Procs III 2011.indb - Journal of Bone & Joint Surgery, British Volume ...

Hellenic Association Of Orthopaedic Surgery And Traumatology 

Thessaloniki, Greece: 7–10 October 2009 

President: Anastasios G. Christodoulou MD 

Correspondence should be addressed to Anastasia C. Tilentzoglou MD, General Secretary of the Board of 

Directors of HAOST, 20 A. Fleming Str. (N.Filothei), Gr. 15123 Maroussi, Athens Greece. 

E-mail: info@eexot.gr 

001 COMPARISON OF TWO 

REHABILITATION PROGRAMS FOR SIMPLE 

POSTERIOR ELBOW DISLOCATION 

CH. Thanassas, I. Paraskeuopoulos, G. 

Papadimitriou, Ch. Charambidis, A. Papanikolaou 

Red Cross Hospital of Athens, Greece 

Simple posterior elbow dislocations are often being 

treated with strict immobilization after reduction. We 

performed a study in order to investigate if a functional 

protocol of rehabilitation, allowing early motion, would 

be more effective. 

We prospectively followed twenty fi ve consecutive 

patients for simple posterior elbow dislocation in a nonrandomized 

study. Patients were divided in two groups. 

Group A (twelve cases) was treated with immobilization 

using a cast in 90 degrees of fl exion and neutral rotation 

for three weeks. Group B (thirteen cases) was treated 

according to a functional rehabilitation program that 

allowed early controlled mobilization starting on the 

2nd post-traumatic day, consisting of immediate fl exion 

from 90° and gradual extension after the 2nd week. 

Follow-up of the patients was recorded at six weeks and 

three months. The functional scores used were Mayo 

Clinic Performance Index, Liverpool Elbow score and 

Broberg and Morey. 

None of the patients had an incident of redislocation. 

Patients of group B had statistically signifi cant better 

(p3mm) 

and good elasticity (the footprint is covered properly 

under tendon traction with tissue grasper). The inde- 

pendent variable studied here was the tissue quality of 

rotator cuff tendon. Clinical outcomes preoperatively 

and postoperatively, were assessed with use of ASES, 

CONSTANT and UCLA scores. Statistical analysis was 

performed by using STATA 8.0. 

Good tissue quality was identifi ed in 119 patients 

(82%) and poor tissue quality in 26 (18%) patients 

respectively. At the follow up the patients with good 

tissue quality achieved Constant score: 86.85±12.49, 

ASES score:84±3.4, UCLA score: 28.7±1.9 and the 

patients with poor tissue quality achieved Constant 

score: 62.35±13.85, ASES score: 61.49±8.9, UCLA 

score:21±3.2. Signifi cant difference between the two 

groups concerning the clinical outcome was observed 

after adjusted the data for age. Besides high correlation 

was noticed between old age and increased rate of poor 

tissue quality (r=0.88). 

Better clinical outcomes are expected in patients associated 

with good tissue quality, adjusted for age. So the 

tissue quality is positively correlated with the fi nal functional 

outcome. 

003 GRADE OF ANATOMIC 

RECONSTRUCTION OF ROTATOR CUFF 

AND FUNCTIONAL OUTCOME 

N. Tzanakakis, G. Mouzopoulos, E. Mataragas, 

Ch. Yiannakopoulos, E. Antonogiannakis 

Athens Orthopedics, Center for Arthroscopy & 

Shoulder Surgery, IASO General, Athens, Greece 

One hundred and twenty-four patients who had undergone 

arthroscopic repair of rotator cuff tear, during the 

period of 2006-2008, were evaluated. All operations 

were performed under the same surgeons. The mean 

follow-up period was 1.1±0.4 years (range, 0.5 to 2 ys). 

The patients were devided in three groups: a) patients 

underwent complete repair (n=104), b) patients underwent 

incomplete repair (n=8) and c) patients underwent 

medialized technique repair (n=12). Clinical outcomes 

preoperatively and postoperatively, were assessed with 

use of ASES, CONSTANT and UCLA scores. Statistical 

analysis was performed by using STATA 8.0. 

Postoperative functional scores were better than 

preoperative ones, in all patients (p

340 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 

release of the ulnar nerve with or without partial medial 

epicondylectomy and the anterior transposition and 

release respectively. 

Material and Method: From 1991 since 2008, 119 

patients, (81 men and 38 women) with an average 

age of 51(13-72 years) years were treated surgically 

for ulnar nerve compression at the elbow. The average 

duration of symptoms before surgery was 15 months 

(2- 48 months). Preoperatively 2 patients were grade I, 

52 patients were grade IIA, 31 patients were IIB and 

34 were grade III according to the modifi ed McGowan 

score. We performed in-situ decompression of the ulnar 

nerve in 35 patients, release with partial medial epicondylectomy 

in 44 patients and release with anterior transposition 

of the nerve in 40 patients. 

17 patients were lost to follow-up. 108 patients were 

clinically assessed.Comparing the results among different 

surgical procedures, an improvement of at least 

one McGowan grade was obtained in 26 of 30 patients 

treated with simple decompression, in 29 of 35 patients 

treated with release and anterior transposition of the 

nerve and in 38 of 43 patients treated with release and 

medial epicondylectomy. 

The results of this study show that the possibility for 

complete recovery is inversely related to the initial neuropathy 

grade. Partial medial epicondylectomy is a valuable 

surgical procedure for treating grade I to IIB ulnar 

neuropathy because is an anatomic method with minimal 

nerve manipulation preserving regional blood supply. 

006 TREATMENT OF THE CLOSED 

FRACTURES OF METACARPALS AND 

PHALANGES. COMPARISON BETWEEN 

KIRSCHNER WIRES AND MINI EXTERNAL 

FIXATION 

K. Makridis, M. Georgoussis, V. Mandalos, N. 

Daniilidis, S. Kourkoubellas, L. Badras 

Orthopaedic Department, General Hospital, 

Volos, Greece 

Fractures of metacarpals and phalanges are common in 

hand injuries. The goal of treatment is the immediate 

mobilization of the fi ngers and restoration of the hand 

anatomy thus avoiding contractures of the metacarpophalangeal 

and phalangophalangeal joints and hand 

dysfunction. The aim of this study is the comparison 

between two methods of fi xation of these fractures. 

Between 2000–2007, 74 patients who suffered metacarpophalangeal 

fractures were treated by K-wires 

and 62 patients were treated by mini external fi xation. 

Parameters recorded were the operating time, postoperative 

range of motion, cost and complications. The 

surgical time was lesser with the use of K-wires, the 

operative technique much simple and the cost minimum 

as compared to mini external fi xators. The postoperative 

range of motion was inferior with the external fi xation. 

However, there was no statistical difference between the 

two groups. 2 patients with the external fi xation and 

1 patient with K-wires developed pin-track infection. 

There were 3 failures of fi xation in the external fi xator 

group but no failure occurred with the use of K-wires. 

The majority of the fractures healed within 6 weeks. 

K-wires seem to be the ideal method of treatment 

considering the fractures of metacarpals and phalanges. 

The use of mini external fi xation presents many disadvantages 

and probably is restricted to the treatment of 

the open and comminuted hand fractures. 

007 REDUCTION OF ACUTE ANTERIOR 

DISLOCATION: A PROSPECTIVE 

RANDOMIZED COMPARATIVE STUDY 

COMPARING A NEW TECHNIQUE WITH 

HIPPOCRATES AND KOCHER METHODS 

F. Sayegh, E. Kenanidis, M. Potoupnis, 

K.Papavasiliou, St. Pellios, G. Kapetanos 

3rd Orthopaedic Clinic of Aristotle University of 

Thessaloniki –G.H. “Papageorgiou”, Greece 

Aim of this prospective, randomized study is to introduce 

and compare a new technique of reduction of the anterior 

dislocation of the shoulder with the “Hippocrates” 

and “Kocher” methods, as far as its effi cacy, safety and 

intensity of the pain felt by the patient during the reduction, 

are concerned. This is the fi rst reported prospective, 

randomized comparative study of three reduction 

techniques of anterior dislocations of the shoulder. 

154 patients suffering from acute anterior shoulder 

dislocation participated in the study. Patients were randomly 

assigned to one of the three study groups (New, 

“Hippocrates” and “Kocher”) and underwent reduction 

of their dislocation performed by residents orthopaedic 

surgeons. 

The groups were statistically comparable (age, male/ 

female ratio, mechanism of dislocation, mean time interval 

between injury and fi rst attempt of reduction). 

Reduction was achieved with the “Fares” method 

in 88.6%, with the “Hippocrates” in 72.5% and 

with the “Kocher” in 68% of the patients. This difference 

was statistically signifi cant, favoring the new 

method (p=0.033). The mean duration of the reduction 

(p=0.000) and the mean reported by the patients VAS 

with the new method (p=0.000) were also statistically 

signifi cantly lower than those of the other methods. No 

complications were noted in any group. 

The new method seems to be more effective, faster 

and less painful method of reduction of the anterior 

shoulder dislocation, when compared with the “Hippocrates” 

and the “Kocher” methods. It is easily performed 

by only one physician and it is not more morbid 

that the other two methods. 

008 FUNCTIONAL OUTCOME AFTER 

SURGICAL EXCISION OF HETEROTOPIC 

OSSIFICATION ABOUT THE ELBOW IN ICU 

PATIENTS 

G.I. Mitsionis, A.V. Korompilias, M.G. Lykissas, 

D. Nousias, G. Mataliotakis, A.E. Beris 

Department of Orthopaedic Surgery, University of 

Ioannina School of Medicine, Ioannina, Greece 

The objective of this study was to evaluate the functional 

outcome of the elbow joint in patients with heterotopic 

ossifi cation of the elbow joint who underwent surgical 

excision of pathologic bone. 

From 5/1994 to 12/2006, 24 patients (33 joints) with 

heterotopic ossifi cation of the elbow joint were evaluated. 

All patients were attended in the Intensive Care Unit 

(ICU). The patient\’s age ranged from 19-48 years (mean; 

32 years) The median ICU hospitalization was 3 weeks. 

In nine patients both elbows were affected. Unilateral 

involvement was equally noticed to the right (seven cases) 

and the left elbow (eight cases). The DASH SCORE and 

the range of motion were used for the evaluation of the 

results.All patients underwent surgical treatment in order 

to extract heterotopic bone and to improve the range of 

motion of the affected elbow joint. 

Postoperatively 18 out of 33 operated elbow joints 

(54.54%) demonstrated improvement of the range of 

motion, whereas no improvement was observed in the 

remaining 15 elbow joints (45.45%). Higher DASH 

SCORE was obtained in 19 out of 24 patients (79.17%). 

Surgical excision of the ectopic bone around the affected 

elbow signifi cantly improves the range of motion of the 

joint providing better use of the upper extremity and 

therefore a superior quality of life in these patients. 

009 CONGENITAL PSEUDARTHROSIS 

OF THE RADIUS TREATED WITH FREE 

VASCULARIZED FIBULAR GRAFT. A CASE 

REPORT WITH A LONG-TERM FOLLOW-UP 

A.E. Beris, M.G. Lykissas, I. Kostas, T. 

Vasilakakos, M.D. Vekris and A.V. Korompilias 


Ioannina School of Medicine, Ioannina, Greece 

We present a case of a 19-year-old white female patient 

with neurofi bromatosis type I who, 10 years ago, underwent 

free vascularized fi bular grafting for isolated congenital 

pseudarthrosis of her left radius. 

An external fi xator was applied for gradual distraction 

and correction of the deformity of the pseudarthrosic site 

for fi ve weeks. Wide resection of pseudarthrosis with sur- 

rounding fi brotic and thick scar tissue and bridging of 

the gap with a free vascularized fi bular graft followed. 

Four months postoperatively, union was established in 

both graft ends. At the last follow-up, 10 years postoperatively, 

the patient has excellent function with full wrist 

fl exion-extension and forearm pronation-supination. 

Free vascularized fi bula transfer is considered the 

treatment of choice for congenital radial pseudarthrosis. 

It allows complete excision of the pathologic tissue and 

covering of the gap in one operation. Due to the vascularity 

of the free vascularized fi bular graft both sides of 

fi bula unite easily with no additional intervention. 

010 SEVERE POST-TRAUMATIC 

ELBOW LESIONS TREATED WITH 

SEMI-CONSTRAINED TOTAL ELBOW 

ARTHROPLASTY 

I.Ignatiadis, D. Arapoglou, E. Pateromihelakis, 

P. Psyllakis, N.Hatzinikolaou, E.Pananis, N. 

Gerostathopoulos 

Dept. of Upper limb-Hand Surgery and 

Microsurgery KAT General Hospital, Athens, 

Greece 

To show the role and effectiveness of semi-constrained 

total elbow arthroplasty in restoring elbow function in 

severe, irreversible post-traumatic osseous and chondral 

injuries. 

Eighteen patients, aged 19-80, 11 male and 7 female, 

suffering from serious, irreversible anatomical and functional 

lesions of the elbow joint due to previous severe 

untreated or inadequately treated fractures (T-type 

transcondylar, trochlear-condylar, open fxs with large 

bony defects, severe osteochondral, heterotopic ossifi cation 

in ICU fracture patients). Post-op follow up was 

9–57 months. 

All patients were treated with modular, cemented, 

semi-constrained linked total elbow arthroplasty. A 

functional brace was used post-operatively, and motion 

was permitted on the 3rd post-op day. The patients were 

allowed a full range of motion at 1 week post-op and 

they were subjected to vigorous physiotherapy. 

Post-op results were evaluated by using Mayo, DASH, 

quick-DASH scores and measuring grip strength and 

range of motion. Our results ranged from satisfactory 

to excellent in 16 patiens, with good strength and wide 

motion arc (with up to 15o extension-fl exion defi cit). 

One old female patient suffered a severe cerebral stroke 

with a bad outcome. In another young male patient the 

motion arc reached only 40% of the normal (spasticity, 

ICU patient with brain injury). 

Semi-constrained linked total elbow arthroplasty 

proves to be an effective method of treatment in severe, 

irreversible, intraarticular post-traumatic elbow injuries 

with chondral destruction and grave functional defi cit, 

provided the proper technique is employed and a vigorous 

rehabilitation program is followed. 

011 MECHANICAL BEHAVIOR OF THE 

RADIOCARPAL JOINT DURING THE 

HEALING PROCESS OF A SCAPHOID 

FRACTURE 

F.N.Xypnitos, E.Kolliakou, D. T.Venetsanos, C. G. 

Provatidis, N. E. Efstathopoulos 

Second Department of Orthopaedics, Athens 

University Medical School, Athens, Greece; 

Radiology Department, Konstantopoulio 

Hospital, Nea Ionia, Athens, Greece; National 

Technical University of Athens, School of 

Mechanical Engineering Mechanical Design and 

Control Systems Section, Laboratory of Dynamics 

and Structures, Athens, Greece 

The aim of the study was to investigate, fi rstly, the force 

distribution between scaphoid/radius and lunate/radius 

in the normal wrist and in the presence of a scaphoid 

fracture, secondly, how stresses and strains at the 

fractured area change during the healing process and 

thirdly, how the direction of the applied forces affects 

load transmission. 

A 3D fi nite element model of the normal wrist was 

J BONE JOINT SURG [BR] 2011; 93-B:SUPP III

initially developed. Two typical scaphoid fractures B2 

and B3 according to Herbert’s classifi cation, were investigated. 

The fractured areas were modeled with a range 

of modulus of elasticity to resemble the various stages of 

the healing process. Furthermore, three different directions 

of the externally applied loads were examined. 

The applied compressive vertical load in the normal 

joint was transmitted to the radius through the 

radioscaphoid and the radiolunate articular surfaces 

at a ratio equal to 56:46 respectively. The ratio was 

equal to 54:48 and 53:49 for the B2 and the B3 fracture 

respectively. The load direction resembling an ulnary 

deviated wrist caused the appearance of a signifi cantly 

higher strain fi eld at the fractured area. The maximum 

developed stresses at the fractured area for scaphoid 

fracture B2 were approximately 37%-58% higher than 

those of B3, for all three loading directions. 

Based on our results, the onset of osteoarthritic 

changes in a wrist with a scaphoid fracture is due to 

carpal collapse and scaphoid deformity.The recorded 

maximum developed strains for both B2 and B3 scaphoid 

fractures suggested intense bone remodeling activity. 

Among the examined three different load directions, the 

one simulating an ulnary deviated wrist corresponded to 

the most severe effects. 

012 WILSON’S OSTEOTOMY FOR THE 

TREATMENT OF HALLUX VALGUS: A 

REVIEW OF 240 CASES 

A. Fasoulas, A.Baikousis, N. Markantonis, Ch. 

Petrou 

General Hospital of Messologi, Greece 

To assess the outcome of Wilson’s osteotomy of the fi rst 

metatarsal to correct Hallux Valgus. 

Two hundred and forty feet in 172 patients who had 

surgery for pain were reviewed clinically and radiologically. 

Age ranged from 28 to 82 years (mean 55 years) 

and duration of follow-up ranged from 2 to 15 years 

(mean 6 years). A mini external fi xation was used to 

stabilize the osteotomy. 

The average AOFAS score improved from 51.6 to 

89.5 points at the last follow-up. In 96% of the cases, 

the fi nal outcome was satisfactory as far symptomatic 

improvement was concerned. A 4% only was dissatisfi 

ed with the outcome of the surgery due to metatarsalgia, 

restricted fi rst metatarsophalangeal joint motion 

or lack of correction. There were no cases of avascular 

necrosis of the metatarsal head. We had fi ve cases of 

delayed union but they didn’t need further surgery. 

The average preoperative HVA and IMA were 34.80 

(range: 180-540) and 15.10 (range: 100-290), while the 

average postoperative HVA and IMA were 16.10 (range: 

70-280) and 7.20 (range: 30-90) respectively. 

Wilson’s osteotomy as a method of treatment of 

Hallux Valgus is technically straightforward, effective 

and with a predictable outcome. We believe that the 

external fi xation offered increased stability at the osteotomy 

site and could be the reason why patients had a 

very low incidence of postoperative metatarsalgia and 

returned to their normal activities faster, thus giving a 

higher satisfaction rate. 

013 GRICE-GREEN SUBTALAR 

ARTHRODESIS FOR VALGUS HINDFOOT 

(FLAT FOOT) DEFORMITIES IN CHILDREN 

I. Flieger, O. Leonidou, N. Pettas, A. 

Apostolopoulos, K. Antonis, N. Baxevanos 

A’ Orthopaedic Department of the Children 

Hospital “Agia Sophia” Athens, Greece 

Grice-Green subtalar arthrodesis was initially reported 

to correct valgus hindfoot deformities in patients with 

poliomyelitis. Nowadays, the indications of the Grice- 

Green arthrodesis have been signifi cally broadened. 

The aim of this study is to analyse the indications of 

treatment and evaluate the results of the Grice-Green 

arthrodesis in children. 

During the period 1986-2006, 17 children with valgus 

hindfoot deformities were treated in our department. In 

12 of them the procedure was performed in both feet 

J BONE JOINT SURG [BR] 2011; 93-B:SUPP III 

HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 341 

and in the rest (5 patients) unilaterally. The mean age 

at operation was 8.8 years. The most common group 

of patients suffered from cerebral palsy (10 patients), 

followed by the patients suffering from myelomeningocele 

(4 patients), 2 patients suffered from overcorrection 

following treatment of congenital equinovarus 

and one patient from Charcot Marie Tooth disease. In 

neine patients the operation was combined with Achilles 

tendon lengthening, capsulotomies, tendon transfers, 

tendonotomies, and Evans arthrodesis. In all operations 

bone graft from the tibia or the fi bula was used. Postoperatively 

a balow knee non weightbearing cast was 

applied for 8 weeks followed by a weightbearing cast 

for 4 weeks. The results were avaluated according to 

Alman and Zimbies criteria. The mean follow up of the 

patients was 4.2 years. The results in 24 feet were considered 

excellent and in 5 cases satisfactory. In all cases 

subtalar arthrodesis was achieved. 

Grice-Green arthrodesis is a very useful operative 

technique for the correction of severe valgus hindfoot 

deformities in children. The results of the technique are 

usually good and the operation does not infl uence the 

normal growth of the foot. An accurate preoperative 

planning and a good surgical technique is neccesary for 

good results. 

014 CONSERVATIVE AND OPERATIVE 

MANAGEMENT OF BODY AND NECK 

TALAR FRACTURES (RESULTS PER 

CATEGORY) 

A. Papapanos, C. Rossas, V. Dalagiannis, 

L.Tsiopos, I. Alexopoulos, N. Roussis 

Orthopaedic Department,General Hospital of 

Agrinio, Greece 

To analyze the results in proportion to the type of talar 

fracture. 

Eighteeen talar fractures(8 of the body and 20 of the 

neck)in 28 patients(24 men and 4 women, between 22 

and 60 years, of average age 42 years) were treated in 

our department in the period 1981-2007. 24 fractures 

were closed and 4 were open (2 B and 2 C1 grade). The 

Hawkins classifi cation for the fractures of the neck is: 

10 type I, 6 type II, 4 type III. The fractures of the body 

were: 1 type A, 4 type B, 3 type E. The most common 

mechanism of injury was fall from a height in 16 cases 

and car accidents in 12 cases. 18 patients had associated 

injuries. The fractures managed within 6 hours. Time of 

follow up ranged between 2 and 9 years. 

All type I fractures of neck were treated conservatively 

with excellent results (Hawkins score). All type II were 

operated and healed with results ranging from very good 

ones to medium ones. From type III, one had a very good 

result, one medium and 2 manifested osteonecrosis. From 

the fractures of the body all (except three: 1 type A, 1 type 

B and 1 type E) manifested osteonecrosis. The time of 

union ranged between 2,5 and 4,5 months. There was no 

deep infection and 9 complications were observed. 

Our results agree with those of international bibliography 

for these rare fractures. The fractures of the body 

and the type III of the neck have the worst prognosis. 

015 ARTHRODESIS OF THE HINDFOOT 

IN PATIENTS WITH HEMOPHILIC 

ARTHROPATHY 

P. G. Tsailas, J. D. Wiedel 

University of Colorado Hospital (UCHSC), 

Orthopaedic Department, Aurora, CO 

There have only been a few studies in the literature 

which reported on the outcome of ankle arthrodesis in 

patients with hemophilia, furthermore the number of 

patients is usually low and the operative technique is 

not uniform. The aim of this study is to evaluate the 

outcome of surgery in hemophilic arthropathy of the 

hindfoot, using internal fi xation. 

From 1983 to 2006, 20 fusions were performed in 

13 consecutive patients due to advanced hemophilic 

arthropathy of the hindfoot. There were 11 ankle 

fusions, 1 isolated subtalar fusion and 8 ankle and subtalar 

fusions, 3 of the latter on a second operation. The 

mean age at operation was 38.7 years and the mean followup 

was 9.4 years. Preoperativelly the mean modifi ed 

Mazur score was 47.7. In the majority of cases the ankle 

fusion was achieved by two crossing screws, while, for 

the subtalar fusion either staples were used, or the tibiotalar 

screws were extended to the os calsis. 

Arthrodesis of the ankle was successful in all but one 

patient, who was revised and progressed to fusion. The 

mean postoperative modifi ed Mazur score was 94.9. 

There was also one painless incomplete union of the 

subtalar joint which did not need revision. There was 

no recurrent bleeding, and no deep infection. 

Arthrodesis with cross screw fi xation and staples is 

a quick, simple and effective method for fusion of the 

hindfoot in patients with hemophilia. 

016 TREATMENT OF TIBIAL PILON 

FRACTURES WITH THREE DIFFERENT 

TECHNIQUES: OUR CLINICAL EXPERIENCE 

N. Vlachos-Zounelis, G. Malakasiotis, E. Sarras, 

E. Christodoulou, P. Theodorakopoulos, P. 

Baltopoulos 

1st Orthopaedic Department of General Hospital 

“KAT”, Athens, Greece 

Pilon fractures present a unique challenge to the patient 

and orthopaedic surgeon. Care for the soft tissue envelope 

is as important as management of this articular 

fracture. Assessment of the degree of energy causing the 

fracture and careful planning of the joint reconstruction 

will lead to acceptable results in most cases. 

Forty-fi ve patients (AO-ASIF classifi cation) treated 

between 2003 and 2008 were examined clinically and 

radiologically at an average of 24 months after injury. 

The patients were treated in three different ways: primary 

internal fi xation with a plate following, which 

was reserved for patients with closed fractures without 

severe soft tissue trauma; one-stage minimally invasive 

osteosynthesis for reconstruction of the articular surface 

with long-term transarticular external fi xation of 

the ankle for at least eight weeks and hybrid external 

fi xation. Objective evaluation criteria were infection 

rate, pseudarthrosis, amount of posttraumatic arthritis, 

range of ankle movement. 

In 65% of all pilon tibial fractures we observed an 

uncomplicated course of healing. Early complications were 

mainly soft tissue infections, whereas we found pseudarthrosis 

to be the most frequent late complication. 

The complication rate depends mainly on the type of 

fracture, the soft tissue damage and the type of treatment. 

