed by paired t test and its correlations were identified.ResultsThe FAA and AI are significantly greater in displaced hips (42.7° vs. 36.3° and 32.8° vs. 22.7°, respectively, p &lt; 0.001). However, the NSA is similar between displaced and nondisplaced hips. The AI and FAA have significantly positive correlations with MP between nondisplaced hips and displaced hips (0.69 and 0.57, respectively).Conclusion Using reconstructed 3D-CT images we can directly measure and prove these femoral deformities. We found that AI has a positive correlation with MP (0.69), which is consistent with the results of previous studies. The displaced side has greater femur anteversion (42.7° vs. 36.3°), and coxa valga is common in these nonambulatory patients, irrespective of whether or not these patients underwent hip displacement. In addition, the severity of AI and anteversion angle will be affected by the MP.

Chang Gung Medical Journal, 2010

Background: Tuberculous osteomyelitis of the long bone in children is often neglected, and establ... more Background: Tuberculous osteomyelitis of the long bone in children is often neglected, and established transphyseal bone lesions are common. The purpose of this study was to evaluate the clinical outcomes of these patients. Methods: Between January 1990 and December 2008, 19 patients (10 boys and 9 girls) with sustained tuberculous osteomyelitis of the long bone accompanied by physeal involvement were treated at our institute. The average age was 23.8 months (range, 10-58 months). All patients received surgical treatment and antituberculosis therapy for at least 6 months. The final radiographic and functional results were analyzed. Results: All patients were followed up for an average of 61.8 months (range, 14-123 months). The most common site of infection was the distal femur (8 patients, 42.1%), followed by the proximal tibia (5 patients, 26.3%) and the distal tibia (3 patients, 15.8%). Most of the lesions were osteolytic, round to oval in shape, and showed marginal sclerosis. Some lesions were expanding or multiloculated. The periosteal reaction was minimal. Even in cases with extensive surgical curettage through the physis, the growth plate maintained its function and gradually remodeled. Clinical symptoms improved within 4-6 weeks. All bone lesions decreased in size in 3-6 months. Further, physeal bar formation was observed, but the extent was minimal. All transphyseal lesions healed gradually over a period of several years. Good remodeling of skeletal lesions was noted. Conclusions: The diagnosis of tuberculous osteomyelitis of the long bone should be considered in every child with unexplained chronic limb pain or swollen limbs. The lesions are usually located in the metaphysis and easily cross the growth plate to the epiphysis. Surgical debridement is beneficial in both diagnosis and treatment. In patients with growth plate involvement, careful surgical debridement is recommended to eradicate infection since the risk of permanent physeal damage is minimal. The physis can heal gradually, and full range of motion of the adjacent joints can be maintained.

Chang Gung Medical Journal, Jun 1, 2002

Background: The cementless fixation technique in total hip arthroplasty (THA) was developed to so... more 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.

Chang Gung Medical Journal, 2005

Background: The optimal treatment for femoral fractures in children is controversial. The purpose... more Background: The optimal treatment for femoral fractures in children is controversial. The purpose of this study was to compare the results of Rush pin fixation with those of conservative treatment, and to evaluate the sequels of growth plate injury by internal fixation. Methods: Eighteen femoral shaft fractures in 17 children who had concomitant head injury or multiple traumas were treated surgically. The mean age at operation was 9 years 3 months (range, 7 years 5 months to 11 years 1 month). One Rush pin was inserted from the tip of the greater trochanter, without reaming, to fix the fracture. Another 20 age-matched children treated by traction and casting were the control subjects. Results: All the fractures united without consequences. In addition to a decrease in hospital stay with the use of the Rush pin (10 days vs. 27 days, p<0.05), fewer leg length discrepancies (4.2 mm vs. 7.1 mm, p<0.05) were also noted, compared with conservative treatment. The growth of the proximal femur after Rush pin fixation was evaluated after an average of 59 months. No femur shortening, coxa valgus, or hip dysplasia was noted. Conclusions: Intramedullary Rush pin fixation for femoral shaft fracture in children older than 7 years is a simple and reliable alternative. One narrow and non-reaming pin inserted from greater trochanter did not demonstrate femoral growth inhibition.

