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Piskopakis A, Totlis T, Achlatis V, Zampeli F, Georgoulis JD, Hantes M, Piskopakis N, Vekris M. Manual and Device-Assisted Hamstring Autograft Tensioning Yield Similar Outcomes following ACL Reconstruction. J Clin Med 2023; 12:4623. [PMID: 37510738 PMCID: PMC10380746 DOI: 10.3390/jcm12144623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The optimal initial graft tension during ACL reconstruction is still a matter of debate. Manual tension is commonly applied to the graft during tibial fixation. However, this has been associated with a greater graft failure rate than that associated with device-assisted tensioning. This study aims to compare the clinical outcomes between the application of manual tension and the use of the ConMed Linvatec SE™ Graft Tensioning System during graft fixation while performing anatomic single-bundle ACL reconstruction. METHODS A prospective comparative study was conducted between September 2015 and May 2017. Sixty-four patients (mean age 29.3 years, range 14-45) with isolated ACL injuries (and who would be subjected to ACL reconstruction with a quadruple hamstring tendon graft) were divided into two groups. In Group A (n = 29), common tension was applied manually to both grafts. In Group B (n = 35), specific tension was applied to the grafts with the use of a tensioner device (ConMed Linvatec SE™ (Stress Equalization) Graft Tensioning System). A total of 60 N was applied to the semitendinosus, and 40 N was applied to the gracilis. Clinical outcomes were assessed at 6, 12, and 24 months. RESULTS There were no significant differences between the baseline demographic and clinical data among the patients of the two groups (all p > 0.05). The patients were followed up for a minimum of 24 months (mean ± SD). There were no significant differences in the side-to-side anterior knee laxity, the IKDC, the Lysholm Knee, and the Tegner Activity Scale scores for up to 24 months after operation. The pivot shift test was negative in all cases, and no graft failure was reported at a 2-year follow-up. CONCLUSION No significant differences were found with respect to postoperative anterior knee laxity, clinical outcomes, activity level, and patient satisfaction between the application of manual tension and the use of the graft-tensioning system during tibial fixation while performing anatomic single-bundle ACL reconstruction with a quadruple hamstring tendon graft. Further high-quality clinical studies are required to elucidate whether device-assisted tension is superior to manual tension.
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Affiliation(s)
- Andreas Piskopakis
- Department of Orthopaedics and Traumatology, KAT General Hospital, 14561 Kifissia, Greece; (A.P.); (F.Z.); md. (N.P.)
- Department of Orthopaedics and Sports Injuries, Medical Center of Athens, 15125 Marousi, Greece
| | - Trifon Totlis
- Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke’s Hospital, 55236 Thessaloniki, Greece
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Vlasios Achlatis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Frantzeska Zampeli
- Department of Orthopaedics and Traumatology, KAT General Hospital, 14561 Kifissia, Greece; (A.P.); (F.Z.); md. (N.P.)
| | - Jim Dimitris Georgoulis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece;
| | - Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, 41334 Larissa, Greece;
| | - Nikolaos Piskopakis
- Department of Orthopaedics and Traumatology, KAT General Hospital, 14561 Kifissia, Greece; (A.P.); (F.Z.); md. (N.P.)
- Department of Orthopaedics and Sports Injuries, Medical Center of Athens, 15125 Marousi, Greece
| | - Marios Vekris
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 45110 Ioannina, Greece;
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Flevas DA, Pappas E, Ristanis S, Giakas G, Vekris M, Georgoulis AD. Effect of laterality and fatigue in peroneal electromechanical delay. SICOT J 2022; 8:22. [PMID: 35616599 PMCID: PMC9135018 DOI: 10.1051/sicotj/2022018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Extremity dominance is one of the intrinsic factors that have been identified for ankle sprains. Electromechanical delay (EMD) is an integral part of the peroneal motor response and, therefore, substantial in preventing ankle sprains. This study aimed to investigate the effect of laterality on EMD times before and after fatigue. Methods: Fifteen healthy male volunteers participated in the study. Measurements were taken with the ankle in a neutral (0°) position, and all subjects followed an isokinetic fatigue protocol. Repeated ANOVA was used for statistical analysis, and the α level was set a priori at p ≤ 0.05. Results: No significant difference was noted in EMD times between the dominant and non-dominant legs of the volunteers (p = 0.940). Fatigue caused a significant increase in EMD by 10–15 ms (p = 0.003), while the leg × fatigue interaction was not significant (p = 0.893). Conclusions: In a non-injured athlete, both ankles seem to be under the same protection of the reactive response of the peroneal muscles. Therefore, athletes should be aware that both their extremities are equally exposed to the danger of an ankle injury. Also, fatigued ankles demonstrate longer EMD times, implying that improving resistance to fatigue may add another layer of protection that has the potential to prevent ankle sprain recurrence.
