Evaluation of Magnetic Nanoparticle-Labeled Chondrocytes Cultivated on a Type II Collagen-Chitosan/Poly(Lactic-co-Glycolic) Acid Biphasic Scaffold.

Chondral or osteochondral defects are still controversial problems in orthopedics. Here, chondrocytes labeled with magnetic nanoparticles were cultivated on a biphasic, type II collagen-chitosan/poly(lactic-co-glycolic acid) scaffold in an attempt to develop cultures with trackable cells exhibiting growth, differentiation, and regeneration. Rabbit chondrocytes were labeled with magnetic nanoparticles and characterized by scanning electron microscopy (SEM), transmission electron (TEM) microscopy, and gene and protein expression analyses. The experimental results showed that the magnetic nanoparticles did not affect the phenotype of chondrocytes after cell labeling, nor were protein and gene expression affected. The biphasic type II collagen-chitosan/poly(lactic-co-glycolic) acid scaffold was characterized by SEM, and labeled chondrocytes showed a homogeneous distribution throughout the scaffold after cultivation onto the polymer. Cellular phenotype remained unaltered but with increased gene expression of type II collagen and aggrecan, as indicated by cell staining, indicating chondrogenesis. Decreased SRY-related high mobility group-box gene (Sox-9) levels of cultured chondrocytes indicated that differentiation was associated with osteogenesis. These results are encouraging for the development of techniques for trackable cartilage regeneration and osteochondral defect repair which may be applied in vivo and, eventually, in clinical trials.

Two-year effects of an interdisciplinary intervention on recovery following hip fracture in older Taiwanese with cognitive impairment.

OBJECTIVE: This article aims to evaluate the long-term effects of an interdisciplinary intervention program on cognitively impaired older persons after hip fracture in Taiwan. METHODS: Of 160 subjects randomly assigned to control (n = 81) and intervention (n = 79) groups, 24 (29.6%) and 27 (34.2%) were cognitively impaired in the control and intervention groups, respectively, and outcomes were followed for 2 years after discharge. RESULTS: Among cognitively impaired subjects, more in the intervention group recovered their previous walking ability (odds ratio [OR] =3.49; confidence interval [CI] = 1.64 to 7.42), activities of daily life performance (ß = 18.59; p = 0.0002), and more were readmitted to the hospital (OR = 4.44, CI = 1.53 to 12.89) than those in the control group during the first 2 years following discharge. Among subjects without cognitive impairment, more in the intervention group recovered their previous walking ability (OR = 2.6; CI = 1.33 to 5.07), had fewer falls (OR = 0.47; CI = 0.25 to 0.86), and made fewer emergency room visits (OR = 0.33; CI = 0.11 to 0.97) during the first 2 years following discharge than those in the control group. CONCLUSIONS: Cognitively impaired individuals benefited from our interdisciplinary intervention by improving their walking ability and physical function during the first 2 years following discharge. Specific strategies on fall prevention following hip fracture need to be further developed for cognitively impaired individuals.

Postoperative pain and its impact on quality of life for hip-fractured older people over 12 months after hospital discharge.

AIMS AND OBJECTIVES: To describe pain severity and pain interference and to explore the impact of pain severity on postoperative health-related quality of life of older people during their first year after discharge for hip surgery in Taiwan. BACKGROUND: Few studies have examined the impact of pain on postoperative quality of life for hip-fractured older persons. DESIGN: A descriptive, correlational design was used for this longitudinal study. METHODS: Pain intensity, pain interference and quality of life were investigated prospectively for 87 elders within 12 months after discharge for hip surgery at a medical centre in Taiwan. Pain intensity and pain interference were measured by items from the Bodily Pain scale of the Medical Outcomes Study Short Form-36, Taiwan version. Quality of life dimensions were measured by all instrument scales, except bodily pain. RESULTS: Moderate to severe pain was reported by 41.3% and 24(.)8% of subjects at one and 12 months following discharge, respectively. Pain interference with life was reported as quite a bit or extreme by 31.1% of subjects at 12 months after discharge. Subjects who reported moderate/severe pain at one month after discharge experienced declines in general health (p = 0.03) and vitality (p = 0.02) from 6-12 months after discharge. CONCLUSIONS: Around a quarter of hip-fractured older persons experienced moderate to very severe pain and quite a bit to severe pain interference from six months to one year after discharge. Furthermore, pain experienced during the first month after discharge significantly impacted quality of life throughout the year following discharge, even after controlling for covariates. RELEVANCE TO CLINICAL PRACTICE: Nurses must pay attention and intervene with long-term postoperative pain in hip-fractured elders to prevent further declines in physically related outcomes. The findings of this study can be used to develop effective pain-management strategies for hip-fractured older patients.