Formosan Journal of Musculoskeletal Disorders, 2012

We report the case of a patient in whom the use of monolateral double-row Trauma-Fix lengthener w... more We report the case of a patient in whom the use of monolateral double-row Trauma-Fix lengthener was successful for femur lengthening after initial difficulty in lengthening by using the single-row lengthener. Problem and case report: A girl 12 years of age presented with a leg-length discrepancy (LLD) of 8 cm and left genu valgum deformity due to a trauma-induced left distal femur physial lesion during her infancy. The patient's weight and height were 38 kg and 148 cm, respectively, and the mechanical axis was 16 degrees of valgus at the time of operation. The lengthening procedure was initiated on postoperative day 7 after the initial correction of the genu valgum deformity. However, no distraction was observed at the osteotomy site, and a convergent angulation deformity developed at the pin-clamp joint. Method and outcome: This problem was resolved successfully with the addition of another row of the Trauma-Fix lengthening device, which was linked via the previously applied pins. A final lengthening of 7.5 cm was achieved in 3 months by using the double-row lengthener without pin tract infection or breakage. The monolateral frame of the Trauma-Fix lengthener was removed in the 11th postoperative month after a solid union of the femur was achieved. The postoperative mechanical axis of the knee was 4 degrees varus. The monolateral double-row lengthener device that showed high efficiency and improved the strength of the ball joints were used along the single-row lengthener, and it may serve as a good alternative for augmentation of insufficient ball joints during limb lengthening.

BioMed Research International, 2015

Pin site infection is a common complication after fracture fixation and bone lengthening, and dai... more Pin site infection is a common complication after fracture fixation and bone lengthening, and daily pin site care is recommended. Weather is a strong environmental factor of infection, but few articles studied the issue of weather and pin site infection. We performed a prospective comparative study of 61 children with supracondylar humeral fractures treated by closed reduction and percutaneous pinning. The patients were divided into high-temperature season or low-temperature season by the months they received surgery. The patients within each season were further allocated to 2 groups by the different postoperative pin site care methods of daily care or noncare. The infection rate per patient was significantly higher in the high-temperature season compared to low-temperature season (45% versus 19%,P= 0.045). In the high-temperature season, the infection rate per patient was significantly higher in the daily care group versus the noncare group (70% versus 20%,P= 0.001). In the low-tem...

Journal of orthopaedic surgery (Hong Kong), 2000

One hundred and sixty-six cementless primary total hip arthroplasties were performed in 133 patie... more 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.

Changgeng yi xue za zhi / Changgeng ji nian yi yuan = Chang Gung medical journal / Chang Gung Memorial Hospital, 1998

Os trigonum tarsi is found in 7% of the world adult population. However, it rarely causes symptom... more Os trigonum tarsi is found in 7% of the world adult population. However, it rarely causes symptoms. The majority of patients with os trigonum tarsi are found incidentally. This condition is often found in ballet dancers, javelin throwers and soccer players. It rarely produces symptoms in normally active adults. The etiology of os trigonum syndrome is impingement of an unfused ossicle or a fractured posterior lateral tubercle of talus over the posterior rim of tibial plafond. We present a case of os trigonum syndrome in a young man. His posterior heel pain was due to tophaceous gout around the os trigonum tarsi, instead of the common pathogenesis of repeated hyperflexion of the ankle joint. Pictures of the specimen showed marked giant cell reaction which resulted in pseudotumor formation. We reviewed the clinical characteristics of os trigonum tarsi and gout and present the treatment of our patient.

Journal of Pediatric Orthopaedics B, 2015

Radiographic parameters for evaluating hip development are altered by Salter osteotomy, and their... more Radiographic parameters for evaluating hip development are altered by Salter osteotomy, and their prognostic value require further validation. A total of 63 patients who underwent open reduction and Salter osteotomy for unilateral hip dysplasia were evaluated with Severin classification 10.8 years later. The initial first-year postoperative acetabular index, c/b ratio, head-teardrop distance, and head coverage were compared with the final outcome of Severin classification. Greater c/b ratio was significantly associated with later Severin class III hip. Using receiver operating characteristics curve, a c/b ratio greater than 0.72 at 6 months and 1 year postoperatively can predict the possibility of a class III hip in 30 and 60% of patients, respectively.