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Affiliation(s)
- Dimitrios A Flevas
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45110, Greece - Department of Arthroscopy and Orthopaedic Surgery, Metropolitan Hospital, Neo Faliro, Athens 18547, Greece
| | - Evangelos Pappas
- School of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, NSW 2522, Australia
| | - Stavros Ristanis
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45110, Greece - Department of Arthroscopy and Orthopaedic Surgery, Metropolitan Hospital, Neo Faliro, Athens 18547, Greece
| | - Giannis Giakas
- Department of Physical Education and Sport Science, Institute of Kinesiology, Research Centre Iason, University of Thessaly, Trikala 4100, Greece
| | - Marios Vekris
- Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45110, Greece
| | - Anastasios D Georgoulis
- Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina 45110, Greece
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Gkiatas I, Kostas-Agnantis I, Batistatou A, Kosmas D, Korompilia M, Gelalis I, Pakos E, Vekris M, Korompilias A. Neonatal brachial plexus injuries and their impact on growing bone. An experimental study. Injury 2020; 51:2851-2854. [PMID: 32122625 DOI: 10.1016/j.injury.2020.02.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 02/02/2023]
Abstract
Neonatal brachial plexus palsy remains a problem, even in light of current advances in perinatal care. While many cases resolve spontaneously, the concern remains on the best means of surgical management for restoration of elbow flexion and shoulder reanimation. The present experimental study in an animal model examines the evidence that supports that neonatal brachial plexus injuries result in structural changes in the affected bone. The study suggests that if the microsurgical reinnervation takes place early enough, these changes may be diminished. On the other hand there is no way to identify at birth, which injuries will be permanent and will need surgical repair and which will spontaneously improve.
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Affiliation(s)
- Ioannis Gkiatas
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece.
| | - Ioannis Kostas-Agnantis
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Anna Batistatou
- Department of Pathology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Dimitrios Kosmas
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Maria Korompilia
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Ioannis Gelalis
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Emilios Pakos
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Marios Vekris
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Anastasios Korompilias
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
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Gkiatas I, Kostas-Agnantis I, Agathopoulos S, Papadopoulos D, Vekris M, Gelalis I, Gavrielatos V, Korompilias A. The effect of peripheral nervous system in growing bone biomechanics. An experimental study. J Orthop 2019; 16:289-292. [PMID: 31193261 DOI: 10.1016/j.jor.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022] Open
Abstract
Objective There are several factors which affect bone growth. One of them is the peripheralnervous system whose effect on the biomechanics has not been extensively studied. The purpose of this study is to assess the effect of peripheral nervous system in bone biomechanics in an experimental rat model. Materials & methods 27 male Wistar rats were used. In all animals, the roots of the right brachial plexus were dissected and after that the animals were divided into three groups A, B and C. The animals were sacrificed six, nine, and twelve months respectively after the denervation. Both humerus were resected and biomechanical analysis was performed. Results According to the findings of the present study the denervated bones sustain less loading before fracture and they become also more elastic. Additionally, in greater time after denervation plastic deformity is noticed. Conclusion Apart from structural changes, the peripheral nerves are responsible for biomechanic changes in the bones such the greater elasticity of the bone and the reduced strength.
