Publications by authors named "Christos K Yiannakopoulos"

32 Publications

Biomolecules Related to Rotator Cuff Pain: A Scoping Review.

Biomolecules 2022 Jul 22;12(8). Epub 2022 Jul 22.

"Georgios Papanikolaou" Hospital, 57010 Thessaloniki, Greece.

The pathophysiology of pain in patients suffering from rotator cuff (RC) tendinopathy or tears has been examined in various ways. Several molecules from tissue samples taken from the subacromial bursa, supraspinatus tendon, glenohumeral joint fluid, and synovium as well as from peripheral blood have been investigated. This article explores these studies, the assessed biomarkers, and groups their results according to the status of tendon integrity (tendinopathy or tear). Through a structured PubMed database search, 9 out of 658 articles were reviewed. Interleukins, mostly IL-1b and its antagonist, IL-1ra, matrix Metalloproteinases (MMPs), the vascular endothelial growth factor (VEGF) and TNF-a are biomarkers directly searched for correlation to pain level. Most studies agree that IL-1b is directly positively correlated to the degree of pain in patients with RC tendinopathy, especially when the examined sample is taken from the subacromial bursa. VEGF, and TNF-a have been related to shoulder pain preoperatively and TNF-a has also been linked with sleep disturbance. Further studies pointing to more biomarkers taken from the subacromial bursa or tendon directly relating to pain degree are warranted.
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http://dx.doi.org/10.3390/biom12081016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9332043PMC
July 2022

Modified Graft Loop Technique Augmented With Nonabsorbable Suture Tape for Chronic Elbow Dislocation.

Tech Hand Up Extrem Surg 2022 Apr 5. Epub 2022 Apr 5.

Department of First Orthopaedic, Georgios Papanikolaou Hospital, Aristotle University, Thessaloniki.

The task of achieving a good clinical outcome on patients with chronic elbow dislocation is arduous. Any stabilization method used should be robust enough in order to allow for early elbow motion. Immobilization of the elbow for a prolonged time period may lead to stiffness and heterotopic ossification. Several methods of ligament reconstruction have tried to address the global instability that is present in such scenarios. We describe a technique of reconstructing both bands of the medial ligament, and the lateral ulnar collateral ligament of the elbow, by using a looped tendon graft and reinforcing the lateral side with nonabsorbable tape and anchors. The graft is passed as a loop once through the humerus and ulna, recreating the anterior portion of the medial collateral ligament and the lateral ulnar collateral ligament. Then the lateral side is augmented with the tape and anchors and the loop is fixed. Lastly, the medial tail of the graft is used in order to recreate the posterior part of the medial ligament. This technique uses a single graft along with nonabsorbable tape and anchors to make a robust construct that will withstand early range of motion, without jeopardizing elbow stability. Potential complications include damage to the ulnar nerve, infection, elbow stiffness, or persistent instability in complex cases with bone involvement.
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http://dx.doi.org/10.1097/BTH.0000000000000385DOI Listing
April 2022

Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair.

Knee Surg Sports Traumatol Arthrosc 2021 Jul 18;29(7):2090-2095. Epub 2020 Jun 18.

Orthopaedic Department, Medical School, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece.

Purpose: To evaluate the significance of untreated primary acromioclavicular joint (ACJ) osteoarthritis, encountered during arthroscopic rotator cuff repair (RCR), as a cause of persistent symptomatology and need for revision surgery.

Methods: In a cohort of 811 consecutive patients older than 55 years who underwent RCR, the effect of primary ACJ osteoarthritis presence was prospectively examined. A total of 497 patients with mild/moderate and severe ACJ osteoarthritis based on preoperative MRI evaluation were allocated to Group A (n = 185, symptomatic ACJ) and Group B (n = 312, asymptomatic ACJ). Distal clavicle excision was not performed regardless of the presence of pain. The minimum follow-up was 28 months (28-46). The visual analogue scale (VAS) pain scores were assessed for ACJ pain on palpation, the cross body adduction test, the Constant-Murley, and the American Shoulder and Elbow Surgeons (ASES).

Results: The overall loss to follow-up rate was 3.82% (19 patients: 11 in Group A and eight in Group B). The mean ASES score at the latest follow-up was 91.16 ± 9.3 and 92.37 ± 10.44 in Groups A and B, respectively, and the mean Constant-Murley score was 96.36 ± 5.7 and 95.76 ± 4.6 in Groups A and B, respectively. There was no statistical significance between regarding both scores. Localised ACJ pain on palpation and pain on cross body adduction were diminished in both the symptomatic and asymptomatic group. There were five cases (1%: two in Group A and three in Group B) with persistent ACJ pain who had failed the conservative treatment, and ACJ excision was necessary to alleviate the symptoms. All revision operations were uncomplicated with symptom resolution.

