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ABSTRACT: BACKGROUND: Abscesses involving the inguinal region as manifestations of complex soft-tissue infections are rare, and the infectious route is usually unclear. To ascertain the importance of imaging study and whether the clinical presentations differ between the extrapelvic and intrapelvic origin. METHODS: Patients who presented with inguinal abscess between January 2003 and December 2010 were evaluated retrospectively. All patients received broad-spectrum antibiotic therapy and debridement. Imaging studies, including computed tomography or magnetic resonance imaging, were performed in all patients to elucidate the origin and extent of infectious disease, and the results were reviewed. Clinical data, laboratory examination findings, and culture results were analyzed. RESULTS: Twenty-eight patients were enrolled in the study: 13 patients whose infections were of extrapelvic origin (Group 1) and 15 patients of intrapelvic origin (Group 2). Imaging studies yielded information that helped guiding the treatment. Gram-positive coccus infection was more frequent in Group 1 (p < 0.001), while mixed pathogen and anaerobic bacterial infection were more frequent in Group 2 (p = 0.002 and p = 0.006, respectively). Group 2 had a higher incidence of history of malignancy and chronic renal failure (p = 0.044 and p = 0.038, respectively). CONCLUSIONS: Computed tomography and magnetic resonance imaging are helpful in diagnosing cases of inguinal abscess and determining the extent of infection. In patients presenting with acute pyogenic inguinal abscess, a higher prevalence of chronic renal failure and history of malignancy were found in those with an intrapelvic, as compared with an extrapelvic, origin of infection.
BMC Infectious Diseases 03/2013; 13(1):155. · 3.12 Impact Factor
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ABSTRACT: BACKGROUND: Iliosacral screw fixation has generally been accepted as a treatment for unstable pelvic fractures with posterior sacroiliac joint disruption despite a 2-16% rate of screw malposition. The integration of an intraoperative computed tomography (iCT) with a navigation system was utilized in percutaneous sacroiliac screwing to provide an alternative. METHODS: From October 2010 to November 2011, thirteen patients presented pelvic fractures with posterior ring disruption (lateral compression type 2-3 [n=12] and vertical shear type [n=1] by Young-Burgess Classification) and underwent percutaneous iliosacral screwing using an iCT integrated with navigation system. The perioperative data and radiographic outcomes of the patients were collected and analyzed. RESULTS: Navigation times ranged from 10 to 45min (mean of 21.2±10.6min). Radiation exposure to the skin utilizing integrated navigation system ranged from 23.5 to 28.1mGy (mean of 26.4±1.5mGy), and the dose associated with examining the screw position ranged from 22.5 to 26.8mGy (mean of 25.5±1.1mGy). Effective dose of radiation ranged from 9.26 to 17.43mSv (mean of 13.16±2.52mSv). The iCT demonstrated iliosacral screws in adequate position (i.e., no penetration or encroachment of the neuroforamen or cord). No neurologic or vascular injury occurred in these cases. CONCLUSIONS: An iCT with an integrated navigation system provided accuracy for percutaneous iliosacral screwing. In addition, the accumulated dose was minimized for surgeons. However, effective dose of radiation in iCT with an integrated navigation system group was higher than fluoroscopic-assisted iliosacral screwing in hands of the same group of surgeons. No neurologic complications occurred. The iCT with an integrated navigation system provided an alternative to percutaneous iliosacral screwing.