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Affiliation(s)
- Ioannis Gkiatas
- Department of Orthoapedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioannis Kostas-Agnantis
- Department of Orthoapedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Symeon Agathopoulos
- Laboratory of Ceramics and Composite Materials, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Dimitrios Papadopoulos
- Department of Orthoapedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Marios Vekris
- Department of Orthoapedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioannis Gelalis
- Department of Orthoapedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasilios Gavrielatos
- Department of Orthoapedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Anastasios Korompilias
- Department of Orthoapedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
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Gelalis I, Gkiatas I, Spiliotis A, Papadopoulos D, Pakos E, Vekris M, Korompilias A. Current Concepts in Intradiscal Percutaneous Minimally Invasive Procedures for Chronic Low Back Pain. Asian J Neurosurg 2019; 14:657-669. [PMID: 31497082 PMCID: PMC6703031 DOI: 10.4103/ajns.ajns_119_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Study Design: A systemic review of thermal annular procedures (TAPs) and percutaneous disk decompression procedures (PDDPs) for the treatment of discogenic chronic low back pain (CLBP) was conducted. Objective: The objective of this review is to evaluate and to compare the effectiveness of TAPs and PDDPs in treating discogenic CLBP and to assess the frequency of complications associated with those procedures. Materials and Methods: English-language journal articles were identified through computerized searches of the PubMed database and bibliographies of identified articles and review papers. Articles were selected for inclusion if percutaneous minimally invasive procedures were the treatment options for patients with CLBP and if follow-up outcome data included evaluations of back pain severity, functional improvement, and/or incidence of complications. For this review, 27 studies were included. Results: Intradiscal electrothermal therapy (IDET) procedure in properly selected patients may eliminate or delay the need for surgical intervention for an extended period, whereas few adverse effects have been reported. In contrast to IDET, there is far less literature on the effectiveness of radiofrequency annuloplasty and intradiscal biacuplasty procedures. Nucleoplasty is a potentially effective treatment option for patients with contained disc herniation, while the procedure is well tolerated. Increased success rates have been found for percutaneous laser disc decompression and automated percutaneous lumbar discectomy in strictly selected patients. Conclusions: These procedures can be effective and may obviate the need for surgery completely. Further prospective randomized sham-controlled trials with higher quality of evidence are necessary to confirm the efficacy of these procedures.
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Affiliation(s)
- Ioannis Gelalis
- Department of Orthopaedic Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Gkiatas
- Department of Orthopaedic Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Antonios Spiliotis
- Department of Orthopaedic Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Emilios Pakos
- Department of Orthopaedic Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Marios Vekris
- Department of Orthopaedic Surgery, University Hospital of Ioannina, Ioannina, Greece
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Pakos E, Gkiatas I, Rakkas G, Papadopoulos D, Gelalis I, Vekris M, Korompilias A. Calcific deposit needling in combination with extracorporeal shock wave therapy (ESWT): A proposed treatment for supraspinatus calcified tendinopathy. SICOT J 2018; 4:45. [PMID: 30339523 PMCID: PMC6195344 DOI: 10.1051/sicotj/2018043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/10/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Calcified tendinopathy of the rotator cuff is one of the most common conditions concerning the shoulder pathology. It is characterized by a reactive calcification that affects the tendons being part of the rotator cuff. The reported prevalence varies from 2.7% to 22%. Most of the patients can be treated effectively with non-operative measures such as anti-inflammatory drugs, subacromial injection of steroid, physiotherapy, extracorporeal shock wave therapy (ESWT) and needle aspiration irrigation. Results of a treatment combining some of these methods have not been reported. Objectives: The purpose of this study is to present the radiological as well as the clinical results of our proposed protocol which combines drilling of the calcium deposits with xylocaine under ultrasound guidance, with a specific program of physiotherapy for 1 month without the use of NSAIDs. Methods: Sixty-six consecutive patients (68 shoulders) were treated for calcified tendinitis of supraspinatus, which was diagnosed clinically and radiologically, with needle drilling using xylocaine under ultrasound