Conclusion: Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure. Routine distal clavicle excision is not absolutely necessary, even in patients with symptomatic ACJ osteoarthritis.

Level Of Evidence: II, Prospective cohort study.
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http://dx.doi.org/10.1007/s00167-020-06098-yDOI Listing
July 2021

Ultrasound-guided versus palpation-guided corticosteroid injections for tendinosis of the long head of the biceps: A randomized comparative study.

Skeletal Radiol 2020 Apr 12;49(4):585-591. Epub 2019 Nov 12.

Department of Orthopaedics, University of Patras, Patras, Greece.

Purpose: To compare accuracy, patient discomfort, and clinical outcome of ultrasound-guided versus palpation-guided corticosteroid injections to the bicipital groove in patients with long head of biceps (LHB) tendinosis.

Materials And Methods: Forty-four patients with primary LHB tendinosis were randomized into two groups (group A, n = 22; group B, n = 22). All patients underwent treatment with a single corticosteroid injection to the bicipital groove. Injections in group A were performed under ultrasound-guidance, while in group B using a palpation-guided technique. The duration of each procedure was recorded. To assess accuracy, ultrasound examination was performed in both groups after injection. Patient discomfort was evaluated with visual analogue scale (VAS) for pain. The clinical outcome was assessed comparing the VAS, the Single Assessment Numeric Evaluation (SANE) score and the QuickDASH score before treatment and after 4 weeks and 6 months.

Results: The mean duration of the procedure was 64 ± 6.87 s in group A and 81.91 ± 8.42 s in group B (p < 0.001). Injection accuracy in group A was 100% and in group B 68.18%. Discomfort was lower in group A, as compared to group B (22.10 vs. 35.50; p < 0.001). Symptoms, as measured by VAS, SANE and QuickDASH scores, improved in both groups at 4 weeks and 6 months (p < 0.05). Superior clinical improvement was recorded in group A in both time points (p < 0.05).

Conclusions: Corticosteroid injections are an effective treatment for primary LHB tendinosis. Under ultrasound guidance, injections to the bicipital groove are faster and produce lower discomfort. Superior accuracy and clinical outcomes can be achieved using the ultrasound-guided technique.

Level Of Evidence: Level II; Prospective Randomized Comparative Study.
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http://dx.doi.org/10.1007/s00256-019-03315-9DOI Listing
April 2020

Osteoid osteoma of the radial styloid mimicking wrist arthritis: a case study.

Hand Surg 2012 ;17(2):225-8

Department of Orthopaedic Surgery, IASO General Hospital, Athens, Greece.

Osteoid osteoma in the wrist and hand region is an uncommon but severely symptomatic primary bone tumour. We report the case of a professional athlete with a radial styloid osteoid osteoma who presented with significant wrist pain and stiffness resembling arthritis for which she was treated initially. The symptoms started after a fall on the outstretched hand and significant delay in the diagnosis occurred. Following detailed imaging evaluation of the tumour site excision biopsy was curative.
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http://dx.doi.org/10.1142/S0218810412720215DOI Listing
November 2012

The morphologic variations of low and high hip dislocation.

Clin Orthop Relat Res 2008 Apr 21;466(4):820-4. Epub 2008 Feb 21.

Department of Orthopaedics, University of Athens Medical School, Byzantiou 2, Athens, Nea Smyrni, 17121, Greece.

Unlabelled: Three different types of congenital hip disease in adults have been distinguished based upon the position of the femoral head relative to the acetabulum and the underlying pathoanatomy of the joint: (1) dysplasia; (2) low dislocation; and (3) high dislocation. To facilitate classification of borderline or ambiguous cases, we studied the morphologic variations of low and high dislocation as observed on the radiographs of 101 hips with low and 74 hips with high dislocation. In low dislocation, 54 hips (53.5%) had extended coverage of the true acetabulum (Type B1) and 47 hips (46.5%) had limited coverage (Type B2). Among the cases with high dislocation, a false acetabulum with an adjacent femoral head occurred in 46 hips (62.2%) (Type C1), and the femoral head was floating within the gluteal muscles in 28 hips (37.8%) (Type C2). The kappa value for interobserver agreement between two raters who made radiographic measurements was 0.963, and for intraobserver agreement between the two evaluations of the same observer it was 0.946 and 0.971, respectively. The two types of low and high dislocation were associated with high intra- and interobserver agreement. Whether these distinctions have clinical utility requires further validation.