In the case of low-grade soft tissue damage, good 

to excellent results were accomplished. In the case of 

higher-grade soft tissue damage, the problem of soft 

tissue coverage and reconstruction of the joint surface 

could be solved with good results by the hybrid external 

fi xation. Herewith it is important to use limited open 

reduction of displaced fragments and fi xation by cannulated 

screws and K-wires 

017 UNSTABLE ANKLE FRACTURES. THE 

MEANING OF SYNDESMOSIS SCREW 

M.Vlagkopoulos, N.Markopoulos, M.Avramidis, 

Ch.Lyrtzis,.Aleksiadis, Ch.Kristallis 

B’ Orthopaedic Department, General Hospital of 

Kilkis 

Is to present our clinical experience in how we evaluate 

ankle fractures as unstable and the use of syndesmosis 

screw in their treatment. 

Since 2004–2008, 85 ankle fractures treated surgically. 

Of them 31 were evaluated as unstable according to: 

a) preoperative x-rays fi ndings 

b) intraoperative tests, and syndesmosis screw was used. 

We used AO-Weber classifi cation: 14 cases type B(7 

cases of B2 and 7B3), 16 cases type C(4 cases of C1 

and 12 C2). Twenty-one of them were females and 10 

were males. Their age rage was from 17-61 years old 

(Mean 42,5).The follow-up was from 6months to 4 

years(Mean 2,5 years). Syndesmosis screw was removed 

afters six weeks. Postoperative results were evaluated 

according the scoring system of Olerud and Malander.


Postoperative there were 2 ankle O.A.(6,45%) due to 

false surgical technique. They treated by arthrodesis. 

The proper evaluation of the fi rst x-ray fi ndings of the 

fracture is of great importance for the proper treatmet. 

The syndesmosis screw is obligatory in unstable ankle 

fractures, in which, in combination with proper osteosynthesis 

preserves the ankle’s stability and viability. Ligament 

and bone lesions are responsible for ankle stability 

018 SURGICAL TREATMENT OF 

RHEUMATOID ARTHRITIS OF THE 

FOREFOOT 

V. N. Psychoyios, P. Intzirtzis, S. Thoma, K. Dakis, 

A. Alexandris 

5th Orthopaedic Department, Hand & Upper 

Extremity Service, Asclepeion Hospital of Voula, 

Athens 

Forefoot involvement in rheumatoid arthritis (RA) is 

extremely common and the majority of the patients with 

RA have active foot symptoms and signs of the disease. 

This rertospective study was undertaken to assess the 

outcomes and complications in the surgery of the forefoot 

RA. 

Seventeen patients (27 feet) with RA underwent surgical 

correction for the forefoot deformities. Anteroposterior 

and lateral weight bearing radiographs of all 

feet were taken preoperatively. The forefoot deformities 

seen with RA varied and included hallux valgus with 

subluxed metatarsophalangeal (MTP) joint in 23 feet, 

hallux valgus with dislocation of the MTP in 4, hammer 

or claw toes in 12 and 8 feet respectively. In addition, all 

27 feet presented with variable levels of intermetatarsal 

deviations or widening. All the patients with hallux 

valgus underwent fi rst MTP joint arthrodesis with 

various techniques. Deformities of the lesser toes were 

treated in all but 3 cases with resection arthroplasty, 

while the remaining 3 feet received a Weil osteotomy. 

Postoperatively the toes and the MTP joints were stabilised 

with K-wires for 6-8 weeks. 

All patients have been studied for a minimum follow 

up of 9 months. Twenty six patients were satisfi ed by 

the outcome of the surgical treatment. Only one patient 

complained of persistent metatarsalgia postoperatively. 

The surgical complications included 2 cases of delayed 

union, 5 cases of delayed wound healing, 2 cases of 

wound infection, and 4 cases of plantar callosity. Overall, 

4 patients required reoperation. 

Even though complications occur in patients with 

RA who undergo surgical correction of the forefoot 

deformities, most of these complications can be 

treated successfully. Thus, the overall outcome of the 

surgical treatment is good leading to satisfactory correction 

of the forefoot deformities and to pain elimination 

019 ‘SCARF’ OSTEOTOMY COMBINED 

OR NOT WITH FIRST PHALANX GREAT 

TOE OSTEOTOMY FOR TREATMENT OF 

SEVERE HALLUX VALGUS DEFORMITY.OUR 

EXPERIENCE IN 23 CASES 

G. Stamatopoulos, N. Zacharakis, V. Zois, A. 

Maris, A. Papailiou, A. Asimakopoulos 

2nd Orthopaedic Department, General Hospital 

of Athens, «G. Gennimatas» 

The purpose of this retrospective study was to report the 

results using scarf, fi rst metatarsal osteotomies, in correcting 

Hallux Valgus deformity with H-V angle >35°. 

During the period 2003-2008 we did 23 scarf, fi rst 

metatarsal osteotomies in 15 patients (8 bilateral).In 

order to evaluate the effectiveness of this operation, 

patients were clinically (aofas score) and radiologically 

(X –ray in 4, 8, 12 weeks) assessed. 

Mean follow up was 32 months. The results evaluated 

with the aofas score in order to study the function, 

the pain and the overall satisfaction of the patients. We 

had excellent results in 13 %, very good in 48 % good 

32% and poor 7 %.There was only one complication 

and no one infection. 

According the above results it seems that scarf osteot- 

omy is quite reliable surgical treatment of severe Hallux 

– Valgus deformity with an increased IM angle. 

020 FOOT AND ANKLE INJURIES DURING 

THE ATHENS 2004 OLYMPIC GAMES 

A. Badekas, S.Papadakis, S. Galanakos, K. Panagi, 

G. Tsakotos, T. Anastasopoulos 

Orthopaedic Dept., Hellenic Police, D’ 

Orthopaedic Dept., “KAT” General Hospital 

This study concerns an epidemiological analysis of foot 

and ankle injuries during the Athens Olympic Games 

2004. 

An epidemiological survey was used to analyse injuries 

in all sport tournaments over the period of the 

Games. During the Athens Olympic Games 2004 in the 

period from August 1st to September 1st, 624 patients 

presented to the Foot and Ankle Department for treatment. 

The mean age of athletes was 24 years (range 21 

to 32). Among the patients there were more males, 358 

(58%) than females, 266 (42%). 

In 525 (84.1%) patients there was only a soft tissue 

injury and in 99 (15.9%) patients there was bone 

involvement. Regarding specifi c diagnoses, tendinitis 

was the most common reason for a visit, followed by 

ankle sprains, nail infections/injuries, lesser toes sprains, 

and stress fractures. Sixty-nine (11%) required emergency 

transfer to the hospital. 

Our experience from the Athens Olympic Games will 

inform the development of public health surveillance 

systems for future Olympic Games, as well as other 

similar mass events. 

021 ARTHROSCOPIC REPAIR FOR PRIMARY 

TRAUMATIC PATELLAR DISLOCATION, 5- 

YEARS FOLLOW UP 

A. Karagiannis, I. Tsolos, E.Tyrpenou 

IASO General Hospital 

The assessment of the long –term outcome (5 years) of 

patients treated with arthroscopic stabilization for acute 

traumatic patellar dislocation. 

From September 2004 until April 2009 we treated 

29 patients (25 male, 4 female) with a median age of 18 

years (range 14-23 years), two of them had suffered from 

traumatic dislocation of the patella of the other knee joint 

in the past. The median range from injury to our surgical 

intervention was 20 days (7-29 days). The return 

in sporting activities, the possible redislocation or joint 

instability and the subjective assessment of the symptoms 

of the patients, were evaluated in a 5 years follow-up. 

After 5 years, 23 patients (20 males, 3 females), were 

re-evaluated. After the arthroscopic medial retinacular 

repair all the patients return to sporting activities. All 

the patients presented chondral lesions at the medial 

facet of the patella and to the lateral femoral condyle 

and hemarthrosis too. The functional outcomes were 

evaluated with Kujala scoring scale, with Visual analog 

scale and Tenger scale the range of results was good. 

The acute arthroscopic repair of the medial retinacular 

ligaments, protects the patient from redislocation 

or subluxation, allows the evaluation and stabilisation 

of the chondral lesions, the removal of free chondral 

bodies, as well as the evaluation of the possible damage 

to the menisci or ACL, PCL ligaments. 

All the patients returned to normal sporting activity 

avoiding further injury, or the development of osteoarthritis 

of the knee joint 

022 EARLY RESULTS OF DOUBLE-BUNDLE 

VERSUS SINGLE-BUNDLE ANTERIOR 

LIGAMENT RECONSTRUCTION 

D.D. Nikolopoulos, A. Apostolopoulos, A. Nakos, 

S.N. Vasilas, S. Drabalos, N. Barbounakis, J.B. 

Michos 

D Orthopaedic Department, General Hospital 

Asklipieion Voulas 

To compare the early functional and clinical results, 

between single (SB) and double-bundle (DB) of Anterior 

Cruciate Ligament (ACL) reconstruction with hamstrings 

(HS). 

Thirty-six patients from 17 to 36 years old (average 

age 23), 22 ♂ and 14 ♀, from January 2006 to May 2008, 

were randomly allocated for ACL reconstruction with HS 

(SB – DB). Eighteen patients underwent a 4-stranded SB 

reconstruction (group A) and the remaining 18 underwent 

an anatomic, 2-stranded DB ACL reconstruction 

with 2 tibial and 2 femoral tunnel technique (group B), by 

using the Smith & Nephew instrumentation system. The 

follow-up was from 8 to 22 months (average 16 months) 

for both groups and included clinical evaluation (pivotshift 

test, anterior laxity test with KT-1000 arthrometer 

and Lysholm knee score) and radiographs. 

There were no statistically signifi cant difference in the 

results between the 2 groups with regard to the pivotshift 

test and the Lysholm score (SB: mean 91, DB: mean 

89) (Mann-Whitney test, T-test). The anterior laxity 

was not signifi cantly different between group A (mean, 

2.2mm) and group B (mean, 0.9mm), according to KT- 

1000 measurements. Rotational stability, as evaluated 

by pivot-shift test, was better in group B than in group 

A, but statistical analysis showed no signifi cant difference. 

The average operation time was longer in DB (110 

min) compared to SB (80 min). There were no infections, 

though one patient of each group was found to 

be complicated with fi xed fl exion and extension lag >5°; 

and underwent arthroscopic lysis. 

Our study shows no statistically signifi cant advantage 

of DB versus SB ACL reconstruction, concerning 

the clinical evaluations and the complications 

023 A PROSPECTIVE COMPARISON OF ACL 

RECONSTRUCTION WITH ENDOBUTTON 

VS CROSS-PIN TECHNIQUEI. 

Apostolopoulos, A. Karagiannis, I. Tsolos, 

I. Staikidou, G. Giannikouris, I. Vrionis, N. 

Panigirakis, A. Andreakos 

1st IKA Hospital, Athens 

The assessment of graft stability in ACL reconstruction 

with two different techniques (endobutton vs. crosspin) 

and the comparative evaluation of the results of the two 

techniques. 

From October 2005 until May 2009, 69 patients 

underwent ACL reconstruction with the above-mentioned 

techniques by two surgeons; follow-up examinations 

took place after a minimum of two (2) years. 

Postoperative radiographic and clinical assessment 

were carried out and Lysholm, Tenger and IKDC scores 

were obtained at 3, 6, 12 and 24 months; stability was 

checked by KT-1000 arthrometer. Clinical evaluation by 

Lachman and pivot shift was normal or near-normal in 

65 patients. No signifi cant differences were found both 

as regards the KT-1000 (1.0 mm less with the cross-pin 

technique) and as regards the subjective variables (the 

endobutton having a slight advantage). Mean postoperative 

IKDC evaluation was 87.4 vs. 85.3, while 

Lysholm was 89 vs. 86. Two patients underwent revision 

after a new traumatic incidence and one displayed a 

new meniscal lesion, which was treated accordingly. The 

vast majority of the patients returned to their previous 

occupational activities and social life (overall patient 

satisfaction was at 88.2 vs. 85.4). 

Both the endobutton and the crosspin techniques 

proved to be reliable fi xation methods for the treatment 

of ACL ruptures using the hamstrigs tendons; both 

methods provided safe fi xation even in cases when back 

wall blow had occurred 


024 ARTHROSCOPIC REPAIR OF 

ACETABULAR CHONDRAL DELAMINATION 

WITH FIBRIN ADHESIVE 

R. Villar, A. Tzaveas 

The Richard Villar Practice, Wellington Hospital, 

London 

Acetabular chondral delamination is a frequent fi nding 

at hip arthroscopy. The cartilage is macroscopically 

normal but disrupted from the subchondral bone. Excision 

of chondral fl aps is the usual procedure for this type 

of lesion. However, we report 19 consecutive patients in 

whom the delaminated chondral fl ap was re-attached to 

the underlying subchondral bone with fi brin adhesive. 

We used the modifi ed Harris hip score for assessment of 

pain and function. 

Improvement in pain and function was found to be 

statistically signifi cant six months and one year after 

surgery. No local or general complications were noted. 

Three patients underwent further surgery for unrelated 

reasons. In each, the area of fi brin repair appeared intact 

and secure. 

Our results suggest that fi brin is a safe agent to use 

for acetabular chondral delamination. 

025 COMPERATIV STUDY OF TREATMENT 

PARTIAL ROTATOR CUFF TEAR ONLY BY 

ACROMIOPLASTY VS SUPRASPINATUS 

REPAIR 

I. Tsolos A. Karagiannis E. Tyrpenou 

Iaso General Hospital 

The assessment of the arthroscopic fi ndings in patients 

suffering from impingement syndrome and partial 

tear of the supraspinatus tendon, staged as type 1&2 

under Ellman, Gartsman, Snyder, that were treated by 

acromioplasty, debridment and repair of the supraspinatus 

tear. 

Thirty four patients,(20 male, 14 female), with a 

median age of 52 years, (48-64 years old), underwent 

shoulder joint arthroscopy. All were evaluated by two 

physicians and subjected to plain fi lms (AP&Y views) 

as well as to MRI. 

Clinically, the differencies in the evaluation of patients 

with type 1&2a lesion were insignifi cant. Type 2b had a 

better outcome, but in comparison to type 1, that were 

subjected only to acromioplasty, variations involving 

range of motion, pain and scoring (Constant & Oxford 

scores), were observed, from the fi rst stages of rehabilitation, 

with no further improvement. The comparative 

method in relation to the clinical trials was in favor of 

those patients treated with repair of the tear. 

After a 29 m follow up, we suggest only acromioplasty, 

in stages 1& 2a, although the daily activities of 

each patient can change the approach. In type 2b lesions, 

irrespective of age, we suggest the repair of the tear 

026 ARTHROSCOPIC REPAIR OF “HILL- 

SACHS” LESSION WITH “REMPLISSAGE” 

D. Alexakis, A. Siderakis, A. Tragkas, P. 

Katsakou, G. Dendrinos, C. Skordis 

“Euroclinic” Athens, Orthopaedic Department 

We describe the treatment of traumatic anterior shoulder 

instability complicated with Hill-Sachs lesion, using 

a combined arthroscopic technique of anterior & posterior 

capsular fi xation and infraspinatus tenodesis by 

means of suture-anchors, in order to fi ll the humeral 

head bone defect (i.e. “remplissage”). 

We use 2 posterior portals introducing the arthroscope 

through the upper one. A double-armed sutureanchor 

is inserted through each portal piercing the 

infranspinatous tendon & posterior capsule in an extraarticular 

mattress mode. The humeral head bone defect 

is fi lled with the aforementioned tissues. 

18 patients with well established anterior instability 

were subject to this technique between March 2005 

and December 2008. The follow-up time was 6 to 36 

months (average 18 months). All were evaluated using 

the Rowe protocol for shoulder instability which assess 

stability, ROM & shoulder functionality. 



In 13 patients the outcome was assessed as excellent, 

in 4 good & in 1 average. In one patient, post-op stiffness 

was developed which managed successfully with 

conservative means. 

The arthroscopic technique of “remplissage” is an 

innovative choice in the armamentarium of treatment 

of anterior traumatic instability with concomitant Hill- 

Sachs lesion. The results of this technique are excellent 

regarding the recurrence rate of anterior instabiliy (in 

our series there was none episode of recurrent instability 

during the study period). 

027 THE INFLUENCE OF KNEE FLEXION 

FOR DRILLING POSTEROLATERAL 

FEMORAL TUNNELS DURING DOUBLE- 

BUNDLE ACL RECONSTRUCTION 

THROUGH A MEDIAL PORTAL 

G. Basdekis, P. Christel, Claude Abisafi 

Institut de l’Appareil Locomoteur Nollet, 

Paris, France, University Hospital of Larissa, 

Department of Orthopaedic Surgery, Medical 

School, University of Thessalia, Larissa, Greece 

The purpose of this study is to determine the infl uence 

of knee fl exion angle for drilling the posterolateral (PL) 

femoral tunnel during double-bundle anterior cruciate 

ligament (ACL) reconstruction via the anteromedial 

(AM) portal on resulting tunnel orientation and length. 

Methods: In nine fresh cadaveric knees, the ACL was 

excised and 2.4 mm guide wires were drilled through 

the PL bundle footprint via an AM portal. We compared 

knee fl exion angles of 90, 110, 130 degrees. AP-, lateral- 

and tunnel view radiographs were measured to determine 

tunnel orientation, o’clock position, and direct 

measurement to determine intra-osseous tunnel length 

On AP view, increased fl exion resulted in more horizontal 

tunnels. The angles were 31.9 ± 7.1°, 26.4 ± 8.9° 

and 23.0 ± 8.1° for 90°, 110° and 130°. The pin orientation 

was signifi cantly different when comparing 90° and 

130°.On lateral view, increased fl exion resulted in more 

horizontal tunnels. The angles were 68.9 ± 19.9°, 50.4 

± 11.6°, 31.3 ± 12.3° for 90°, 110° and 130°. On tunnel 

view, pin orientation was 22 ± 8.2°, 28.3 ± 6.7° and 

35.9 ± 6.2° for 90°, 110° and 130°. Mean o’clock position 

was 09:00 ± 0:12. Intra-osseous length of the pins 

did not signifi cantly change with knee fl exion.The exit 

of the pins on the lateral femur with regard to femoral 

attachment of the LCL was proximal. The distance was 

0.1 ± 6.6 mm, 6.4 ± 6.4 mm and 9.2 ± 2.4 mm for 90°, 

110° and 130°. This was signifi cant when comparing 

90° and 130°. The shortest distance between the exit 

and the posterior femoral cortex was 4.0 ± 1.8 mm, 9.7 

± 3.5 mm, and 13.2 ± 2.8 mm for 90°, 110° and 130°. 

All values were signifi cant.Conclusion: At 110°, exit of 

the PL pin is close to the attachment of the LCL. 90° 

fl exion risks damage to the LCL and posterior cortex 

blow-out.Thus we recommend drilling the PL tunnel at 

130° of knee fl exion 

028 FULLY ARTHROSCOPICALLY 

PERFORMED 3-DIMENSIONAL 

AUTOLOGOUS CHONDROSPHERE 

IMPLANTATION (ACT) FOR FOCAL 

CHONDRAL DEFECTS AT THE KNEE- 

PRELIMINARY RESULTS 

S.Alevrogiannis, G.A.Skarpas, A. 

Triantafyllopoulos, A. Karavasili, P. Lygdas 

“Neo Athinaion” General Clinic, Orthopaedic 

Dept., Athens-GR; Barnet & Chase Farm 

Hospital, NHS Trust, London-UK; Orthopaedic 

Dept., P&A Kyriakou, Athens General Children’s 

Hospital, Orthopaedic Dept 

To present our preliminary results in fully arthroscopically 

performed 3-dimensional autologous cartilage 

transplantation (ACT-3D) for medium to large focal 

chondral defects at the knee. 

We treated operatively in our Dept., 35 symptomatic 

patients between March 2007 and May 2008. The 

mean age was 32 years old. The mean area of cartilage 

defect was 6.75cm² (2.2-10cm²) and all the cases were 

classifi ed as grade III(16) and IV(18) according to Outerbrigde 

scale. 18 of the cartilage lesions were located 

in the weight-bearing surface of the medial femoral 

condyle, 8 in the lateral one,6 in the trochlea area and 

2 in the lateral facet of the patella. We performed 15 

applications of ACT3D as single procedure. Apart from 

that, we performed 11 ACL reconstructions combined 

with the 3D-spheres.Preop. and postoperative evaluation 

of patients was done using the Modifi ed Cincinatti 

(MC) Rating System(0-100), the VAS (visual analogue 

pain score) (0-10), IKDC Knee examination score and 

Patient Outcome Function score. 

All the cases were performed uneventfully.No major 

complications were seen.All cases followed a specialized 

rehabilitation protocol. In MC Rating System the result 

rose from 41.5 to 72.5 and in VAS, pain signifi cantly 

reduced from 6.1 to 1.8 in 12 months time. The Patient 

Outcome Function score showed 81% better, 18% 

same and 1% worse results. The follow-up using MRI 

showed adequate fi lling of the defect without signifi cant 

bone swelling. 

Arthroscopically performed chondrocyte implantation 

(ACT) is an innovative technique with early results 

very promising.It’s surgeon demanding,although it’s fast 

performed technique and well tolerated operation.A 

greater number of cases and further mid and long term 

follow-up has to be studied in order to prove the effi cacy 

of the method. 

029 MALALIGNMENT AND CARTILAGE 

LESIONS IN THE PATELLOFEMORAL 

JOINT TREATED WITH AUTOLOGOUS 

CHONDROCYTE IMPLANTATION-LONG 

TERM RESULT 

H.S.Vasiliadis, Mats Brittberg, A. Lindahl, Lars 

Peterson 

Molecular Cell Biology and Regenerative 

Medicine, Sahlgrenska University Hospital, 

Gothenburg, Sweden; Gothenburg University, 

Gothenburg, Sweden; Department of 

Orthopaedics, Kungsbacka Hospital, Kungsbacka, 

Sweden; Orthopaedic Sports Medicine Center, 

Department of Orthopaedics, University of 

Ioannina, Greece 

Since 1987, autologous chondrocyte implantation (ACI) 

has been performed in Gothenburg, Sweden in more 

than 1600 patients. Out of the fi rst 442 patients operated 

with ACI, 153 (35%) had patella lesions and 91 

(21%) had trochlea lesions. Forty two patients (9.5%) 

had kissing lesions of the patellofemoral joint. 

The aim of the study was to evaluate the current 

clinical status of operated patients. Lysholm and Tegner- 

Wallgren self-assessment questionnaires were used. The 

patients were requested to compare their current status to 

previous states and to report whether they would do the 

operation again. Concomitant realignment procedures of 

the patellofemoral joint were also recorded and preoperative 

scores were also assessed from the medical fi les. 

Patients were divided into groups according to the location 

of lesion. All the groups showed a signifi cant improvement 

compared with the preoperative assessment. Over 

90% of the treated patients were satisfi ed with the ACI 

and would have undergone the procedure again. 

It seems that correcting the coexisting background 

factors with realignment, stabilizing or unloading procedures 

is improving the results over time. Despite the 

initial controversy about the results and indication for 

ACI in patellofemoral lesions, it is clear that ACI provides 

a satisfactory result even for the diffi cult cases with 

concomitant patellar instability. Our study reveals preservation 

of the good results and of high level of patients’ 

activities, even 10 to 20 years after the implantation.


030 HUMERAL AND GLENOID BONE 

LOSS AS FACTORS OF RECURRENCE 

AFTER ARTHROSCOPIC TREATMENT OF 

SHOULDER INSTABILITY 

E. Mataragas, C. Vassos, N. Tzanakakis, G. 

Mouzopoulos, C.K. Yiannakopoulos, Emm. 

Antonogiannakis 

Arthroscopy and Shoulder Unit, IASO 

GENERAL Hospital 

To evaluate humeral and glenoid bone loss in patients 

surgically treated for shoulder instability as factors of 

recurrence. 

During the period 2000-2008, 114 patients (103 men 

and 11 women) with mean age of 28 yrs underwent 

arthroscopic treatment for shoulder instability by the 

same surgeon. Mean age of the 1st shoulder dislocation 

was 20,89 yo and the average number of dislocations 

per patient was 17,14. Glenoid bone loss was found in 

all patients (16 Large, 59 Medium, 29 Small), as well 

as Hill Sachs lesions (66 Large, 23 Medium, 8 Small) 

or both. Thirteen (13) patients had an “inverted pear” 

glenoid shape. Seventy fi ve (75) were into sports and 

for 57 (76%) of them this involved Overhead/Contact 

activities. Also 20 patients presented joint hypermobility. 

Complete follow up existed for 92 patients and it 

ranged from 4-108 months (Mean=44). The recurrence 

of instability and the functional outcome were evaluated 

post-op using the Rowe Zarins Score. 

Recurrence of instability was noted in 5 patients 

(4,38%). All of them presented Hill Sachs lesions and 

glenoid bone loss (2 Large, 2 Medium, 1Small) but without 

an “inverted pear” glenoid shape or joint hypermobility. 

All 5 of them were into Overhead/Contact sports 

activities (2 Professional: Mean=15hr/w and 3 Amateur: 

Mean=2,5hr/w). The post op Rowe Zarins Score ranged 

from 80-100 (Mean=95,11). 

From the evaluation of our data, it seems that 

humeral and glenoid bone loss do not signifi cantly 

contribute to the recurrence of arthroscopically treated 

shoulder instability. 

031 COMPLEX OSTEOLIGAMENTAL 

UNSTABLE ELBOW LESIONS. TOTAL JOINT 

RECONSTRUCTION. 17 PATIENTS 

I. Ignatiadis, D. Arapoglou, E. Pateromihelakis, 

K. Mpeis, E. Pananis, P.Psyllakis, N. 

Gerostathopoulos 

Hand surgery-Upper limb and Microsurgery Dept, 

KAT Hospital of Athens, Greece. 