guidance. After the drilling the patient followed a physiotherapy protocol with ESWT which included five visits within a month. After the end of the physiotherapy, the patients were evaluated clinically and radiologically. The Visual Analogue Scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were measured before and after the end of the therapy. Results: All the patients showed clinical improvement of the symptoms at the follow-up. The mean VAS score showed improvement from 8.1 to 3.3 whereas the mean DASH score was 27 and after the end of the therapy 5. Radiologically all but one calcific deposits were disappeared. Conclusions: The ultrasound-guided drilling of the calcific deposit using xylocaine, in combination with physiotherapy using ESWT provides a reliable alternative treatment for the calcific tendinitis of the supraspinatus
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Affiliation(s)
- Emilios Pakos
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Gkiatas
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - Ioannis Gelalis
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
| | - Marios Vekris
- Orthopaedic Department, University Hospital of Ioannina, Ioannina, Greece
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Vekris M, Lykissas M, Pakos E, Gelalis I, Korompilias A, Soucacos P, Beris A. Digital ray reconstruction through distraction osteogenesis: a retrospective study of 82 rays with long-term follow-up. Injury 2015; 46:1354-8. [PMID: 25702251 DOI: 10.1016/j.injury.2015.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/20/2015] [Accepted: 01/24/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the present study was to present the long-term radiographic results with distraction osteogenesis in traumatic or congenital length discrepancies of long bones of the hand. METHODS The medical records and radiographs of 65 consecutive patients (27 metacarpals and 55 phalanges) with either traumatic or congenital digital length discrepancies were retrospectively reviewed. The mean follow-up was 8.2 years. The mean distraction period was 21 days with a distraction rate of 4×0.25mm/day. Callus consolidation was obtained in all patients. RESULTS The bones were lengthened by a mean amount of 17.5mm, with a mean increase in bone length of 68±17.3%. The mean healing index was 28.57 days/cm. Ray reconstruction with callus distraction can be applied effectively in skeletally immature or mature patients with congenital differences of the hand or amputated fingers. CONCLUSION A distraction rate of 1mm/day proved to be a safe rate of lengthening in both metacarpals and phalanges.
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Beris A, Lykissas M, Kostas-Agnantis I, Vekris M, Mitsionis G, Korompilias A. Management of acute acromioclavicular joint dislocation with a double-button fixation system. Injury 2013; 44:288-92. [PMID: 23352675 DOI: 10.1016/j.injury.2013.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Numerous static and dynamic techniques have been described for the management of acute acromioclavicular (AC) joint dislocation. To date, no standard technique has been established and several complications have been described for each of these techniques. The purpose of the present study was to evaluate the functional and radiographic outcomes of acute AC joint reconstruction after a mini-open technique using the double-button fixation system. PATIENTS AND METHODS Twelve patients with acute AC joint dislocation treated with the double-button fixation system by one surgeon were retrospectively reviewed. Functional assessment was performed by an independent reviewer using the DASH, Constant and the VAS scores. The coracoclavicular (CC) distance of the affected shoulder was assessed on a standard radiograph and compared with the contralateral normal one. RESULTS Eight patients were operated on for grade III AC joint dislocation and 4 for grade IV. The mean age of the patients at the time of surgery was 27.5 years. The mean follow-up was 18.25 months (range: 12-30 months). At the most recent follow-up, the mean Constant score was 94.8 (range: 84-100) showing a significant increase compared with the mean pre-operative value of 34.4 (range: 25-52) (p<0.001). The mean DASH score was significantly decreased from 19.6 (range: 14-28) preoperatively to 0.25 (range: 0-3) at the last follow-up (p<0.001). The mean VAS score showed a significant decrease from 5.75 (range: 4-7) to 0.2 (range: 0-2) (p<0.001). The mean CC distance on the operated shoulder was found to have no significant difference from the CC distance on the contralateral normal side (10.5 vs. 10mm) (p>0.05). There was no evidence of AC joint osteoarthrosis, CC calcification or osteolysis of the distal clavicle or the coracoid process. CONCLUSIONS The proposed mini-open technique provides adequate exposure of the base of the coracoid with minimal damage to the soft tissues surrounding the CC ligaments while ensures an excellent cosmetic result. We recommend this fast and relatively simple technique for all type IV injuries and for type III injuries in heavy manual workers and high-demand upper extremities athletes.
