Publications by authors named "Panagiotis Givissis"

83 Publications

Biomolecules Related to Rotator Cuff Pain: A Scoping Review.

Biomolecules 2022 07 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

Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis.

World J Orthop 2022 Apr 18;13(4):381-387. Epub 2022 Apr 18.

1Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece.

Background: Iliopsoas muscle abscess (IPA) and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management. They are both frequently related to underlying conditions, such as immunosuppression, and in many cases they are combined. IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process, including spondylodiscitis. Computed tomography-guided percutaneous drainage has been established in the current management of this condition.

Aim: To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.

Methods: Patient demographics, clinical presentation, underlying conditions, isolated microorganisms, antibiotic regimes used, abscess size, days until the withdrawal of the catheter, and final treatment outcomes were recorded and analyzed.

Results: All patients presented with night back pain and local stiffness with no fever. The laboratory tests revealed elevated inflammatory markers. Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases. was isolated in 3 patients and in 2 patients. Negative cultures were found in the remaining 3 patients. The treatment protocol included percutaneous computed tomography-guided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy. All procedures were done in an outpatient setting with no need for patient hospitalization.

Conclusion: The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.
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http://dx.doi.org/10.5312/wjo.v13.i4.381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048501PMC
April 2022

Axillary Artery Injury and By-Pass Restoration After Open Reduction of a Chronic Shoulder Dislocation: A Case Report.

Cureus 2022 Mar 29;14(3):e23594. Epub 2022 Mar 29.

School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC.

Injury of the axillary artery after open reduction of a chronic shoulder dislocation is a rare and life-threatening condition. We present a case of an elderly woman suffering from a chronic shoulder dislocation which was addressed initially with close reduction and secondarily, after re-dislocation, with open reduction. Intraoperatively axillary artery rupture was established. By-pass restoration with a saphenous vein graft successfully managed the complication. The humeral head was immobilized in the glenoid with temporary K-wires. A CT-angiography was performed on the first and second days postoperatively.
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http://dx.doi.org/10.7759/cureus.23594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053552PMC
March 2022

Simultaneous Compression of the Neurovascular Bundle of Both Arms by a Bilateral Supracondylar Humeral Process: A Rare Case of Bilateral Nerve Entrapment of the Elbow in a Child.

Cureus 2022 Feb 28;14(2):e22694. Epub 2022 Feb 28.

First Department of Orthopedics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC.

The supracondylar process is a beak-shaped bone spur arising from the anteromedial area of the distal humerus and in the majority of cases, it is connected to the medial epicondyle with a band of connective tissue which is known as ligament of Struthers. The complex of bone spur and ligament creates a ring that may compress the median nerve causing soreness and paresthesia of the hand and fingers. We present a rare case of bilateral supracondylar process compressing the neurovascular bundles in both arms and causing simultaneous bilateral upper limb pain, numbness, and weakness in an otherwise healthy young child. Surgical excision of the bone spurs and release of Struthers' ligaments provided immediate pain relief and complete resolution of symptoms. Three years after the index surgery, no limitations of activities or signs of recurrence were reported. Median nerve compression neuropathy in a child or a young adult should always raise the suspicion of the presence of supracondylar process particularly when bilateral symptoms exist. Although there are limited data about the incidence of recurrence and the extent of bone resection, the supracondylar process should be excised together with the overlying periosteum to minimize the theoretical risk of local regrowth.
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http://dx.doi.org/10.7759/cureus.22694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8967118PMC
February 2022

Evaluation of Adipose Cell-Based Therapies for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis.

Biomolecules 2022 03 20;12(3). Epub 2022 Mar 20.

1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece.

Adipose tissue and its regenerative products which are isolated with enzymatic or mechanical processing of the harvested fat have been studied in a wide range of degenerative diseases, including osteoarthritis of the knee and hip. Intra-articular injection of these products can provide symptomatic relief of pain and postpone surgery. However, their use in the treatment of thumb carpometacarpal joint (CMCJ) osteoarthritis is limited and just a few studies have been published on that topic. For this reason, a review of the literature was performed by a thorough search of eight terms using the Pubmed database. In total, seven human studies met the selection criteria, including case-control studies, case-series and one case report. In all studies, intra-articular injection of autologous fat in osteoarthritic thumb CMCJ provided reduction in pain and improvement in hand function. Grip and pinch strength showed variable results, from no change to significant improvement. Fat-processing techniques were based on centrifugation and mechanical homogenization but biological characterization of the injected cells was not performed in any study. Although the results are encouraging, a uniformly standardized method of fat processing and the conduction of randomized controlled trials in the future could better evaluate the effectiveness of this procedure for thumb CMCJ osteoarthritis.
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http://dx.doi.org/10.3390/biom12030473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946069PMC
March 2022

Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis.

Int Orthop 2022 06 24;46(6):1215-1224. Epub 2022 Feb 24.