We prove the importance of the complete osteoligamentary 

elbow reconstruction and the usefulness of the ligamentoplasty 

by palmaris longus combined with other 

procedures in complex elbow unstable injuries. 

17 patients aged between 17 and 72 suffered elbow 

luxation or subluxation with rupture of the medial collateral 

ligament, associated with: 1)Fracture of the 

radius head, 2)fracture of the coronoidal process(terrible 

triade),1)olecranon fractures. In 3 compaound injuries we 

had open fractures with Brahial artery lesion, Ulnar nerve 

pulsy, radial nerve laceration, Brahial plexus injury. 

The lesions happened between 2 hours and 2 yrs preoperatively, 

caused to work accidents or to traffi c accidents 

with a follow up between 8-62 months. 10 of the 

injuries were operated almost in emergency by ligamentoplasty 

with palmaris longus, coronoidal process fi xation 

with screw or ancor, radial head osteosynthesis or 

prosthesis. The vascular injuries urgently operated while 

the nerve lesions left for secondary repair. 

A functional splint was applied postoperatively, 

initially fi xated between 110-85 degrees. The splint 

removed 2 months postoperatively, while full rang of 

motion obtained. 

We performed both Mayo clinic, DAS scores and 

grasp strength force and Range of Motion measurement 

evaluation procedures 

Satisfactory to excellent results have been obtained 

in 11 cases with stable joints and range of motion with 

20 degrees extension-fl exion defi cit while in I case the 

instability persited, in another one arrived 50% of the 

normal range of motion. 

The complex elbow injuries with ligamentary insta- 

bility are effectively treated if except fractures we always 

repair The medial-anterior ligaments lesion with ligamentoplasty 

and ancors. 

032 MANAGEMENT OF COMMINUTED 

RADIAL HEAD FRACTURES WITH 

ARTHROPLASTY 

K. Gouvalas, K. Kavvadias, A. Papachristos, Ch. 

Oikonomou, D. Xanthopoylos, H. Delkos, Th. 

Mylonas A. Mpeltegris 

Orthopaedic Department of General Hospital 

of Lamia, Radiological Department of General 

Hospital of Lamia 

The treatment of radius head comminuted fractures 

remains controversial.The radius head excision and 

the radius head arthroplasty have been proposed as the 

main treatment methods. 

We present 13 cases, 6 men and 7 women aged 25-68 

years old with radius head comminuted fractures Mason 

type III during 2005-2006. Elbow dislocation was also 

present in 3 patients, ulnar comminuted fracture in 1 

patient and ipsilateral cubitocarpal comminuted fracture 

in another patient. 

All patients were managed operatively with radius 

head removal and cementless monopolar metallic prothesis 

placement. The others musculoskeletal injuries were 

managed at the same time.The average hospitalization 

was 6.8 days without complication postoperatively. 

12 cases were followed up and the average follow up 

period was 26 months. 

In 6 cases the results were excellent, in 3 cases the results 

were moderate and in 3 cases the results were bad. 

We believe that the arthroplasty is the acceptable 

method in radius head comminuted fractures management 

especially in cases were complicated elbow damages 

are present. 

033 DELAYED FOREIGN BODY REACTION 

TO ABSORBABLE IMPLANTS IN 

METACARPAL FRACTURE TREATMENT 

S.I. Stavridis, P. Savvidis, K. Ditsios, P. Givissis, A. 

Christodoulou 

1st Orthopaedic Department of Aristotle 

University, “G. Papanikolaou” General Hospital, 

Thessaloniki, Greece 

The aim of this study was to explore whether adverse 

reactions would occur during the material’s degradation 

period even at a later time point after surgery and 

whether these phenomena were clinically signifi cant and 

would infl uence the fi nal outcome. 

12 unstable, displaced metacarpal fractures in 10 

patients (7 males, 3 females; mean age 36.4 y, range 18- 

75 y) were treated with the Inion ® OTPSTM Biodegradable 

Mini Plating System. 9 patients (10 fractures) were 

available for follow-up (mean 25.6 months, range 14 to 

44 m). For patients without appearance of foreign body 

reaction the minimum follow-up time was 24 months 

Patients were examined both radiologically to evaluate 

fracture healing, and clinically by completing the 

DASH-score and a visual analogue scale for pain assessment. 

Grip strength, fi nger strength and range of motion 

of metacarpo-phalangeal and interphalangeal joints 

were measured. 

Fracture healing occurred uneventfully in all patients 

within six weeks. The most important complication was 

a foreign body reaction observed in 4 of our patients 

more than a year postoperatively. All were re-operated 

and had the materials removed. Histological examination 

confi rmed the diagnosis of aseptic infl ammation 

and foreign body reaction. 

Although internal fi xation of metacarpal fractures by 

using bioabsorbable implants is a satisfactory alternative 

fi xation method, patients should be advised of this possible 

late complication and should be followed postoperatively 

for at least one and a half year, possibly longer. 

034 SURGICAL TREATMENT OF PROXIMAL 

HUMERUS FRACTURES IN MEDIAL AGE 

PATIENTS 

S. Theocharakis, V. Goulidakis, N. Manetakis, E. 

Dracoulakis, G.Adamopoulos 

6th Orthopaedic Department, Asklepiion Voulas 

General Hospital, Athens. 

The goal of this study is to analyze the surgical management 

of proximal humerus fractures in medial age 

patients (50-65 years of age). 

From 2003-2008 were treated 49 patients, 14 male 

and 35 female with mean age of 61 years. All patients 

had a proximal humerus fracture classifi ed by the AO 

Universal Classifi cation. The fractures were treated 

with either open reduction internal fi xation (ORIF-21 

patients) or with shoulder hemiarthroplasty (HSA-28 

patients) under general anesthesia. 

Among the patients that were treated with ORIF or 

HSA we did not observe statistical signifi cant differences 

in the days of hospital stay, the change of pre and 

postoperative hemoglobin, the need of blood transfusion 

and the acute postoperative complications. On the 

contrary there were statistical signifi cant differences in 

the level of acute postoperative pain, the clinical results 

and the range of shoulder movements after a period of 

3,6 and 12 months (constant score). 

ORIF seems to have better clinical results for younger 

medial age patients in comparison with HSA that seems 

to have poorer results. On the contrary HSA seems to 

have better clinical results for older medial age patients. 

035 POSTERIOR INTEROSEOUS NERVE 

PALSY 

D. Efstathopoulos. El. Karadimas, G. 

Stefanakis, D. Chardaloubas, D. Klapsakis, G. 

Chatzhmarkakis 

Hand Surgery and Microsurgery Clinic 

– General Hospital of Attica “KAT” Dir. N. 

Gerostahopoulos 

Posterior interoseous nerve (PIN) syndrome is an entrapment 

of the deep branch of the radial nerve just distal to 

the elbow joint. It may result in the paresis or paralysis 

of the fi ngers and thumb extensor muscles. 

We present a review of 26 cases of PIN entrapment 

syndrome, diagnosed an treated over a ten years period 

form 1996 to 2005. Their ages ranged form 12 to 57 

years, they were 18 men and 8 women. The interval 

between, the onset or paralysis and operation ranged 

from 4 months to 1 year. All the patients were diagnosed 

preoperatively as having PIN palsy from physical 

examination and electromyographic (EMG) studies 

of the posterior interoseous innervated muscles and all 

were treated by operation. 

The cause of compression was, ganglia in four cases, 

fascia thickening at the arcad of frohse in six cases, the 

radial recurrent vessels in three cases, lipoma in four 

cases, dislocated head of the radius in two cases, infamed 

synovium in four cases, tumour in two cases, and 

Intraneural Perineurioma in one case. The periods of 

postoperative observation were from 1 to 10 years. The 

paralysis recovered completely by the six postoperative 

months in all cases except one girl with intraneural perineurioma. 

Three patients developed mild refl ex sympathetic dystrophy 

which resolved with physiotherapy and auxilary 

blocks. Two patients developed hyperaesthesia in the 

distribution of the superfi cial radial nerve which recovered 

in a few weeks. 

Having arrived at a diagnosis of PIN syndrome, it is 

important to select the correct level for the release of the 

radial nerve. Fair or poor results can be due to incorrect 

diagnosis, incomplete release or irreversible nerve injury. 


036 ENDOSCOPIC VERSUS OPEN CARPAL 

TUNNEL RELEASE IN CARPAL TUNNEL 

SYNDROME: A COMPARATIVE STUDY 

H. Vasiliadis, G. Mitsionis, Th. Xenakis, An. 

Georgoulis 

Molecular Cell Biology and Regenerative 

Medicine, Sahlgrenska University Hospital, 

Gothenburg, Sweden, Department of 

Orthopaedics, Kungsbacka Hospital, Kungsbacka, 

Sweden, Department of Orthopaedics, University 

of Ioannina, Greece 

This study compares the endoscopic carpal tunnel 

release with the conventional open technique with 

respect to short and long-term improvements of functional 

and clinical outcomes. 

We assessed 72 outpatients diagnosed with carpal 

tunnel syndrome. Thirty-seven patients underwent the 

endoscopic method according to Chow and 35 were 

assigned to the open method. Improvement in symptoms, 

severity and functionality were evaluated shortly 

preoperatively (at two days, one week and two weeks) 

and one year after using the Symptom Severity Scale, 

Symptom Severity Status and DASH questionnaire. 

Changes in clinical outcomes (grip strength, key pinch 

and two-point discrimination test) were evaluated one 

year postoperatively. Complications were also assessed. 

Both groups showed similar improvement in all but 

one outcome one year after the release; increase in grip 

strength was signifi cantly higher for the endoscopic 

group. The endoscopic method was also associated with 

a signifi cantly faster short-term improvement. Separate 

analysis of the questionnaire components referring to 

pain reveals that the delay of improvement in the open 

group is due to the persistence of pain for a longer 

period. Paresthesias and numbness decrease shortly after 

the operation with comparable rates for both groups. 

037 MANAGEMENT AND OUTCOME OF 

CLAVICULAR FRACTURES IN A UNIVERSIY 

TEACHING HOSPITAL: A TWO YEARS 

EXPERIENCE 

P.V. Giannoudis, P. Stavlas, C. Tzioupis, R. Singh, 

C. Kontakis 

Academic Department of Trauma and 

Orthopaedics, Leeds Teaching Hospitals, NHS 

Trust, Leeds, UK 

To estimate the prevalence of clavicular fractures, 

number of cases required operative treatment, and 

whether removal of the implant is a frequent necessity. 

Between November 2005 and Nov 2007 all patients 

presenting in our institution with clavicular fractures 

were eligible for participation. Patients below 18 years 

of age, and pathological fractures were excluded. Retrospective 

review of clinical notes and radiographs. Demographic 

details, mode of injury, treatment protocol, 

operative procedures performed, time to union, complications 

post-surgery stabilization, and the number of 

cases that required implant removal were documented 

and analysed in a computerized database. The mean 

time of follow up was 24 weeks (12-48). 

Out of 16,280 adult fractures that presented to our 

institution, 200 (1.23%), (137 males) patients met the 

inclusion criteria with a mean age of 43 years (19-95) 

and a mean ISS of 9 (4-38). There were 4 of the medial, 

153 of the middle and 43 of the lateral clavicle fractures 

(3 were open). 178 (89%) patients were treated 

non-operatively and 22 (11%) operatively. Indications 

for surgery included open fracture, bony spike/skin 

threatened, grossly displaced/comminuted fracture, 

polytrauma and non-union. Mean time to radiological 

union was 14 weeks (5-38 weeks). Out of the 200 

patients 12 (6%) developed non-union. Out of the 

22 operated patients, 7 (32%) required plate removal 

and 1 had screw removal. Indications for removal of 

implant included, periprosthetic fracture (1), prominent 

metal work through skin (3), pain in shoulder (2), pressure 

symptoms (1). Post removal of implant, 6 (75%) 

patients claimed improvement in symptoms. Functional 

outcome was excellent/good in 90% of cases. 

The incidence of clavicular fractures was 1.23%. A 

small number of patients (11%) required operative treat- 



ment out of which one third had metal work removal. 

The majority of clavicular fractures can be treated nonoperative 

with good functional results. 

038 THE INFRASPINATUS TENODESIS AND 

POSTERIOR CAPSULODESIS (REMPLISSAGE) 

IN CASES WITH HUMERAL BONE LOSS 

(HILL SACHS DEFECTS) 






This paper aims to evaluate the Remplissage arthroscopic 

technique as described by Eugene Wolf used in patients 

with traumatic shoulder instability that present glenoid 

bone loss and Hill Sachs defects. 

In our study 28 patients (5 women and 23 men) with 

mean age of 31 yrs underwent arthroscopic stabilization 

of the shoulder by the same surgeon during 2007-2008 

period. All patients presented Hill Sachs lesion, 11 of 

them had medium or large glenoid bone loss, 10 had 

an “inverted pear” glenoid shape, 4 had been revised 

for stabilization in the same shoulder and 14 presented 

joint hypermobility. Mean age for the age of 1st dislocation 

was 20,1 yrs and our follow up ranged from 5-28 

months (Mean=18). The recurrence of instability and 

the functional outcome were evaluated pre-op and postop 

with the Rowe Zarins Score. The post op rehabilitation 

was performed by a specialist. 

None of the patients presented recurrent instability. 

The Rowe Zarins Score raised from a mean pre op 

score of 23,33 (15-60) to a mean post op score of 97,11 

(75-100) (p


042 TREATMENT OF HUMERAL SHAFT 

FRACTURES WITH INTRAMEDULLARY 

NAILING 

K. Papanastasopoulos, K. Sarantos, E. 

Myriokefalitakis, I. Georgopoulos, C. Agisilaou, 

K. Kateros 

A’ Orthopaedic Department, General Hospital of 

Athens “G. Gennimatas” 

In this study we try to evaluate the results of intramedullary 

nailing in the treatment of fractures of diaphysis 

of humerus. 

During the time period of 2002 to 2006 46 patients 

were admitted in our clinic with fracture of the diaphysis 

of the humerus and 23 patients were treated surgically 

with intramedullary nailing. 14 patients were directly 

submitted to intramedullary nailing, 6 patients after 

unsuccessful conservative treatment and 3 patients due 

to nonunion after internal fi xation. Average age was 51 

years old. In 5 patients open reduction was applied while 

bone grafts were not used in any case. In all cases bone 

healing was obtained within 6 to 20 weeks (average 11 

weeks). Final functional outcome was evaluated with 

Constant Score and according to it 10 patients demonstrated 

excellent score (>75), 7 satisfactory (50-75) and 

6 poor(

048 PERIPROSTHETIC FEMORAL 

FRACTURES.TREATMENT – CLINICAL 

RESULTS 

A. Boutsiadis,G. Venetsanakis.V. Venetsanaki, G 

Petsatodis, I. Chatzokos, A. Christodoulou 

A Orthopaedic Department AUTH General 

Hospital Papanikolaou 

Periprosthetic fractures are rare complications (0.3%- 

2.5%) of total knee and hip Arthroplasty. Purpose of 

this study is to present our experience and the mid-term 

clinical results of periprosthetic fracture care. 

Between 2005 and 2009 nineteen femoral periprosthetic 

fractures were treated in our department. Seven 

patients with TKA had supracondylar fractures,type II 

according to Lewis and Rorabec classifi cation. Twelve 

patients with THR had type B2 fractures according to 

Vacouver Classifi cation. Seven patients were men and 

12 women with average age 78.15 years. Femoral shaft 

fractures were treated with ORIF and DCP 4.5mm femoral 

plate in 8 cases,revision THR in 3 cases and 4.5mm 

plate with wires in one case. Supracondylar fractures 

were treated with ORIF abd LCP plate 4.5mm in 5 cases, 

Ilizarov fi xator in one case and DCS plate in the last case. 

The average follow up was 22months postoperatively. 

Fracture healing observed in16 patients at an average 

of 6 months postoperatively. No infection or non union 

complicated our treatment goal. Three patients died at 

an average of 2 months postoperatively. One should 

point out that mobilization and return to previous 

activity level is very diffi cult for these patients, despite 

fracture healing. Best clinical results observed with DCP 

and LCP 4.5mm plates. 

Periprosthetic fractures are serious and complex complications 

of an arthroplasty that require stable osteosynthesis 

and primary patient mobilization. 

049 THE DISPLACED PROXIMAL HUMERUS 

FRACTURE – TREATMENT WITH LOCKING- 

SCREW FIXED ANGLE PLATE 

E. Christodoulou, C. Ballhorn, D. Retzlaff, S. 

Elenz 

St. Marien Hospital Muelheim an der Ruhr, 

Germany, Clinic for Trauma- and Orthopedic- 

Surgery 

The treatment of the displaced proximal humerus-fracture 

with solid osteosynthesis is complicating by coexistence 

of osteoporosis and simultaneous degenerative 

changes of the rotator cuff. These specifi c problems, as 

well as the usage of primary endoprosthetic replacement 

should be reduced through the introduction of lockingscrew-plate-systems. 

From April 2006 to March 2008, 70 patients received 

the clinical application of a newly developed lockingscrew-plate 

(Winsta PH) in a prospective study. 48 of 

70 patients were subjected to re-examination after averagely 

15 months (1-3 years), 34 women and 14 men. 

The average age was 68.7 years. The classifi cation of 

the fractures occurred after Neer. Concerned are 12 

two-fragment, 21 three-fragment and 15 four-fragment 

fractures. The functional result after surgery was rated 

according to the Constant- and Dash-Score. 

The average absolute Constant-Score was 63% and 

the Dash-score 18.3. Patients with accurate anatomical 

reduction achieved a signifi cantly better score. Secondary 

loss of correction occurred in 3 patients with 

collapse of the humeral-head and perforation of the 

screws. An early metal removal combined with subacromial 

decompression took place in 3 patients, because of 

post-traumatic impingement. In a Neer VI-fracture-case, 

an early revision to hemiarthroplasty occurred due to a 

postoperative dislocation. One postop-wound discharge 

was surgically debrided. 

Modern locking-screw systems like Winsta-PH plate 

allow a safe treatment of complex fractures of the 

proximal humerus, diminishing the need for primary 

endoprosthetic replacement signifi cantly. Anatomic 

reduction is essential for the locking screw plate system 

to form the pillar for a successful outcome. 



050 INTRAMEDULLARY CORTICOGENESIS 

AFTER INTRAMEDULLARY NAILING: A 

‘BONE-NAIL’ PHENOMENON 

S.A. Papadakis, D. Segkos, V. Katsiva, P. Pantoula, 

S. Galanakos, P. Katonis 

D’ Department of Orthopaedics, KAT General 

Hospital, Kifissia, Greece, Department of 

Radiology, Nikaia General Hospital, Pireaus, 

Greece, Department of Pathology, Nikaia 

General Hospital, Piraeus, Greece, Department 

of Orthopaedics, University of Crete, Herakleion, 

Greece 

To determine the gross structural alterations of the 

nailed bone (femur or tibia) after the removal of an 

intramedullary nail (IMN). 

Eighteen patients (14 femoral and 4 tibia nail) underwent 

an IMN removal from their femur or tibia. Every 

patient had a spiral computed tomography scan and a 

plain X-ray study, immediately after the nail removal 

and also at their latest follow-up (24–30 months). The 

4 patients with a tibia nail were additionally examined 

using a peripheral quantitative computed tomography 

study at their latest follow-up. All patients were asymptomatic. 

An intramedullary shell of compact bone was demonstrated 

around the nail track. This new bone was apparent 

on plain radiographs in all of the patients. Peripheral 

quantitative computed tomography study revealed that 

the density of the bony ring was similar to that of subcortical 

bone. The histologic examination of the intramedullary 

shell of one of our patients suggested that the 

bony ring was made of cortical bone. 

Intramedullary nailing may enhance new cortical 

bone formation within the bone marrow cavity. This 

“cortical bone” still exists more than 2 years after 

implant removal. Nail insertion also causes thickening 

of the normal cortex at the sites of nail–cortex contact 

where loads are transferred from the nail to the cortex. 

This new fi nding could probably lead the research of 

intramedullary nailing biomechanics toward new directions 

as to understand the body’s reaction to IMNs. 

051 SHORTENING DEROTATIONAL 

SUBTROCHANTERIC OSTEOTOMY FOR 

CROWE IV HIGH HIP DYSPLASIA. THE 

EXETER EXPERIENCE. 

J.A.F. Charity, E. Tsiridis, A. Sheeraz, J.R. Howell, 

A.J. Timperley, G.A. Gie 

Princess Elizabeth Orthopaedic Centre, Royal 

Devon & Exeter Hospital, Barrack Rd., Exeter, 

Devon, UK 

Restoration of an anatomical hip centre frequently 

requires limb lengthening, which increases the risk of 

nerve injury in the treatment of Crowe 4 Developmental 

Dysplasia of the Hip (DDH). Prospective evaluation of 

the use of subtrochanteric derotational femoral shortening 

with a cemented Exeter stem. 

15 female patients (18 hips – 3 bilateral) with a 

mean age at time of operation of 51 years followedup 

for a mean of 114 months (range 52 to 168). 16 

cemented and 2 uncemented acetabular components 

were implanted. Exeter cemented DDH stems were 

used in all cases. No patient lost to follow up. All 18 

Crowe IV hips reviewed. Charnley-D’Aubigne-Postel 

score for pain, function and range of movement were 

improved from a mean of 2-2-3 to 5-4-5 respectively. 

One osteotomy failed to unite at 14 months and revised 

successfully. Clinical healing was achieved at a mean of 

6 months while radiological evidence of union at a mean 

of 9 months. The mean length of the excised segment 

was 3 cm and the mean true limb lengthening was 2 cm. 

3.5mm DCP plate with unicortical screws was used to 

reduce the osteotomy, and intramedullary autografting 

performed in all cases. Mean subsidence was 1 mm and 

no stem was found to be loose at the latest follow up. 

No sciatic nerve palsy was observed and there were no 

post-operative dislocations. 

Cemented Exeter femoral components perform well 

in the treatment of Crowe IV DDH with when a subtrochanteric 

derotational shortening osteotomy (SDSO) 

was necessary. A transverse osteotomy is necessary to 

achieve derotation and reduction can be maintained 

with a DCP plate. Intramedullary autografting prevents 

cement interposition at the osteotomy site and promotes 

healing. 

052 IN VITRO BIOMECHANIC EVALUATION 

OF CEMENT-IN-CEMENT INTERFACE IN HIP 

ARTHROPLASTY REVISIONS 

G. Rudol, I. Pagkalos, I. Polyzois, R. Wilcox, E. 

Tsiridis 


Orthopaedics, Leeds General Infirmary, Great 

George Street, Leeds 

In selected patients in-cement revision of the total hip 

arthroplasty components is an attractive option. Recommended 

roughening of the primary mantle surface 

remains controversial. Aim of the study was to investigate 

the infl uence of the cement surface roughening on 

the strength of bilaminar cement interface. 

Flat, laboratory model of bilaminar cement interface 

was used. Prior to its creation, modeled primary mantle 

surface was machined to the roughness of either smooth 

surface observed after removal of a highly polished stem 

(Ra=200nm) or that following roughening (Ra=5μm). 

Two viscosities of interfering fl uids (water and bone 

marrow) were also used. 6 variants (smooth or rough, 

both stained with water, bone marrow or with no fl uid) 

with 7 repeats were exposed to single shear to failure. 

No signifi cant difference in resistance to shear 

was observed between the groups with dry smooth 

(16.82MPa) and rough surfaces (16.96MPa), and those 

stained with large volume of low viscosity fl uid. In 

the presence of water, roughening did not signifi cantly 

infl uence the interface (smooth – 17.04MPa and rough 

– 16.25MPa respectively). 

In the smooth variant with large volume of viscous 

fl uid, ultimate stress value dropped to 5.53MPa, and 

9.87MPa in the roughened group with the same amount 

of viscous fl uid (p


signifi cantly improved their range of joint movement 

and were relieved from pain. Surgical excision seems to 

provide a superior quality of life in these patients, as 

they have a high risk for major complications due to 

their poor level of mobility. 

054 THE 22-TO 34YEARS OUTCOME 

OF CHARNLEY LOW FRICTION 

ARTHROPLASTY IN YOUNG PATIENTS 

WITH OSTEOARTHRITIS 

G. Georgiades, G. Babis, G. Kourlaba, G. 

Hartofilakidis 

1st Department of Orthopaedics, University of 

Athens Medical School 

We reported on the outcome of 84 Charnley low friction 

arthroplasties performed by one of us (GH), the 

period 1973 to1984, in 69 patients, less than fi fty-fi ve 

years old, with osteoarthritis mainly due to congenital 

hip disease. 

The patients were followed prospectively; clinically 

using the Merle D’Aubigné and Postel scoring system, as 

modifi ed by Charnley and also radiographically. 

At the time of the latest follow-up, thirty-seven hips 

had failed (44%). In thirty-two hips, twenty-eight acetabular 

and thirty femoral components were revised 

because of aseptic loosening (six of the femoral components 

were broken). Three hips were infected and 

converted to resection arthroplasty. In two more hips 

a periprosthetic femur fracture occurred three and ten 

years postoperatively and were treated with internal 

fi xation. After a minimum of twenty-two years from 

the index operation, 37 original acetabular components 

and 36 original femoral components were in place for 

an average of 29 years. The probability of survival for 

both components with failure for any reason as the end 

point was 0.51 (95% confi dence interval, 0.39 to 0.62) 

at twenty-fi ve years when 35 hips were at risk. 