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Affiliation(s)
- Alexander Beris
- Orthopaedic Department, University Hospital of Ioannina, Greece.
| | - Marios Lykissas
- Orthopaedic Department, University Hospital of Ioannina, Greece
| | | | - Marios Vekris
- Orthopaedic Department, University Hospital of Ioannina, Greece
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Abstract
INTRODUCTION In upper brachial plexus palsy patients, loss of shoulder function and elbow flexion is obvious as the result of paralysed muscles innervated by the suprascapular, axillary and musculocutaneus nerve. Shoulder stabilisation, restoration of abduction and external rotation are important as more distal functions will be affected by the shoulder situation. PATIENTS AND METHODS Between 2005 and 2011, eleven patients with upper type brachial plexus palsy were operated on with triceps nerve branch transfer to anterior axillary nerve branch and spinal accessory nerve transfer to the suprascapular nerve for shoulder abduction and external rotation restoration. Nine patients met the inclusion criteria for the study. All patients were men with ages ranged from 21 to 35 years (average, 27.4 years). The interval between injury and surgery ranged from 4 to 11 months (average, 7.2 months). Atrophy of the supraspinatus, infraspinatus and deltoid muscle and subluxation at the glenohumeral joint was obvious in all patients preoperatively. During the pre-op examination all patients had at least muscle grading 4 on the triceps muscle. RESULTS The mean post-operative value of shoulder abduction was 112.2° (range: 60-170°) while preoperatively none of the patients was able for abduction (p<0.001). The mean post-operative value of shoulder external rotation was 66° (range: 35-110°) while preoperatively none of them was able for external rotation (p<0.001). Postoperative values of shoulder abduction were significantly better that those of external rotation (p=0.0004). The postoperative average muscle grading for shoulder abduction according the MRC scale was 3.6±0.5 and for the shoulder external rotation was 3.2±0.4. CONCLUSIONS Combined nerve transfer by using the spinal accessory nerve for suprascapular nerve neurotisation and one of the triceps nerve branches for axillary nerve and teres minor branch neurotisation is an excellent choice for shoulder abduction and external rotation restoration.
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Affiliation(s)
| | | | - Marios Vekris
- Orthopaedic Department, University Hospital of Ioannina, Greece
| | - Marios Lykissas
- Orthopaedic Department, University Hospital of Ioannina, Greece
| | - Ioannis Gkiatas
- Orthopaedic Department, University Hospital of Ioannina, Greece
| | | | - Alexander Beris
- Orthopaedic Department, University Hospital of Ioannina, Greece
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Koulouvaris P, Stafylas K, Mitsionis G, Vekris M, Mavrodontidis A, Xenakis T. Long-term results of various therapy concepts in severe pilon fractures. Arch Orthop Trauma Surg 2007; 127:313-20. [PMID: 17354011 DOI: 10.1007/s00402-007-0306-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Intra-articular fractures of the tibia plafond are among the most challenging of orthopaedic problems. This is a retrospective case-control study of surgically treated pilon fractures which was undertaken to compare the internal fixation with the two external fixation methods. METHODS This is a case-control study of 55 patients with 55 pilon fractures. There were 36 type C and 19 type B. Of these fractures, 24 were open and 31 closed. Three surgical protocols were used. In 20 patients, Group A, a half pin external fixator with ankle spanning was performed. The mean age of patients was 42.0 years (22.0-74.0), SD 14.1 and the mean follow-up was 77.7 months (38.0-132.0), SD 25.4. In 22 patients, Group B, a single ankle sparring ring hybrid external fixator under a small arthrotomy was performed. The mean age of patients was 48.4 years (28.0-76.0), SD 12.4 and mean follow-up was 67.9 months (36.0-132.0), SD 27.8. In 13 patients, Group C, a two-staged internal fixation was performed. The mean age was 45.6 years (30.0-66.0), SD 9.7 and the mean follow-up was 78.6 months (55.0-132.0), SD 25.4. We addressed the dissimilarity of the type of fracture in each group performing supplementary stratified analyses within each fracture type group. RESULTS Group A had union in 6.9 months, group B in 5.6 months and group C in 5.1 months; P = 0.009. Six patients (Group A), two (Group B), and one (Group C) had limitation of ankle motion; P = 0.47. One patient from group C developed infection and the plate was removed. Four patients (Group A), one (Group B), and one (Group C) have developed posttraumatic arthritis (loss of joint space and pain); P = 0.25. Seven patients from Group A have reduced their activities; P = 0.004. In stratified statistical analysis by type of fracture, the associations noted for both fracture groups combined were also noted separately within each fracture group. CONCLUSION In this long term follow-up study, the two-staged internal fixation and the hybrid fixation with small arthrotomy were equally efficacious in achieving bone union. Patients in external fixation with the ankle spanning had a significantly higher rate of delayed union. Also more patients in this group have reduced their activities.