Injury 10/2012; · 1.98 Impact Factor
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ABSTRACT: Medial collateral ligament (MCL) healing proceeds in a temporally ordered fashion after injury. Despite the critical roles of fibroblasts during ligament repair, the phenotypic features of these healing fibroblasts have not been well characterized. Here, we show that healing MCL fibroblasts obtained from rabbits at 3-week postinjury exhibited higher rates of senescent phenotypes and produced higher levels of TGF-β1, collagens, α-SMA, and matrix metalloproteinases (MMPs), than the corresponding fibroblasts from sham-operated MCLs. Mechanical stretch further enhanced the cellular senescence and the expression of TGF-β1, collagens, α-SMA, and MMPs in both sham and healing MCL fibroblasts. In addition to MCL fibroblasts at 3-week postinjury, the increased cellular senescence was also detected in healing MCL fibroblasts obtained at 4- and 6-week postinjury. Most importantly, the association between the cellular senescence and ligament healing was confirmed in tissue sections by the senescence-associated β-galactosidase (SA-β-gal) staining. Using a recombinant TGF-β1 and a neutralizing antibody, we found that those phenotypic changes, such as cellular senescence and the expression of collagens and MMPs, in MCL fibroblasts under mechanical loading conditions were regulated through TGF-β1. Taken together, our results propose that cellular senescence and turnover of extracellular matrixes regulated by TGF-β1 in MCL fibroblasts are critical for ligament healing. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Journal of Orthopaedic Research 09/2012; · 2.81 Impact Factor
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ABSTRACT: Necrotizing fasciitis is a true surgical emergency. This study was undertaken to determine whether clinical indicators could be used to initiate early surgery, and to compare the characteristics observed on initial examination of necrotizing fasciitis in patients who died and those who survived.
We retrospectively reviewed the medical records of 143 patients with surgically confirmed necrotizing fasciitis of the extremities over a period of 3.5 years at a tertiary hospital of southwest Taiwan. Differences in mortality, patient characteristics, laboratory findings, and hospital course were compared between patients who died and those who survived, and between patients with Gram-positive infections and those with Gram-negative infections.
A patient with a fungal infection died. Nine of the 58 patients in the Gram-positive group (15.5%) and 12 of the 60 cases in the Gram-negative group (20%) died. Hence a total of 22 patients died, giving a mortality rate of 15.4%. Hypotension, lower counts of total and segmented leukocytes, higher counts of banded leukocytes, and lower levels of serum albumin were significantly associated with mortality. Monomicrobial infections had a stake of 70.6%, and Vibrio spp were the predominant causative agents (26.6%).
Hypotensive shock, severe hypoalbuminemia, and increased counts of banded leukocytes can be considered the clinical and laboratory risk indicators to initiate early surgery and to predict mortality for all types of necrotizing fasciitis. The clinical characteristics of Gram-negative infections were more fulminant than those of Gram-positive infections.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 12/2011; 16(3):e159-65. · 2.17 Impact Factor
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ABSTRACT: The value of computer-assisted surgery in total knee arthroplasty for arthritic knees continues to be debated. We hypothesized that the usefulness of computer assistance is related to the magnitude of the deviation from the preoperative mechanical axis and that computer-assisted surgery may be beneficial under certain circumstances.
Patients with bilateral knee osteoarthritis and genu varus deformity who were to have staged bilateral total knee arthroplasty were enrolled. The patients randomly underwent computer-assisted total knee arthroplasty in one knee and conventional total knee arthroplasty in the contralateral knee. The two methods were compared for accuracy of placement of the components and lower extremity alignment after total knee arthroplasty as determined by six radiographic parameters.
One hundred and thirteen patients (226 knees) met the inclusion criteria. For patients with a preoperative mechanical axis deviation of <10° and those with a deviation of 10° to 14.9° in both knees, the postoperative radiographic parameters did not differ significantly between the two techniques. In patients with a preoperative mechanical axis deviation of >20°, the reconstructed mechanical axes were significantly closer to normal in the computer-assisted total knee arthroplasty group. Significant results were also noted in the anatomical axes, femoral valgus angle, and femoral flexion angle. Furthermore, a higher percentage of knees in which computer-assisted surgery was used had restoration of the mechanical axis within 3° of neutral.
Computer-assisted surgery was a valuable adjunct for obtaining proper alignment during total knee arthroplasty in patients with knee osteoarthritis with severe varus deformity. Conventional total knee arthroplasty was as effective as computer-assisted total knee arthroplasty for obtaining proper alignment in patients with a minor to moderate deformity.