Study of High Performance Sulfonated Polyether Ether Ketone Composite Electrolyte Membranes.

In this study, high performance composite electrolyte membranes were prepared from polyether ether ketone polymeric material. An initial sulfonation reaction improved the membrane hydrophilicity and its water absorbability and thus enhanced the ionic conductivity in electrochemical cells. Protonic conductivity was improved from 10-4 to 10-2 S cm-1 with an increasing sulfonation time from 72 to 175 h. The effects of blending nano SiO2 into the composite membranes were devoted to improve thermal and mechanical properties, as well as methanol permeability. Methanol permeability was reduced to 3.1 × 10-7 cm2 s-1. Finally, a further improvement in ionic conductivity was carried out by a supercritical carbon dioxide treatment under 20 MPa at 40°C for 30 min with an optimum SiO2 blend ratio of 10 wt-%. The plasticizing effect by the Lewis acid-base interaction between CO2 and electron donor species on polymer chains decreased the glass transition and melting temperatures. The results show that sulfonated composite membranes blended with SiO2 and using a supercritical carbon dioxide treatment exhibit a lower glass transition temperature, higher ionic conductivity, lower methanol permeability, good thermal stability, and strong mechanical properties. Ionic conductivity was improved to 1.55 × 10-2 S cm-1. The ion exchange capacity and the degree of sulfonation were also investigated.

Comparison of Percutaneous Endoscopic Surgery and Traditional Anterior Open Surgery for Treating Lumbar Infectious Spondylitis.

Minimally invasive surgery is becoming popular for treating spinal disorders. The advantages of percutaneous endoscopic debridement and drainage (PEDD) for infectious spondylitis include direct observation of the lesion, direct pus drainage, and earlier pain relief. We retrospectively reviewed 37 patients who underwent PEDD and 31 who underwent traditional anterior open debridement and interbody fusion with bone grafting from 2004 to 2012. The causative organisms were isolated from 30 patients (81.1%) following PEDD, and from 25 patients (80.6%) following open surgery (p = 0.48). Staphylococcus aureus was the most common pathogen (38.2%). In the PEDD group, blood loss (<50 mL versus 585 ± 428 mL, p < 0.001) was significantly lesser and the duration of hospitalization (24.4 ± 12.5 days versus 31.5 ± 14.6 days, p = 0.03) was shorter than that in the open surgery group. Serologically, there were significantly faster C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) normalization rates in the PEDD group (p < 0.001, p = 0.009, respectively). In the two-year follow-up radiographs, 26 out of 30 (86.7%) open surgery patients showed bony fusions of the infected segments. On the contrary, sclerotic change of the destructive endplates was observed and the motion of infected spinal segments was still preserved in the PEDD group. There was no significant difference in the change of sagittal profile, including primary correction gain, correction loss, and actual correction gain/loss. PEDD is an effective alternative option and should be considered prior to traditional extensive spinal surgery-particularly for patients with early-stage spinal infection or serious complicated medical conditions.

Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year.

BACKGROUND: Little is known about the effects of interventions for elderly patients with hip fracture in Asian countries, particularly beyond the short term. METHODS: Outcomes (service utilization, clinical outcomes, self-care ability, and depressive symptoms) were assessed at 1, 3, 6, and 12 months after discharge. Self-care ability (ability to perform activities of daily living [ADLs]), was measured by the Chinese Barthel Index. Depressive symptoms were measured by the Chinese Geriatric Depression Scale, short form. RESULTS: The experimental group (n = 80) had a significantly better ADL trajectory than the control group (n = 82) during the 1st year after discharge (p =.002). More participants in the experimental group than in the control group recovered their previous walking ability both at 6 months (81% vs 58%, respectively) and 12 months (84% vs 66%, respectively) after discharge. Overall, the odds ratio for the experimental group recovering their previous walking ability was 2.72 (p <.001) compared to the control group. The experimental group had significantly fewer depressive symptoms than the control group during the 1st year following discharge (p =.004). CONCLUSION: An interdisciplinary intervention for hip fracture with a discharge support component benefited elderly persons with hip fracture by improving both self-care ability and walking ability, and by decreasing depressive symptoms during the 1st year after hospital discharge.