These long term results can be used as a benchmark of 

endurance of current total hip arthroplasties performed 

in young patients, with OA mainly due to congenital 

hip disease. 

055 HYBRID STEM FIXATION IN REVISION 

HIP ARTHROPLASTY 

A. Tsamatropoulos, C.Vassos, E. Karavas, G. 

Epaggelis, D. Chalatsis, K. Sarafis 

1st Orthopaedic Department, General Hospital of 

Asclepeion Voulas 

This study reports the results of hybrid stem fi xation 

in diffi cult revision hip arthroplasties where proximal 

femoral bone stock loss was severe. 

Twenty-six revision arthroplasties (21 women and 

5 men, aged from 58 to 86 years), were performed 

between 1998 and 2008. The indication for surgery was 

aseptic loosening. In all cases, stabilization of the stem 

presented problems because of severe proximal femoral 

bone stock loss (due to extensive periprosthetic osteolytic 

defects), or because of iatrogenic defects or surgical 

procedures (attempts to remove the stem and cement 

with fenestration or extended osteotomy). The average 

follow-up was 48 months (range 16 to 120). 

Primary stability is necessary for the successful defi - 

nite fi xation of a cementless implant by bone. When this 

was not possible (because of proximal cortical insuffi - 

ciency), we used a modular distally cemented long stem, 

bypassing the area of bone defect for at least 6-7 cm. 

Proximally bone defects were grafted and osteotomy 

was closed with cerclage wires. 

Four stems (15%) had an asymptomatic subsidence 

(3 stems subsided less than 3-4 mm and 1 stem about 

15mm). No stem was revised to date. Major complications 

did not occur. The mean Harris hip score improved 

from 32 points preoperatively to 82.3 points (at the 

most recent evaluation). 

Hybrid fi xation offers the advantage of initial and 

secure stability of the cemented stem on the short term, 

until stabilization of the entire implant by bone occurs. 

Thus early subsidence and loosening is avoided and on 

the long term benefi ts of the cementless fi xation are 

attained. Our results support the method of hybrid 

fi xation in patients with severe femoral bone loss (and 

consequently problematic stabilization), when primary 

stability is needed. 

056 TOTAL HIP REPLACEMENT IN PATIENTS 

WITH FEMORAL DYSPLASIA USING 

STRAIGTH CONICAL WAGNER-TYPE STEMS 

R.A. Giannakos, K. Bargiotas, L. Papatheodorou, 

S. Varitimidis, T. Karachalios, K.N. Malizos 

University of Thessalia, Department of 

Orthopaedics 

The evaluation of the middle term behaviour of the 

Wagner-type stems in dysplastic femurs and the presentation 

of the technical and surgical differences with the 

implantation of a Wagner stem. 

Between 1997 and 2008 we implanted 64 Wagner 

stems in 58 patients. Average age at the time of implantation 

was 64 years. 52 patients was operated because 

of DDH, and 12 had had previous osteotomy. All 

patients were prospectively evaluated radiographically 

and clinically at annual intervals. Functional outcome 

was assessed with Harris Hip Score and Oxford Score. 

Mean follow-up of these series was 4 years (11-1)One 

stem was revised because of fracture of the lesser trochander 

and two more patients were re-operated for 

open reduction. With the re-operation as end-point 

and 95% Confi dence Interval survivorship rate was 98, 

5%. There were no progressive radiolucent lines. Stem 

migration was at an average 2mm (1-6) during the fi rst 

two years and remained stable thereafter.There was no 

deep infection in these series. After the second year a 

dense zone is evident in all Gruen zones at the implant 

–bone interface with a width of 2-3 mm. 

Dysplasia of the proximal femur may pose signifi cant 

technical problems during THA due to the distortion of 

the geometry and the narrowing of the femoral canal. 

The sort, conical Wagner type stems can offer a very 

good alternative is such patients. They allow control of 

the anteversion and they are able get a good press-fi t 

despite the metaphyseal/diaphyseal mismatch and the 

femoral bowing. 

Wagner type stems are a reliable alternative when 

performing THA in patients with dysplastic femurs. 

057 THE USE OF A CALCIUM 

HYDROXYAPATITE ANTIBIOTIC CARRIER 

(PEROSSAL*) AS A SPACER IN TWO-STAGE 

REVISION INFECTED ARTHROPLASTY 

A. Drakou, G. I. Karaliotas, V. Sakellariou, H. 

Tsibidakis, P. Pantos, A. Papadopoulos 

1st Department of Orthopaedics, Athens 

University Medical School, ATTIKON University 

Hospital, Athens, Greece, 4th Department of 

Internal Medicine, Athens University Medical 

School, ATTIKON University Hospital, Athens, 

Greece 

Two-stage revision procedure is the gold standard in 

management of periprosthetic infections. Cement spacers 

have long been used to preserve the space created 

during resection procedure and to release antiobiotics 

within the created dead space. However, the problems 

related to cement as an antibiotic carrier are well recognised 

(thermal necrosis, random porosity, unspecifi ed 

antibiotic delivery rate). 

To present the concept of using PerOssal as a canal 

fi lling spacer and local antibiotic delivery system in twostage 

revisions of hip and knee infected arthroplasty. 

8 patients (6 females, 2 males) with infected arthroplasty 

(4 TKRs, 4 THRs) were managed with two-stage 

revision procedures during the years 2006-2008 (minimum 

FU: 12 months). Our protocol consisted of: a) 

Preoperative determination of the causative organism 

b) Radical debridement surgery and cement spacer with 

PerOssal implantation c) Appropriate IV antibiotic therapy 

for 6 weeks, postoperative clinical evaluation and 

monitoring of infl ammation markers d) After a six-week 

antibiotic free interval and infl ammation markers normalization 

second stage surgery took place: Medullary 

canal reaming, intraoperative cultures, thorough wound 

irrigation and prostheses implantation e) Postoperative 

antibiotic therapy until culture results; IV antibiotic 

treatment for 6 more weeks if they were positive. f) FU 

evaluation at 3, 6, 12, and 24 months. 

We had 7 cases with eradication of infection, 2 with 

delayed wound closure, and 1 late recurrence of disease. 

We think that PerOssal can offer a very useful additional 

and genuine support in managing infected joint 

arthroplasties with so far good clinical results. 

058. COMPRESS ® PROSTHESIS IN REVISION 

OF A DISTAL FEMORAL RECONSTRUCTION 

I. Panastasiou, M. Ioannou, G. Farfalli, P. Boland, 

C. Morris, J. Healey 

Department of Surgery, Memorial Sloan 

–Kettering Cancer Center, Orthopaedic 

Department, General Hospital of Kimi, Greece 

We present the results of 15 patients revised with a 

Compress ® prosthesis secondary to failure of other 

distal femur reconstruction. 

One prosthesis had to be removed because of deep 

infection. Three patients needed a second surgery due 

to a vertical crack proximal to the anchor plug at the 

level of a cortical bone defect. At last follow-up, radiologic 

evaluation of the entire series showed a mean bone 

growth ratio higher than did preoperative radiographs. 

All patients had mainly good or excellent MSTS functional 

results. 

Distal femoral prosthetic replacement with a Compress 

® implant in severe cases of bone loosening and 

instability provides a reliable reconstruction alternative 

that promotes bone formation. Patients with cortical 

defects proximal to the anchor plug should be protected 

with extracortical supports. 

059 TOTAL HIP ARTHROPLASTY 

WITH MODULAR NECKS AND BIG 

FEMORAL HEADS. EARLY CLINICAL AND 

RADIOLOGICAL FINDINGS 

C.S. Georgiou, P.D. Megas, E.G.Theodorou, C.G. 

Provatidis 

Orthopaedics Department, Medical School, 

University of Patras, National Technical 

University of Athens, School of Mechanical 

Engineering 

Total Hip Arthroplasty (THA) is one of the most important 

procedures in the fi elds of Reconstructive Orthopaedics. 

This study aims to present the preliminary 

results of the clinical and radiological evaluation of 

patients who have undergone THA with metal bearings, 

modular necks and big femoral heads and to correlate 

them with the results of the Finite Element Analysis. In 

the period from 1/1/2006 until today 90 patients (33 

men and 57 women) with mean age 62,4 years have 

undergone primary THA. The patients were clinically 

and radiographically evaluated preoperatively, as well 

as postoperatively, in regular time intervals (1st, 3rd, 

6th, 12th month and every year afterwards). The clinical 

assessment was based on two scales, Harris Hip Score 

(HHS) and Merle d’ Aubigne (MDA) score, whereas 

the radiographic on Engh criteria. The mean follow up 

was 16 months. The mean preoperative HHS and MDA 

score were 45 and 10,3 respectively, whereas 89 and 

16,74 at the last evaluation. The mean Engh score was 

16,12. No incidence of dislocation, infection and cup 

or stem adverse effect occurred. We demonstrate extensively, 

with respect to the used combination of neck and 

femoral head, the radiographic fi ndings in the zones of 

Grün and Charnley, in the areas of the tip of the stem 

and the calcar, as well as the resulting clinical manifestations. 

The early clinical and radiological data are in line 

with the increase in the stresses and strains on the upper 

part of the femur, which are revealed through the Finite 

Element Analysis. 


060 COMBINING BIGGER FEMORAL HEADS 

WITH MODULAR NECKS IN TOTAL HIP 

ARTHROPLASTY. A FINITE ELEMENT 

ANALYSIS 

E.G. Theodorou, C.G. Provatidis, C.S. Georgiou, 

P.D. Megas 

National Technical University of Athens, School 

of Mechanical Engineering, Orthopaedics 

Department University of Patras 

Total hip arthroplasty is nowadays a common treatment 

for a large number of pathological cases regarding the 

hip joint and is considered as the most successful orthopedic 

operation. With the mean age of patients constantly 

decreasing and the more intense way of life, the 

need for versatile implant designs has arisen. Currently 

modular hip implant systems are used extensively in 

order to compensate for diffi cult occasions, where offset 

and version correction are required. In addition to this 

femoral heads of bigger diameter have been introduced 

to deal with issues such as dislocation and impingement, 

although their infl uence on the mechanical behavior on 

the bone – implant assembly is not widely documented. 

Towards this direction a fi nite element model was generated. 

Computed tomographies of a cadaveric femur 

were used as raw data and processed, a Profemur-E 

system with variable heads was digitized, thus leading 

to a complete assembly consisting of the femur, the stem, 

the necks and the femoral heads in the commercial CAD 

software Solidworks. For typical loading scenarios – the 

stance phase of the gait cycle – the fi nite element analysis 

was performed in ANSYS Workbench. The results 

showed that the implementation of BFH and the neck 

version produced an increase in strains and stresses with 

respect to a normal head of 28mm and a straight neck 

in areas of clinical interest such as the calcar, the greater 

trochanter area and the stem tip region, considered 

responsible for thigh pain. 

061 REVISION TOTAL HIP REPLACEMENT. 

PROBLEMS – COMPLICATIONS 

K. Papageorgiou, P. tilaveridis, A. Hatizioannidis, 

I. Papageorgiou, S. Christodoulou, S. Gerakas 

General Hospital Drama, Orthopaedic 

Department 

The revision of the hip surgery belongs to the major 

orthopaedic surgery and the purpose of our research is 

the presentation of our experience. 

During the period 2004-2008, revision in surgery 

of the hip was performed in 15 patients, while most of 

them were women with average 73 years. 190 subcapital 

fractures were revisioned in 7 patients, 277 pertrochanteric 

fractures in 3 patients, 75 total arthroplasties 

in 5 patients and all of them were bipolar arthroplasties 

and osteosynthesis with DSH plate. The average interval 

between the primary operation and revision arthroplasty 

was 28 months, revision of the acetabular was 

performed in 3, revision of the femoral in 1 and regarding 

to the other patients both types of revision were performed. 

According to Paprosky classifi cation we noted 

lesions of type I and type II and in 13 cases operation 

was made in a time. Early complications appeared in 6 

patients (mostly postoperative infections). For the stabilization 

of the acetabular we used supporting rings with 

bone grafts or press fi t acetabulars without cement, 

while for the femoral, according to the injury extend 

and the bone quality, the stabilization of the stem was 

made with cement.The average follow-up time was 20 

months, we re-examined 14/15 patients and chronic 

complications appeared in 2 patients. The fi nal result 

was satisfactory, according to Harris-Hip score with the 

radiological evaluation. 

Conclusively, hip revisions are diffi cult and demanding 

operations, accompanied by serious complications. 

For their success good preoperative planning, experience 

and complete material-technical supporting are required 

with use, most of the times, of custom made prosthesis, 

supporting rings of the acetabular with bone graft. 



062 COMPRESSION NEUROPATHIES OF 

THE ELBOW- SIMULTANEOUS EXISTENCE 

OF PRONATOR AND CUBITAL TUNNEL 

SYNDROME 

V. N. Psychoyios, I. Kormpakis, P. Intzirtzis, S. 

Thoma, I. Stathakopoulos 

5th Orthopaedic Department, Hand & Upper 

Extremity Unit, Asklipeion Hospital of Voula, 

Athens 

Simultaneous compression of the median and ulnar 

nerve at the elbow is rather uncommon. The aim of this 

study was to describe 10 such cases which have been 

treated in our unit. 

The patients presented with a combination of ulnar 

neuritis symptoms at the elbow with a pronator syndrome. 

Five patients were female and 5 male with an 

average age of 33 years. All patients were manual workers. 

Regarding the cubital tunnel syndrome, all patients 

complained for hypesthesia in the ulnar nerve’s distribution 

in the hand and 6 for additional night pain in 

the medial aspect of the elbow. Regarding the pronator 

syndrome, the patients complained for mild tenderness 

or pain at the proximal forearm as well as hypesthesia 

or paresthesias at the digits. Nerve conduction studies 

were positive only for the ulnar nerve compression 

neuropathy. Six patients were treated by decompressing 

both nerves at the same time through the same medial 

incision, creating large medial fl aps. The ulnar nerve 

underwent a simple decompression. In one case that 

the symptoms were initailly attributed to ulnar nerve, 

a second operation for medial nerve decompression was 

required. 

In all patients symptoms subsided following surgical 

decompression. Four patients developed an ugly scar 

and 2 a hematoma. All returned to their previous occupation. 

Clinical tests and nerve conduction studies were 

performed postoperatively to evaluate the results; all of 

them turned out negative for ulnar and median nerve 

compression neuropathy. 

Simultaneous compression of the median and ulnar 

nerve at the elbow is rather rare. Careful evaluation of the 

patient’s symptoms as well as thorough clinical examination 

are the keystones for the correct diagnosis. Although 

decompression can be performed through the same 

medial incision, extensive dissection may be required. 

063 FRACTURES OF THE RADIAL HEAD 

AND DISRUPTION OF THE INTEROSSEOUS 

COMPLEX. IS THE RECONSTRUCTION 

POSSIBLE? 

E. Apergis, G. Papadimitriou, A. Palamidi, I. 

Paraskeuopoulos, E. Tsialogiannis, T. Papagiavis 

Red Cross Hospital of Athens 

In Essex-Lopresti injuries, the prevailing concept, according 

to which the stability of the forearm can be restored 

after fi xation of the fracture or replacement of the radial 

head by a metallic implant, is disputable. The aim of this 

study is to evaluate the midterm results in 12 patients with 

an Essex-Lopresti injury who were treated operatively. 

We studied 12 patients, with comminuted fracture 

of the radial head, either isolated (4 patients) or with 

injury of the ipsilateral (4 patients) or the contralateral 

(4 patients) arm. Initially, 10 patients were treated with 

excision of the radial head whereas 2 underwent internal 

fi xation of the radial head and pinning of the DRUJ. 

Eventually, everyone developed a subluxation of DRUJ 

and had to be treated for an established Essex-Lopresti 

injury, 1-7 months after the initial injury. Six patients 

were treated with equalization of the radioulnar length 

(ulnar shortening osteotomy with or without a distractor-external 

fi xator) and restoration of the TFC, while 

six patients underwent replacement of the radial head 

with a titanium implant, equalization of the radioulnar 

length and restoration of the TFC. 

The results were evaluated after a mean follow-up of 

4 years (1-12 years), based on radiological and clinical 

criteria. The six patients in whom the titanium radial 

head implant was used presented with good results, 

even though two of them reported forearm pain during 

activity. On the contrary, in the rest of the patients the 

radioulnar incongruity reappeared in varying degrees. 

However the poor radiological result was not consistent 

to the clinical one. 

We conclude that in cases of complete rupture of the 

interosseous membrane, internal fi xation or replacement 

of the radial head with a metallic implant will not probably 

provide us with a good long-term functional result. 

064 OPEN SURGICAL TREATMENT OF 

THE STIFF ELBOW IN PATIENTS WITH 

NEUROMUSCULAR DISEASE 

V. N. Psychoyios, I. Kormpakis, S. Thoma, P. 

Intzirtzis, E. Zampiakis 

5th Orthopaedic Department, Hand Unit, 

Asklipeion Hospital of Voula, Athens 

Elbow contracture is a well recognised sequel of neuromuscular 

disorders and can be a rather debilitating condition. 

Non operative treatment, such as physiotherapy 

and splinting, results in an improved range of motion, 

but since musculoskeletal pathology in neuromuscular 

diseases is progressive, an open surgical release of the 

elbow is often required. Therefore, the purpose of the 

present study was to assess the results of surgical treatment 

of elbow stiffness in patients suffering from neuromuscular 

disorders. 

Between January 2000 and October 2008, 11 

patients with neuromuscular diseases underwent surgical 

treatment of elbow contracture. The mean age of 

the patients was 21 years. Eight patients had cerebral 

palsy, 2 arthrogryposis and 1 brachial plexus palsy. Preoperatively 

the lag of elbow fl exion and extension was 

45° and 38° respectively. In 6 patients releases were performed 

through a lateral approach, while 3 required an 

additional medial incision. In 2 patients the pathology 

was addressed through a posterior approach. 

The mean follow up was 26 months. Postoperatively 

one patient developed skin necrosis which was treated 

conservatively. Furthermore, another patient developed 

transient ulnar neuritis, and fi nally one more presented 

with medial collateral ligament insuffi ciency. All patients 

had an improved functional arc of motion. Namely, the 

lag of elbow fl exion and extension was reduced to 22° 

and 10° respectively. At the fi nal follow up the patients 

maintained 90% of the range of motion that was 

achieved immediately postoperatively. 

Open release of the elbow contracture in neuromuscular 

diseases yield satisfactory results. Therefore, it can 

be expected that patients will obtain a functional range 

of motion. 

065 CHRONIC RUPTURES OF THE 

INSERTION OF THE BICEPS TENDON 

V. N. Psychoyios, P. Intzirtzis, S. Thoma, V. 

Bavellas, K. Dakis 



Chronic distal biceps tendon rupture is a relatively 

uncommon situation with diffi culties in treatment. Surgical 

treatment with allograft has been described in the 

literature with varying results. The purpose of this study 

was to describe 9 cases of chronic distal biceps tendon 

rupture which have been treated in our unit with local 

soft tissue as a graft. 

All patients were male with an average age of 54 

years. The mean interval between tendon rupture and 

reconstruction was 11 months. In all patients a fl ap 

from lacertus fi brosus was used in continuation with 

the remnants of the tendon. The fl ap was entubulated 

and advanced to the bicipital tuberocity. The biceps 

was released and mobilized as necessary. In addition, 

3 patients underwent a fractional lengthening of the 

muscle. All procedures were performed through a single 

anterior approach. Anchors and anchor sutures were 

used to stabilize the tendon to the tuberocity. 

The mean follow up was 3 years. No complications 

were encountered except for a superfi cial infection 

which resolved with oral antibiotics. All patients 

returned to their previous occupation. Furthermore, 

they all achieved 5/5 muscle strength regarding fl exion 

and supination on manual testing. According to the


Mayo Elbow performance score, the results were excellent 

in 8 patients, and fair in one. 

We believe that the aforementioned technique is useful 

in treating chronic biceps ruptures. It requires no additional 

cost and also the risk, even if marginal, of transmitting 

diseases with allografts, such Achilles tendon 

is avoided. Furthermore, the possibility of rerupture is 

minimal compared to the techniques using allograft or 

free autografts, since a revascularisation process during 

which the risk for failure is high does not take place as 

in other types of allografts. 

066 HINGE FIXATOR FOR INSTABILITY OF 

THE ELBOW 

V. N. Psychoyios, A. Alexandris, S. Thoma, I. 

Kormpakis, A. Mpogiopoulos 



Hinged external fi xators of the elbow joint can be a 

valuable tool in managing complicated trauma associated 

with instability, instability after contracture release, 

and distraction interposition arthroplasty or distraction 

arthroplasty alone. This retrospective study focuses 

on the performance of the device in acute and chronic 

elbow instability associated with complex injuries 

around the elbow. 

Thirteen hinged external fi xators were applied in 13 

patients with an average age of 46 years. All fi xators 

were applied for various types of fractures around the 

elbow joint associated with elbow dislocation. In 12 

patients prior to the application of the fi xator, a formal 

open reduction and internal fi xation was performed so 

as to neutralise the whole construct and permit early 

mobilisation of the joint. In one patient with a minimally 

displaced fracture which required no internal fi xation 

the fi xator was used to permit early mobilisation. A 

circular multiplanar frame was used in 4 patients and a 

unilateral one in the rest of them. 

Eight out of 13 patients with fracture-dislocation 

had an uneventful outcome. Three patients required a 

revision surgery to correct a fracture malalignment and 

a subluxation of the joint. The results were evaluated 

according to the Mayo Elbow Performance score. Complications 

included 4 cases of pin tract infection and 2 of 

transient ulnar neuritis. 

Despite the complexity of its application and the 

complications that may follow such device, an articulating 

external fi xator can be a valuable tool in treating 

complex elbow instability. 

067 REVERSE SHOULDER ARTHROPLASTY. 

INDICATIONS – CLINICAL RESULTS 

P. Papadopoulos, D. Karataglis, A. Boutsiadis, 

F.Agathaggelidis, V.Alexopoulos, A. 

Christodoulou 

1st Orthopaedic Department, Aristotelion 

University of Thessaloniki, General Hospital 

Papanikolaou 

Although, reverse shoulder arthroplasty has initially 

been introduced for rotator cuff arthropathy, its application 

has been expanded on fracture sequelae, chronic 

dislocations and even comminuted fractures of the 

humeral head in elderly patients. The purpose of this 

study is to present our experience and the mid-term 

clinical results of this type prosthesis. 

Between 2006 and 2008 16 reverse shoulder arthroplasties 

have been carried out in our department. Fourteen 

patients were female and 2 male with an average 

age of 72.4 years (55-81). Eleven patients had true rotator 

cuff arthropathy, 3 malunion of 4-part fractures, one 

chronic anterior shoulder dislocation and fi nally one 

patient had bilateral chronic posterior shoulder dislocation. 

In 2 cases we used the Delta prosthesis and in a 

further 14 cases the Aquealis Arthroplasty. 

Routine postoperative follow up was at 3,6,12 and 

24 months and included plain radiographic control and 

clinical evaluation with the Constant Shoulder Score. 

All patients report signifi cant pain relief and an average 

improvement of the Constant Score from 40.5 to 72.3. 

Two patients had anterior dislocation of the prosthesis 

4 days postoperatively and we proceeded to the application 

of a 9 mm metal spacer and bigger polyethylene 

size. In one patient neuroapraxia of the axillary nerve 

was observed; this resolved 3 months postoperatively. 

Continuous clinical improvement was observed in some 

patients up until 18 months postoperatively. 

Our clinical results are very satisfactory and reveal that 

reverse shoulder arhroplasty is a very good option for a 

broad spectrum of pathologic shoulder conditions. 

068 FLOATING ELBOW. SURGICAL 

TREATMENT: MID-TERM RESULTS 

A. Boutsiadis, K. Ditsios, P. Savvides, S. Stavridis, 

P. Givisis, A. Christodoulou 

1st Orthopaedic Department, Aristotelion 


Papanikolaou 

Although, reverse shoulder arthroplasty has initially 

been introduced for rotator cuff arthropathy, its application 

has been expanded on fracture sequelae, chronic 

dislocations and even comminuted fractures of the 

humeral head in elderly patients. The purpose of this 

study is to present our experience and the mid-term 

clinical results of this type prosthesis. 

Between 2006 and 2008 16 reverse shoulder arthroplasties 

have been carried out in our department. Fourteen 

patients were female and 2 male with an average 

age of 72.4 years (55-81). Eleven patients had true rotator 

cuff arthropathy, 3 malunion of 4-part fractures, one 

chronic anterior shoulder dislocation and fi nally one 

patient had bilateral chronic posterior shoulder dislocation. 

In 2 cases we used the Delta prosthesis and in a 

further 14 cases the Aquealis Arthroplasty. 

Routine postoperative follow up was at 3,6,12 and 

24 months and included plain radiographic control and 

clinical evaluation with the Constant Shoulder Score. 

All patients report signifi cant pain relief and an average 

improvement of the Constant Score from 40.5 to 72.3. 

Two patients had anterior dislocation of the prosthesis 

4 days postoperatively and we proceeded to the application 

of a 9 mm metal spacer and bigger polyethylene 

size. In one patient neuroapraxia of the axillary nerve 

was observed; this resolved 3 months postoperatively. 