Level Of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1007/s11999-008-0131-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504667PMC
April 2008

Severe upper limb injuries with or without neurovascular compromise in children and adolescents--analysis of 32 cases.

Microsurgery 2008 ;28(2):131-7

Department of Upper Limb and Hand Surgery and Microsurgery, KAT Hospital, Athens, Greece.

The healing and regeneration capacity of the injured tissues in childhood, adolescence, and adult life differs significantly. As a result, the prognosis of compound injuries of the upper limb in different age groups varies; therefore, the decision making and management of these cases should be age-specific. This article presents a series of 32 patients aged 1.5-14 years, with compound injuries of the upper limb that have been treated in our hospital during the period of the last 6 years. Ten of the above cases involved major vascular lesions that required revascularization or replantation. The injuries were classified according to the SATT (Severity, Anatomy, Topography, Type) classification system. This study shows that the outcome of compound upper limb injuries is age-related, while the SATT classification system is a valuable tool in the decision making process. Further research should be undertaken to determine age group-specific indications for the management of compound upper limb injuries, based on the SATT classification system.
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http://dx.doi.org/10.1002/micr.20464DOI Listing
May 2008

Mechanical stability of total hip replacement using pressurization of bone cement during curing: push-out tests in cadaver femora.

Orthopedics 2007 12;30(12):1028-32

Department of Orthopedics, University of Athens, Greece.

An experimental model was used to assess the mechanical stability of a cemented hip prosthesis, comparing the result from applied pressurization versus its absence during the curing process. Twelve pairs of cadaveric femora underwent simulated total hip replacement. The right femurs were pressurized for 10 minutes in the upper surface of the construct. The applied pressure was 325.4 KPa. All the femurs were osteotomized 30 days postoperatively and push-out tests were performed. The mean failure load at the cement-bone interface was found to be 58% higher with the pressurization technique (7.619 KN versus 4.817 KN) (P <.001). The amount of pressure we used proved advantageous, however the required physical effort proved exhausting. The design of a new surgical instrument could possibly resolve the problem.
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http://dx.doi.org/10.3928/01477447-20071201-10DOI Listing
December 2007

The biomechanical capacity of the periosteum in intact long bones.

Arch Orthop Trauma Surg 2008 Jan 15;128(1):117-20. Epub 2007 Sep 15.

Laboratory for the Research of the Musculoskeletal System, School of Medicine, University of Athens, Byzantiou 2, Nea Smyrni, 171 21 Athens, Greece.

Introduction: The biological function of the periosteum is profusely described but its contribution to the biomechanical properties of the bone has been considered negligible. The purpose of this study was to examine the biomechanical properties of periosteum-preserved long bones.

Materials And Methods: The biomechanical properties of both femora and tibiae of 30 male, 4-month-old Wistar rats were evaluated using a destructive three-point-bending testing protocol. In both bones from one side the periosteum was preserved, while in the contralateral bones the periosteum was stripped off. Ultimate strength, stiffness, energy absorption and deflection were derived automatically from the load-deformation curve recorded for each bone.

Results: As regards the femur, the periosteum-covered bones displayed statistically significant higher values for all parameters measured compared to the periosteum-stripped bones. Ultimate strength, stiffness, absorbed energy and deflection of stripped and periosteum-covered femora were, respectively, 146.76 +/- 44.71 and 196.01 +/- 41.47 N, 44.25 +/- 17.35 and 61.62 +/- 15.07 N/mm, 0.00054 +/- 0.00274 and 0.00011 +/- 0.00354 Nmm, 0.67 +/- 0.25 and 1.07 +/- 0.28 mm. In the tibia, only energy absorption (0.00353 +/- 0.00199 and 0.0010 +/- 0.00339 Nmm) and deflection (1.71 +/- 0.56 and 0.86 +/- 0.36 mm) were significantly higher in the periosteum-covered bones. The pattern of bone failure was also different in the two groups. In periosteum-covered bones the two bone parts remained in close apposition stabilized by the periosteal membrane, while in a few cases the periosteum was stretched or torn opposite the loading site.

Conclusion: The periosteum not only has significant biological function but also provides mechanical support to the bone and amplifies the biomechanical capacity of intact rat long bones in bending, probably taking advantage of its fibrous and elastic properties.
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http://dx.doi.org/10.1007/s00402-007-0433-5DOI Listing
January 2008

A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability.