A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan.

OBJECTIVES: To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan. DESIGN: Randomized experimental design. SETTING: A 3,800-bed medical center in northern Taiwan. PARTICIPANTS: Elderly patients with hip fracture (N=137) were randomly assigned to an experimental (n=68) or control (n=69) group. INTERVENTION: An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning. MEASUREMENTS: Demographic and outcome variables were measured. Outcome variables included service utilization, clinical outcomes, self-care abilities, health-related quality-of-life (HRQOL) outcomes, and depressive symptoms. RESULTS: Subjects in the experimental group improved significantly more than those in the control group in the following outcomes: ratio of hip flexion 1 month after discharge (P=.02), recovery of previous walking ability at 1 month (P=.04) and 3 months (P=.001) after discharge, and activities of daily living at 1 month (P=.01) and 2 months (P=.001) after discharge. Three months after discharge, the experimental group showed significant improvement in peak force of the fractured limb's quadriceps (P=.04) and the following health outcomes: bodily pain (P=.03), vitality (P<.001), mental health (P=.02), physical function (P<.001), and role physical (P=.006). They also had fewer depressive symptoms (P=.008) 3 months after discharge. CONCLUSION: This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes, self-care abilities, and HRQOL and by decreasing depressive symptoms within 3 months after discharge.

Floating knee injuries: a high complication rate.

Floating knee injuries are usually associated with complications and mortality, regardless of the treatment regimen. Orthopedic surgeons typically recommend various treatment regimens, especially aggressive and early stabilization of both femoral and tibial fractures. Some authors have reported that the complication and mortality rates remain high regardless of the treatment regimen used. The purpose of this retrospective study was to review the long-term results of treatments for floating knee injuries performed at our institution, and also to calculate the distribution of fracture types within patient age groups and the association with complications related to floating knee injury. We retrospectively reviewed medical records and radiographs of 419 floating knee injuries treated for postoperative complications from November 1987 to April 2003. Of the 419 patients with floating knee injuries, 104 (24.8%) developed complications. The result showed that the complication rate was associated with fracture type (open fracture [32.2%; P<.001], Fraser type IIc [36.8%; P<.001], tibial plateau [28.6%; P=.037], and distal tibia [28.6%; P=.035]). This study revealed that the complication rate associated with floating knee injuries remained high, regardless of the treatment regimen used. Surgeons should focus on reducing complications while treating floating knee injuries.

Two-year effects of interdisciplinary intervention for hip fracture in older Taiwanese.

OBJECTIVES: To explore the 2-year outcomes of an interdisciplinary intervention for elderly patients with hip fracture. DESIGN: Randomized experimental design. SETTING: A 3,000-bed medical center in northern Taiwan. PARTICIPANTS: Patients with hip fracture (N=162): 80 in the intervention group and 82 in the usual care control group. INTERVENTION: An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning. MEASUREMENTS: Outcomes (clinical outcomes, self-care ability, health-related quality of life (HRQoL), service utilization, and depressive symptoms) were assessed 1, 3, 6, 12, 18, and 24 months after discharge. Self-care ability (ability to perform activities of daily living (ADLs)) was measured using the Chinese Barthel Index. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey, Taiwan version (SF-36). Depressive symptoms were measured using the Chinese Geriatric Depression Scale, short form. RESULTS: Subjects in the intervention group had significantly better ratios of hip flexion (beta=5.43, P<.001), better performance on ADLs (beta=9.22, P<.001), better recovery of walking ability (odds ratio (OR)=2.23, P<.001), fewer falls (OR=0.56, P=.03), fewer depressive symptoms (beta=-1.31, P=.005), and better SF-36 physical summary scores (beta=6.08, P<.001) than the control group during the first 24 months after discharge. The intervention did not affect the peak force of the fractured limb's quadriceps, mortality, service utilization, or SF-36 mental summary score. CONCLUSION: The interdisciplinary intervention for hip fracture benefited elderly persons with hip fracture by improving clinical outcomes, self-care ability, and physical health-related outcomes and by decreasing depressive symptoms during the first 24 months after hospital discharge.

Treatment of undisplaced femoral neck fractures in the elderly.