1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Purpose: Even though effective techniques in diagnosis of periprosthetic joint infections (PJIs) have been developed, the optimal modality has yet to be determined. The present meta-analysis aimed to compare the diagnostic accuracy of dithiothreitol (DTT) and sonication against the Musculoskeletal Infection Society criteria in patients undergoing revision joint surgery.

Methods: We searched the PubMed, Scopus, and Central Cochrane register of controlled trials as well as gray literature until the 9th of November, 2021. We included articles considering the comparative diagnostic accuracy of sonication and DTT in adult patients having revision hip and knee arthroplasty for septic or aseptic reasons. We calculated pooled sensitivity, specificity, and diagnostic accuracy of the above diagnostic techniques against the Musculoskeletal Infection Society (MSIS) criteria and created receiver operating characteristics (ROC) curves to enable comparisons between each other. The quality of included papers was evaluated utilizing QUADAS-2 and QUADAS-C tools.

Results: Data from five comparative studies totaling 726 implants were pooled together. The diagnostic accuracy of DTT and sonication were 86.7% (95% CI 82.7 to 90.1) and 83.9% (95% CI 79.7 to 87.5), respectively. Pooled sensitivity and specificity showed no statistically significant differences between DTT and sonication (0.7 [95% CI 0.62 to 0.77] vs 0.72 [95% CI 0.65 to 0.78], p = 0.14; and 0.99 [95% CI 0.97 to 1] vs 0.97 [95% CI 0.93 to 0.99], p = 5.5, respectively).

Conclusions: This meta-analysis did not identify any clinically meaningful difference between the diagnostic potential of sonication and the chemical-based biofilm dislodgment methods. This finding remained robust after adjusting for the administration of antibiotics prophylaxis, implementation of the polymerase chain reaction of sonicated fluid, and study quality.
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http://dx.doi.org/10.1007/s00264-022-05350-zDOI Listing
June 2022

Mortality and complication rates in nonagenarians and octogenarians undergoing total hip and knee arthroplasty: a systematic review and meta-analysis.

Eur Geriatr Med 2022 06 24;13(3):725-733. Epub 2022 Jan 24.

Department of Orthopaedic Surgery, 1st Orthopaedic Department, "George Papanikolaou" Hospital, Aristotle University of Thessaloniki, 55210, Thessaloníki, Greece.

Purpose: Advancing age is a significant risk factor for the development of perioperative complications and mortality in patients undergoing total hip or knee arthroplasty (THA or TKA) due to their compromised health status and the associated medical comorbidities. The purpose of this review is to identify if nonagenarians having a THA or TKA are associated with a higher incidence of mortality and morbidity compared to octogenarians.

Methods: Medline, Scopus, and the Cochrane library were searched for relevant studies. The primary outcome of the review was the incidence of mortality. The secondary outcomes were the 30-day readmission, the perioperative complications, and the length of hospital stay (LOS).

Results: Six studies with 479,630 patients were included in the review. No difference between nonagenarians and octogenarians was detected regarding the in-hospital mortality, the 30-day readmission rate, and the LOS. However, nonagenarians were associated with a greater 1-year mortality rate (OR: 2.4; 95% CI 1.91-3.01, P < 0.001; I = 0%) and increased odds of perioperative complications (OR: 1.6; 95% CI 1.48-1.72, P < 0.001; I = 0%). This finding was unchanged after adjusting for baseline characteristics (OR: 1.68; 95% CI 1.53-1.84, P < 0.001; I = 0%).

Conclusion: Although nonagenarians undergoing TKA or THA can achieve the same clinical benefit as octogenarians, they have a higher risk of perioperative complications and 1-year mortality. Therefore, meticulous preoperative screening, proper patient selection and optimization of comorbidities are essential to minimize any postoperative side effects in patients over 90 years of age.
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http://dx.doi.org/10.1007/s41999-022-00610-yDOI Listing
June 2022

Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty.

World J Orthop 2021 Dec 18;12(12):1008-1015. Epub 2021 Dec 18.

The First Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 57010, Greece.

Background: Development of infrapatellar saphenous neuroma (ISN) is a well-recognized reason for knee pain following total knee arthroplasty (TKA). So far, very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient satisfaction.

Aim: To present the results of surgical treatment for ISN after primary TKA, the level of pain relief, and the improvement of knee motion and function.

Methods: Fifteen patients (13 women, 2 men) with persistent medial pain for more than six months after primary TKA, due to osteoarthritis, underwent surgical excision of ISN. ISN diagnosis was confirmed with the presence of Tinel's sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local anesthetic. Component loosening, malalignment, instability and infection were excluded systematically in all patients as a source of pain. Pain relief in terms of visual analog scale (VAS), active knee range of motion (ROM), and the Knee Society Score (KSS) for pain and function were evaluated preoperatively and at least six months postoperatively.