Arthroscopy 2007 Sep;23(9):985-90

Second Orthopaedic Department, Army General Hospital, Athens, Greece.

Purpose: The purpose of the study was to compare the incidence of secondary intra-articular shoulder lesions in patients with acute and chronic anterior shoulder instability. The occurrence of glenoid shape alterations (inverted pear glenoid) in recurrent instability was especially examined.

Methods: Data for all arthroscopically ascertained intra-articular shoulder lesions in a series of 127 patients with acute and chronic traumatic anterior instability were recorded.

Results: Hemarthrosis was evident in all patients with acute dislocation and in 7 patients with chronic laxity who underwent surgery shortly after a dislocation episode. In both groups the presence of a chondral or osteochondral Hill-Sachs lesion was noted in 112 patients (88.1%), a Bankart lesion was noted in 106 patients (83.46%), an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion was noted in 13 patients (10.23%), a SLAP lesion was noted in 26 patients (20.47%), a humeral avulsion of the glenohumeral ligament (HAGL) lesion was noted in 2 acutely dislocated shoulders (1.57%), and capsular laxity was noted in 33 patients (25.98%). All ALPSA lesions were noted in patients with chronic instability (P = .044), and both HAGL lesions were found in patients with acute dislocations (P = .002). In patients with acute dislocations the incidence of Bankart lesions was 78.2% (18/23), whereas in chronic cases the incidence of Bankart or ALPSA lesions was 97.11% (101/104) (P = .002). In the group with acute dislocations there was a Hill-Sachs lesion in 15 cases (65.21%) and chronic recurrent instability accounted for 97 cases (93.26%) (P = .001). The capsule was considered lax in 2 patients with acute instability and 31 patients with chronic instability (8.69% v 29.8%, P = .037). The overall frequency of SLAP lesions was not statistically significant between acute and chronic cases (P = .868), unlike their distribution. In acute cases there were 3 type I and 2 type II SLAP lesions, whereas in chronic cases there were 4 type I, 13 type II, 3 type III, and 1 type IV SLAP lesions. Loose bodies were found and removed in 17 chronic and 4 acute cases (16.34% v 13.04%, P = .903). A partial-thickness articular rotator cuff tear was found in 14 patients: 12 with chronic dislocations and 2 with acute dislocations (11.53% v 8.69%, P = .694). The cuff tears were partial articular surface tears, involving less than 25% of the cuff thickness, and were treated with debridement, and cuff repair was not necessary in any case. The inverted pear configuration of the glenoid was found in 16 cases with chronic instability (15.38%), whereas no patient with an acutely dislocated shoulder had an inverted pear-shaped glenoid (P = .044).

Conclusions: Associated, secondary intra-articular lesions are more frequent in patients with chronic compared with acute shoulder instability, probably as a result of the repeated dislocation or subluxation episodes.

Level Of Evidence: Level IV, prognostic case series.
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http://dx.doi.org/10.1016/j.arthro.2007.05.009DOI Listing
September 2007

Distal radial and ulnar arteries perforator-based adipofascial flaps for covering hand traumatic defects.

Microsurgery 2007 ;27(5):372-8

Hand Surgery and Microsurgery Department, KAT Hospital, Athens, Greece.

Aim: The clinical value of adipofascial flaps based on distal ulnar or radial-artery perforators is demonstrated in a series of 14 patients with severe hand injuries and significant soft tissue defects requiring coverage.

Material And Methods: There were 10 male and 4 female patients, aged between 23 and 72 years. The defects were 7 dorsal, 4 palmar, 1 combined dorsal-palmar, and 2 with thumb or total digit amputation. In the patients with a dorsal defect, the extensor tendons were intact in 2 cases, reconstructed in 2 cases, and reconstructed in 3 cases using silicon rods. Following debridement, a fascial flap based on a distal ulnar (12) or radial (4, 2 primarily and 2 secondarily) artery perforator was fashioned and used to cover the defect. A split thickness skin graft was used to cover the defect and the hand was immobilized for 2 weeks.

Results: All cases were followed up for at least 6 months. The donor and recipient sites healed uneventfully, and the functional result was very good in terms of wrist and hand joint range of motion, which approximated the normal rates. The extension or flexion deficit was less than 25 degrees. The esthetic result was satisfactory. Two ulnar flap partial (involving approximately 35% of the area) necroses have been treated using reversed radial-distal perforator flaps.