The Journal of Bone and Joint Surgery 07/2011; 93(13):1197-202. · 3.27 Impact Factor
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ABSTRACT: A two-stage revision arthroplasty was suggested optimal treatment for deep infections in hip joint. The effect of endoskeleton of cement spacers on the interim function and infection control remains unclear.
From Jan. 2004 to Dec. 2007, we collected a prospective cohort of consecutive 34 patients who treated with two-stage revision total hip arthroplasty for deep infection of hip joint. In group 1, fifteen patients were treated by a novel design augmented with hip compression screw while nineteen patients were treated by traditional design in group 2.
No fracture of cement spacer occurred in group 1 while 6 cases developed spacer failure in group 2. (p < 0.05) There were significant differences in bodily pain and general health perception between groups (p < 0.05).
Patients being treated for deep infection of hip joint using cement spacer augmented with stronger endoskeleton have lower pain levels and better joint function between stages.
BMC Musculoskeletal Disorders 01/2011; 12:10. · 1.58 Impact Factor
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ABSTRACT: Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen.
Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1) and 35 patients with a gram-negative pathogen (Group 2).
Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors.
Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis.
BMC Infectious Diseases 01/2011; 11:5. · 3.12 Impact Factor
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ABSTRACT: A 2-stage revision arthroplasty has been suggested as the optimal treatment for deep infections in the hip joint. Improvement of the surgical technique to increase the interim function is subject to investigation. From 2004 to 2007, we collected a cohort of 15 consecutive patients who were treated by a novel design augmented with a modified hip compression screw. No fracture of the cement spacer occurred. We believe the modified hip compression screw is a good alternative for the functional endoskeleton of an antibiotic loaded cement prosthesis in the treatment of deep hip infection.
The Journal of arthroplasty 12/2010; 25(8):1304-6. · 1.79 Impact Factor
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ABSTRACT: To assess whether disruption of the posterior cortex of intracapsular femoral fractures leads to an increased incidence of complications following closed reduction and internal fixation by multiple cannulated screws in young adults.
A total of 146 consecutive adult patients with 146 femoral neck fractures were treated by closed reduction and internal fixation with parallel cannulated screw in inverted triangle or diamond configurations. All enrolled patients were divided into three groups: those with a non-displaced femoral neck fracture (Garden types I or II), those with a displaced femoral neck fracture (Garden types III or IV)but no posterior cortex disruption and those with a displaced femoral neck fracture (Garden types III or IV) and a disrupted posterior cortex.Results: Based on an average follow-up of 4.76 years (range, 2–6 years), displaced femoral neck fractures with a disrupted posterior cortex demonstrated an increased risk for avascular necrosis of the femoral head, shortening, redisplacement and conversion of prosthetic replacement as compared with those fractures without posterior cortex disruption (p = 0.002, 0.016, 0.001 and <0.0001, respectively).
As compared with a femoral neck fracture with an intact posterior cortex, a displaced femoral neck fracture with a disrupted posterior cortex increases the risk for avascular necrosis,redisplacement and shortening and raises the likelihood that prosthetic replacement will be needed.Orthopaedic surgeons should be aware of this prognostic factor.
Injury 11/2010; 42(2):217-22. · 1.98 Impact Factor
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ABSTRACT: Computer-assisted surgery-total knee arthroplasty (CAS-TKA) has been suggested to afford greater precision than conventional TKA; however, it is unclear whether this is influenced by preoperative angular deformity. This prospective study was conducted to determine the effect of preoperative angular deformity on the postoperative mechanical axis. Sixty patients underwent stage bilateral TKA; CAS-TKA was performed on one side and conventional TKA on the other side. It was demonstrated that severity of preoperative angular deformity affected the resulting alignment in conventional TKA, but not in CAS-TKA. The mechanical axis of the leg was within 3° of the planned axis in 83% of CAS-TKA but only 32% of conventional TKA cases when the preoperative angular deformity was >12° (P < 0.01). When the preoperative angular deformity was <12°, the mechanical axis of the leg was within 3° of the planned axis in 90% of CAS-TKA but only 69% of conventional TKA (P < 0.025). This study thus concluded that the resulting alignment in conventional TKA is influenced by large preoperative angular deformity. Consistent results in alignment can be achieved with CAS-TKA, though preoperative angular deformity still played a role in predicting the postoperative mechanical axis. CAS-TKA achieves better postoperative alignment than conventional TKA in both severe and mild preoperative angular deformity.