Results: The mean patients' age was 71.3 ± 5.4 years old. The mean interval between TKA and neuroma excision was 10 mo (range, 6 to 14 mo), while the mean follow-up was 8 mo (range: 6 to 11 mo). All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after surgery. Pain on the VAS scale improved from 8.6 ± 1.3 preoperatively to 0.8 ± 0.9 at the final follow-up ( = 0.001). KSS pain and function scores were improved from 49.3 ± 5.9 and 62.7 ± 12.8 before surgery to 91.8 ± 4.2 and 75.3 ± 11.3 after surgery, respectively ( = 0.001 and = 0.015). Active knee ROM was also increased postoperatively from 96 ± 4 to 105 ± 6 degrees ( = 0.001). There were no complications and no further operations required.

Conclusion: ISN should be considered a potential cause of persistent pain following TKA. Neuroma excision not only provides immediate pain relief and resolution of symptoms but may also improve the knee range of motion.
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http://dx.doi.org/10.5312/wjo.v12.i12.1008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696598PMC
December 2021

Assessing the accuracy of arthroscopic and open measurements of the size of rotator cuff tears: A simulation-based study.

World J Orthop 2021 Dec 18;12(12):983-990. Epub 2021 Dec 18.

1Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece.

Background: Arthroscopic procedures are commonly performed for rotator cuff pathology. Repair of rotator cuff tears is a commonly performed procedure. The intraoperative evaluation of the tear size and pattern contributes to the choice and completion of the technique and the prognosis of the repair.

Aim: To compare the arthroscopic and open measurements with the real dimensions of three different patterns of simulated rotator cuff tears of known size using a plastic shoulder model.

Methods: We created three sizes and patterns of simulated supraspinatus tears on a plastic shoulder model (small and large U-shaped, oval-shaped). Six orthopaedic surgeons with three levels of experience measured the dimensions of the tears arthroscopically, using a 5 mm probe, repeating the procedure three times, and then using a ruler (open technique). Arthroscopic, open and computerized measurements were compared.

Results: A constant underestimation of specific dimensions of the tears was found when measured with an arthroscope, compared to both the open and computerized measurements (mean differences up to -7.5 ± 5.8 mm, < 0.001). No differences were observed between the open and computerized measurements (mean difference -0.4 ± 1.6 mm). The accuracy of arthroscopic and open measurements was 90.5% and 98.5%, respectively. When comparing between levels of experience, senior residents reported smaller tear dimensions when compared both to staff surgeons and fellows.

Conclusion: This study suggests that arthroscopic measurements of full-thickness rotator cuff tears constantly underestimate the dimensions of the tears. Development of more precise arthroscopic techniques or tools for the evaluation of the size and type of rotator cuff tears are necessary.
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http://dx.doi.org/10.5312/wjo.v12.i12.983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696604PMC
December 2021

A New Surgical Technique and Clinical Outcomes of Operated Proximal Metadiaphyseal Humeral Fractures and Nonunions With the Use of Reversed Anatomic Distal Femoral Locking Plate.

Cureus 2021 Sep 27;13(9):e18309. Epub 2021 Sep 27.

School of Medicine-1st Orthopaedic Department, Aristotle University of Thessaloniki, Thessaloniki, GRC.

Introduction Proximal humeral fractures complicated with metaphyseal and diaphyseal extension are usually treated operatively with 3.5 mm long anatomic proximal humerus plates. However, frequently these comminuted and segmental fracture types may be associated with delayed union, nonunion, and/or plate failure. We present a technique for addressing this fracture pattern by using an anatomic contralateral 4.5 mm distal femoral plate in a reversed fashion. Methods Eleven patients (eight women and three men) with a mean age of 70 years (range, 52 to 84 years) were operated on with the described technique. The dominant hand was involved in seven out of 11 patients. There were seven acute metadiaphyseal fractures and four nonunions. In one patient, humeral shaft nonunion was associated with segmental metadiaphyseal defect and a free fibular graft was applied. Results All fractures healed and patients regained almost normal function of the affected shoulder and upper limb. Shoulder abduction and forward elevation ranged from 80 to 110 degrees (mean, 97 degrees) and 90 to 120 degrees (mean, 102 degrees), respectively. The disabilities of the arm, shoulder and hand (DASH) score varied from 6 to 11 points (median 8). No major trauma or systemic complications were recorded. Conclusion The morphology, strength, and characteristics of the plate could effectively conform to the anatomy of the proximal humerus and offer adequate stability for fracture union. The described technique is more useful in case of osteoporosis and/or presence of previous failed internal fixation that further compromise the vascularization and the mechanical properties of the bone.
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http://dx.doi.org/10.7759/cureus.18309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548934PMC
September 2021

Does Bone Regrow After Notchplasty in ACL Reconstruction? A Prospective Computed Tomography Study With 2-Year Follow-up.

Orthop J Sports Med 2021 Sep 8;9(9):23259671211029228. Epub 2021 Sep 8.

1st Orthopaedic Department, 424 Army General Training Hospital, Thessaloniki, Greece.

Background: During notchplasty in anterior cruciate ligament (ACL) reconstruction, bone is excised from the lateral and roof area of the notch to widen the intercondylar space and avoid notch-graft impingement in extension. There are concerns that bone regrowth of the area will cause narrowing and increase the risk of complications.

Purpose: To determine the possibility of late narrowing of the notch after notchplasty using computed tomography (CT) analysis.