Continuous clinical improvement was observed in some 

patients up until 18 months postoperatively. 

Our clinical results are very satisfactory and reveal that 

reverse shoulder arhroplasty is a very good option for a 

broad spectrum of pathologic shoulder conditions. 

069 SURGICAL TREATMENT OF RADIAL 

HEAD FRACTURES IN COMPLEX ELBOW 

INJURIES 

V.N. Psychoyios, P. Intzirtzis, S. Thoma, V. 

Bavellas, E. Zampiakis 



Radial head fractures are the most common fractures 

occurring around the elbow and are often associated with 

other fractures or soft tissue injuries in the elbow. The 

purpose of this study was to characterise the morphology 

and to evaluate the outcome of the surgical management 

of radial head fractures in complex elbow injuries. 

Nineteen patients with this pattern of injury underwent 

surgical treatment in our unit. In addition, seven 

patients had posterior dislocation of the elbow, 2 medial 

collateral ligament rupture, one capitellar fracture, 3 posterior 

Monteggia, 1 Essex-Lopresti lesion and 5 coronoid 

fracture plus posterior dislocation. Non comminuted 

radial head fractures were treated by open reduction and 

internal fi xation or simple excision of small fragments. 

Patients with comminuted, displaced radial head fractures 

underwent radial head replacement. 

The average follow up was 44 months. Two patients 

developed post-traumatic elbow contractures, one elbow 

instability and 2 mild arthritis. Overall, according to the 

DASH Outcome Measure, the results were excellent in 

12 patients, fair in 3 and poor in 4. 

In complex injuries of the elbow the characteristics of 

the radial head fracture and in particular the comminution, 

the fragment number, the displacement as well as 

the age of the patient should determine the appropriate 

surgical technique which will lead to satisfactory longterm 

results. Anatomical restoration and maintenance of 

elbow stability will allow early mobilisation of the elbow 

joint and should be the goals of surgical management. 

070 OUTCOME OF FLEXOR CARPI RADIALIS 

TENDON TRANSFER FOR RADIAL NERVE 

PALSY 

N. Korres, I. Kormpakis, S. Thoma, V. Bavellas, E. 

Zampiakis, P. A. Kinnas 



Among the most popular techniques for the management 

of radial nerve palsy is the transfer of the Pronator Teres 

(PT) to the Extensor Carpi Radialis Brevis (ECRB), of the 

Flexor Carpi Radialis (FCR) to the Extensor Digitorum 

Communis (EDC) and of the Palmaris Longus (PL) to 

rerouted Extensor Pollicis Longus (EPL). This retrospective 

study was undertaken to assess the outcome of fl exor carpi 

radialis transfer in the treatment of radial nerve palsy. 

Twenty patients with a mean age of 36 years were 

included in this study. Surgical management, as described 

above, was decided since all patients had irreparable damage 

to the nerve. Parameters that were assessed included range 

of wrist motion, dynamic power of wrist fl exion and extension, 

and radial and ulnar deviation and function. 

The average follow-up was 4.5 years. Compared to a 

control group of 10 volunteers of similar characteristics, 

all patients achieved a functional range of motion and 

satisfactory power of wrist motion. All patients returned 

to their previous occupation. 

Transfer of Flexor Carpi Radialis tendon for irreparable 

radial nerve palsy yields satisfactory results. 

Therefore, it can be expected that patients will obtain 

a functional range of motion as well as an adequate 

strength of motion. 

071 REPLACEMENT OF THE RADIAL HEAD 

WITH A PYROCARBON HEAD PROSTHESIS: 

MIDTERM RESULTS. AIM OF THE STUDY 

I. Sarris, M. Kyrkos, N. Galanis, G. Kapetanos 

3rd Orthopaedic Department Aristotelion 

University of Thessaloniki, Papageorgiou General 

Hospital 

The aim of this study is the presentation of the midterm 

results of the radial head replacement with pyrocarbon 

head prosthesis (MoPyc). 

Thirty two patients (20 males and 12 females) with 

a mean age of 54 y.o. (32-68 y.o.) were subjected to 

replacement of the radial head with a pyrocarbon head 

prosthesis. Twenty of them had a comminuted radial 

head fracture(15 Mason IV type and 5 Mason III), two 

had a malunion and ten had a complex elbow injury (ligamentous 

rupture and comminuted radial head fracture 

with/without coronoid process fracture). In 22 patients 

the fracture was on the dominant side. The mean follow 

up time was 27 months (21 – 46 months). 

The post-operative results were: 

1) The mean range of motion in fl exion-extension was 

130° (105° to 150°), while in pronation and supination 

was 74° (60°-80°). 

2) The mean grip strength was 96% of the contralateral 

side. 

3) There was no clinical laxity in the varus or valgus 

stress test. 

4) According to the Broberg-Morrey score the good and 

excellent result were 77%, while according to the 

Mayo Clinic Elbow Performance Score (MEPS) good 

and excellent results were up to 97% of the total. 

Pain was evaluated with a visual analogue scale. 

Finally there was also a radiographic evaluation of 

the patients (that yielded six cases of loosening or 

osteolysis without any clinical manifestation) 

Replacement of the radial head with the specifi c prosthesis 

leads to very satisfactory results when performed 

under specifi c indications. 


072 THE USE OF VAC SYSTEM IN 

ORTHOPAEDIC PROCEDURES 

V.I. Sakellariou, H. Tsibidakis, G. Mazis, A. F. 

Mavrogenis, P.J. Papaggelopoulos 

1st Orthopaedic Department, Musculoskeletal 

Oncology, ATTIKON University General 

Hospital, Athens 

The purpose of this study is to compare the healing 

progress in cases with wound healing complications 

with or without VAC assistance. 

From 2005 to 2008, 32 patients with a mean 56 

years of age had wound healing complications necessitating 

for further operative intervention. 26 cases 

were classifi ed as stage III and 6 cases were classifi ed as 

stage IV according to the National Pressure Ulcer Advisory 

Panel. The mean extent of wounds was 7cm2. 17 

cases (group A) were treated with repeated removal of 

necrotic debris. In 15 cases (group B) the VAC device 

was applied (75mmHg). The 2 groups were compared 

on the basis of total hospital stay, need for additional 

operation, and re-infection rates. 

Mean hospital stay was 25.2 days in group A and 

16.5 days in group B (p


078 BOTULINUM TOXIN INJECTION WITH 

AND WITHOUT ELECTROMYOGRAPHIC 

ASSISTANCE FOR TREATMENT OF 

SPASTICITY 

D. Varvarousis, A. Ploumis, A. Beris 

Rehabilitation Center “S. Niarchos”, University 

Hospital of Ioannina 

To compare the effects of botulinum toxin injection 

with and without electromyographic (EMG) assistance 

for the treatment of spastic muscles. 

In a prospective comparative study, botulinum toxin 

was injected intramuscularly into 17 patients with spasticity 

due to CNS damage (CP, SCI, head injury, stroke). 

All patients were evaluated using the modifi ed Ashworth 

scale and the score was 2-4. In 9/17 patients, group A 

(53%), the injection was given with EMG assistance, 

while in 8/17 patients, group B (47%), without, always 

from the same injectionist. The follow-up period ranged 

from 4 to 24 months. 

Average spasticity decreased in all injected muscles 

and new scores were 1-2 grades less according the modifi 

ed Ashworth scale. No complications or side effects 

were noted. The average reduction of spasticity reached 

1.66 (SD 0.5) in group A and 1.25 (SD 0.46) in group 

B. The average reduction of spasticity was statistically 

more pronounced in group A (p

084 THE ROTAGLIDE MOBILE BEARING 

TOTAL KNEE ARTHROPLASTY RESULTS OF 

5 TO 8 YEAR FOLLOW-UP 

D. Neophytou, T. Liakos, N. Sakorafas, M. 

Iosifidis, D. Albanos, A. Kyriakidis 

2nd Orthopaedic Surgery Department, 

“Papageorgiou” General Hospital, Thessaloniki 

Failure of a TKA is caused many times from the polyethylene 

debris or the mechanical forces which lead to loosening 

mostly to tibial component. The mobile meniscal 

knee prosthesis could provide solution as it simulates 

better normal knee function. 

The aim of our study is to present the midterm results 

of TKA using mobile bearing platform Rotaglide. 

During the period 2000-2004 we performed 261 

TKA with the Rotaglide mobile polyethylene prosthesis 

(Corin Medical, UK). They are 235 women and 26 men, 

mean age 76.33 years, and the 93.7% of them (N=245) 

with primary osteoarthritis. The tibial component was 

cemented for all them, and for the femur was cementless 

for 146 cases (hybrid) and cemented for 115. None of 

them had patella replacement. One hundred fi ve patients 

(59 hybrid and 46 cemented) were examined clinically 

and radiologically and the minimum follow-up time was 

5 years (mean 6,6 /range 5-8 years). We use the Knee 

injury and Osteoarthritis Outcome Score (KOOS- range 

of scale for each subscore 0-100). 

There was signifi cant improvement of knee function 

and the majority of our patients were satisfi ed from the 

result. Specifi cally, the score for general symptoms and 

joint stiffness was 89.1, for pain was 83.3, for daily 

activities was 75.6 and for the quality of life was 72.5. 

One patient had revision TKA for femur component 

aseptic loosening. 

Our results indicate that the Rotaglide total knee 

arthroplasty is a great choice for primary knee OA with 

excellent functional result. 

085 REVISION HIP ARTHROPLASTY IN 

CONGENITAL DISEASE OF THE HIP 

G. Babis, V.I. Sakellariou, G. Mazis, B. 

Tsouparopoulos, P.N. Soukakos, G. Hartofilakidis 


Oncology, ATTIKON University General 

Hospital, Athens 

The purpose of this study is to present early results, 

common pitfalls and management in in cases of revision 

hip arthroplsty in patients with congenital disease 

of the hip. 

From 2001 to 2006, 36 consecutive cemented THAs 

with a history of congenital hip disease were revised due 

to aseptic loosening (31 cases), stem fracture (3 cases), 

septic loosening (2 case). There were thirty patients, all 

females, with a mean age at revision 61.7 years (range, 

40 to 76). The revision was performed after a mean 15.4 

years post primary operation (range, 9 to 26). In 7 cases 

the cup only, in 5 cases the stem only, and in 24 cases 

both components were revised. 

The mean follow-up was 43 months (range, 24 to 84). 

There were 3 intraoperative femoral fractures managed 

with long stem and circlage wires. Postoperatively, 5 hips 

were infected and sustained a 2 stage revision using a 

cement spacer. 3 hips were revised due to loosening. 

28 cups and 28 stems remained intact for an average 

45.2 months (range, 24 to 84). The probability of survival 

at 48 months was 76.3% (±9.7%) for the cups (12 

components at risk) and 76.4% (±11.3%) for the stems 

(9 components at risk). 

Revision of a CDH arthroplasty is diffi cult and non 

predictable. Lack of acetabular bone stock and anatomical 

abnormalities of the femur lead to increased intra 

and postoperative complication rate. 



086 TO PRESENT A SERIES OF CASES WITH 

MASSIVE BONE LOSS OF THE PROXIMAL 

FEMUR MANAGED WITH ALLOGRAFT- 

PROSTHETIS COMPOSITES (APCS) 

G. Babis, V.I. Sakallariou, G. Mazis, M’ O’ 

Connor, A.D. Hanssen, F.H. Sim 


Oncology, Attikon University General Hospital, 

Athens, Mayo Clinic, Rochester MN 

Between 1986 and 1999, 94 patients (96 hips) including 

31 male and 63 female (mean age 59.5 years), with 

massive bone loss had a revision hip arthroplasty using 

an allograft-prosthesis composite (APC). A previous history 

of infection was present in 21 of these cases. 

At an average follow-up of 11 years (range, 8 to 20 

years), 72 patients were alive, 21 patients died, and 

1 patient was lost to follow-up. Major complications 

occurred in 33 cases: femoral stem loosening (12); dislocation 

(15); periprosthetic fracture (10); and infection 

(7). Further revision surgery was performed in 21 of 

the 96 cases including revision of the acetabular component 

(3), femoral APC (16) or both (2). The 10 year 

survival of the APCs was 68.8% (95% CI 58.6%-79%, 

26 cases remaining at risk). There was no statistically 

signifi cant difference in survival time between gender, 

age, indication for APC (including infection), surgical 

approach and APC technique. Statistically signifi cant 

factors negatively impacting APC survival included two 

or more prior revisions, severity of preoperative bone 

loss (Paprosky type IV) and use of plates and screws 

(p


090 BILATERAL SIMULTANEOUS TOTAL HIP 

ARTHROPLASTY: SAFETY AND EFFICACY 

– A META-ANALYSIS 

E. Tsiridis, I. Pagkalos, I. Polyzois, G. Pavlou, J. 

Charity, E. T i h , G. Gie, R. West 


Orthopaedics, Leeds General Infirmary; Leeds 

School of Medicine, Leeds University, LS1 3EX 

Leeds, UK; Princess Elizabeth Orthopaedic 

Centre, Hip Unit, Royal Devon and Exeter 

Hospital, EX2 5DS Exeter, UK; Institute of 

Health Sciences, Centre for Epidemiology and 

Biostatistics, Leeds University, LS1 3EX Leeds, 

UK; Cardio-Thoracic Anaesthetic Unit, “Blue 

Cross” Hospital, Thessaloniki, Greece. 

Comparison of the safety and effi cacy of Bilateral Simultaneous 

Total Hip Arthroplasty (BSTHA) with that of 

staged (SgTHA) and unilateral (UTHA) was conducted 

using DerSimonian–Laird heterogeneity meta-analysis. 

A review of the English-language literature identifi ed 

23 citations eligible for inclusion. A total of 2063 bilateral 

simultaneous THR patients were identifi ed. Metaanalysis 

of homogenous data revealed that there were 

no statistically signifi cant differences between rates of 

thromboembolic events (p=0.268 and p=0.365) and 

dislocation (p=0.877) when comparing staged or unilateral 

with bilateral simultaneous THR procedures. A 

systematic analysis of heterogenous data demonstrated 

that mean length of hospital stay was shorter after bilateral 

simultaneous THR. Blood loss was reduced after 

bilateral simultaneous THR in all studies except for one, 

and surgical time was not different between groups. 

This procedure was also found to be economically and 

functionally effi cacious when performed by experienced 

surgeons in specialist centres. 

091 CEMENT-IN-CEMENT STEM REVISION 

FOR VANCOUVER TYPE B PERIPROSTHETIC 

FEMORAL FRACTURES AFTER TOTAL HIP 

ARTHROPLASTY: 3 YEAR FOLLOW UP OF 24 

CASES 

T.W. Briant-Evans, D. Veeramootoo, E. Tsiridis, 

MJ. Hubble 

Princess Elizabeth Orthopaedic Centre, Royal 

Devon and Exeter Hospital, Barrack Road, Exeter 

EX2 5DW, Academic Department of Trauma and 


George Street, Leeds, LS1 3EX, UK 

Periprosthetic fractures around a cemented femoral 

stem present a challenge to the treating surgeon. We 

propose a technique whereby a well fi xed cement mantle 

can be retained in cases with simple fractures that can be 

reduced anatomically. This technique is well established 

in femoral stem revision, but not in association with a 

fracture. 

24 Vancouver type B periprosthetic femoral fractures 

were treated by reducing the fracture and cementing a 

revision stem into the pre-existing cement mantle, with 

or without supplementary fi xation. 

3 patients died in the fi rst 6 months for reasons 

not related to surgery and one was too frail to attend 

follow up. The remaining 20 cases were followed up for 

a mean of 3.0 years. The median time to radiological 

and clinical union was 3.0 months (2-11). The median 

Modifi ed Harris Hip Score was 76.9 (35-97) and there 

was no sign of loosening or subsidence of the revision 

stems within the old cement mantle in any case at most 

recent follow up. One patient had further surgery for 

a delayed union and there were 2 subsequent fractures 

distal to the original fracture site in patients with poor 

bone stock. 

Our results support the use of the cement-in-cement 

stem revision technique in anatomically reducible periprosthetic 

fractures with a well preserved pre-existing 

cement mantle. It is particularly suitable for older 

patients. 

092 TREATMENT OF FEMORAL 

PERIPROSTHETIC FRACTURES AFTER TKR 

AND THA AT A PROVINCIAL HOSPITAL – 8 

YEARS EXPERIENCE 

K. Papageorgiou, I. Papageorgiou, P. Tilaveridid, 

D. Voutsas, A. Chatzioannidis, S. Gerakas 

Orthopaedic Department of G.H Dramas 

Periprosthetic fractures represent a challenging problem 

in joint arthroplasty the incidence of which seems to be 

increasing due to the big number of the arthroplasties 

and the increasing average life expectancy. 

The purpose of this study is to present the methods 

of treatment,the problems that we have to solve intraoperatively 

and our long term results about the healing 

procedure and the fuctional restoration. 

Between 2000-2008 we operated 15 femoral periprosthetic 

fractures(1 re-fracture). 10 of them were after 

hip arthroplasties. 

The classifi cation which used was Lewis-Rorabeck 

for the fractures after TKR and Vancouver for them 

after THA. 

Cause of fracture was fall and the time interval from 

the primary operation was 1-14years. The majority of the 

patients were women(14), and the mean age 65 years. 

13 of the 15 fractures were treated with ORIF and the 

remaining two need to be revised. During the follow up 

2 of them died due to other pathological problems.The 

post op follow up ranged from 1-8(3.5)years. 

The postoperative evaluation was done according the 

Harris Hip Score and the Knee Society Clinical Rating 

System. 

The fractures healed after a mean time of 6 months. 

Two postoperative wound infections were registered to 

the revised fractures and their treatment were successful 

with surgical debridement. 

All the patients are in good health condition,moving 

with some kind of support and they are selfreserved. 

As a conclusion we believe that this kind of fractures 

demand the proper surgical planning, prediction of all 

possible complications and the cooperation of other 

specialties and physiotherapisties. 

093 THE EFFECTS OF SYSTMENIC 

ADMINISTRATION OF SIMVASTATIN TO 

FRACTURE HEALING 

D. Chissas, P.G. Ntagiopoulos, G. Stamatopoulos, 

D. Verettas, K. Kazakos, A. Papalois, G. Loupasis, 

A. Papaeliou, G. Anastopoulos, A. Asimakopoulos 

2nd Department of Orthopaedic and Trauma 

Surgery, “G. Genimmatas” General Hospital 

of Athens, Athens, Greece, Department of 

Orthopaedic and Trauma Surgery, School of 

Medicine, Demokritus University of Thrace, 

Greece, Experimental-Research Department, 

Elpen Pharmaceuticals, Athens, Greece 

Several observational and experimental studies have 

investigated the potential anabolic effects of statins on 

undisturbed bone but only a few recent studies have 

examined the effect of statins on skeletal repair. The 

goal of the study is to investigate any potential early 

anabolic effect of the systemic administration of simvastatin 

in low doses (based on earlier safety and effi cacy 

studies on undisturbed bone) on fracture healing. 

Fifty-four skeletally mature male New Zealand White 

rabbits were used for the study. The rabbits were assigned 

to one of three experimental groups: a control group, and 

two groups that were orally administrated a diet with 10 

and 30 mg/kg/day of simvastatin, respectively. A complete 

biochemical blood count was performed to exclude 

drug-induced complications. Half of the animals of each 

group were sacrifi ced at 15 days and the other half at 30 

days after surgery at which time intervals healing quality 

was assessed. The bones were subjected to biomechanical 

testing, histomorphometric analysis and peripheral 

Quantitative Computed Tomography. 

In animals received simvastatin of 30 mg/kg/day 

a signifi cant reduction of BMD, stiffness, and energy 

absorbed to failure were observed. At 15 days, the 

amount of cartilaginous callus formation was reduced, 

and the void space was signifi cantly increased, in the 

animals of both groups that received simvastatin when 

compared to the control group (p

We found that FGF23 and FGFR1c mRNA expression 

levels were signifi cantly increased in osteoarthritic 

chondrocytes compared to normal, while KL mRNA 

levels were decreased (p=0.001 for all genes). We 

showed that klotho-FGF23-FGFR1c form complexes in 

normal chondrocytes and confi rmed the participation 

of klotho in the initiation of FGF23-FGFR1c signalling. 

Treatment of normal chondrocytes with 1,25D resulted 

in a signifi cant dose and time dependent increase of 

FGF23 and FGFR1c mRNA levels and in an increase 

of KL mRNA levels in osteoarthritic chondrocytes compared 

to untreated (p=0.001). We revealed, for the fi st 

time, the presence of conserved, canonical VDREs in the 

proximal promoters of KL, FGF23 and FGFR1c. 

We propose a common regulatory scheme of mineral 

homeostasis and aging in osteoarthritic chondrocytes 

evidenced by the positive/negative feedback actions 

by KL, FGF23, FGFR1c and 1,25D, through binding 

of vitamin D receptor (VDR) on the promoters of the 

above mentioned genes. 

096 THE ROLE OF ATORVASTATIN IN 

OSTEOARTHRITIS: AN IN VITRO AND IN 

VIVO STUDY 

A. Tsezou, F. Kostopoulou, L. Poultsides, Th. 

Simopoulou, K.N. Malizos 

University of Thessaly, Medical School, 

Laboratoty of Cytogenetics and Molecular 

Genetics, Larissa, Greece, University of Thessaly, 

Medical School, Department of Orthopaedics, 

Larissa, Greece, Institute for Biomedical Research 

and Technology, Larissa, Greece, University of 

Thessaly, Medical School, Department of Biology, 

Larissa, Greece 

Our study aimed to investigate the role of an HMG- 

CoA reductase inhibitor (atorvastatin) in human osteoarthritic 

chondrocytes and to test the in vivo effects 

of intra-articular injections of atorvastatin in a rabbit 

experimental osteoarthritis model. 

Human articular osteoarthritic chondrocytes were 

cultured in the presence and absence of atorvastatin. 

mRNA and protein expression of MMP-13, COL2A1 

and aggrecan were measured using real-time PCR and 

Western Blot analysis. 

New Zealand rabbits (n=15) underwent bilateral 

anterior cruciate ligament transection (ACLT) to induce 

osteoarthritic degeneration and received intra-articular 

injections of atorvastatin and normal saline in the left 

and right knees respectively. The fi rst injection was at 

the time of ACLT and injections were repeated every 3 

days for 3 weeks. Data were obtained from macroscopic 

and histological evaluation as well as from gene expression 

analysis for COL2A1, aggrecan and MMP-13. 

Incubation of the cultures with atorvastatin produced 

a decreasing effect in MMP-13 expression. Regarding 

aggrecan and COL2A1 expression a signifi cant increase 

was observed. 

Gross morphologic evaluation showed that the joints 

which received atorvastatin injections, showed minimal 

cartilage erosion, compared to the non-treated knees 

where the cartilage was markedly eroded, especially on 

the medial knee compartment. These results were supported 

by histological and gene expression analysis. The 

mRNA expression of MMP-13 was signifi cantly reduced 

in the cartilage of the statin-treated knee joints, while the 

expression of COL2A1 and aggrecan was increased. 

The clinical relevance of our results indicates a potential 

protective effect of atorvastatin on articular cartilage 

undergoing osteoarthritic degeneration. 



097 IFFERENTIAL EXPRESSION OF 

GENES IMPLICATED IN CHOLESTEROL 

EFFLUX IN HUMAN OSTEOARTHRITIC 

CHONDROCYTES 

A. Tsezou, Th. Simopoulou, F. Kostopoulou, K.N. 

Malizos 

Πανεπιστήμιο Θεσσαλίας, Τμήμα Ιατρικής, 

Εργαστήριο Κυτταρογενετικής και Μοριακής 

Γενετικής, Πανεπιστήμιο Θεσσαλίας, Τμήμα Ιατρικής, 

Ορθοπαιδική Κλινική, Ινστιτούτο Βιοϊατρικής Έρευνας 

και Τεχνολογίας, Πανεπιστήμιο Θεσσαλίας, Τμήμα 

Ιατρικής, Εργαστήριο Βιολογίας 

The aim of the study was to investigate the expression of 

genes regulating cholesterol effl ux in human chondrocytes 

and to study the effect of an LXR agonist on cholesterol 

effl ux and lipid accumulation in osteoarthritic 

chondrocytes. 

Human cartilage was obtained from 24 patients 

with primary osteoarthritis (OA) undergoing total knee 

replacement surgery. Normal cartilage was obtained from 

8 individuals undergoing fracture repair surgery, with 

no history of joint disease. ATP-binding-cassette transporter 

A1(ABCA1), apolipoprotein A1 (ApoA1), and 

liver X receptors(LXRα and LXRβ) mRNA expression 

levels were evaluated using real-time PCR. The effect of 

the synthetic LXR agonist TO-901317 was studied after 

treatment of osteoarthritic chondrocytes and subsequent 

investigation of ABCA1 and ApoA1 mRNA expression 

levels. Cholesterol effl ux was evaluated in osteoarthritic 

chondrocytes radiolabeled with [1,2(n)-3H] cholesterol 

after LXR treatment, while intracellular lipid accumulation 

was studied after Oil-red-O staining. Apoptosis was 

evaluated using fl ow cytometry. 

ApoA1, ABCA1, LXRα and LXRβ mRNA expressions 

were signifi cantly lower in osteoarthritic chondrocytes 

compared to normal. Treatment of osteoarthritic 

chondrocytes with the LXR agonist TO-901317 signifi - 

cantly increased ApoA1 and ABCA1 mRNA expression 

levels as well as cholesterol effl ux, while it signifi cantly 

reduced apoptosis. Additionally, osteoarthritic chondrocytes 

presented intracellular lipids deposits, while no 

deposits were found after treatment with TO-901317. 