Knee Surgery Sports Traumatology Arthroscopy 10/2010; 18(10):1323-7. · 2.21 Impact Factor
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ABSTRACT: Osteomyelitis characterized by an inflammatory response often leads to bone loss and the spread of bacterial infection to surrounding soft tissues. To overcome the side effects induced by the systemic antibiotic treatment for osteomyelitis, recent investigations have explored the use of antibiotic-loaded undegradable or biodegradable delivery implants at the infected bone. Here, we show a novel biodegradable thermosensitive implant composed of poly(ethylene glycol) monomethyl ether (mPEG) and poly(lactic-co-glycolic acid) (PLGA) copolymer as a sol-gel drug delivery system for treating bone infection. The physical properties of a series of mPEG-PLGA nanocomposites, including the critical micelle concentration (CMC), particle size, polyindex (PI), sol-gel transition, viscosity and degradation rate, have been characterized in vitro. This sol-to-gel drug delivery system could provide several advantages in treating osteomyelitis, including easy preparation, 100% encapsulated rate, near-linear sustained release of drugs, injectable design and in situ gelling at the target tissue. Similar to the undegradable teicoplanin-impregnated polymethylmethacylate (PMMA) bone cements, we showed that implantation of the mPEG-PLGA hydrogel containing teicoplanin was effective for treating osteomyelitis in rabbits as detected by the histological staining and immunoblotting analyses. The use of the mPEG-PLGA-based biodegradable hydrogels may hold great promise as a therapeutic strategy for other infected diseases.
Biomaterials 04/2010; 31(19):5227-36. · 7.40 Impact Factor
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ABSTRACT: Vibrio species are a rare cause of necrotizing soft-tissue infections and primary septicemia, which are likely to occur in patients with hepatic disease, diabetes, adrenal insufficiency, and immunocompromised conditions. These organisms thrive in warm seawater and are often present in raw oysters, shellfish, and other seafood. This study examined fulminating clinical characteristics of Vibrio vulnificus and Vibrio cholerae non-O1 soft-tissue infections and identified outcome predictors.
Thirty patients with necrotizing fasciitis and sepsis caused by Vibrio species were retrospectively reviewed. Twenty-eight patients had a history of contact with seawater or raw seafood. Eight patients had hepatic disease such as hepatitis or liver cirrhosis, and seven patients had diabetes mellitus. Nine patients had hepatic dysfunction combined with diabetes mellitus. Microbiology laboratory culture studies confirmed V. vulnificus in 23 patients and V. cholerae non-O1 in seven patients.
Surgical debridement or immediate limb amputation was initially performed in all patients with necrotizing soft-tissue infections. Eleven patients (37%) died within several days of admission and 19 survived. The mortality of V. cholerae non-O1 group (57%) is higher than that of the V. vulnificus group (30%). A significantly higher mortality rate was noted in patients with initial presentations of a systolic blood pressure of < or =90 mm Hg, leukopenia, decreased platelet counts, and a combination of hepatic dysfunction and diabetes mellitus.
Vibrio necrotizing soft-tissue infections should be suspected in patients with appropriate clinical findings and history of contact with seawater or seafood. V. cholerae non-O1 may cause bacteremia more often than V. vulnificus in patients with liver cirrhosis. Early fasciotomy and culture-directed antimicrobial therapy are aggressively recommended in patients with hypotensive shock, leukopenia, high band forms of white blood cells, decreased platelet counts, severe hypoalbuminemia, and underlying chronic illness, such as hepatic dysfunction and diabetes mellitus.