Study Design: Case series; Level of evidence, 4.

Methods: Measurements were performed on CT scans (axial and sagittal planes with knee in extension) in patients who had undergone single-bundle anatomic ACL reconstruction using hamstring graft. Two axial image levels were used: at the anterior outlet and the anterior one-eighth level of the notch. The maximum notch height and width, the notch width at one-third and two-thirds of the preoperative notch midwidth height, the maximum condylar width, and the surface area of the lateral half of the notch were measured preoperatively and at 1 week and 2 years postoperatively.

Results: Included were 20 consecutive patients (mean ± standard deviation age, 28 ± 7.3 years; follow-up, 24.2 ± 3.3 months). At the anterior notch outlet, the maximum notch width increased by 1.9 ± 1.7 mm at 1 week postoperatively and narrowed by 0.3 ± 1.1 mm at the final follow-up, while the maximum notch height increased by 1.7 ± 1.9 mm and narrowed by 0.8 ± 1.8 mm, respectively. At one-eighth of the roof length, the maximum notch width increased by 1.1 ± 1.7 mm at 1 week postoperatively and narrowed by 0.1 ± 1.1 mm at the final follow-up, and the maximum notch height increased by 1.2 ± 1.5 mm and narrowed by 0.5 ± 1.5 mm, respectively. All differences were statistically significant when comparing the pre- to the immediate postoperative measurements, and they were nonsignificant when comparing the immediate postoperative to the final follow-up measurements. The same applied for the ratio of maximum notch width to maximum condylar width, indicating no postoperative narrowing of the notch.

Conclusion: Notch size-shape after a 2-mm notchplasty did not change significantly in stable knees during the first 2 years after anatomic ACL reconstruction. Surgeons should consider performing this adjuvant technique when there is notch-graft impingement during surgery.
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http://dx.doi.org/10.1177/23259671211029228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435929PMC
September 2021

Single sterile silicon ring technique for utilization of upper limb intravenous regional anesthesia: A prospective study of patients with operated distal radius fractures.

Injury 2021 Dec 12;52(12):3611-3615. Epub 2021 Aug 12.

Aristotle University of Thessaloniki, 1st Orthopaedic Department, George Papanikolaou Hospital, Thessaloniki, Greece. Electronic address:

Introduction: Intravenous regional anesthesia is a well-established method of anesthesia in upper extremity surgery. In this study, we present a modification of the technique using a silicon ring tourniquet in 30 patients undergoing internal fixation for distal radius fractures.

Methods: A sterile silicone ring wrapped within a stockinette sleeve was applied, and a local anesthetic solution (3 mg/kg lidocaine 0,5%) was injected intravenously. After anesthesia onset, the ring was rolled distally to provide immediate pain and discomfort relief.

Results: The silicone ring achieved adequate exsanguination in all patients. Mean pain VAS score was 2.7 ± 0.9 intraoperatively and 4.3 ± 1.3 during the first hour postoperatively. The onset and termination times of sensory block were 5.8 ± 2.1 and 102 ± 7.8 min, and of motor block 13.8 ± 2.8 and 54.2 ± 4.6 min, accordingly. All patients were satisfied from the procedure.

Conclusion: Sterile silicone ring tourniquet application is a simple, safe and effective analgesic and anesthetic technique for the operative treatment of distal radius fractures.
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http://dx.doi.org/10.1016/j.injury.2021.08.011DOI Listing
December 2021

Tricortical Bone Grafting with Limited Midcarpal and Carpometacarpal Fusion for the Treatment of Giant Cell Tumor of the Capitate.

J Wrist Surg 2021 Aug 4;10(4):347-349. Epub 2020 Nov 4.

1st Orthopaedic Department of Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Exohi, Thessaloniki, Greece.

 Giant cell tumor (GCT) of capitate is a rare lesion that is challenging to treat.  We present a case of a 12-year-old girl suffering from a GCT of the capitate. Wide excision combined with adjuvant treatment including hydrogen peroxide, alcohol, tricortical bone grafting, and limited midcarpal and carpometacarpal fusion achieved good functional result without evidence of tumor recurrence or radiocarpal degeneration at 8 years postoperatively.  In this case with long-term follow-up, surgical treatment of capitate GCT with limited midcarpal and carpometacarpal fusion led to a satisfactory outcome despite the alteration of wrist kinematics.
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http://dx.doi.org/10.1055/s-0040-1719040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328559PMC
August 2021

Surgical management of a delayed post-traumatic saccular aneurysm of the radial artery.

Clin Case Rep 2021 Jul 24;9(7):e04541. Epub 2021 Jul 24.

1st Orthopaedic Department George Papanikolaou Hospital Aristotle University of Thessaloniki Thessaloniki Greece.

Post-traumatic aneurysm of the radial artery is a rare and often misdiagnosed vascular lesion of the wrist. Radial artery ligation can lead to excellent results if Allen test confirmed that ulnar artery is the dominant feeding artery to the hand.
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http://dx.doi.org/10.1002/ccr3.4541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305410PMC
July 2021

Isolated extrapulmonary tuberculosis with flexor tenosynovitis and compression of the median and ulnar nerves: a case report.