Our fi ndings suggest that impaired expression of genes 

regulating cholesterol effl ux may be a critical player in 

osteoarthritis, while the ability of the LXR agonist to 

facilitate cholesterol effl ux and decrease apoptosis suggests 

that it may be a target for therapeutic intervention 

in osteoarthritis. 

098 BONE MORPHOGENETIC PROTEIN 

MRNA EXPRESSION IN HUMAN 

PERIOSTEUM 

C.G. Chassanidis, P. Kollia, S. Samara, T. 

Koromila, S. Varitimidis, K.N. Malizos, Z. 

Dailiana 

Laboratory of Medical Genetics and Cytogenetics, 

University of Thessalia; Laboratory of Human 

Genetics, University of Athens, Greece; 


Thessalia; Institute for Biomedical Research and 

Technology, Larissa 

Periosteum is a specialized connective tissue that surrounds 

bone, containing progenitor cells that develop 

into osteoblasts. The osteo-progenitor cells along with 

growth factors, such as BMPs, play critical role in development, 

reconstruction and bone formation. Aim: to 

evaluate the expression of BMPs in human periosteum 

and in different subrgroups, including different donor 

sites, gender, and smoking habits. 

Gene expression of BMPs 2,4,6,7 was performed in 

60 periosteal samples using quantitative RT-PCR. Samples 

were obtained from 32 men/28 women, 22 smokers/38 

non-smokers, 29 lower/31 upper extremities. 

BMP2 gene expression was signifi cantly higher 

(median: 12.02, p


tion in general, between different university hospitals 

across Europe. Demographic data, intraoperative details, 

complications, clinical outcome parameters, radiological 

healing, VAS pain score, EuroQol-5D, and return-towork 

were prospectively recorded. Radiological healing 

was defi ned as the presence of callous in two planes over 

3 cortices. The minimum follow up was 12 months. 

Seventeen patients, who had undergone a median of 

1(1 to 4) prior revision operations, over a median period 

from the injury of 17months(9 to 42), were included 

in this observational study. In 76.4%(13/17) the BMP7 

was combined with revision of the fi xation. Non-union 

healing was verifi ed in 14/17cases(82.3%) in a median 

period of 6.5 months(3-15). Over 80% of these patients 

returned to their pre-injury level of activities, the 

median overall health state score was 82.5(35 to 100). 

No adverse events or complications were associated 

with the BMP7 application over the median follow-up 

of 24 months(12-68). 

101 ALARMINS AND IL-6 RELEASE 

FOLLOWING FEMORAL NAIL: 

QUANTIFICATION OF SIRS AND THE 

SECOND HIT 

R.K. Mallina, N.K. Kanakaris, C. Tzioupis, H.C. 

Pape, P.V. Giannoudis 


Orthopaedics, Leeds Teaching Hospitals; School 

of Medicine, University of Leeds, UK 

The role of the pro-infl ammatory cytokine HMGB1 

(alarmins) has not been investigated in the clinical setting. 

This study aims to assess its relationship to IL-6 

release, ISS, and to quantify the second hit phenomenon 

after femoral nailing. 

22 (13 males, mean age 37.5y) consecutive patients 

entered in this prospective randomised trial. All patients 

underwent stabilisation of the femoral shaft fracture 

with reamed (10 patients) or unreamed nailing. Patient 

demographics, ISS, and complications were recorded 

prospectively. Peripheral blood samples were collected 

on admission, induction of anaesthesia, entry into femoral 

canal, wound closure and on day 1, 3, and 6. Serum 

HMGB1 and IL-6 concentrations were measured using 

ELISAs. 6 healthy volunteers formed the control group. 

The median ISS was 14.5 (9-29). Admission median 

HMGB1 and IL-6 concentrations were 7.2 ng/ml 

and 169 pg/ml respectively. A direct correlation was 

observed between ISS and IL-6 and HMGB1 concentrations. 

HMGB1 concentrations reached to peak levels 

on day-6. On the contrary, the median concentration of 

IL-6 peaked around day 1 postoperatively (reamed: 780 

vs. unreamed: 376 pg/ml) and then showed a downward 

trend. The median increase of HMGB1 by day 6 was 

4.21ng/ml in the reamed and 2.98ng/ml in the unreamed 

population; the median increase of IL-6 by day 1 measured 

462 pg/ml and 232 pg/ml in the respective groups. 

Day 6 concentration of HMGB1 in patients with an ICU 

stay >5 days (n=4), compared to the rest of the patients 

(n=16), was 11.04ng/ml (6.13 – 35.84) vs. 7.14ng/ml 

(4.06 – 12.8), (p=0.03). 

Femoral nailing and reaming induces a second hit as 

supported by the post-operative increased levels of both 

IL-6 and HMGB1. While IL-6 has been suggested as a 

marker of assessment of the early infl ammatory response, 

alarmins can provide useful information at the later stage 

of an evolving immuno-infl ammatory process. 

102 NEW PROTOCOL FOR EMG STUDIES OF 

SUPRASPINATUS TEARS. EXPERIMENTAL 

STUDY ON RATS 

K. Ditsios, D. Kapoukranidou, A. Boutsiadis, A. 

Chatzisotiriou, M Alpani, A. Christodoulou 

A Orthopaedic Department Aristotelion 


Papanikolaou; Laboratory of Physiology, 

Aristotelion University of Thessaloniki, 

Thessaloniki 

Purpose of this study is to create an experimental model 

on rats for EMG evaluation of the supraspinatus muscle 

after traumatic rupture of its tendon. 

The population of this study consisted of 5 male rats 

of 300-400g.Under general anaesthesia we proceeded 

with traumatic rupture of the supraspinatus tendon and 

exposure of the muscle. The electrode of a stimulator was 

placed under suprascapular nerve and the supraspinatus 

tendon was sutured on a transducer for digital record of 

the produced signal. Initially we found the resting length 

and the electric intensity for higher muscle contracture. 

The parameters that were evaluated after single contracture 

(single twitch) were strength, time to peak, half relaxation 

time. Furthermore, it was evaluated the strength of 

tetanic contractures at 10,20,40,80,100 Hz (Stimulation 

for 350msec each time).Finally it was evaluated the 

muscle fatigue with stimulation at 40Hz for 250msec and 

total duration of 3 minutes. Fatigue index was calculated 

according to the decrease of titanic muscle contracture 

(Initial value-Final Value/Initial Value x 100) 

Our results are presented in mean±sd. The single twitch 

was 8.2(5.1),the time to peak 0.034(0.02) msec, the half 

relaxation time 0.028(0.008)msec. The strength of titanic 

muscle contractures was 5.7msec at 10Hz and 17.7 at 

100Hz.Finally the fatigue index was calculated at 48.4. 

We believe that EMG evaluation of the supraspinatus 

muscle in rats will help us understanding the pathology 

of muscle atrophy after rotator cuff tears and possibly 

the functional restoration after cuff repair. 

103 INVESTIGATION OF A TROCHANTERIC 

FI-NAIL INTRAMEDULLARY IMPLANT 

FIXATION USING THE FINITE ELEMENT 

METHOD 

N.E. Efstathopoulos, F.N. Xypnitos, V. Nikolaou, 

J. Lazarettos, E.N. Kaselouris, D.T.Venetsanos, 

C.G. Provatidis 

Athens University Medical School, Second 

Department of Orthopaedics 1 ; National Technical 

University of Athens, School of Mechanical 

Engineering; Mechanical Design and Control 

Systems Section; Laboratory of Dynamics and 

Structures 2 

We investigated the effect of the location and the number 

of distal screws in the effi ciency of an intramedullary 

nail implementing the fi nite element method (FEM). 

The left proximal femur of a 93-year old man was 

scanned and two series of full 3D models were developed. 

The fi rst series, consisting of fi ve models, concerned 

the use of a single distal screw inserted in fi ve 

different distal locations. The second series, consisting of 

four models, concerned the use of four different pairs of 

distal screws. Each model was analyzed with the (FEM) 

twice, fi rst considering that the femur is fractured and 

then considering that the femur is healed. 

For nails with a single distal screw, stresses around 

the nail hole were reduced with proximal placement of 

the distal screw but the area around the nail hole where 

the lag screw is inserted is stressed more. Furthermore, 

for nails with a pair of distal screws, placing the pair of 

distal screws at a specifi c location is most benefi cial for 

the mechanical behavior of the femur/nail assembly. 

The distal area of the nail generally gets less stressed 

when a pair of distal screws is introduced, while the 

presence of two distal screws far away from each other 

results in lower proximal femoral head displacements. 

The stress fi eld at the area of fracture is not infl uenced 

signifi cantly by the presence of a single distal screw or a 

pair of distal screws. 

104 FOLLOW UP OF PATIENTS 

ARTHROSCOPICALLY TREATED FOR 

SHOULDER INSTABILITY 






The evaluation of the results obtained after a long term 

follow up (over 60 months) from patients that were 

treated arthroscopically for shoulder instability. 

In our paper we evaluated 116 patients (108 men and 

8 women) with mean age of 24 yo, that were treated 

surgically by the same surgeon from 1999-2004. Seventy 

seven (77) of them (66,4%) were into sports activities 

and during pre op clinical examination 15 patients 

(12,9%) were diagnosed with joint hypermobility 

syndrome taking into account the Beighton criteria. 

Arthroscopic fi ndings showed that 80 of them (68,9%) 

had some kind of bone loss, either glenoid (7 Large, 23 

Medium, 6 Small) or Hill Sachs lesion (28 Large, 30 

Medium, 20 Small) and in 8 patients an “inverted pear” 

glenoid shape was found. Our follow up ranged from 

60-117 months (Mean=84) and the recurrence of instability 

and functional outcome were evaluated post-op 

using the Rowe Zarins Score. 

Recurrent instability presented in 7 patients. Five (5) 

of them was due to high energy accidents, one was due 

to non-compliance and one was involuntary. Of these 

patients 5 presented Hill Sachs lesion, 3 showed glenoid 

bone loss (2 Large, 1 Small) and in none of them an 

“inverted pear” glenoid shape was found. All recurrent 

cases were into some kind of Overhead/Contact sports 

activity (6 Amateur, 1 Professional). The post op Rowe 

Zarins Score ranged from 80-100 (Mean=95,53). 

The arthroscopic treatment of glenohumeral instability 

is an excellent method that provides similar or better 

results when compared to the open surgical treatment 

and with clear advantages over the latter because of lower 

morbidity, better cosmetic effect and lower total cost. 

EVALUATION OF THE ARTHROSCOPIC 

TREATMENT OF SHOULDER INJURIES 

FOR WEIGHTLIFTERS. OF THE HELLENIC 

NATIONAL WEIGHTLIFTING FEDERATION 

2000–2009 

G. Tsikouris, A. Kyriakos, Th. Papatheodorou, A. 

Tamviskos 

Athens – Kolonaki Orthopaedic & Sports 

Medicine Centre 

The expansion of arthroscopic treatment to serious and 

catastrophic injuries to the weightlifters of the Hellenic 

National Weightlifting Team. The evaluation of the 

results of this specifi c arthroscopic treatment. 

45 athletes (36male,9female) with shoulder injuries 

2000-2009. 15yrs – 35yrs, average: 27yrs.One 

3-times Golden Olympic.One Bronze medalist,Two 

Silver Olympic,Three Olympic winners,Five World 

championsetc.Clinical examination and musculoskeletal 

ultrasound.Plain X-rays. E.M.G, M.R.I.-arthrography, 

3DC/T when that was required. Strength measurement 

with Nottingham McMecin Myometer for ipsi-contro 

lateral shoulder. Full ROM was necessary for the operated 

shoulder before starting exercise for a competition. 

All 48 underwent arthroscopic treatment (3 miniopen). 

Arthroscopic stabilization using absorbable or 

non anchors.45 athletes, 48 shoulders operated,(3 bilaterally).36 

RC tears,6 bony-bankart,2 posterior and 28 

anterior labrum detachment,3 avulsion osteochondral 

fractures,2 AMBRII,4 deranged LH of biceps,4 underwent 

SSN release. 

All patient returned at same sport level except one 

with AMBRII and cervical spine pathology. Rehabilitation 

time for basic weightlifting exercise was 3.5 months 

and for competition level was 4,5 -6 months. 

The shoulder demands during the snatch, clean 

and jerk of the weightlifters provoke often shoulder 

injuries. The arthroscopic surgery gives thorough and 

broad knowledge of their shoulder injuries. The minimal 

detachment, less postoperative joint stiffness and 

decreased shoulder pain are encouraging factors for the 


arthroscopic treatment. Additionally, the returning time 

for training and competition combining with a proper 

rehabilitation seems to be less than open surgery. 

106 THE ROLE OF THE ARTHROSCOPIC 

SUPRASCAPULAR, NERVE RELEASE IN ELITE 

OVERHEAD ATHLETES – THROWERS. OUR 

RESULTS 

G. Tsikouris, Th. Papatheodorou, A. Kyriakos, A. 

Tamviskos 

Kolonaki Orthopaedic & Sports Medicine Centre 

The early diagnosis of the suprascapular nerve (SSN) 

entrapment in overhead athletes with simultaneous shoulder 

injuries and its arthroscopic release plays an important 

role for their appropriate treatment and recovery.SSN 

release at suprascapular and spinoglenoid notches,seems 

very helpful for increasing their performance. 

21 Elite overhead athletes were treated from Jan 

2005–May 2009.From 16 to 34 years old,mean 

26years,4 Javelin throwers (Olympic and National level 

thrower),4 Weightlifters (International level),8 Volleyball 

Players,3 Kick Boxer,2 Water Polo Players. 

Extreme ROM of arm creates large torques about 

the shoulder cycle of repetitive microtrauma to the 

SSN,Direct trauma: fracture, dislocation, blunt trauma 

traction injury,Sling effect with hyper-abduction injury 

at the SS Notch,Correlation ROM with SSN entrapment 

in volley ball players, Eccentric contraction of the 

ISP (spinoglenoid notch),Internal impingement,Rotator 

cuff tears,Biceps lesions,Instability,SLAP lesion,Bankart 

lesion,Mainly infraspinatus muscle atrophy.Xrays,Nerve 

conduction studies,EMG studies,MRI 

All of them had complete pain relief, especially at the 

posterior shoulder,regained full ROM of the operated 

shoulder,19 fully recovered at the pre-injury level,2 at 

the postoperative phase,Muscle atrophy improved 

Advanced SSN entrapment provoke signifi cant muscle 

wasting,often irreversible.This underscores the importance 

of a quick and accurate diagnosis to appropriate 

intervention.The overhead athletes with increased ROM 

of their shoulder predispose in SSN entrapment and 

shoulder injuries and vice-versa.An arthroscopic shoulder 

procedure for repairing the glenohumeral pathology with 

a simultaneous arthroscopic SSN release seems to be the 

appropriate treatment regarding to our resu 

107 THE IMPORTANT ROLE OF THE 

ARTHROSCOPIC HIP SURGERY IN 

THE ATHLETES WITH HIP INJURIES. A 

RETROSPECTIVE STUDY 

G. Tsikouris, A. Kyriakos, Th. Papatheodorou, A. 

Tamviskos 

Kolonaki Orthopaedic & Sports Medicine Centre 

Hip arthroscopy has gradually evolved over the past 

two decades.Recently hip arthroscopy has an increasing 

role in diagnosis and treatment for specifi c intra articular 

and extra articular hip injuries and especially for soft 

tissue injuries. 

February 2002 – May 2009 

• 18 athletes 

• 5 football players 

• 8 basketball players 

• 2 weight lifters 

• 3 gymnasts 

Mean age: 32 y.o. (19-39 y.o.) 

Undiagnosed hip pain, Osteoarthritis, Labral pathology, 

Loose bodies, Osteochondral defects, Sepsis, Ligamentum 

Teres, Trauma, Synovitis 

Symptoms: Deep dull ache pain during hip fl exion 

and external or internal rotation. Decreased R.O.M. 

12/18 Cam sign + (positive), 11/18 Pincher sign + 

(positive), 14/18 Impingement syndrome in adduction 

and in fl exion. 

Instrumentation and Equipment: 30°, 70°, 4,5mm 

arthroscope, High fl ow rate mechanical pump, 15 

gauge 6’’cardiac needle, Convex full radius chondroplasty 

blades, Special electrocautery (Philippon), 

Distraction apparatus, Mechanical water pump unit, 

Image intensifi er 



• Surgery: Standard orthopaedic traction table, Supine 

position, Hip is extended and abducted 25° 

• Portals: Anterior, Anterolateral, Posterolateral 

• Intraoperative Findings – Results 

Detachment of the labrum, 2/18 erosion of the articular 

cartilage of the acetabulum and drilling of the 

bare area, 12/18 Cam sign excision 

The athletes with symptoms of an internal hip pain 

and impingement signs after a clinical exam of their hip 

will get a benefi t from an arthroscopic procedure for 

treating any existing cetabulo -femoral pathology, especially 

for the athletes with femoraloacetabular impingement 

syndrome (FAI). 

108 TUNNEL ENLARGEMENT AFTER ACL 

RECONSTRUCTION WITH A HAMSTRING 

AUTOGRAFT. A CT-SCAN ANALYSIS. 

V. Chouliaras, D. Giotis, C. Roussi, S. Boulis, A. 

Grestas, C. Tatsis 

Ortopaedic Department of General Hospital of 

Arta; Radiology Department of General Hospital 

of Arta 

Tunnel enlargement after AC reconstruction with a 

hamstring autograft has been noticed mainly the fi rst 

3-6 months postoperatively. Its etiology involves biomechanical 

and biological factors. The aggressive rehabilitation 

program is another etiological factor. The aim of 

this study is to investigate the tunnel enlargement after 

ACL reconstruction with a Hamstring autograft by the 

aid of CT-scan. 

We investigate the tunnel diameter in a series of 25 

consecutive patients who operated with a Hamstring 

autograft 3 months postoperatively. The mean age of 

the patients was 23.6 years old (18-35). The same femoral 

fi xation system (XObutton) and the same tibial fi xation 

system (bioabsorbable screw) were used in all the 

patients. All the follow the same rehabilitation program, 

partial weight bearing from the 1st postoperative day, 

brace for 3-5 weeks and return to sports activities in 

6 months. 

In 2 patients a meniscal suture was performed and in 

3 patients a partial meniscectomy was performed. All 

patients had excellent clinical result which was demonstrated 

by the physical examination and by the KT-1000 

results. Statistical analysis was performed with the SPSS 

system. We noticed a tunnel enlargement in the majority 

of the patients, but this was not statistical signifi cant 

(P


an excellent or good result according to the Lysholm 

knee score. Four patients had a restriction of knee joint 

motion postoperatively, and an arthroscopic arthrolysis 

was performed in one of them. Analysis showed that, 

age, length of tear, simultaneous ACL reconstruction, 

chronicity of injury, and location of tear did not affect 

the clinical outcome. Conclusions: Our results, shows 

that arthroscopic meniscal repair with the FasT-Fix 

repair system provides a high rate of meniscus healing 

and offers reduction of both the risk of serious neurovascular 

complications and operative time. 

112 AUGMENTATION OF FEMORAL 

FIXATION IN HAMSTRING ANTERIOR 

CRUCIATE LIGAMENT RECONSTRUCTION 

WITH A BIOABSORBABLE BEAD 

M. Iosifidis, I. Melas, G. Karnatzikos, N. 

Sakorafas, A. Kyriakidis 

2nd Orthopaedic Surgery Department, 

“Papageorgiou” General Hospital, Thessaloniki 

The bead EndoPearl is bioabsorbable material which 

placed in the ACL graft edge, and augment the stabilization 

in the femoral tunnel when an interference screw is 

used. Our aim was to recorded the operative characteristics 

of this technique and the clinical results after using 

EndoPearl in ACL reconstruction with hamstrings graft. 

In 36 of our patients who had ACL reconstruction 

with hamstrings we used EndoPearl bead. They were 23 

men and 13 women mean age 27.8 years (17-46). The 

graft was fi xed in the femur side with interference screw. 

All patients followed the same p.o. rehabilitation regime. 

We followed them up the 1st, 2nd, 3rd, 6th and 8th p.o. 

month. During the last follow-up we checked the anterior 

drawer test, Noulis-Lachman test and in some cases pivot 

shift test, and in parallel Lysholm score was recorded preoperatively 

and in the last examination. 

In this last F.U. check none of them had positive 

Noulis-Lachman test or pivot shift test. The anterior 

drawer test was negative to 32 patients and in 4 we 

found slight laxity in comparison with the health leg. 

Lysholm score showed signifi cant improvement (mean 

90.2 p.o.), and nobody had “giving way”. 

The application of the EndoPearl in conjunction with 

a bioscrew in the femoral tunnel in autogenous ACL 

reconstruction using semitendinosus and gracilis tendon 

grafts provides a signifi cantly decreased in p.o. laxity. 

113 DYNAMIC INVESTIGATION OF KNEE 

ROTATIONAL STABILITY FOLLOWING 

DOUBLE BUNDLE ACL RECONSTRUCTION 

A. Tsarouhas, M. Iosifidis, D. Kotzamitelos, I. 

Spyropoulos, C. Chrysanthou, I. Giakas 

Orthopaedic Department, Naoussa General 

Hospital, Greece; Department of Physical 

Education, University of Thessaly, Greece; 

Institute of Human Performance and 

Rehabilitation, Centre for Research and 

Technology of Thessaly, Trikala, Greece 

To evaluate in-vivo the effectiveness of the double 

bundle technique for Anterior Cruciate ligament (ACL) 

reconstruction in restoring knee rotational stability 

under varying dynamic loading conditions. 

The study group included 10 patients who underwent 

double-bundle ACL reconstruction with hamstrings 

tendon autograft, 12 patients with single-bundle reconstruction, 

10 ACL defi cient subjects and 12 healthy 

control individuals. Kinematic and kinetic data were collected 

using an 8-camera optoelectronic motion analysis 

system and one force plate. Knee rotational stability was 

examined during two maneuvers: a combined 60o pivoting 

turn and immediate stairs ascend and a combined 

stairs descend and immediate 60o pivoting maneuver. 

The two factors evaluated were the maximum 

There were no signifi cant differences in tibial rotation 

between the four groups in the examined maneuvers. 

Tibial rotation in the single- and the double-bundle 

groups were even lower than the control group. Rotational 

moments did not differ signifi cantly between the 

four groups in any of the examined maneuvers. In gen- 

eral, rotational moments in the affected side of the ACL 

reconstructed and defi cient groups were found reduced 

compared to the unaffected side. 

Double-bundle reconstruction does not reduce knee 

rotation further compared to the single-bundle technique 

during dynamic stability testing under varying 

conditions. The injured side of ACL reconstructed or 

defi cient individuals is exposed to substantially lower 

rotational moment compared to the intact side. 

114 TREATMENT OF ACUTE RUPTURES 

OF ACL WITH AN ACHILLES TENDON 

ALLOGRAFT 

N.E. Efstathopoulos, J. Sourlas, J. Lazarettos, V. 

Nikolaou, E. Brilakis, F.N. Xypnitos 

B’ Orthopaedic Department, Medical School, 

University of Athens 

To evaluate the clinical outcome of arthroscopic treatment 

of ACL with an Achilles tendon allograft in patient 

with acute rupture. 

22 patients, between 2003 and 2006, with acute 

rupture of ACL, were treated with an Achilles tendon 

allograft. The mean age was 26 years. Patients were evaluated 

before and after surgery and at the latest follow-up 

with Noulis-Lahmann test and Pivot shift test. We also 

used IKDC score, Lysholm score and one leg stance test 

and functional reach test. Patients were also evaluated 

with Cybex II + and with plain radiographies. 

The mean follow-up time was 3.5 years. 90% of the 

patients had a negative pivot shift test and 95% of the 

patients had a score at Noulis-Lahmann test +1. The 

mean value of IKDC score was 88 (62-100) and the 

mean time of Lysholm score was 91 (75-100). Until the 

latest follow-up there were no clinical sighs of infl ammation 

or graft rejection. Radiologic evaluation revealed 

no sign of tunnel enlargement. 

We believe that the use of a fresh-frozen allograft in the 

treatment of acute ACL ruptures is an effective procedure 

for the restoration of ligamentous stability of the knee. 

115 OVERUSE SYNDROMES IN YOUNG 

ATHLETES. 

N. Markeas, A. Constantopoulou, N. Marinos, C. 

Patrikareas, J. Glykokalamos, D. Pasparakis 

2nd Orthopaedic Department, Children’s Hospital 

of Athens “P. & A. Kyriakou” 

The aim of this retrospective study is to isolate the cases 

of “overuse syndromes” in young athletes in whom the 

initial diagnosis proved wrong. 

During six-year period 2002 – 2007, 28 young athletes 

(16 boys and 12 girls) aged 9.6 years (ranged from 

6.5 to 14 years), suffering an underlying disease that 

had initially attributed to “overuse syndromes”, were 

treated in our Department. In all of the cases the history 

was misleading and the clinical examination was 

precarious, while the x-ray examination proved to be 

unclear. The remaining imaging exams led fi nally to the 

correct diagnosis that was confi rmed in the operating 

room or via the biopsy. 