Conclusion: The described fascial flaps offer several advantages over other local flaps, and are rather easy to perform and cover effectively both dorsal and palmar hand defects without causing significant functional deficits to the upper limb.
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http://dx.doi.org/10.1002/micr.20374DOI Listing
December 2007

Transdermal anaesthesia for percutaneous trigger finger release.

Hand Surg 2006 ;11(3):159-62

Laboratory for the Research of the Musculoskeletal System, University of Athens, Athens, Greece.

The purpose of this study was to evaluate the safety and efficiency of transdermal anaesthesia using eutectic mixture of lidocaine and prilocaine (EMLA) in patients undergoing percutaneous trigger finger release and to compare it with lidocaine infiltration. In this prospective, randomised study percutaneous release of the A1 annular pulley was performed to treat stenosing tenosynovitis (trigger finger syndrome) in 50 patients (50 fingers). The procedure was performed either under transdermal anaesthesia using EMLA applied transcutaneously 120 minutes prior to the operation (Group A, n = 25) or using local infiltration anaesthesia using lidocaine (Group B, n = 25). Pain experienced during administration of anaesthesia and during the operation was assessed using a 10-point Visual Analogue Pain Scale (VAPS), while all patients rated the effectiveness of anaesthesia with a 5-point scale. There were no significant differences between the two groups in the VAPS during the operation (1.33 +/- 0.52 versus 1.59 +/- 0.87) and the satisfaction scores (4.6 +/- 0.2 versus 4.4 +/- 0.3). The VAPS score during the administration of anaesthesia was statistically significantly less in the EMLA group (0 versus 5.96 +/- 2.41). All patients were satisfied with the final result of the operation. Percutaneous trigger finger release can be performed as an office procedure with the use of EMLA avoiding the use of injectable local infiltration anaesthesia.
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http://dx.doi.org/10.1142/S0218810406003218DOI Listing
July 2007

Diverse types of epineural conduits for bridging short nerve defects. An experimental study in the rabbit.

Microsurgery 2007 ;27(2):98-104

Hand Surgery and Microsurgery Department, KAT Hospital, Athens, Greece.

In this study the process of peripheral nerve regeneration through an epineural flap conduit was examined using four groups of 126 New Zealand rabbits. There were three study groups (A, B, and C) and 1 control group (D). A 10-mm long sciatic nerve defect was bridged either with 3 variations of an epineural flap (Groups A, B, and C) or with a nerve autograft (Group D). Animals from all groups were examined 21, 42, and 91 days postoperatively to evaluate nerve regeneration employing light microscopy and immunocytochemistry. Nerve regeneration was studied in transverse sections at 3, 6, and 9 mm from the proximal stump. The gastrocnemius muscle contractility was also examined prior to euthanasia at 91 days postsurgery in all groups using electromyography. Immunohistochemical, histochemical and functional evaluation showed the presence of nerve regeneration resembling the control group D, especially in group A, where an advancement epineural flap was used. In this experimental model an epineural flap can be used to bridge a nerve defect successfully.
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http://dx.doi.org/10.1002/micr.20313DOI Listing
June 2007

Diagnosis and treatment of postarthroscopic synovial knee fistulae: a report of four cases and review of the literature.

J Knee Surg 2007 Jan;20(1):34-8

Department of Orthopedics, IASO General Hospital, Athens, Greece.

Development of synovial knee fistulae following arthroscopic knee surgery is a rare but under-reported complication. The diagnosis and treatment of this complication is described in a series of four patients. Synovial knee fistula formation is a benign complication and in the majority of patients it can be treated conservatively with immobilization until healing occurs. The presence of infection should always be excluded.
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http://dx.doi.org/10.1055/s-0030-1248017DOI Listing
January 2007

Closed, locked intramedullary nailing of pediatric femoral shaft fractures through the tip of the greater trochanter.

J Trauma 2006 Jan;60(1):217-22; discussion 222-3

Department of Pediatric Orthopaedics, KAT Accident Hospital, 13a Davaki Str., Pefki, 15121 Athens, Greece.

Background: Closed femoral nailing is universally accepted as the treatment of choice in almost all diaphyseal femoral fractures in adults. Numerous authors reported favorable results applying the same surgical technique in the adolescent patient group. Nevertheless, reports of complications such as avascular necrosis and alteration of the proximal femoral anatomy have dampened the initial enthusiasm. The purpose of this paper was to evaluate the possible effect of closed intramedullary nailing through the greater trochanter on the proximal femoral anatomy.