The Journal of trauma 03/2009; 66(3):899-905. · 2.48 Impact Factor
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ABSTRACT: This prospective study analyzed computer-assisted surgery (CAS) navigation and conventional instrumentation in bilateral total knee arthroplasty. Sixty patients underwent CAS navigation in 1 knee and conventional instrumentation in the contralateral knee randomly. The target zone resided in the reconstructed mechanical axis within a range of 3 degrees varus or valgus. The reconstructed mechanical axes in the CAS navigation group were significantly closer to planned axes than those in the conventional group. Average blood loss in the CAS navigation group was lower, whereas mean tourniquet time was longer than in the conventional group. No surgery-related complications existed in either group. The results indicate that, despite longer operative time, CAS navigation total knee arthroplasty is a safe procedure and outperforms conventional technique in accuracy of leg axes.
The Journal of arthroplasty 07/2008; 24(5):668-73. · 1.79 Impact Factor
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01/2008: pages 85 - 100; , ISBN: 9780470757987
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ABSTRACT: A 38-year-old black-belt karate practitioner presented with acute disabling injury of his knee after swift-withdrawal of a reverse-roundhouse-kick. Examination confirmed the diagnosis of grade III ACL tear. Although there are reports documenting injury rate in modern karate, no previous cases of karate-related ACL injuries have been reported. The trauma mechanism is different than ACL injuries during other non-contact and contact sports. The current case report indicates that ACL injury can occur without any contact of the lower limb as a result of dynamic muscular forces during karate training.
The Knee 07/2007; 14(3):245-8. · 1.74 Impact Factor
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ABSTRACT: Vibrio and Aeromonas species, which can cause necrotizing fasciitis and primary septicemia, are members of the Vibrionaceae family and thrive in aquatic environments. Because the clinical symptoms and signs of necrotizing fasciitis and sepsis caused by these two bacteria are similar, the purposes of this study were to describe the clinical characteristics of Vibrio vulnificus and Aeromonas infections, to analyze the risk factors for death, and to compare the effects of surgical treatment on the outcome.
The cases of thirty-two patients with necrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus (seventeen patients) and Aeromonas species (fifteen patients) were retrospectively reviewed over a four-year period. Surgical débridement or immediate limb amputation was initially performed in all patients. Demographic data, underlying diseases, laboratory results, and clinical outcome were analyzed for each patient in both groups.
Six patients in the Vibrio vulnificus group and four patients in the Aeromonas group died. The patients who died had significantly lower serum albumin levels than did the patients who survived (p < 0.05). The patients with a combination of hepatic dysfunction and diabetes mellitus had a higher mortality rate than those with either hepatic disease or diabetes mellitus alone (p < 0.05). The patients with Vibrio vulnificus infections had a significantly lower systolic blood pressure at presentation (p = 0.006). The patients with Aeromonas infections who died had significantly lower white blood-cell counts (p = 0.03) with significantly fewer numbers of segmented white blood cells than those who died in the Vibrio vulnificus group (p = 0.01).
The contact history of patients with a rapid onset of cellulitis can alert clinicians to a differential diagnosis of soft-tissue infection with Vibrio vulnificus (contact with seawater or raw seafood) or Aeromonas species (contact with fresh or brackish water, soil, or wood). Early fasciotomy and culture-directed antimicrobial therapy should be aggressively performed in those patients with hypotensive shock, leukopenia, severe hypoalbuminemia, and underlying chronic illness, especially a combination of hepatic dysfunction and diabetes mellitus.
The Journal of Bone and Joint Surgery 03/2007; 89(3):631-6. · 3.27 Impact Factor
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ABSTRACT: Because of the documented cellular and biochemical benefits of hyperbaric oxygen (HBO), HBO therapy is applied now with increasing frequency to various orthopedic conditions. Many traumatologists and orthopedic surgeons might refer their patients for adjuvant HBO therapy. However, the potential risks and risk-benefit ratio have often been underemphasized in therapeutic trials.
From October 2002 to September 2004, 240 patients with a total of 4,638 treatments received HBO therapy at the hyperbaric medicine center of our institution on an identical treatment protocol. HBO therapy patient treatment logs were reviewed to analyze the incidence of complications during HBO treatment.