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Affiliation(s)
- Panagiotis Koulouvaris
- Hospital for Special Surgery-Reconstruction of Joints, Weill Medical School of Cornell University, 542E-79st-Apt 4O, New York, NY 10021, USA.
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11
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Arnaoutoglou CM, Sakellariou A, Vekris M, Mitsionis GI, Korompilias A, Ioakim E, Harhantis A, Beris A. Maximum intraoperative elongation of the rat sciatic nerve with tissue expander: Functional, neurophysiological, and histological assessment. Microsurgery 2006; 26:253-61. [PMID: 16634083 DOI: 10.1002/micr.20236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to assess the maximum rapid intraoperative elongation of the rat sciatic nerve with the use of tissue expander, and its possible functional recovery. One hundred and eight rats were divided into five groups, and their right sciatic nerves were expanded with a 10-cc, 12-cc, 14-cc, 16-cc, and 18-cc expander, respectively, for 1 h. The functional recovery of the nerve was assessed at intervals up to 3 months, using the sciatic function index (SFI), neurophysiological indices, and histology. The maximum intraoperative elongation was observed in group IV (16-cc volume of tissue expander), at about 23.83%. SFI decreased between the first and seventh postoperative days, but gradually recovered, reaching preoperative values in all groups according to the formulas of De Medinaceli et al. (Exp. Neurol. 77:634-643, 1982) and Bain et al. (Plast. Reconstr. Surg. 83:129-136, 1989). Latency and motor conduction velocity demonstrated deterioration after expansion, which peaked after surgery. Recovery was gradually completed by the end of the experiment. The histological findings indicated minor aberrations immediately after expansion and maximal demyelination with axonal disruption on day 15. The reparative process started by day 30 and continued until day 90, when almost no histological changes were observed. In conclusion, intraoperative nerve expansion successfully elongates the rat sciatic nerve up to 23.83%. But it causes functional and morphological abnormalities, which are of moderate to severe degree, are of short duration, and are reversible. Intraoperative nerve expansion might be a valuable solution in the treatment of short nerve gaps, but its clinical application still needs to be evaluated.
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Abstract
The functional outcome of 67 successfully replanted single digits (excluding the thumb) involving 31 complete and 36 incomplete nonviable amputations was found to be strictly related to the level of the amputation. While the survival rate was higher in patients with incomplete nonviable amputations (89 percent), compared to those with complete amputations (81 percent), the ability of the patient to use their digit was almost uniform among both groups of patients. All except 2 of the 9 digits with complete amputations at the level of the proximal phalanx or at the proximal interphalangeal joint (PIP) resulted in limited motion (less than 20 degrees-30 degrees) at the PIP and distal interphalangeal (DIP) joints. Only 9 from the group of patients with incomplete nonviable amputations at the proximal phalanx exceeded flexion greater than 40 degrees at the PIP joint. From these results, we conclude that the indications for replantation of a single digit amputation should be as follows: 1) amputation distal to the insertion of the flexor digitorum sublimis; 2) ring injuries type II and IIIa; and 3) amputations at the level of or distal to the DIP joint.
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Affiliation(s)
- P N Soucacos
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Greece
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Abstract
Reconstruction of large bony defects of long bones was performed using vascularised fibular grafts in four patients at the Department of Orthopaedic Surgery of the University of Ioannina Medical School. Indications for grafting procedures in this small series had been the loss of bone due to the extensive resection of avascular and necrotic bone from septic pseudoarthrosis in three patients and congenital pseudarthrosis secondary to neurofibromatosis in a child. Primary skeletal union with graft hypertrophy occurred in three of the patients. The fourth patient had an asymptomatic nonunion at the proximal end of the graft. The result in each patient was the presence of a well-aligned limb that had normal or nearly normal motion and acceptable length.
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Affiliation(s)
- T H Xenakis
- Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Greece
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