Methods: We report the results of intramedullary nailing in 20 skeletally immature patients (13 men and 7 women) with a mean age of 14.4 years (range, 11-16 years). All were treated with closed, reamed, percutaneously performed nailing, using the tip of the greater trochanter as the nail insertion point. The patients were followed for 29 months in average (range, 19-37 months).

Results: No major complication (limb length discrepancy, avascular necrosis, coxa valga) occurred during the observation period. All fractures healed clinically and radiographically within 9 weeks in average (8-13 weeks) and all patients returned to the preinjury activity level. The mean ATD difference was 1.10 +/- 3.51 (range, -5-7 mm, 95% CI -0,54/2,74, p = 0.177). The mean LTA distance difference was 0.3 mm (range, -6-5 mm, p = 0.158), the mean femoral length difference was 1.9 mm (-9-12 mm, p = 0.122) and the overall limb length difference was 1.4 mm (-25-20 mm, p = 0.178). The mean neck-shaft angle difference was 0.20 +/- 1.74 (range, -3-4, p = 0.612) and the mean neck width was 0.60 +/- 1.50 (range, -3-3, p = 0.09). Fourteen nails (70%) were removed within 13 months in average (range, 10-18 months) without any complications.

Conclusion: This study showed that with strict adherence to a surgical technique that respects the growing proximal femur and its vascular anatomy, using the tip of the greater trochanter as an entry point to the femoral canal, the proven advantages of closed, intramedullary nailing can safely be offered to the adolescent patient population as well.
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http://dx.doi.org/10.1097/01.ta.0000199913.02341.d6DOI Listing
January 2006

Flexible intramedullary nailing of pediatric unstable forearm fractures.

Am J Orthop (Belle Mead NJ) 2005 Sep;34(9):420-4

Department of Pediatric Orthopaedics, KAT Accident Hospital, Athens, Greece.

In the pediatric population, the majority of displaced 2-bone forearm fractures can be reduced and stabilized by conservative means. In this article, we report on a retrospective study of 23 patients with unstable or open forearm fractures treated with closed reduction and percutaneous stabilization with flexible titanium nails. All fractures healed without complication, and final functional results were excellent.
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September 2005

Percutaneous reaming of simple bone cysts in children followed by injection of demineralized bone matrix and autologous bone marrow.

J Pediatr Orthop 2005 Sep-Oct;25(5):671-5

Department of Pediatric Orthopaedics, KAT Accident Hospital, Athens, Greece.

The authors report the successful treatment of 19 patients (mean age 10 years) with active unicameral bone cysts using a combination of percutaneous reaming and injection of a mixture of demineralized bone matrix and autologous bone marrow. Follow-up ranged from 12 to 42 months (mean 28 months). All patients were asymptomatic at the latest follow-up. Two required a second intervention to accomplish complete cyst healing. Radiographic outcome was improved in all patients according to the Neer classification at the latest follow-up. There were no significant complications related to the procedure, nor did any fracture occur after initiation of the above regimen.
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http://dx.doi.org/10.1097/01.bpo.0000164874.36770.42DOI Listing
November 2005

The triad knot: a new sliding self-locking knot.

Arthroscopy 2005 Jul;21(7):899

Second Orthopaedic Department, General Army Hospital, Athens, Greece.

Tying secure knots is essential in arthroscopic surgery. A new slip knot for arthroscopic shoulder surgery is described. Locking of the knot is accomplished by pulling the post strand. Knot tying is simple and a low-profile, secure knot is produced.
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http://dx.doi.org/10.1016/j.arthro.2005.04.100DOI Listing
July 2005

Intraoperative arthroscopic suture anchor reloading.

Arthroscopy 2005 Jul;21(7):898

Second Orthopaedic Department, General Army Hospital, Athens, Greece.

The success of an arthroscopic procedure depends considerably on the successful and secure tying of arthroscopic knots, which reapproximate and stabilize avulsed or torn soft tissues to their original bed. Failure to perform appropriate knot tying may jeopardize the success of the operation. We describe a simple and reliable technique for intraoperative arthroscopic replacement of the suture through the eyelet of an already-inserted bone anchor. This technique allows for replacement of a fretted suture or a loose knot with a new suture, offering the opportunity to repeat the knot tying procedure with a new intact suture.
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http://dx.doi.org/10.1016/j.arthro.2005.04.098DOI Listing
July 2005

Arthroscopic anterior cruciate ligament reconstruction using quadriceps tendon autograft and bioabsorbable cross-pin fixation.