In 4 cases a slipped capital femoral epiphysis was 

ascertained. In other cases we verifi ed an osteochondritis 

dissecans of femoral condyle or talus (4), an osteoid 

osteoma (4), Perthes disease (3), osteochondromas 

(3), calcaneonavicular synchondrosis (3), hemangioma 

(2), discoid meniscus (1), herpes zoster along the sciatic 

nerve (1), aneurysmal cyst of fi bula (1), accessory 

navicular (1), and osteosarcoma of fi bula (1). 

Overuse syndromes in young athletes should be 

treated with skepticism because another more serious 

disease may be hidden behind the symptoms and clinical 

signs. The children and adolescents have a skeleton that 

grows constantly and develops a special pathogenesis 

and this fact must be always kept in mind of parents, 

trainers and therapists. The young subjects who expect 

to be integrated in the athletic family should be previously 

examined by Pediatrician and Pediatric Orthopedic 

Surgeon so that a congenital anomaly or an acquired 

disease will be diagnosed in time. 

116 LONGTERM OUTCOMES OF SURGICAL 

TREATMENT OF SUPRACONDYLAR 

HUMERAL FRACTURES IN CHILDREN. 

BAUMAN’S ANGLE RELEVANCE WITH 

COMPLICATIONS. 

V. Tsiampa, A. Hitzios, D. Topsis, Z. 

Zaharopoulos, I. Tsagias, C. Dimitriou 

General Hospital of Thessaloniki, Hippokration 

During the period 2004-2009, 35 children were admitted 

to the emergency department,(24 males:11females),aged 

3-14 years old,(MEAN 8,45years),with supracondylar 

humeral fractures (33 extension type and 2 fl exion type). 

All fractures were closed and result of sports injuries 

or games and were treated with closed reduction under 

general anesthesia and percutaneous k-w fi xation. 

The postoperative follow-up lasted from 6months to 

4 years. The Bauman’s angle was evaluated postoperatively 

on the operated and normal elbow and was 76, 

6 ±1° and 74, 7 ±0, 6°. According to Flynn’s criteria 

the functional outcome was excellent in 29 cases. In 6 

cases where the Bauman’s angle was greater than 10-15° 

there has been observed varus deformity (4cases), valgus 

deformity (1case), and fl exion defi cit (1case). 

The percutaneous k-w fi xation and preservation of 

Bauman’s angle with carrying angle too, on supracondylar 

humeral fractures on children is a safe solution to 

avoid future complications. 

117 ELASTIC INTRAMEDULLARY NAILING 

FOR THE TREATMENT OF FOREARM 

FRACTURES IN CHILDREN 

J. Anastasopoulos, D. Petratos, E. Ballas, E. 

Morakis, G. Matsinos 

2nd Orthopaedic Department, “Aghia Sophia” 

Childrens’ Hospital, Athens, Greece 

To evaluate the effi cacy of elastic stable intramedullary 

nailing (ESIN) for the treatment of forearm fractures in 

children and adolescents. 

Between June 2002 and August 2007, 28 patients (19 

boys – 9 girls) with 28 forearm fractures were treated 

with ESIN in our department. The mean age was 12.88 

years (range 10.9-14.82). Both forearm bones were 

affected in all cases. 13 patients were treated by intramedullary 

splinting immediate after the accident whilst 

15 children were operated after failure of conservative 

treatment and fracture redisplacement. The radius was 

nailed in a retrograde fashion in all cases. On the other 

hand antegrade nailing of the ulna was performed in 18 

cases whilst retrograde nailing in 5 patients. In 8 cases 

closed reduction was possible whilst a small incision at 

the fracture site was necessary in 20 children. In all cases 

an above-elbow cast was applied for 5 – 6 weeks postoperatively. 

The healing process was determined on the 

basis of two-projection radiographs. At the latest followup 

elbow and forearm motion were also assessed. 

Mean follow-up was 16 months (range, 7 – 28). With 

the exception of one case all fractures healed within 9 

weeks. No case of infection, cross-union or non-union 

occurred. At the latest follow-up all children presented 

with complete restoration of elbow movement but three 

of them had a defi cit of pronation of 15-20 degrees. In 

those cases where an open reduction was required the 

results were the same as in other cases. 

Based on our results, retrograde, of both bones, nailing 

is recommended for the treatment of all displaced 

forearm fractures in children older than 7 years-old. 

Proper preoperative curving of the nails offers increased 

stability maintaining the anatomic relation of the forearm 

bones. 


118 EARLY RESULTS OF THE PONSETI 

METHOD FOR THE TREATMENT OF 

IDIOPATHIC CLUBFOOT IN THE ISLAND OF 

CRETE 

Ch. Konstantoulakis, S. Kandanoleon, C. 

Krommydakis, G. Grigorakis, V. Petroulakis 

Orthopaedic Department, Chania General 

Hospital 

The purpose of the present study is to evaluate the early 

results of the Ponseti method when used for the treatment 

of idiopathic clubfoot among the population of 

the island of Crete. 

Fourteen consecutive infants (twenty-one feet) with 

idiopathic clubfoot deformity were managed with the 

Ponseti method and were retrospectively reviewed at a 

minimum of six months. The severity of the foot deformity 

was classifi ed according to the grading system of 

Pirani et al. The number of casts required to achieve 

correction was compared with published data for the 

treatment of idiopathic clubfoot. Recurrent clubfoot 

deformities or complications during treatment were 

recorded. Initial correction was achieved with a mean 

of 5.2 casts. Tenotomy and Dennis-Browne braces followed 

the cast applications. One foot had a relapse 

which was then treated by a repeat tenotomy at the 

age of 8 months. Two children abandoned the protocol 

because the parents could not comply with bracing. No 

extensive surgery is needed so far and all feet are fl exible 

and pain free. X-rays when taken showed the talo-calacneal 

angle within normal limits. 

We support the use of the Ponseti method for the 

treatment of idiopathic clubfoot, since it can deliver 

fl exible physiological feet, in the outpatient environment, 

thus avoiding the consequences of extensive open 

surgery. 

119 LATE OUTCOMES IN SURGICAL 

TREATMENT OF PES EQUINOVARUS OUR 

EXPERIENCE FROM 1995 TO DATE 

N. Pettas, I. Nikolopoulos, C. Antonis, D. 

Kypriadis, A. Apostolopoulos, O. Leonidou 

General Childrens’ Hospital of Athens “Agia 

Sofia” 

Pes equinovarus is a multi-factorial congenital disease 

that involves 1/1000 births, is bilateral in half of the 

cases and affects usually male children. 

From 1995 – 2008 we have treated in total 172 children 

with pes equinovarus, 116 male and 56 female 

with age from 1 week to 4 years-old. There was bilateral 

pes equinovarus in 36 children whereas unilateral disease 

revealed equal rate of incidence. All children were 

treated initially with corrective casts and sequentially 

122 children had surgery consisting of Achilles tendon 

lengthening and posterior capsulotomy, whereas in the 

rest of the cases was necessary medial hind foot structures 

and tendons release. 

Final correction with only one operation were 

achieved in 108 children, there were pes equinovarus 

recurrence in 18 children that was treated with new 

soft tissue operation whereas 3 children had to undergo 

some kind of osteotomy in a later time. The recurrence 

time varied from 30 months to 13 years. The treatment 

was successful in 70% of the cases and 30% of them 

needed more than one operation for achieving a satisfactory 

functional result. 

Pes equinovarus is a severe condition that now-a-days 

can be early diagnosed even in fetal life, but leads to 

signifi cant handicap if left without treatment. In our 

department there were successful rates similar to international 

reports. The importance of an established longterm 

follow up of children that were operated for pes 

equinovarus is the keystone of a successful outcome and 

the early treatment is mandatory. 



120 ELBOW DISLOCATIONS IN CHILDHOOD 

WITH EMPHASIS IN ASSODIATED 

FRACTURES 

G. Christodoulou, G. Tagaris, P. Tsoumpos, V. 

Syribeis, B. Bitas 

Orthopaedic Clinic, Karamandaneio Children 

Hospital of Patras 

The aim of our study is to report on our experience with 

elbow dislocations in childhood, the spectrum of the associated 

injuries and the various treatment modalities used. 

In a period of 18 years, 52 children (33 male and 

12 female) with elbow dislocations were treated in our 

clinic. 45 patients were followed-up with an average 

time of 7.2 years.13(29%) dislocations were pure while 

associated injuries were present in 32(71%). Three had 

compound injuries. 23 of the associated injuries involved 

medial epicondyle fractures, 6 radial head fractures, 2 

coronoid fractures, 2 lateral humerus condyle fractures, 

1 ulnar diaphysis fracture and 1 radial peripheral metaphysic 

fracture.27 patients treated conservatively while 

18 patients treated surgically. 

At the fi nal re-examination, according to Roberts PH 

criteria, the clinical results were excellent in 24(56%) 

patients, good in 11(27%) patients, fair in 4(13%) and 

poor in 2 (4%) patients. A transit ulnar nerve paresis 

was perceived in 1 patient. The x-ray fi ndings demonstrated 

6 patients with medial epicondyle pseudartrosis 

and 6 patients with ectopic ossifi cation. 

Most elbow dislocations are associated with elbow 

fractures, therefore examination for an associated fracture 

is necessary. Closed reduction is the treatment of 

choice for elbow dislocations.Surgical treatment is indicated 

in elbow dislocations that are not reduced closely, 

in open injuries and in the presence of associated injuries 

that demand surgical treatment. The clinical and x-ray 

results are usually excellent. The presence of associated 

fractures, especially fractures of the radial head tent to 

lead in poor results. 

121 THE EFFECT OF RADIAL BOWING 

TO FOREARM ROTATION IN FOREARM 

FRACTURED CHILDREN 

T. Oney, C. Copuroglou, M. Ozcan, K. Saridogan 

Department of Orthopaedic & Traumatology, 

University of Trakya 

We aimed to evaluate the relationship of forearm rotation 

with the magnitude of radial bowing and the 

localization of maximal radial bowing in children.The 

purpose of the study was to estimate the future forearm 

rotation limitation related the with the radial bowing. 

Forearm fractured 26 children (younger than 15 

years, 20 male, 6 female) were evaluated in 2 groups. 

Operatively treated (n=14) and nonoperatively treated 

(n=12) groups included diaphysis fracture of both forearm 

bones. In the early postreductive X-rays, maximal 

radial bowing (MRB) and the localization of maximal 

radial bowing (LMRB) were measured. Both groups 

were re-evaluated after a mean follow up of 25.5 

months (range 4-62) clinically by the technique of Price 

et al. and radiologically by the method of Schemitsch 

and Richards. The relation of the MRB and LMRB with 

the forearm rotational movements were evaluated statistically. 

No meaningful difference could be observed between 

the MRB and LMRB values of the injured and normal 

sides statistically (p>0.05). Operatively treated patient 

group had closer degrees of MRB when compared with 

the normal side but there was not any meaningful statistical 

analysis. The number of patients having forearm 

rotation was so low that limits of forearm rotation 

could not be determined by the statistical methods. In 

the forearm pronation limited cases, it was observed 

that, when MRB decreases, the ability of pronation 

decreses and when LMRB increases, the ability of pronation 

also decreases. 

If radial bowing degrees close to the normal side 

can be obtained, forearm rotation limitations due to 

differences of radial bowing can be prevented. The 

mean values of radial bowing and localization of radial 

bowing must be measured after forearm fractures of 

both bones. 

122 TREATMENT APPROACH OF 

OLECRANON FRACTURES IN CHILDHOOD 

G. Christodoulou, P. Tsoumpos, G. Tagaris, G. 

Sdougkos, V. Syribeis 

Orthopaedic Clinic, Karamandaneio Children 

Hospital of Patras 

Study of olecranon fractures in childhood and evaluation 

of the treatment approach. 

During a 20 year period, 64 children with olecranon 

fractures were treated in our clinic. 51 children 

(41 males and 10 females) aged from to 2.5 to 14 

years were reviewed. The follow up period was 1 to 

20 years(average 9 years). Coexisting skeletal injury 

appeared in 31 patients. 36 children were treated conservatively 

while we follow operative treatment (open 

reduction and stabilization with Kirschner wires with or 

without tension-band or screws) in 15 children. 

At the very last examination 2 children complained 

of mild pain during weather changes. Elbow extension 

was reduced from 5° to 15° in 6 patients and elbow 

fl exion was reduced up to 5° in 3 patients. Pronation 

shortage was observed in 3 patients from 5° to 20° and 

a 10° supination shortage was observed in 1 patient. 

One case with pronation – supination shortage (40°and 

70° respectively) while persisting subluxation of radial 

head was in 1 patient. The greatest degree of mobility 

limitation was observed in patients with comminuted 

fractures and associated injuries. Transient paresis of 

the radial nerve was observed in 1 patient. 

The usual therapeutic approach to olecranon fractures 

is conservative. 

In cases of displaced fractures, especially when the 

intra-articular displacement is greater than 3mm, surgical 

approach is indicated. Complications tend to occur 

more frequently among those cases with associated 

injuries. Olecranon paramorphosis in varus needs special 

attention since it usually coexists with radial head 

dislocation. 

123 RECTUS FEMORIS SPASTICITY IN 

PATIENTS WITH CEREBRAL PALSY 

D. Metaxiotis, Th. Nikodelis, D. Moscha, C.A. 

Milonas, A. Kiriakidis 

ELEPAP Thessaloniki; Biokinetic Laboratory, 

Department of Physical Education and Sport 

Sciences, Thessaloniki; B’ Orthopaedic clinic, 

Papageorgiou Hospital, Thessaloniki 

The objective and dynamic documentation of the knee 

kinematics in ambulatory children with spastic cerebral 

palsy and the examination of possible causes of differences 

when compared to normals. 

17 ambulatory patients with an average age of 10,5 

years (6-17 years) with cerebral palsy, spastic diplegia 

where examined clinically including Duncan-Ely test. 

They were also examined with 3-D instrumented gait 

analysis. The Elite system with six cameras was used and 

the knee kinematics in the sagittal plane was recorded. 

Almost all patients (16/17) had a positive Duncan-Ely 

test during clinical examination. The knee kinematics in 

the sagittal plane showed that in 20/34 knees the range 

of motion was decreased compared to normal values. In 

30/34 knees there was a delayed maximum knee fl exion 

in swing phase and in 16/34 knees the amplitude of the 

maximum knee fl exion was decreased compared to normals. 

Patients with severe crouch or mild rectus spasticity 

had almost normal knee fl exion. 

Foot clearance in swing phase is one of the basic prerequisites 

of normal gait. Patients with spastic cerebral 

palsy who are able to walk have an impaired foot clearance 

because of the pathological action of the rectus 

femoris. 

In our study the majority of the patients with clinically 

confi rmed rectus spasticity had decreased timing 

and amplitude of max. knee fl exion in swing. In patients 

with severe co-contraction of the knee fl exors and extensors 

max. knee fl exion within normal range. Therefore it 

should not be considered as the only evaluation parameter 

in rectus femoris spasticity.


124 FACTORS WITH A FAVOURABLE 

IMPACT REGARDING THE SURGICAL 

TREATMENT OF LEGG-CALVE PERTHES 

DISEASE IN CHILDREN 

I. Flieger, N. Pettas, A. Leonidou, N. Liarakos, I. 

Platanitis, O. Leonidou 

Orthopaedic Department, Childrens Hospital 

“Agia Sofia” 

The cause of Legg-Calve Perthes disease, 97 years after 

its original description remains undefi ned. In the present 

study we examined factors, which were correlated 

with a favourable or negative impact on the outcome of 

surgical treatment. 

From a total of 98 children, treated during the period 

1994-2006, we studied 20 cases (classifi ed as Catterall 

III and IV), treated surgically. The average age was 7.4 

years (4-13 years). We studied in comparison the most 

common procedures performed: these were the varus 

femoral osteotomy (12) and the lateral shelf acetabuloplasty 

(7). The subtrochanteric osteotomy yielded superior 

radiological results Stuhlberg I-II (I:6, II:6), than the 

lateral shelf procedure Stuhlberg II-IV (II:3,III:3,IV:1). 

The clinical results were similar between the two groups 

according to the Barrett scale, excellent or good. 

Regarding the subtrochanteric osteotomy the most 

important factor was the precise varisation of the femoral 

neck and secondly the timing of surgical treatment 

early during the fragmentation stage of the disease, 

before the femoral head is signifi cantly distorted. The 

most important positive factor regarding the lateral 

shelf procedure appears to be the accuracy of the surgical 

technique, in order that the graft coverage of the 

femoral head is accurately placed on the hip capsule. 

Negative factor for the lateral shelf procedure in one 

case was early weightbearing, which resulted in collapsing 

of the femoral head. It appears that with extensive 

necrosis (Caterall IV) the femoral head isn’t biomechanically 

enough resistant with this procedure to resist loads 

that result from early ambulation. 

001 COMPUTER-ASSISTED THREE- 

DIMENSIONAL CORRELATION BETWEEN 

THE FEMORAL NECK-SHAFT ANGLE 

AND THE OPTIMAL ENTRY POINT FOR 

ANTEGRADE NAILING 

G. Anastopoulos, D. Chissas, J. Dourountakis, 

P.G. Ntagiopoulos,G. Stamatopoulos, N. 

Zacharakis, A. Asimakopoulos,Th.A. Xenakis 

2nd Dpt. of Orthopaedic & Trauma Surgery, 

“G. Gennimata” Hospital of Athens, Greece; 

Dpt. of Orthopaedic Surgery, University Hospital 

of Ioannina, University of Ioannina School of 

Medicine, Ioannina, Greece. 

Optimal entry point for antegrade femoral intramedullary 

nailing (IMN) remains controversial in the current 

medical literature. The defi nition of an ideal entry point 

for femoral IMN would implicate a tenseless introduction 

of the implant into the canal with anatomical alignment 

of the bone fragments. This study was undertaken 

in order to investigate possible existing relationships 

between the true 3D geometric parameters of the femur 

and the location of the optimum entry point. 

A sample population of 22 cadaveric femurs was used. 

Computed-tomography sections every 0.5 mm for the 

entire length of femurs were produced. These sections 

were subsequently reconstructed to generate solid computer 

models of the external anatomy and medullary 

canal of each femur. Solid models of all femurs were subjected 

to a series of geometrical manipulations and computations 

using standard computer-aided-design tools. 

In the sagittal plane, the optimum entry point always 

lied a few millimeters behind the femoral neck axis 

(mean=3.5±1.5 mm). In the coronal plane the optimum 

entry point lied at a location dependent on the femoral 

neck-shaft angle. Linear regression on the data showed 

that the optimal entry point is clearly correlated to the 

true 3D femoral neck-shaft angle (R2=0.7310) and the 

projected femoral neck-shaft angle (R2=0.6289). Anatomical 

parameters of the proximal femur, such as the 

varus-valgus angulation, are key factors in the determination 

of optimal entry point for nailing. 

The clinical relevance of the results is that in varus 

hips (neck-shaft angle ≤ 120o) the correct entry point 

should be positioned over the trochanter tip and the 

use stiff nails is advised. In cases of hips with neck-shaft 

angle between 120o and 130o, the optimal entry point 

lies just medially to the trochanter tip (at the piriformis 

fossa) and the use of stiff implants is safe. In hips with 

neck-shaft angle over 130o the anatomical axis of the 

canal is medially to the base of the neck, in a “restricted 

area”. In these cases the entry point should be located 

at the insertion of the piriformis muscle and the application 

of more malleable implants that could easily follow 

the medullary canal should be considered. 

002 FLOW CYTOMETRY LEUKOCYTE 

IMMUNOPHENOTYPE INVESTIGATION IN 

TOTAL HIP ARTHROPLASTY LOOSENING 

M. Ovrenovits, E.E. Pakos, G. Vartholomatos, 

G.I. Mitsionis 

Haematology Laboratory – Unit of Molecular 

Biology, University Hospital of Ioannina; 

Department of Orthopaedic Surgery, University 

Hospital of Ioannina; University of Ioannina, 

School of Medicine, Ioannina, Greece 

The aim of the study to analyze the circulating white 

blood cells including the intensity expression of surface 

receptors and cytoplasmic molecules in patients underwent 

total hip replacement, with either aseptic or septic 

loosening of hip prostheses in order to identify cell-surface 

and cytoplasmic markers that could be indicative 

of early loosening. Flow cytometry was performed in 

whole peripheral blood samples of 20 patients with 

loosening (10 septic and 10 aseptic). Ten healthy individuals 

served a control group. The CD62L, CD18, 

CD11a, CD11b and CD11c expressions were evaluated. 

The mean fl uorescence intensity (MFI) of CD 18 

was decreased on all leukocytes subsets compared to 

control group. For patients with aseptic loosening we 

demonstrated an increase of MFI for CD11b in granulocytes 

and for CD11c in monocytes and granulocytes 

compared to control group. In patients with septic loosening 

an increase of MFI for CD 11c was observed in 

monocytes compared to control group. The comparison 

between aseptic and septic loosening showed a statistically 

signifi cant lower CD18 MFI value in granulocytes 

for aseptic loosening. A trend towards lower MFI 

values of CD 62L in lymphocytes and granulocytes were 

observed in aseptic but not in septic loosening patients 

compared to control group. The present study is the fi rst 

study in published literature to demonstrate cell surface 

and cytoplasmic markers in peripheral blood indicative 

of loosening of THAs by means of fl ow cytometry. 

003 THE INFLUENCE OF PRP ON TENDON 

HEALING. AN EXPERIMENTAL STUDY IN 

RABBITS 

K. Kazakos, D. Lyras, D. Verettas, A. 

Polychronidis, S. Botaitis, G. Agrogiannis 

Democritus University of Thrace, Orthopaedic 

Clinic 

We investigated the effect of Platelet Rich Plasma (PRP) 

in tendon healing. The aim was to assess the effect of an 

application of PRP on angiogenesis and immunohistochemical 

expression of TGF-b1 and IGF-I during tendon 

healing.We used a patellar tendon defect model after 

resecting its central portion. 48 skeletally mature New 

Zealand White rabbits were divided into the respective 

group and each group they were randomised into controls 

and PRP treated cases. The rabbits were sacrifi ced at 

weekly intevals and histological and immunohistological 

assessments were performed. The results showed a faster 

healing rate, increased vascularity, and higher expression 

of the growth factors in the PRP group. We conclude 

that the mixture of growth factors present in PRP gel 

improved the rate and quality of tendon healing. 

004 IS TUMOR RESPONSE TO 

PREOPERATIVE CHEMOTHERAPY A SOLE 

PROGNOSTIC FACTOR OF SURVIVAL IN 

OSTEOSARCOMA PATIENTS? 

M. Ioannou, I. Papanastassiou, S. Kottakis, N. 

Demertzis 

Department of Orthopaedics, METAXA 

Anticancer Hospital 

In the treatment of osteosarcoma, many reports in the 

literature outline that tumor response to chemotherapy 

directly correlates with disease-free survival and/or mortality. 

The aim of this study is to evaluate if the percentage 

of tumor necrosis is a sole prognostic indicator of 

overall survival in osteosarcoma patients. 

We retrospectively studied 33 osteosarcoma cases 

treated in our institution from 1997 to 2006. All 

patients were treated preoperatively with HDMTX chemotherapy.The 

percent necrosis of the excised specimen 

were compared with survival rates of the patients. 

Sixteen patients were good responders (Huvos 

III,IV- >90% necrosis), 16 patients were poor responders 

(Huvos I,II- < 90% necrosis), and one patient died 

during preop. chemotherapy.With a mean follow-up of 

5,48 years (3-12 years) 22 patients are NOD (not evident 

disease), in 8 patient disease progressed, 8 patients died. 

Statistical analysis could not establish a signifi cant correlation 

between percent necrosis and patient survival. 

Outcome of osteosarcoma may be dependent on a 

variety of factors s.a. tumor size, location, metastasis, 

surgical therapy, pathologic fracture. Tumor necrosis 

itself may be dependent on the histological subtype of 

the tumor and P-glycoprotein expression. In this series 

we could not establish tumor necrosis as a sole prognostic 

factor of patient survival. 

00 LOW-DENSITY LIPOPROTEIN RECEPTOR- 

RELATED PROTEIN 5 (LRP5) GENE 

EXPRESSION IN HUMAN OSTEOARTHRITIC 

CHONDROCYTES 

A. Tsezou, I. Papathanasiou, T. Orfanidou, K.N. 

Malizos 

University of Thessaly, Medical School, 

Laboratory of Cytogenetics and Molecular 

Genetics, Larissa, Greece; University of Thessaly, 

Medical School, Department of Orthopaedics, 

Larissa, Greece; Institute for Biomedical Research 

and Technology, Larissa, Greece; University of 

Thessaly, Medical School, Department of Biology, 

Larissa, Greece 

The Wnt/b-catenin signaling pathway participates in 

normal adult bone and cartilage biology and seems to be 

involved in cartilage degeneration and subsequent OA 

progression. The aim of this study was to investigate 

the activation of Wnt/b-catenin pathway in osteoarthritis 

and the role of LRP5, a coreceptor of Wnt/b-catenin 

pathway, in human osteoarhritic chondrocytes. 

Human cartilage was obtained from 11 patients with 

primary osteoarthritis (OA) undergoing total knee and 

hip replacement surgery. Normal cartilage was obtained 

from 5 healthy individuals. b-catenin and LRP5 mRNA 

and protein levels were investigated using real time 

PCR and western blot analysis, respectively. Blocking 

LRP5 expression was performed using small interfering 

(siRNA) against LRP5 and subsequent MMP-13 mRNA 

and protein levels were evaluated by real time RCR and 

western blot analysis, respectively. 

