Gau-Tyan Lin

Dome corrective osteotomy for cubitus varus deformity

Between 1994 and 1998, 15 patients had corrective dome-shaped osteotomy of the humerus for posttraumatic cubitus varus deformity. Thirteen patients had surgery before puberty and two patients had surgery after puberty. In the prepuberty group, all the osteotomies were done by a posterior approach with triceps muscle splitting, and cross pins were used to fix the osteotomy. In the postpuberty group, the osteotomies were done by a posterior approach with olecranon osteotomy, and reconstructive plates were used for fixation. The average followup was 2 years and 4 months. Preoperative carrying angle ranged from 19° to 31° varus (average, 26.2° ) and postoperative carrying angle ranged from 7° to 15° valgus (average, 10.7°). No loss of correction was observed and all osteotomies united. The preoperative and postoperative differences of the lateral condylar prominence index ranged from −67% to +6% (average, −30.1%). After reviewing these cases, a dome-shaped osteotomy was found to have the following advantages for correction of cubitus varus deformity: the osteotomy site is more stable than a lateral closing wedge osteotomy for maintaining the correction obtained; the domed osteotomy avoids having the lateral condyle becoming prominent; and the posterior scar is more cosmetically acceptable than the lateral scar in the lateral closing wedge osteotomy.

Development of a Chinese Version of the Oswestry Disability Index Version 2.1

Study Design. Cross-cultural adaptation and cross-sectional psychometric testing in a convenience sample of patients with low back pain. Objective. To translate and culturally adapt the Oswestry Disability Index version 2.1 (ODI 2.1) into a Mandarin Chinese version and to assess its reliability and validity. Summary of Background Data. The Chinese ODI 2.1 has not been developed and validated. Methods. The ODI 2.1 was translated and culturally adapted to the Chinese version. The validity of the translated Chinese version was assessed by examining the relationship between the ODI and other well-known measures. Test–retest reliability was examined in 52 of these patients, who completed a second questionnaire within 1 week. Results. Internal consistency of the ODI 2.1 was excellent with Cronbach’s &agr; = 0.903. The intraclass correlation coefficient of test–retest reliability was 0.89. The minimal detectable change was 12.8. The convergent validity of the Chinese ODI is supported by its high correlation with other physical functional status measures (Roland Morris Disability Questionnaire and SF-36 physical functioning subscale, r = 0.76 and −0.75, respectively), and moderate correlation with other measures (Visual Analogue Scale, r = 0.68) and certain SF-36 subscales (role-physical, bodily pain, and social functioning, r range: −0.49 to −0.57). As expected, the ODI was least correlated with nonfunctional measures (SF-36 mental subscale and role-emotional subscale, r = −0.25 and −0.33, respectively). Conclusion. The results of this study indicate that the Chinese version of the ODI 2.1 is a reliable and valid instrument for the measurement of functional status in patients with low back pain.

Management Strategy for Unicameral Bone Cyst

The management of a unicameral bone cyst varies from percutaneous needle biopsy, aspiration, and local injection of steroid, autogenous bone marrow, or demineralized bone matrix to the more invasive surgical procedures of conventional curettage and grafting (with autogenous or allogenous bone) or subtotal resection with bone grafting. The best treatment for a unicameral bone cyst is yet to be identified. Better understanding of the pathology will change the concept of management. The aim of treatment is to prevent pathologic fracture, to promote cyst healing, and to avoid cyst recurrence and re‐fracture. We retrospectively reviewed 17 cases of unicameral bone cysts (12 in the humerus, 3 in the femur, 2 in the fibula) managed by conservative observation, curettage and bone grafting with open reduction and internal fixation, or continuous decompression and drainage with a cannulated screw. We suggest percutaneous cannulated screw insertion to promote cyst healing and prevent pathologic fracture. We devised a protocol for the management of unicameral bone cysts.

Carpal Tunnel Syndrome and Finger Movement Dysfunction Caused by Tophaceous Gout: A Case Report

We describe a case of tophaceous gout with a combination of carpal tunnel syndrome and finger movement dysfunction. Carpal tunnel syndrome secondary to gout is uncommon. The concomitant presence of finger movement dysfunction is rare and suggests the involvement of the flexor tendons inside the carpal tunnel. Surgery is recommended to decompress the median nerve, to confirm the diagnosis, and for immediate improvement of flexor tendon excursion. Our patients finger movement improved dramatically soon after surgery.

Core decompression for osteonecrosis of the femoral head at pre-collapse stage.

Twenty-five patients (27 hips) were retrospectively studied for core decompression in the treatment of osteonecrosis of the femoral heads at pre-collapse stage, Ficat and Alert stages I and II, from Apr. 1984 to Jun. 1998 with follow-up period at least 1 yr (mean 28 months). Eleven hips (10 patients) were considered to have failed due to progressive collapsed more than 2 mm, severe pain or reoperation. We further analyzed the results with regard to the stages, the size of the necrotic area according to the Ohzono classification, the lateral head index (LHI) and the Kerboul combined necrotic angle. The survival rate according to the Ohzono classification was type 1B: 100%, 1C: 44%, 2: 25%, and 3B: 0%. Hips with Kerboul angle less than 250 degrees revealed satisfactory results in all except one hip. All hips with Kerboul angle more than 250 degrees collapsed. Fourteen of the 15 hips (93%) with lateral head index more than 20% did not collapse and all hips except one (7/8) with LHI less than 12% collapsed. We conclude core decompression yields satisfactory results in osteonecrotic femoral heads at pre-collapse stage and with small necrotic area or good lateral buttress.