The overall incidence of complications was 1.83%. Over 94% of treatment complications were mild to moderate and designated as minor complications; fewer than 6% were severe or life threatening and designated as major complications. The incidence of major complications (central nervous system [CNS] oxygen toxicity in this series) was 0.109%. There was no mortality. Two patients with unusual presentation of CNS oxygen toxicity were observed during the study period.
HBO therapy in orthopedic conditions is considered as a safe treatment because of a very low complication rate; however, analysis of patients with CNS oxygen toxicity revealed its unpredictability and inevitability. Although it is common sense that patients who develop a seizure in the hospital need help from the medical staff, it cannot be done in a monoplace hyperbaric chamber because of pressure unequalization. Therefore, a multiplace chamber equipped with an antechamber for medical contingency is possibly the better facility in consideration of safety.
The Journal of trauma 11/2006; 61(4):913-7. · 2.48 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the effect of the iliotibial band (ITB) on the kinematics of anterior cruciate ligament (ACL) intact and deficient knees and also on the in situ force in the ACL during a simulated pivot shift test. A combination of 10 N-m valgus and 5 N-m internal tibial torques was applied to 10 human cadaveric knees at 15 degrees, 30 degrees, 45 degrees, and 60 degrees of flexion using a robotic/universal force-moment sensor testing system. ITB forces of 0, 22, 44, and 88 N were also applied. An 88 N ITB force significantly decreased coupled anterior tibial translation of ACL deficient knees by 32%-45% at high flexion angles, but did not have a significant effect at low flexion angles. Further, an 88 N ITB force significantly decreased in situ forces in the ACL at all flexion angles by 23%-40%. These results indicate that during the pivot shift test, the ITB can improve tibial reduction at high flexion angles while not affecting subluxation at low flexion angles. Additionally, the action of the ITB as an ACL agonist suggests that its use as an ACL graft might hinder knee stability in response to rotatory load.
Journal of Orthopaedic Research 06/2006; 24(5):967-73. · 2.81 Impact Factor
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ABSTRACT: In many sports, female athletes have a higher incidence of anterior cruciate ligament injury than do male athletes. Among many risk factors, the lower rotatory joint stiffness of female knees has been suggested for the increased rate of anterior cruciate ligament injuries.
In response to combined rotatory loads, female knees have significantly lower torsional joint stiffness and higher rotatory joint laxity than do male knees at low flexion angles, despite the fact that no such gender differences would be found in response to an anterior tibial load.
Comparative laboratory study.
Joint kinematics of 82 human cadaveric knees (38 female, 44 male) in response to (1) combined rotatory loads of 10 N x m valgus and +/- 5 N x m internal tibial torques and (2) a 134-N anterior-posterior tibial load were measured using a robotic/universal force-moment sensor testing system.
In response to combined rotatory loads, female knees had as much as 25% lower torsional joint stiffness (female: 0.79 N x m/deg; 95% confidence interval, 0.67-0.91; male: 1.06 N x m/deg; 95% confidence interval, 0.95-1.17) and up to 35% higher rotatory joint laxity (female: 26.2 degrees; 95% confidence interval, 24.5 degrees-27.9 degrees; male: 20.5 degrees; 95% confidence interval, 18.8 degrees-22.2 degrees) than did male knees (P < .05), whereas there were no gender differences in response to the anterior tibial load (P > .05).
Female knees had lower torsional joint stiffness and higher rotatory joint laxity than did male knees in response to combined rotatory loads.
Larger axial rotations of female knees in response to rotatory loads may affect the distribution of forces in soft tissues and the function of muscles that provide knee stability. Control algorithms used during the biomechanical testing of cadaveric knees and computational knee models might need to be gender specific.
The American Journal of Sports Medicine 05/2006; 34(5):765-70. · 3.79 Impact Factor
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Acta Orthopaedica 11/2005; 76(5):725-7. · 2.17 Impact Factor