BACKGROUND: While the treatment for displaced femoral neck fractures in the elderly (Garden types III and IV) is quite clear, the procedure for impacted or undisplaced femoral neck fractures (Garden types I and II) is still a subject of controversy. METHODS: Thirty-seven (all >80 years old) patients with undisplaced femoral neck fractures were treated with osteosynthesis by cannulated screws fixation. The clinical outcomes were followed up retrospectively for at least two years. RESULTS: The overall union rate was 94.59% (35 patients) at 6 months after primary internal fixation. The overall success rate was 83.78% (31 patients), and the overall failure rate was 16.22% (6 patients). CONCLUSIONS: Osteosynthesis with cannulated screws fixation is a simple, safe, economical, and reasonably effective procedure for the treatment of undisplaced femoral neck fractures in patients older than 80 years.

Bridge-plating osteosynthesis of 20 comminuted subtrochanteric fractures with dynamic hip screw.

BACKGROUND: A prospective clinical trial was conducted to evaluate the conjunctive use of an extramedullary device and the bridge-plating technique in the treatment of comminuted subtrochanteric fractures with major extension into the femoral shaft. METHODS: A Winquist criteria was used to classify 3 fracture patterns. The type 3 fractures were excluded from this study because of great extent of the fracture zone for which the bridge-plating technique is not indicated. There were 14 men and 6 women, with a mean age of 49 (range, 17-76) years. A dynamic hip screw (DHS) with a long side plate was chosen as the fixation device because of the small learning curve. RESULTS: The fractures united at a mean of 7.6 (range, 3-15) months postoperatively. Mobility was scored at 9 points in 18 patients and 6 points in 2 patients (Mobility score of Parker & Palmer). Pain was absent in 14, mild in 3, and moderate in 3 patients. Two limbs were shortened by 1 and 1.5 cm, respectively. CONCLUSION: Our results indicate that DHS fixation using the bridge-plating technique leads to union of all comminuted Winquist types 1 and 2 fractures without major complications, and it is a valuable alternative to new intramedullary devices. This procedure offers the significant advantage of being less technically demanding.

Mini-open intramedullary nailing of acute femoral shaft fracture: reduction through a small incision without a fracture table.

BACKGROUND: Femoral shaft fractures are usually treated with intramedullary nailing. In this study, we report on a modified surgical technique with reduction through a small incision for this type of fracture. METHODS: From 1994 to 1997, this technique was used on 74 patients with 82 femoral shaft fractures. Seventy patients (76 fractures) with at least 3 years of postoperative follow-up were included for clinical evaluation. The surgical technique involves a mini-wound at the fracture site, and fracture reduction is performed with 1 finger or a bone hook without the use of a fracture table. RESULTS: Seventy-four fractures (97%) healed in the first 6 months. In 2 patients, there was little evidence of fracture union at 6 months. One of these 2 patients was treated with an open bone graft, and the other was treated with a closed exchanging nail. Finally these 2 patients healed. The mean operation time for this procedure was 75 minutes. CONCLUSION: The advantages of this procedure include that no fracture table is needed, there is a shorter operation time, there is a small amount of blood loss, and it is especially suitable for multiple trauma patients.

The use of the 3-mm K-Wire to supplement reduction of humeral supracondylar fractures in children.

BACKGROUND: Most children with humeral supracondylar fractures can be treated with simple closed reduction and cross-fixation with Kirschner (K)-wires. However, in a small proportion of cases, an acceptable closed reduction cannot be obtained, and open reduction becomes necessary. An alternative to open reduction is the use of a temporary 3-mm K-wire to manipulate and reduce the distal fragment. This report introduces the method of manipulation, as well as indications, and draws comparisons with complete close reduction cases. METHODS: Of 118 patients, 76 (64.4%) were managed with the standard closed reduction method and additional K-wire fixation to secure a good alignment (group 1). In the remaining 42 cases (35.6%), acceptable reduction could not be achieved by closed methods alone, and another temporary 3-mm K-wire was used to manipulate the distal fragment. After reduction of the fracture with the additional wire, standard cross K-wires were inserted to stabilize the fracture (group 2). As long as there was contact at the fracture site in cases of humeral supracondylar fracture, the traditional closed method was used easily to achieve excellent restoration. However, for cases in which the fracture site was totally displaced, and contact at the fracture site via traction was unsuccessful, a 3-mm K-wire was used to perform supplemental restoration treatment. All the patients, after the operation, were temporally immobilized with a long-arm splint for about 3 weeks. The fixation K-wires were removed after the radiograph had shown callus formation over the fracture site. Then the operation indications, operation methods and time, complications, and differences in range of motion were analyzed for these two sets of patients. RESULTS: The average group 1 surgery time was 18 minutes (range, 9-32 minutes), whereas the average surgery time for group 2 was 33 minutes (range, 15-45 minutes). Three cases in group 1 were complicated with ulnar nerve injury caused by the fixation wire. There were no ulnar nerve injuries in group 2. However, the ulnar nerve injury complication rates for the two groups (3 in 76 for group 1; 0 in 40 for group 2) did not reach statistical difference (p = 0.5502, Fisher's exact test). The union times for the two groups were almost the same (average, 3 weeks; range, 2-5 weeks). The 3-mm K-wire manipulation reduction cases and the closed reduction cases seemed to yield the same healing results in all aspects, except for the longer surgery time in group 2 (p < 0.0001). Both groups achieved satisfactory results. CONCLUSIONS: The closed reduction method should be used for children with humeral supracondylar fractures, whenever possible. The 3-mm K-wire manipulation method reduces the probability that open reduction will be required in some severe cases. This is a simple method without complications. The prognosis is the same as for closed reduction cases.