J Hand Surg Eur Vol 2022 03 21;47(3):328-329. Epub 2021 Jul 21.

1st Orthopaedic Department of Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece.

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http://dx.doi.org/10.1177/17531934211032874DOI Listing
March 2022

Insulin dependence increases the risk of postoperative complications and inferior outcome but not the survivorship of total joint arthroplasty among diabetic population: a systematic review and meta-analysis.

Eur J Orthop Surg Traumatol 2022 May 7;32(4):701-709. Epub 2021 Jun 7.

1st Orthopaedic Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece.

Purpose: Diabetes mellitus (DM) has been associated with poorer outcomes in total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, it is not clear if insulin-dependent diabetes mellitus (IDDM) patients display more perioperative complications and a worse clinical outcome compared to patients with non-insulin-dependent diabetes mellitus (NIDDM).

Methods: Medline, Scopus, and the Cochrane library were systematically searched from inception to December 2020 to identify studies evaluating the results of THA and TKA in IDDM and NIDDM patients. The primary outcomes of the review were the surgical and systemic complications, 30-day mortality and readmission, and revision arthroplasty. Secondary outcomes were the survival of the prosthetic joints and the Knee Society Score (KSS).

Results: Thirteen studies with 54,215 patients were included in the review. IDDM patients showed a greater risk for developing periprosthetic joint infection (p = 0.02), wound complications (p = 0.01), 30-day readmission (p < 0.01) and mortality (p < 0.01), reoperation (p < 0.01), revision joint surgery (p = 0.02), and systemic complications (p < 0.01) than NIDDM patients. The KSS-knee score was similar in IDDM and NIDDM patients, but the KSS-function score was lower in IDDM patients (p = 0.002). The overall survival rates of the prosthetic joints were similar between the groups.

Conclusion: Among diabetic population who undergo THA and TKA, insulin dependence is a risk factor for postoperative complications, and inferior functional outcome but not for shorter survivorship of the prosthetic joints.
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http://dx.doi.org/10.1007/s00590-021-03027-8DOI Listing
May 2022

Superior Capsular Reconstruction of the Shoulder Using the Long Head of the Biceps Tendon: A Systematic Review of Surgical Techniques and Clinical Outcomes.

Medicina (Kaunas) 2021 Mar 2;57(3). Epub 2021 Mar 2.

1st Orthopaedic Department, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.

Superior capsular reconstruction (SCR) with the use of a fascia lata autograft or a dermal allograft is an established treatment in treating irreparable rotator cuff (RC) tears. The long head of the biceps tendon (LHBT) has been recently proposed as an alternative graft for SCR. The purpose of this study was to present the surgical techniques and clinical studies utilizing the LHBT for SCR. Medline, Scopus, and the Cochrane library were searched for relevant studies up to December 2020. The primary outcomes were pain intensity improvement and the incidence of RC and LHBT graft retears. Secondary outcomes were functional scores and acromiohumeral distance (AHD) improvements. Nine studies described surgical techniques of SCR using the LHBT, and four clinical studies reported the outcomes of the technique. The mean pain intensity improved from 4.9 ± 2.3 to 1.6 ± 1.5 in terms of the visual analog scale, exceeding the minimum clinically important difference for adequate pain relief. Significant improvements were also noted in functional scores and AHD. When compared with other repair techniques for massive RC tears, i.e., the double-row repair, the transosseous-equivalent technique with absorbable patch reinforcement, and the traditional SCR with a fascia lata autograft, there were no significant differences in pain and function improvements. SCR using the LHBT is a useful treatment option for massive RC tears; it is equally effective with the traditional SCR and other established techniques. It presents numerous advantages being a safe, easy, time-saving, and cost-effective method. The only precondition for the technique is the presence of an intact LHBT. Additional clinical trials are necessary to determine which treatment is superior for treating massive RC tears, as well as to evaluate the long-term results of the technique.
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http://dx.doi.org/10.3390/medicina57030229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000769PMC
March 2021

Αbsorbable Plates for Isolated Ulnar Diaphyseal Fractures in Adults - A Case Series Study.

J Orthop Case Rep 2020 Jul;10(4):49-53

Department of Orthopaedics, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Greece.

Introduction: Absorbable materials have been used as fixation devices in orthopaedic surgery. However, their use for treating isolated ulnar diaphyseal fractures in adults has not yet been studied. The aim of this study was to assess whether Inion OTPS™ absorbable implants consisting of L-lactide, D, L-lactide, and trimethylene carbonate provide adequate fixation for the healing of isolated ulnar diaphyseal fractures, their complication rate, and the patients' clinical functional outcome.

Materials And Methods: Three consecutive patients (all women; mean age, 45 years, and range 38-55 years) with isolated, unstable ulnar fractures were enrolled and treated operatively using Inion OTPS™ absorbable plates and screws. Discontinuation of the study was decided because of the early failure of all implants. The patients were assessed clinically (DASH Score and grip strength) and radiographically at 6 weeks, 3 months, 6 months, and 9 months. The incidence of late foreign body reactions was evaluated for 10 years follow-up period.