Journal of Pediatric Orthopaedics, 2014

Osteonecrosis of the femoral head is a major complication in the treatment of developmental dyspl... more Osteonecrosis of the femoral head is a major complication in the treatment of developmental dysplasia of the hip (DDH). Redislocation and secondary surgeries were regarded as risk factors of osteonecrosis. This study aims to clarify whether prior failed closed reduction is a risk factor of osteonecrosis in subsequent surgery. We retrospectively studied 124 patients treated by open reduction and pelvic osteotomy for unilateral DDH before 3 years old. Twenty-five patients had failed closed reduction before the surgery (secondary surgery group), and the other 99 patients had the same surgery as the first treatment (primary surgery group). Osteonecrosis was defined by broadening of femoral neck and fragmentation of epiphysis in the first 3 years after operation. The background data and rate of osteonecrosis were compared between the 2 groups using t test and χ test. Age at surgery and Tönnis grade were not significantly different between the 2 groups. Broadening of the femoral neck was observed in 63 of the 99 hips (63.6%) in the primary surgery group and 7 of the 25 hips (28.0%) in the secondary surgery group (P=0.001). Rate of epiphyseal fragmentation was 34% in primary surgery group and 24% in secondary surgery group (P=0.323). Soft tissue tension could be reduced by previous closed reduction, and redislocation would not carry a greater risk of osteonecrosis in the subsequent open reduction. Therapeutic study: level III.

Archives of Orthopaedic and Trauma Surgery, 2014

Pin site infection is a critical issue for patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; safe... more Pin site infection is a critical issue for patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; safety in skeletal fixation using percutaneous pins or wires. Closed reduction and percutaneous Kirschner wires fixation are the mainstay of treatment in pediatric supracondylar humeral fractures. Little information is available in the literature about the optimal regimen of pin site care in children. We performed a prospective comparative study of 61 children with supracondylar humeral fractures between June 2011 and March 2013 after approval by the institutional review board. They were allocated into two groups of different postoperative pin site care methods by the emergency department arrival date and received fracture fixation within 24 h. Postoperatively, 30 children underwent pin site cleaning every day whereas the other 31 patients did not have the pin sites cleaned until the pins removal 4-6 weeks later. Demographic data were not significantly different between the two groups. The infection rate was significantly higher in patients who underwent daily pin site care (90.3 vs. 53.3 %, p = 0.001). Of the 144 pin sites, infection occurred at 42 (57.5 %) pin sites in the daily care group and at 19 (26.8 %) pin sites in the non-care group. The number of telephone consultations for postoperative care was significantly higher in the daily care group (1.0 vs. 0.27 call/case, p = 0.007). Daily pin site care was associated with a higher infection rate and greater stress in postoperative care that required more telephone consultations. The study results could not support daily pin site care. Careful observation of pin sites was recommended in the treatment of pediatric supracondylar humeral fractures.

The Journal of Trauma: Injury, Infection, and Critical Care, 2004

Two-stage reconstruction is a well-recognized treatment for deep infection of hip joint implants.... more Two-stage reconstruction is a well-recognized treatment for deep infection of hip joint implants. The purpose of the study was to report the results of our treatment using a standardized protocol. Forty-two consecutive patients with deep infection of the hip prosthesis were treated according to a prospective, two-stage resection/reimplantation protocol. Between stages, a custom-made, antibiotic-loaded, cement prosthesis was implanted as an interim spacer. Infection was eradicated in 41 patients after the first-stage operation. Thirty-six patients remained with the ability to walk with the interim cement pros-thesis. For 40 patients who underwent reimplantation, recurrence of infection was observed in only 1 patient at an average of 55.2 months&amp;amp;amp;amp;amp;amp;#39; follow-up. We have found that our two-stage treatment protocol is a reliable approach for the management of infected hip prostheses. It is effective for eradicating infection and for providing a mobile and functional joint through the treatment course.