Arthroscopy 2005 Jul;21(7):894

Second Orthopaedic Department, General Army Hospital, Athens, Greece.

We describe a technique for arthroscopic anterior cruciate ligament (ACL) reconstruction using the middle third of the quadriceps tendon without a patellar bone block and absorbable tibial and femoral cross-pin fixation. The central part of the quadriceps tendon is harvested through a 5-cm long anterior skin incision without a patellar bone block. Tibial and femoral tunnels are prepared, the graft is passed up the tunnels, and is fixed both in the femur and the tibia using absorbable cross pins (Rigid Fix; Mitek, Johnson & Johnson, Norwood, MA). In this way, the graft is stabilized near the joint line, providing outlet fixation. In our practice, very good results have been obtained with the use of this technique.
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http://dx.doi.org/10.1016/j.arthro.2005.04.099DOI Listing
July 2005

Distal intramedullary nail interlocking: the flag and grid technique.

J Orthop Trauma 2005 Jul;19(6):410-4

2nd Orthopaedic Department, 401 General Army Hospital, Athens, Greece.

Distal interlocking in intramedullary nailing of long bone fractures accounts for a significant proportion of the total fluoroscopy and operative time. We describe a modification of the "perfect circles" freehand technique employing a metallic grid temporarily attached to the skin of the lateral surface of the femur or to the medial surface of the tibia that acts as a fixed "navigational" aid. The position of the distal nail holes in relation to the grid is fluoroscopically ascertained. Subsequently, under fluoroscopic control, a modified Steinmann pin with a metallic handle attached to its blunt end ("flag") is used to accomplish targeting and to create the screw holes, affording improved visualization. This technique was compared with the traditional freehand technique in 2 groups of patients. Use of the modified technique led to reduction of radiation exposure and total distal interlocking time, and there were no significant complications related to the technique.
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http://dx.doi.org/10.1097/bot.0000151815.94798.64DOI Listing
July 2005

Revision anterior cruciate ligament surgery using the over-the-top femoral route.

Arthroscopy 2005 Feb;21(2):243-7

Orthopaedic Department, Mayday University Hospital, Croydon, Surrey, England.

Primary anterior cruciate ligament (ACL) reconstruction is considered a successful surgical procedure, but the results reported for revision ACL surgery are less satisfactory. The most common cause of technical failure in primary reconstruction is tunnel misplacement, particularly on the femoral side, although an anterior placement of the tibial tunnel may lead to graft impingement and failure. Several technical problems are encountered during revision procedures. We describe a technique for revision ACL surgery using a special jig for preparing the tibial tunnel that references the apex and roof of the intercondylar notch and an over-the-top routing for proximal femoral placement. This combination avoids graft impingement at the tibial tunnel exit and circumvents the problems associated with further femoral tunnel preparation.
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http://dx.doi.org/10.1016/j.arthro.2004.09.026DOI Listing
February 2005

A simplified arthroscopic outside-in meniscus repair technique.

Arthroscopy 2004 Jul;20 Suppl 2:183-6

2nd Orthopaedic Department, 401 General Army Hospital, Athens, Greece.

A simple and reproducible technique for meniscus tear repair is described. The technique requires the use of a 16-gauge intravenous catheter, a suture hook, and a knot pusher. The catheter is used for perforation of the meniscus and the tear site in two adjacent locations, then the two free suture ends are retrieved and passed along a small arthroscopic cannula placed at the ipsilateral joint space, and finally a sliding arthroscopic knot is tied and advanced to the meniscus surface with a knot pusher. This simple technique provides secure fixation of the meniscus tear during the healing period and has been proven successful and without complications in the patients in whom it has been used.
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http://dx.doi.org/10.1016/j.arthro.2004.04.026DOI Listing
July 2004

Prevention of posttraumatic hypoxaemia in isolated lower limb long bone fractures with a minimal prophylactic dose of corticosteroids.

Injury 2004 Mar;35(3):309-17

Second Orthopaedic Department, 401 General Army Hospital, Athens, Greece.