Results: Implant failure was noticed radiographically in the early post-operative period in all three patients. Subsequently, one patient was treated operatively using metallic devices, and the other two with prolonged splinting. All fractures healed uneventfully in variable time frames. No foreign body reactions were noticed during and beyond the degradation period, other than a small painless mass in one case.

Conclusion: The results of the current study suggest that the Inion OTPS™ plating system is not appropriate for the fixation of isolated unstable ulnar diaphyseal fractures. It seems that these specific implants cannot withstand the internal mechanical forces of this anatomical area despite the protective splinting.
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http://dx.doi.org/10.13107/jocr.2020.v10.i04.1798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885649PMC
July 2020

Osteochondroma of the distal tibia in an 8-year-old child: Do we need to excise a benign tumor?

Clin Case Rep 2020 Dec 9;8(12):3600-3601. Epub 2020 Sep 9.

Department of Orthopaedics George Papanikolaou Hospital Aristotle University of Thessaloniki Thessaloniki Greece.

Osteochondromas are benign tumors that can be responsible for angular deformities, limb-length discrepancy, and impending fractures of the neighboring bones. The risk of future fractures and joint malalignment is an indication for surgical intervention.
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http://dx.doi.org/10.1002/ccr3.3321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752597PMC
December 2020

Seatbelt-induced extrathoracic lung herniation.

Clin Case Rep 2020 Nov 16;8(11):2300-2301. Epub 2020 Jul 16.

1st Orthopaedic Department George Papanikolaou Hospital, Aristotle University of Thessaloniki Thessaloniki Greece.

Traumatic lung herniation is an uncommon complication of blunt chest trauma due to seatbelt injury. High index of suspicion, adherence to ATLS guidelines, and cooperation between different surgical specialties for the prompt stabilization of flail chest and primary or prosthetic closure of the defect may ensure a favorable outcome.
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http://dx.doi.org/10.1002/ccr3.3113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669407PMC
November 2020

Timing of tibial tubercle osteotomy in two-stage revision of infected total knee arthroplasty does not affect union and reinfection rate. A systematic review.

Knee 2020 Dec 13;27(6):1787-1794. Epub 2020 Nov 13.

Aristotle University of Thessaloniki, 1st Orthopaedic Department, George Papanikolaou Hospital, Thessaloniki, Greece. Electronic address:

Background: Tibial tubercle osteotomy (TTO) in two-stage infected revision total knee arthroplasty (RTKA) could be applied at either first, second, or in both stages, and may remain preliminary fixed or unfixed until the second stage. The primary aim of the review was to identify any correlation between the timing of TTO and osteotomy union as well as reinfection rate.

Methods: Medline, Scopus, and CENTRAL were searched up to March 2020. All TTO cases were divided into three groups; Group A: TTO in both stages, left unfixed in first stage; Group B: TTO in both stages, preliminary fixed in first stage; Group C: TTO only in second stage.

Results: Eight studies with 199 patients were included. Apart from two cases in Group C, all the osteotomies achieved bone healing (p = 0.99). There were 29 (15%) reinfections (nine percent in Group A, 13% in Group B, and 16% in Group C, p = 0.67) and 16 (nine percent) knees with proximal avulsion/migration of the tibial tubercle (8.7% in Group A, 16.7% in Group B, and 0.8% in Group C, p = 0.02). Seventeen patients (11%) complained of anterior knee pain and 14 (nine percent) of them underwent hardware removal. However, no difference between groups was identified.

Conclusions: Preliminary fixation of the tibial tubercle with wires and/or screws at the first stage of RTKA does not increase the possibility of reinfection. Therefore, we propose that the tibial tubercle should be stable fixed from the first stage to maximize knee performance in the intermediate period.
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http://dx.doi.org/10.1016/j.knee.2020.09.008DOI Listing
December 2020

Intratendinous Ganglion Cyst of the Hand: A Case Report and Review of the Literature.

Case Rep Orthop 2020 14;2020:8847563. Epub 2020 Oct 14.

Aristotle University of Thessaloniki, 1st Orthopaedic Department, George Papanikolaou Hospital, Thessaloniki, Greece.

Intratendinous ganglion of the hand is an extremely rare benign tumor, and only few cases have been reported so far in the literature. We present a case with an intratendinous ganglion of the extensor digitorum communis that treated with en bloc resection and subsequent tendon repair. According to the review of the literature and published data, the ganglion is predominantly located at hand extensor tendons (82%), and it is more frequent among females (75%) and shows a high incidence in 5 and 6 decades of life (94.5%). Surgical excision with or without side-to-side repair and/or tendon transfer leads to excellent outcome and low potential for recurrence.
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http://dx.doi.org/10.1155/2020/8847563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582087PMC
October 2020

Bilateral Sciatic Nerve Compression Due to Abnormal Termination of the Small Saphenous Vein Into the Popliteal Vein: A Rare Mechanism of Pseudoclaudication of the Lower Extremities.