Predictors of functional recovery for hip fractured elders during 12 months following hospital discharge: a prospective study on a Taiwanese sample.

To examine the longitudinal changes in overall and individual physical activities of daily living (PADLs) and instrumental activities of daily living (IADLs), at 1, 3, 6, and 12 months after hospital discharge in elderly subjects, 110 hip fractured elders (mean+/-SD age, 79.4+/-7.5; 60.9% females) were enrolled in a prospective study. At 12 months following hospital discharge, 56.1% subjects had recovered their overall PADLs, 37.9% had recovered their overall IADLs, and 74.2% could walk independently or with the aide of a cane. When analyzed by generalized estimating equations (GEE), for individual PADL, bathing and climbing stairs had consistently improved at every time point throughout the 1-year follow-up period, while transferring, toileting, and walking ability only improved significantly in the first 3 months after discharge. For individual IADL, the proportion of recovery for mobility appeared to increase significantly during the first 6 months post-discharge, and the remaining IADLs appeared to be stable. These results indicated that the recovery rate is varied for performance of different activities according to the complexity and the involvement of the lower extremities. We also found that less concomitant diseases, and a shorter hospital stay could predict a better recovery trend of overall and of most individual PADLs. These findings may be applicable to other countries with Chinese populations, and could provide a reference for health care providers to develop specific interventions for Chinese hip fractured elders.

Changes in quality of life among elderly patients with hip fracture in Taiwan.

To examine the longitudinal change in health related quality of life (HRQoL) during 1 year following hospital discharge in elderly subjects, 110 hip fractured subjects (age, mean+/-SD: 79.3+/-7.4 years) were enrolled in a prospective study. Face-to-face interviews with the patients were conducted, using Short Form 36 (SF-36) at 1, 3, 6, and 12 months after they were discharged from the hospital. The GEE approach was employed to evaluate changes in the variables of interest among different time points. Subjects in this study appeared to have lower scores in most dimensions of SF-36, with physical function and role limitation being the lowest due to physical problems (mean+/-SD=10.97+/-16.19; 6.32+/-20.60) during the 1st month after hospital discharge, compared to community dwelling subjects (mean+/-SD=77.5+/-20.5; 63.8+/-45.30). Most of the dimensions of SF-36, except general health (6th month versus 3rd month=57.56+/-21.90 versus 61.75+/-23.46, P>0.05) improved significantly from the 1st month to the 3rd month (range of means of improved scores from 12.81 to 30.76, P<0.01). After the 3rd month after discharge, physical functions kept improving significantly until 6 months after hospital discharge (3rd month versus 6th month=25.18+/-23.66 versus 40.30+/-25.94, P<0.05). Role limitation due to physical problems reached a plateau between the 3rd and 6th month, and then again improved significantly during the 6th month and the 1st year after hospital discharge (6th month versus 1st year=17.69+/-31.78 versus 32.22+/-44.47, P<0.05). The rest of the dimensions of SF-36 remained stable from the 3rd month to 1 year after discharge. These results indicated that different aspects of SF-36 recovered differently for the hip fractured patients in Taiwan. Similar studies may be helpful for health-care providers in other countries with Chinese populations to develop specific intervention programs.