The efficacy of a minimum dose of methylprednisolone for the prevention of posttraumatic hypoxaemia and fat embolism syndrome (FES) was prospectively studied in 87 patients with isolated, closed or grade I open, femoral and tibial fractures. On admission, the patients were randomly allocated either to a control group given placebo (40 patients) or to a methylprednisolone-treated group (47 patients). A total dose of 6 mg/kg BW methylprednisolone (SoluMedrol, Upjohn) was administered intravenously, divided in six equal doses at 8 h intervals. Six patients (12.8%) in the control group and one patient (2.5%) in the trial group developed FES (P = 0.079) but the difference is not statistically significant. Twenty-four hours after admission, the steroid-treated patients displayed statistically significant higher p(O2) values compared to the control group (P = 0.035) and this difference persisted on the second and the third post-admission day as well (P = 0.008). No corticosteroid-related side-effects were noticed in any of the patients during hospitalisation. Our results support the prophylactic administration of methylprednisolone in small dosage to prevent posttraumatic hypoxaemia and probably FES in patients with isolated lower limb long bone fractures, especially when early fracture stabilisation is not possible.
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http://dx.doi.org/10.1016/s0020-1383(03)00056-1DOI Listing
March 2004

Innoxious removal of suction drains.

Orthopedics 2004 Apr;27(4):412-4

Orthopedic Department, Veterans Army Hospital, Athens, Greece.

Suction drains are commonly used in orthopedic elective and trauma surgery; however, drain tube removal causes pain, discomfort, and anxiety. A method of drain tube removal is described in patients who underwent total hip replacement and in adolescents who underwent lower extremity surgery. Ten milliliters of lidocaine was injected through the skin wound around the drain tube. The efficiency of this practice was evaluated using a visual analog scale score in two patient groups. Pain during tube removal and pain on post-removal were significantly decreased in the study group compared to the placebo group. Using this technique drain tube removal was painless, comfortable, and safe.
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http://dx.doi.org/10.3928/0147-7447-20040401-19DOI Listing
April 2004

Closed reduction and percutaneous stabilization of pediatric T-condylar fractures of the humerus.

J Pediatr Orthop 2004 Jan-Feb;24(1):13-6

Department of Paediatric Orthopaedics, KAT Accident Hospital, Athens, Greece.

T-condylar fractures of the humerus are a rare fracture pattern in children. The usual recommendation is to treat them with open reduction and internal fixation, in accordance to the usual practice in adult fracture patterns. This involves extensive surgical approach to the elbow to allow anatomic reduction and placement of hardware for rigid fixation. The authors present a technique of closed reduction of the intra-articular component of the T-condylar fracture that is stabilized with partially threaded pins that afford interfragmentary compression, followed by the use of two elastic titanium intramedullary nails to stabilize the supracondylar component of the fracture as well. Two adolescents (12 and 14 years of age) with a T-condylar elbow fracture were treated with the described technique. Both fractures healed without complications. Hardware was removed in the outpatient clinic after 4 weeks, and both patients returned to sports with full range of elbow motion 6 weeks postoperatively.
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http://dx.doi.org/10.1097/00004694-200401000-00003DOI Listing
April 2004

Triplane fracture of the proximal tibia.

Am J Orthop (Belle Mead NJ) 2003 Sep;32(9):452-4

Department of Pediatric Orthopaedics, KAT Hospital, Athens, Greece.

We report a case of successful treatment of a very rare triplane fracture of the proximal tibia in an adolescent boy. The fracture was internally fixed using cannulated Herbert screws. The final result was excellent.
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September 2003

Distal locking of femoral nails under direct vision through a cortical window.

J Orthop Trauma 2003 Sep;17(8):574-7

Department of Pediatric Orthopaedics, KAT Accident Hospital, 4 Kountourioti Street, Pefki 15121, Athens, Greece.

We present a salvage technique for distal femoral interlocking under direct vision through a window in the anterior femoral cortex in a subgroup of six patients, among those presented to our institution during the last 10 years with a femoral shaft fracture treated with reamed, locked intramedullary nailing. The common characteristic of these patients was the performance of distal locking under direct vision through a small window in the anterior femoral cortex because of intraoperative dysfunction of the image intensifier. Screw insertion was successful in all cases. All fractures and all cortical windows healed uneventfully. No postoperative fractures occurred through the cortical defect. This technique, despite being a salvage one, has proven a safe alternative to the common distal targeting techniques. It can be used when an image intensifier is unavailable without jeopardizing the excellent clinical and radiographic outcome of reamed locked nailing of femoral shaft fractures.
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http://dx.doi.org/10.1097/00005131-200309000-00006DOI Listing
September 2003

Imaging diagnosis of the snapping triceps syndrome.

Radiology 2002 Nov;225(2):607-8; author reply 608

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http://dx.doi.org/10.1148/radiol.2252020259DOI Listing
November 2002
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