Journal of Orthopaedic Trauma, 2013

The purpose of this study was to report the efficacy of the Kapandji technique performed in the p... more The purpose of this study was to report the efficacy of the Kapandji technique performed in the prone position for humeral supracondylar fractures in children. Retrospective. Level I trauma center. We retrospectively reviewed 34 children with Gartland type III supracondylar humerus fractures. There were 22 boys and 12 girls with a mean age of 5.2 years (range, 1-12.7 years). Closed reduction and the Kapandji technique were performed in the prone position for all patients. The mean follow-up was 17.4 months (range, 13.2-24.8 months). We assessed preoperative and postoperative radiographs to evaluate the quality of the reduction. The clinical outcome was assessed according to the criteria of Flynn. All operations were performed in a closed manner, no cases required open reduction. Loss of reduction after K-wire fixation was identified in 2 patients. There were no pin-related nerve injuries. The mean range of elbow motion was 139.6 degrees. The clinical outcome was excellent in 31 patients, good in 2 patients (97% excellent or good), and fair in 1 patient. This technique is an effective and safe option to treat type III supracondylar humerus fractures in children. In patients with severe soft tissue swelling, unstable fracture reduction, or unable to achieve acceptable reduction, this technique could facilitate fracture reduction and avoid unnecessary open reduction. The disadvantage of this technique is that the prone position is less desirable for airway management. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Journal of Arthroplasty, 2009

Studies comparing the minimally invasive surgery with 2-incision technique (MIS-2) technique with... more Studies comparing the minimally invasive surgery with 2-incision technique (MIS-2) technique with the conventional transgluteal technique are lacking in the literatures. We compared the clinical outcomes in a series of 166 hips, including 83 MIS-2 total hip arthroplsty (THA) (group I) and another 83 matched-pair series (group II) using conventional transgluteal approach. Demographic data, hospital course, radiographic data, and functional outcome (Western Ontario and McMaster University Osteoarthritis Index and Harris hip score [HHS]) were investigated. The 2 groups significantly differed in 3 and 6-month HHS with a higher HHS in MIS-2 group. But the MIS-2 group had longer operation time, increased blood loss, and more complications. The current study indicates that the benefit of MIS-2 technique was only short-term with quicker functional recovery and shorter duration use of nonsteroid antiinflammatory drugs postoperatively.

The Journal of Arthroplasty, 2008

Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthropla... more Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthroplasty. Between September 2003 and July 2004, 2-incision total hip arthroplasties were done in 18 hips with and another 18 hips without the use of fluoroscopy. In group 1, the anterior skin incision was initially limited to 5 cm. Fracture or instability was checked by fluoroscopy first and then the incision was enlarged to 8 cm for visualization. In group 2, incisions were made long enough to expose the surgical field. There were 2 femoral neck fractures in the fluoroscopy group. The fractures were linear in the anteromedial femoral neck and could not be detected by fluoroscopy. Such linear fractures if overlooked could result in serious complications such as fracture displacement or implant instability. Surgeons should not rely on intraoperative fluoroscopy to check implant stability, and visualization of the surgical field should not be compromised when doing minimally invasive approach for total hip arthroplasty.

The Journal of Arthroplasty, 2008

Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthropla... more Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthroplasty. Between September 2003 and July 2004, 2-incision total hip arthroplasties were done in 18 hips with and another 18 hips without the use of fluoroscopy. In group 1, the anterior skin incision was initially limited to 5 cm. Fracture or instability was checked by fluoroscopy first and then the incision was enlarged to 8 cm for visualization. In group 2, incisions were made long enough to expose the surgical field. There were 2 femoral neck fractures in the fluoroscopy group. The fractures were linear in the anteromedial femoral neck and could not be detected by fluoroscopy. Such linear fractures if overlooked could result in serious complications such as fracture displacement or implant instability. Surgeons should not rely on intraoperative fluoroscopy to check implant stability, and visualization of the surgical field should not be compromised when doing minimally invasive approach for total hip arthroplasty.

Journal of Pediatric Orthopaedics B, 2013