Cureus 2020 Sep 19;12(9):e10543. Epub 2020 Sep 19.

School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC.

Claudication in the young population is a rare condition derived from varied neurogenic and vascular conditions. We report a case of bilateral claudication of the lower extremities in a young athlete after intense training. Apart from tenderness to deep palpation of the popliteal fossa, physical and laboratory examinations did not reveal any abnormal findings. According to the patient's symptoms, sciatic nerve entrapment to the popliteal fossa was suspected and bilateral surgical exploration of the sciatic nerve was performed. The sciatic nerve was found to be entrapped before its division to the tibial and common peroneal nerves from the terminal branch of the small saphenous vein (SSV) into the popliteal vein (PV). The terminal section of SSV was subsequently ligated and resected to relieve the pressure on the sciatic nerve. One year after surgery, the patient was able to run long distances as well as sprint and train without any restriction. Rare conditions may lead to pseudoclaudication in young individuals and athletes during exercise. Normal physical and laboratory tests must raise the suspicion of sciatic nerve compression from fibrous bands or abnormal anastomotic veins that may also exist bilaterally. Surgical exploration along with sciatic nerve release remains the only treatment solution when conservative treatment fails to alleviate the symptoms.
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http://dx.doi.org/10.7759/cureus.10543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574998PMC
September 2020

Coagulopathy in COVID-19 infection: a case of acute upper limb ischemia.

J Surg Case Rep 2020 Jun 2;2020(6):rjaa204. Epub 2020 Jul 2.

First Orthopaedic Department, School of Medicine, Aristotle University of Thessaloniki, George Papanikolaou General Hospital, Thessaloniki 57010, Greece.

Coagulation abnormalities and thrombosis have been recently identified as sequelae of severe infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report a case of severe coagulopathy manifesting with right upper limb arterial and deep vein thrombosis in an 80-year-old male patient with severe COVID-19 associated pneumonia. He clinically deteriorated and received care in the intensive care unit where he was intubated. At that point, his coagulation laboratory tests were deranged, and he eventually developed dry gangrene in his right thumb and index finger, as well as a deep venous thromboembolism in his right axillary vein. Despite receiving treatment dose anticoagulation and undergoing arterial embolectomy, revascularization was unsuccessful. Amputation of the right arm at the level of the elbow was considered, but the patient died from respiratory failure.
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http://dx.doi.org/10.1093/jscr/rjaa204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332286PMC
June 2020

Extensor indicis proprius to flexor pollicis longus tendon transfer to restore thumb flexion: a case report.

J Hand Surg Eur Vol 2020 12 6;45(10):1108-1110. Epub 2020 Jul 6.

Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece.

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http://dx.doi.org/10.1177/1753193420937564DOI Listing
December 2020

Does the Inion OTPS absorbable plating system induce higher foreign-body reaction than titanium implants? An experimental randomized comparative study in rabbits.

Biomed Mater 2020 09 26;15(6):065011. Epub 2020 Sep 26.

Orthopaedic Department of Aristotle University of Thessaloniki, George Papanikolaou Hospital Thessaloniki, Thessaloniki, Greece.

Hardware removal after complete fracture healing is a laborious and traumatic procedure that bears the risks of refracture, infection, and soft tissue damage. Absorbable materials for fracture fixation have the advantage of eliminating the need for removal; however, they may stimulate a considerable inflammatory response. For that reason, we compared in a prospective randomized experimental animal model study the incidence of foreign-body reactions between Inion OTPS absorbable plate implants, consisting of carbon trimethylene, L-polylactic acid, and D, L-polylactic acid, and conventional titanium plates. Seventy rabbits were equally divided into two groups. Titanium (Group A) or absorbable (Group B) plates and screws were implanted in the femoral shaft of the rabbits. Wound reaction and laboratory tests including white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values were measured and compared at different time points. Radiographs and histological analysis of tissue samples from all animals were also used to identify potential foreign-body reactions. WBC showed normal values in both groups. In Group A, ESR levels were higher at all time points but CRP values were normalized at 3 weeks postoperatively. In Group B, ESR and CRP levels reached a peak at 3 weeks and were above normal values throughout the whole experiment (p < 0.001). Radiologic examination revealed periosteal thickening and surrounding sclerosis in 23 out of 35 animals of Group B (66%). All Group A animals had normal radiographic findings. Histopathology showed a typical non-specific foreign-body reaction in all animals in Group B (100%) but none in Group A. However, only four of them (11.8%) developed non-infected wound complications and showed significantly elevated CRP and ESR values (p = 0.054). Although Inion OTPS Biodegradable Plating System stimulates a foreign-body reaction, only a small but not negligible percentage of almost 12% may lead to wound problems. However, this difference compared to titanium plates was of borderline not statistically significant. Future studies should focus on the development of absorbable implants with improved biocompatibility aiming to further decrease the potential of foreign-body reaction and eliminate the need for additional reoperative procedures.
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http://dx.doi.org/10.1088/1748-605X/aba326DOI Listing
September 2020

Tibial tubercle osteotomy in revision total knee arthroplasty: A systematic review.