Clinical application of ultrasonography for detection of septic arthritis in children.

For early detection of the effusion of infected joint, 40 children were examined by ultrasound scanner for suspected septic arthritis. Thirty-one patients were found with joint effusion, and the needle aspirations of these 31 joints confirmed septic arthritis in 22 patients. In 3 patients, in addition to the joint effusion, the joint surrounding subperiosteal abscess and cortical erosion also were found on sonography, resulting in a diagnosis of concurrent osteomyelitis. In two patients, sonography confirmed only soft tissue swelling and abscess formation on the buttock, but without hip joint effusion. These findings excluded the diagnosis of septic arthritis and helped us obviate the unnecessary attempts at joint aspiration. In one patient, sonography revealed only flexor tenosynovitis without wrist joint effusion. This case was later treated by tenosynovectomy rather than wrist arthrotomy and the pathological examination showed to be a tuberculous tenosynovitis. From the preliminary results, we find ultrasonography has the following advantages for the diagnosis of septic arthritis: 1.) ultrasonography is very sensitive in detecting the joint effusion of septic arthritis; 2.) ultrasonography can clearly define the pathological extent of septic arthritis and help clinicians to treat the concurrent osteomyelitis by appropriate surgical debridement; and 3.) ultrasonography can differentiate soft tissue abscess or tenosynovitis from septic arthritis and help clinicians obviate unnecessary needle joint aspiration.

Anterior Approach for Posteromedial Tibial Plateau Fractures

Fractures of the posteromedial tibial plateau are rare and their treatment is not well established. Between January 2004 and December 2008, eight patients with fractures of the posteromedial tibia plateau were identified. All patients were treated with fracture reduction using an anterior approach. After a mean follow‐up of 21 months, the average range of knee motion was 0–123° of flexion. Seven patients had been injured in motor‐scooter accidents, in which the protective front plate of the scooter had hit the knee while it was in the 90°‐flexion position. At the final follow‐up, 87.5% (7/8) patients had satisfactory reductions of the articular surface, and all patients had acceptable alignments. There were no neural or vascular injuries following surgery, and no superficial or deep infections. The average Hospital for Special Surgery Knee Score was 89. In conclusion, fracture reduction using the anterior approach is associated with fewer complications than the posterior approach, and good functional recovery can be expected.

INTRAMEDULLARY PINNING WITH TENSION-BAND WIRING FOR SURGICAL NECK FRACTURES OF THE PROXIMAL HUMERUS IN ELDERLY PATIENTS

Most proximal humeral fractures in the elderly population are related to osteoporosis. Several methods have been proposed to treat surgical neck fractures of the proximal humerus in elderly people. This study investigates a new method of intramedullary pinning with tension‐band wiring. From June 1998 to March 2001, 10 female patients with a mean age of 73.0 years and displaced two‐ or three‐part surgical neck fractures of the proximal humerus were studied. Two intramedullary pins were used with tension‐band wiring via a deltopectoral approach with minimum dissection. The mean follow‐up was 20.6 months. Final outcome was evaluated using the constant score, visual analog scale (VAS) score, questionnaire, and an outcome assessment form. The outcome was excellent in four patients, good in five, and fair in one. The mean Constant score was 80.8 and the VAS score was 83.0. There was no nonunion, avascular necrosis, deep infection, or pin migration. No patient needed further revision open reduction with internal fixation or prosthesis replacement. We therefore concluded that intramedullary pinning with tension‐band wiring is a safe, reliable method, with few complications, for treating surgical neck fractures of the proximal humerus in elderly patients.

Failure of the locking mechanism between the acetabular metal shell and the polyethylene liner after primary total hip arthroplasty--a case report.

The short and intermediate-term clinical and radiographic results associated with Harris-Galante II porous-coated acetabular modular cup without cementing have been excellent in most patients. Nevertheless, its modular design introduced the potential for failure of the locking mechanism. There are four pairs of locking ties on the rim of metal shell to fix the polyethylene liner within it. Failure of any locking tine would result in less rigid fixation between the metal shell and the polyethylene liner and potentially produce instability or even disassembling of the liner. Only nine cases have been reported previously about the fractures of the locking tine, but it has never been reported in literature in Taiwan. We report a case with fracture of one tine following minor trauma at five years after primary total hip arthroplasty. During reoperation, scratching injury on the outer surface of the polyethylene liner in contact with the inferior tines of the metal shell was noted. Although no disassembling of the liner was noted, the remaining locking mechanism was found to be less rigid when the liner was taken out of the shell. The locking mechanism of HG II cup may be mechanically weak and may fail without major trauma; therefore, its design ought to be improved in an attempt to prevent postoperative dissociation of the polyethylene liner.

Close-Wedge Osteotomy for Bony Locking Stiffness of the Elbow in Gorham Disease Patients: A Case Report

Gorham disease is a so‐called massive idiopathic osteolysis or vanishing bone disorder. Massive osteolysis remains an enigmatic condition that involves various skeletal locations and is caused by endothelial proliferation. The diagnosis is difficult and is established via the association of clinical, radiologic and histologic pictures. Treatment modalities yield variable results. We report a case of vanishing bone in the elbow joint and carpal bones following trauma. This 13‐year‐old boy complained of severe restricted motion and deformity of the right elbow. We managed the problem using arthroplasty with close‐wedge osteotomy on the lateral condyle of the humerus.