World J Orthop 2020 Jun 18;11(6):294-303. Epub 2020 Jun 18.

1 Orthopaedic Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki 55210, Greece.

Background: Tibial tubercle osteotomy (TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty (RTKA). However, several reports have described potential osteotomy-related complications such as non-union, tibial tubercle migration and fragmentation, and metalware related pain.

Aim: To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.

Methods: MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.

Results: Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases, respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.

Conclusion: The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.
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http://dx.doi.org/10.5312/wjo.v11.i6.294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298452PMC
June 2020

Radial Extracorporeal Shock Wave Therapy Against Implant-Associated Infections: An in Vitro Trial.

Microorganisms 2020 May 15;8(5). Epub 2020 May 15.

1st Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.

Background: Antibiotic management of low-virulent implant-associated infections induced by may be compromised by multi-drug resistance development, side effects, and increased cost. Therefore, we sought to assess the effects of shock wave therapy against the above pathogen using an in vitro model of infection.

Methods: We used a total of 120 roughened titanium alloy disks, simulating orthopedic biomaterials, to assess the results of radial extracorporeal shock wave therapy (rESWT) against (ATCC 11827) biofilms relative to untreated control. In particular, we considered 1.6 to 2.5 Bar with a frequency ranging from 8-11 Hz and 95 to 143 impulses per disk to investigate the antibacterial effect of rESWT against planktonic (free-floating) and biofilm forms.

Results: Planktonic bacteria load diminished by 54% compared to untreated control after a 1.8-bar setting with a frequency of 8 Hz and 95 impulses was applied (median absorbance (MA) for intervention vs. control groups was 0.9245 (IQR= 0.888 to 0.104) vs. 0.7705 (IQR = 0.712 to 0.864), respectively, = 0.001). Likewise, a statistically significant reduction in the amount of biofilm relative to untreated control was documented when the above setting was considered (MA for treatment vs biofilm control groups was 0.244 (IQR= 0.215-0.282) and 0.298 (IQR = 0.247-0.307), respectively, = 0.033).

Conclusion: A 50% biofilm eradication was documented following application of low-pressure and low-frequency radial shock waves, so rESWT could be investigated as an adjuvant treatment to antibiotics, but it cannot be recommended as a standalone treatment against device-associated infections induced by
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http://dx.doi.org/10.3390/microorganisms8050743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285346PMC
May 2020

Augmented versus non-augmented percutaneous cementoplasty for the treatment of metastatic impending fractures of proximal femur: A systematic review.

Injury 2020 Aug 12;51 Suppl 3:S66-S72. Epub 2020 Feb 12.

Aristotle University of Thessaloniki, 1st Orthopaedic Department, George Papanikolaou Hospital, Thessaloniki, Greece. Electronic address:

Introduction: Percutaneous cementoplasty (PC) has been widely used for the stabilization of impending fractures of the proximal femur due to metastatic lesions. Augmented percataneous cementoplasty (APC) with fixation devices aims to improve mechanical consolidation and stability of the construct. However, the clinical benefit of the combined technique has not been clearly established. The purpose of the current review was to compare the efficacy between APC and PC for impending pathologic proximal femoral fractures from metastatic malignancy, in terms of pain relief, operative time and fracture related complication rates.

Material And Methods: Medline, Scopus, and the Cochrane central register of controlled trials were searched for clinical studies up to July 2019. Studies relevant to cementoplasty of the proximal femur were included. The primary outcome of the study was pain relief as assessed using the Visual Analogue Scale (VAS) change. Secondary outcomes included incidence of post-intervention fracture, operative time and complication rate.

Results: Twelve studies with a total of 343 patients were included. No difference was found for all outcomes. For pain relief, pooled results showed a mean difference in VAS score -4.6 ± 1.7 for PC, and -4.3 ± 2.5 for APC (p = 0.41). Post-intervention fractures of the proximal femur occurred in 7% of patients with PC and in 5% of patients with APC (p = 0.4), and the mean duration of interventions was 57.9 ± 8.4 and 56.5 ± 27.5 min, respectively (p = 0.58). Cement leakage into the hip joint or the soft tissues occurred in 5% of cases in PC group and in 8% of cases in APC group (p = 0.16). Six patients in the APC group (4%) experienced major systemic complications, which were treated successfully.

Conclusions: APC does not seem to improve pain relief, fracture incidence, and operative time when compared with PC. Both techniques appeared effective in terms of resolution of symptoms, prevention of pathologic fractures, and early facilitation of weight-bearing. PC showed more clinical safety, as no major systemic complications occurred. However, due to the relative paucity of large clinical trials, the decision of augmentation of cementoplasty should be individualized according to the size and location of metastatic lesions and the overall medical condition of patients.
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http://dx.doi.org/10.1016/j.injury.2020.02.045DOI Listing
August 2020
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