We confi rmed the activation of Wnt/b-catenin pathway 

in osteoarthritis, as we observed signifi cant upregulation of 

b-catenin mRNA and protein expression in osteoarthritic 

chondrocytes. We also observed that LRP5 mRNA and 

protein expression was signifi cantly up-regulated in osteoarthritic 

cartilage compared to normal. Also, blocking LRP5 

expression using siRNA against LRP5 resulted in a signifi - 

cant decrease in MMP-13 mRNA and protein expressions. 

Our fi ndings suggest that the upregulation of LRP5 

mRNA and protein expression in osteoarthritic chondrocytes 

results in an increased activation of Wnt/b-catenin 

pathway in osteoarthritis. The observed reduction of MMP- 

13 expression after blocking LRP5 expression in osteoarthritic 

chondrocytes, suggests the involvement of LRP5 in 

the progression and pathogenesis of osteoarthritis. 


006 IN VITRO 2D AND 3D BONE 

INDUCTION WITH SIMVASTATIN AND 

MURINE EMBRYONIC STEM CELLS. 

Y. Kang, J. Pagkalos, J.M. Cha, M. Heliotis, E. 

Tsiridis, A. Mantalaris 

Department of Chemical Engineering Imperial 

College London, London SW7 2AZ and Academic 

Orthopaedic Department, Leeds University, Leeds 

Simvastatin is a 3-Hydroxy-3-methylglutaryl Co-enzyme 

inhibitor, widely used to reduce lipid levels. Recent studies 

have demonstrated pleiotropic benefi cial effects the 

skeleton.We aim to demonstrate the effect of Simvastatin 

on the osteogenic differentiation and proliferation 

of murine embryonic stem cells. 

Tg2a cells were cultured in maintenance medium 

until confl uence and passaged twice into tissue culture 

fl asks. They were then seeded into 6well and 24well 

plates at a density of 10.000cells/cm2 and cultured for 3 

days in maintenance medium mixed at 1:1 with HepG2 

conditioned medium. The culture then continued using 

osteogenic medium with different concentrations of simvastatin 

for another 16 days. Measurements included 

Alizarin Red quantifi cation for calcifi ed matrix, ALP 

assay, RT-PCR for genes expressed during osteogenic 

differentiation (osteocalcin, Runx2, osterix, Col1a1). 

Simvastatin has dose dependent effect on mineralized 

matrix formation. Alizarin Red quantifi cation assays 

demonstrated that simvastatin (all dose groups) induced 

a statistically signifi cant increase in calcifi ed matrix formation 

on day 11 (P


anterogradely labelled with MiniRuby, a 10 kD biotinylated 

dextran amine. 

After 4 days the co-cultures were propagated, and 

axonal sprouting occurred. The group of co-cultures 

treated with NT-3 showed an improved cortical cytoarchitecture, 

and sprouting axons were more frequently 

observed. In NT-3-treated co-cultures where spinal cord 

gray matter was directly opposed to cortical slices sprouting 

axons entered the adjacent spinal cord tissue. This 

phenomenon was not observed if spinal white matter was 

opposed to the cortical slices, or if NT-3 was absent. 

Our data suggest that the absence of repellent factors 

such as white matter and the presence of neurotrophic 

factors promote axonal sprouting. Co-cultures 

of motorcortex and spinal cord slices combined with 

anterograde axonal labelling could provide a valuable 

in vitro model for the simplifi ed screening of factors 

infl uencing corticospinal tract regeneration 

012 THE ROLE OF TSF (TAYLOR SPATIAL 

FRAME) IN TREATING TRAUMA AND BONE 

DEFORMITIES IN CHILDREN 

H. Tsibidakis, V. I. Sakellariou, V. 

Tsouparopoulos, G. Mazis, K. Staratzis, A. 

Kanellopoulos 

1st Orthopaedic Department, University of 

Athens, ATTIKON University General Hospital, 

Greece 

To study the use of TSF system in treating trauma and 

bone deformities in children. To determine the diffi culties 

of this process and the risk factors that lead to complications. 

From January 2004, in 61 children (37 male and 24 

female), 67 extremities, with a mean age 8.9 years children 

a TSF external fi xator was applied for the treatment 

of trauma or bone deformities. 21 children were operated 

for angular deformity, 19 for bone lengthening, 10 for 

rotational deformity, 6 for combined angular deformity 

and lengthening and 11 for pseudoarthrosis. Intra and 

postoperative diffi culties were classifi ed using the Palay 

method in problems, obstacles and complications. 

The rate of diffi culties was 22.2 %. Problems were 

presented in 5.9% (4/67) consisting of 2 non-axial 

deformities, 1 pin fracture and 1 subluxation of the 

knee. Obstacles were presented in 10.4% (9/67) including 

3 cases with delayed bone healing that needed infusion 

DBM, 1 peroneal nerve palsy due to hematoma 

formation treated with decompression of the region, 1 

early bone fusion that needed re-operation and 2 cases 

of percutaneous achilles lengthening. Complications 

presented in 5.9% of (4/67) the cases including 1 fracture, 

1 pseudoarthrosis, 1 peroneal nerve palsy and 1 

limitation of range of motion in the knee (0-45 0). 

The problems, obstacles and complications that presented 

during treatment infl uenced the fi nal therapeutic 

objective. Initial deformity, preoperative planning and 

surgeon’s experience are associated with reducing the 

rate of all diffi culties 

013 BONE MORPHOGENETIC PROTEINS 

(BMPS) EXPRESSION IN THE FEMORAL 

HEADS OF PATIENTS WITH AVASCULAR 

NECROSIS 

1 S. Samara; 2 Z. Dailiana; 2,3 K.N. Malizos; 2 S. 

Varitimidis; 1 C. Chassanidis; 4 T. Koromila; 4 P. 

Kollia 

1 Laboratory of Medical Genetics and 

Cytogenetics, University of Thessalia, Larissa; 

2 Department of Orthopaedic Surgery, University 

of Thessalia, Larissa; 3 Institute of Biomedical 

Research and Technology, Larissa; 4 Laboratory of 

Human Genetics, School of Biology, University of 

Athens, Athens 

Avascular necrosis (AVN) is a disorder leading to femoral 

head (FH) destruction, while BMPs are known for 

their osteogenic ability. In this study we analyzed BMP- 

2, BMP-4, BMP-6 and BMP-7 expression at the RNA 

and protein level in the normal and necrotic sites of 

the FHs. 

Quantitative RT-PCR for BMP-2,-4,-6,-7 genes was 

performed in samples from the normal and necrotic sites 

of 52 FHs with AVN. Protein levels of BMP-2,-4,-6 were 

estimated by Western Blot analysis. Statistical analysis 

was performed using the t-test (p

017 AUTOLOGOUS CHONDROCYTE 

IMPLANTATION. LONG-TERM FOLLOW UP, 

10-20 YEARS POSTOPERATIVELY 

C.S. Vasiliadis, M. Brittberg, A. Lindahl, L. 

Peterson 

Molecular Cell Biology and Regenerative Medicine 

Orthopaedics Sahgrenska University Hospital; 

Gothenburg University, Gothenburg, Sweden; 

Department of Orthopaedics, Kungsbacka 

Hospital; Orthopaedic Sports Medicine Center, 

Department of Orthopaedics, University of 

Ioannina 

We assessed 224 patients treated with Autologous 

Chondrocyte Implantation performed 10-20 years ago 

(average 12.8 years). Average age at the time of the 

implantation was 33.3 years. Average size of lesion 

was 5.3 cm2 (range 0.6-16), while 55 patients sustained 

multiple lesions. The participants fi lled out fi ve 

questionnaires. Lysholm score, Tegner-Walgren, modifi 

ed Cincinnati (Noyes), Brittberg score, and KOOS 

were assessed. In addition, the patients were asked to 

grade their current situation compared to their previous 

follow up as better, worse of unchanged. Finally, 

they were asked if they would do the operation again, 

answering with yes or no. 

The patients were divided into groups according to 

the location and characteristics of the cartilage lesions, 

or concomitant surgeries during the ACI. Assessment of 

the outcomes reveals a signifi cant improvement in all 

groups, compared with the preoperative values. 

There is no other study assessing a cartilage treatment 

with such a long follow up. According to the results of 

that study, autologous chondrocyte implantation seems 

to be an effective and durable solution for the treatment 

of large full thickness cartilage and osteochondral 

lesions of the knee joint 

018 IS SLIDING FAVOURABLE IN GAMMA 

NAILING? (A BIOMECHANICAL STUDY) 

A. Kalambokis, C. Kokoroghiannis, A. 

Deligeorgis, E. Magnissalis, I. Aktselis, S. 

Karagiannis. 

5th Orthopaedic Department, KAT Hospital, 

Athens 

Locking strategies of the sliding screw in gamma nailing 

(G3) were tested in an experimental biomechanical study. 

Twelve Composite Femoral Bone models were used. 

An intertrochanteric osteotomy was performed and 

a gamma nail was implanted in each specimen. The 

specimens were divided in 3 groups: a) compressed 

and locked, b) locked at distan¬¬¬ce and c) unlocked. 

Each specimen was subjected to 4 cycles of static vertical 

loading of up to 1100 Newtons (N) at a rate of 10 

mm/minute. Subsequently, the specimens were investigated 

for cut-out patterns using digital photography and 

management. 

All failures occurred under supraphysiological loads. 

During their fi rst loading cycles, no statistical differences 

for stiffness and yield load were noted. Nevertheless, 

there was a non–signifi cant tendency for higher 

failure loads for the unlocked group. Under maximum 

load (1100 N) and already established deformations, all 

Gamma Nails behaved similarly in terms of neck-screw 

displacement, with no statistical differences. 

Unlocked screws exhibited the most moderate failure 

modes followed by the compressed and locked group. 

The third group showed the most severe failures. 

In conclusion, there is evidence that sliding is biomechanically 

superior in gamma nailing. Despite adverse 

mechanical circumstances all specimens behaved satisfactorily 

under physiological loading 



019 MANAGEMENT OF PATHOLOGICAL 

FRACTURES WITH EXTERNAL FIXATION 

UNDER SEDATION AND LOCAL 

ANAESTHESIA 

D. Economopoulos, I. Plaitakis, M. Papaioannou, 

G. Vatikiotis, D. Lekkas, T.P. Kormas 

Department of Orthopaedic Surgery and 

Oncology, St Savvas Hospital, Athens 

Our aim was to assess the value of external fi xation in 

pathological fractures in selected patients. 

During 2003-2008 we treated 35 patients with multiple 

myeloma or disseminated cancer, visceral metastases 

and pathological fractures with external fi xation under 

sedation and local anaesthetic, because they were not 

fi t for general anaesthesia. We used external fi xation on 

1 hip fracture, 1 fracture of the second metatarsal, 2 

wrist fractures, 4 radial, 5 intertrochanteric, 1 subtrochanteric, 

12 fractures of the humerus, 1 ulna fracture, 

4 femoral fractures, 3 tibial fractures and 1 femoral 

osteolysis. Operating times were 15-35 min, all patients 

were comfortable, cooperated well and they did not 

experience any pain during the procedure. In all cases 

XRT was applied either pre- or post-operatively. 

On follow up (2-48 months) 4 of the patients were 

deceased. Fracture stabilization was adequate and Xrays 

confi rmed porosis in 4 fractures; however, two 

lesions expanded further, despite proper adjuvant biopharmaceutical 

therapy. 5 patients impoved so we could 

operate them later to treat the fractures defi nitively. All 

individuals experienced pain relief, they were adequately 

mobilized and most function was restored, while there 

was no major problem with pin tract infections. 

We suggest external fi xation as a palliative treatment 

in patients with pathological fractures and multiple 

metastases, who don’t qualify for major surgery because 

of their critical illness. The later puts under local offer an 

excelent chance to fi x fractures quikly, manage the pain 

and restore function without the risks of general anaesthesia 

020 INTRANEURAL OX7-SAPORIN FOR 

NEUROMAS-IN-CONTINUITY 

A.F. Mavrogenis, P. Liantis, K. Pavlakis, A. 

Stamatoukou, P.J. Papagelopoulos, P.N. Soucacos 

First Department of Orthopaedics 

Department of Pathology, Athens University 

Medical School, Athens Greece 

In the peripheral nervous system of rats, a wide-variety 

of toxins has been studied to selectively target neurons 

projecting through a particular nerve. We employed 54 

adult male rats to create a neuroma-in-continuity and to 

evaluate the effect of the immunotoxin OX7-saporin to 

inhibit neuroma-in-continuity formation. Materials and 

Methods: The left common peroneal, tibial or sciatic 

nerves were crushed by one 10-second application of a 

microforceps. At 3 and 6 weeks after nerve crush, the 

respective nerve was cut distal to the site of nerve crush, 

and microinjection of 2 μl of natural saline or 2 μl of the 

OX7-saporin was done. 

In all nerve specimens of the control group and the 

saline-injection experimental subgroups, gross observation 

showed a thickened area at the site of nerve crush. 

Histology showed features consistent with a neuromain-continuity. 

In 11 of the 14 nerve specimens of the 

OX7-saporin injection experimental subgroups, gross 

observation showed a narrowed area at the site of nerve 

crush. Histology showed prevention of neuroma-in-continuity 

formation as seen by wiping out of almost all 

nerve fi bers, leaving an empty tube encasing by connective 

tissue. 

This study supports the hypothesis that intraneural 

injection of the OX7-saporin may inhibit neuroma-incontinuity 

formation 

021 SENSORY REEDUCATION OF THE 

HAND AFTER MEDIAN NERVE COMPLETE 

TRANSACTION AND MICROSURGICAL 

REPAIR 

A.F. Mavrogenis, P. Liantis, D. Antonopoulos, 

S.G. Spyridonos, P.J. Papagelopoulos 

First Department of Orthopaedics, Athens 

University Medical School, Department of Hand 

and Upper Extremity Surgery and Microsurgery, 

KAT Hospital, Athens Greece 

To evaluate the functional outcome after complete median 

nerve transaction and repair, and sensory reeducation. 

We studied 40 patients, aged 20 to 32 years, with 

median nerve neurotmesis at the wrist. Primary epineural 

microsurgical repair using 8-0 single strand sutures 

was done in all patients, and a hand and wrist cast was 

applied for 4 weeks. After cast removal all patients went 

through physical therapy for 1 month to restore motion 

and reduce stiffness of the injured hand. After reinnervation 

was completed, the patients were randomly allocated 

into 2 equal groups: Group A patients were instructed to 

a sensory re-education program; Group B patients had 

no further treatment. Clinical evaluation was done at 18 

months postoperatively including the localization test 

(locognosia), the static and the moving 2 point discrimination 

tests, the Moberg’s pick-up test (stereognosia), and 

the hand grip and the opposition strength tests. 

All patients were included in the postoperative evaluation. 

Hand grip and opposition strength, static and 

moving two point discrimination were not statistically 

signifi cant between the two groups (p= 0.622, p= 0.112 

and p= 0.340, respectively). The localization test was 

statistically signifi cant in group A (p= 0.007), and a 

trend to statistical signifi cance was observed regarding 

the Moberg’s pick up test in group A (90% statistical 

signifi cance, p= 0.063). 

Sensory reeducation is essential for patients with 

median nerve neurotmesis and repair, as it signifi cantly 

re-educates localization and stereognosia in the shortest 

time following peripheral nerve injury and repair 

022 ILIAC CREST REGENERATION AFTER 

BEEN HARVESTED FOR AUTOLOGOUS 

BONE GRAFTS. A PROSPECTIVE STUDY OF 

18 PATIENTS WITH A MEAN FOLLOW-UP OF 

14 YEARS 

A. Christodoulou, P. Antonarakos, A. Boutsiadis, 

P. Givissis, E. Christodoulou 

1st Orthopaedic department, Aristotle’ s 

University of Thessaloniki 

Autogenous iliac bone grafts has been proved to be the 

most reliable mean to achieve a solid fusion in spine surgery. 

The purpose of our study is to evaluate that healing 

process of the ilium after been used as donor site of bone 

grafts in the treatment of adolescent idiopathic scoliosis. 

Eighteen patients underwent posterior spinal fusion 

for progressive adolescent idiopathic scoliosis between 

1989 and 1993. Thirteen patients were female and fi ve 

were male with a mean age at the time of operation of 

14.6 years (12-33). The same surgeon performed all procedures 

with nearly identical technique using the Hartshill 

frame as stabilizing instrumentation. The average 

of the number of levels involved in spinal fusions was 

10.3 levels. In all cases the autogenous bone graft used 

was harvested from the right posterior iliac crest. 

All patients were reviewed at least fourteen years after 

surgery. CT scans were performed in all 18 patients in order 

to evaluate the status of ossifi cation at the donor site. 

CT scans of the ilium showed that bone defi cit was 

present in 9 cases (50%) and in 9 cases (50%) it was 

found that both cortical and cancellous bone was fully 

restored. Using the T-student test we found that bone 

reformation was independent from the number of levels 

fused and the amount that was harvested. Our important 

result is that younger patients with smaller Risser’s line 

have greater capability to restore bone stock at this area. 

In conclusion ICBG remains the most effective mean 

to achieve fusion in spinal surgery. The iliac wing and 

especially the periosteum of immature patients (Risser 

3,4) seem to have great capabilities to regenerate the 

bone defects


125 INTRAMEDULLARY NAILING OF 

COMBINED / EXTENDED FRACTURES OF 

THE HUMERAL HEAD AND SHAFT 

C.Garnavos, N.Lasanianos, V.Lakka. M.Morakis, 

G.Sinnis, K.Papagiannakos 

1st & 2nd Trauma & Orthopedic surgery dept. 

Athens General Infirmary “Evaggelismos” 

Although intramedullary nail fi xation maybe highly 

indicated for comminuted and segmental humeral fractures 

that require operative treatment, the literature 

lacks reviews of this content. 

The aim of the present study is to prospectively evaluate 

the clinical and radiographic outcomes in patients 

with combined head and shaft fractures of the humerus 

who were treated by antegrade locking intramedullary 

nailing. 

During a period of four years 21 patients (9 men & 

12 women) between 36 and 82 years old, with combined 

fractures of the humeral head and shaft, were operated 

by one surgeon. Three types of nail implants were used 

(Polarus long, Garnavos nail, True fl ex nail) and antegrade 

technique was performed in all cases. 

The mean operating time was 105 min (50’-140’). 

The period of follow-up averaged 14.25 months (range, 

9 to 18 months). Two patients were lost to follow up 

and one died before the callus formation procedure 

was accomplished. The functional assessment included 

determination of the Constant score and documentation 

of shoulder function as compared with the non injured 

extremity. Radiographic control was obtained during 

the follow-up intervals and at the fi nal follow up. No 

neurovascular complications, deep wound infections or 

non-unions were recorded and all fractures were fully 

healed between 4 to 8 months post-operatively. In one 

case the nail was extracted before callus formation was 

achieved, because of acromion impingement. 

The results are judged as very satisfying, taking into 

account the comminution of the fractures. Further evaluation 

of the results, with comparable methods of internal 

fi xation of such fracture patterns, is needed. 

126 ARTHROSCOPICALLY ASSISTED 

REDUCTION AND INTERNAL FIXATION OF 

TIBIAL PLATEAU FRACTURES 

S.Plessas, D. Louverdis,P. Mavroeidis,A. 

Bourlekas,G. Stroboulas,N. Prevezas 

Orthopaedic Dpt.of General Hospital Nikaia 

Peirea 

During the last few years, the arthroscopically assisted 

technique for reduction and internal fi xation of tibial 

plateau fractures is of increasing popularity. The accumulated 

surgical experience allowed the possibility of treating 

type I, II, III according to Schatzker classifi cation. 

During the last two years 17 patients who had suffered 

a tibial plateau fracture were treated this way. 

The mean age was 44 years, while the mean FU was 

16 months. According to Schatzker classifi cation 8 fractures 

were type I, 6 fractures type II and 3 fractures type 

III. The bone reduction was achieved under arthroscopic 

view and fl ouroscopy. In all cases the fracture was fi xed 

by the with cannulated Herbert type screws. Meniscal 

lesions were fi xed in 9 patients, while in 5 patients 

ruptures of the ACL were detected, which were reconstructed 

at a later stage. 

Full range of motion of the knee was restored in 11 

patients, while lack of full knee fl exion (mean 100) was 

found in 6 patients. All patients were assessed with a 

modifi ed Lyslom Knee Scale. The Knee score was 85 

points to 96 points (mean 92 points), while the anterior 

knee pain was the common problem especially following 

increased activities. 

The proposed arthroscopically assisted technique 

for reduction and fi xation of certain types of tibial plateau 

fractures consists a alternative minimal invasive 

approach. Visualization of the whole joint is possible 

and concomitant lesions can be detected and possibly 

fi xed at the same time 

127 A TWO STAGES TREATMENT OF HIGH 

ENERGY FRACTURES OF DISTAL TIBIA. 

RESULTS ESTIMATION. 

G. Antypas, Ath. Konstas, G. Kontogiannis, K. 

Liossis, P. Gakis, N. Prevezas 

Orthopaedic Department, Nikaia, Piraeus General 

Hospital “Ag. Panteleimon” 

The treatment of high energy fractures of distal tibia by 

internal fi xation is followed by a high rate of soft tissue 

complications. 

The result estimation of these fractures in a two stage 

treatment, bridging the ankle by Ex-Fix with/without 

internal fi xation of the fi bula and internal fi xation of the 

tibia after soft tissue recovery 

In a 4 year period (2005-8), 15 patients, average of 42 

years were treated. The AO fracture classifi cation was 

followed. The soft tissue damage estimation (Osternn- 

Tscherne and Gustillo classifi cation), the fracture pattern 

of the fi bula and the injury mechanism consisted of 

the choice method criteria. The majority of the injuries 

was classifi ed Tscherne II & III, and 3 open fractures 

Gustillo II. Fracture reduction was performed by bridging 

Ex-Fix of the ankle with/without plating the fi bula 

with a 1/3 or DCP 3.5 mm plate. Defi nite internal fi xation 

of the tibia by locking plate was performed from 

8th -14th postoperative day after soft tissue recovery. 

Preoperatively CT scan was performed with grate signifi 

cance, defi ning the soft tissue condition, the surgical 

approach and the osteosynthesis type. 

Follow up average 14 months. None of the patients 

developed infection. All wounds were healed in one 

stage. Superfi cial skin necrosis was conservatively 

treated in two patients. 

Soft tissue complications, after internal fi xation of 

high energy fractures of the distal tibial, usually appear. 

Two stages treatment allows better preoperative planning, 

immediate patient mobilization and reduce complication 

rate 

128 TREATMENT OF COMPLEX TIBIAL 

SHAFT FRACTURES USING ILIZAROV 

EXTERNAL FIXATION 

M. Beltsios, O. Savvidou, E. Papavasiliou G. 

Giourmetakis, A. Kaspiris, J. Mpesiris 

Orthopaedic Department, General Hospital of 

Elefsis, «Thriassio» Athens, Greece 

The frequent choice of treatment for tibial shaft fractures 

is intramedullary nailing. However there are cases 

where this treatment is problematic and alternative 

treatments are chosen with satisfi ed results. 

Twenty-nine patients with complex, unstable tibial 

shaft fractures (13 males and 16 females) aged 18 to 76 

years (mean age 49 years) were treated using Ilizarov 

external fi xation, the last decade in our Department by 

the same surgeon. The indications were open Gustillo 

III fractures, comminuted fractures of the proximal or 

distal third tibia near metaphysis, concomitant plateau 

or pillon fractures and fractures after total knee arthroplasty 

(TKA). All frames were applied the fi rst day of 

injury. Patients without concomitant intraarticular 

fracture or bone defi cit allowed to full weight bearing 

within2 weeks after surgery. 

Union and good to excellent alignment with full range 

of motion in the knee and ankle joints was obtained 

in all patients. Three patients needed bone lengthening 

using the initial applied frame after corticotomy in 

second operation. There were 7 delayed unions in fractures 

without bone defi cit, 10 superfi cial pin tract infection 

treated with antibiotics and local care and 1 deep 

infection which needed surgical intervention. 

Ilizarov external fi xation gives the solution in diffi cult 

and problematic tibial shaft fractures and allows early 

weight bearing 

129 CIRCULAR EXTERNAL FIXATION 

AND CLOSED REDUCTION FOR THE 

TREATMENT OF TIBIAL PLATEAU 

FRACTURES 

M. Beltsios, O. Savvidou, G. Giourmetakis, E. 

Papavasiliou, J. Dimoulias, 


Elefsis «Thriassio» Athens, Greece 

Treatment of tibial plateau fractures Schatzker type V and 

VI or with soft tissues injuries is still remains under discussion. 

The purpose of this study is to evaluate the results of 

treatment with circular frame and closed reduction in 25 

patients (15 males and 10 females) with tibial plateau fractures, 

with a mean age of 42 years old (20 – 76 years). 

Five fractures were classifi ed as Schatzker type II and 

III and 20 as type V and VI. Reduction was obtained in 

22 cases under foot traction and in 3 arthroscopically. 

Bone grafts inserted through a hole (≤ 1 cm) in the inner 

cortex of the tibia metaphysis under fl uoroscopy. Eight 

unstable knees needed bridging the joint for 4 weeks. In 

2 cases a cannulated interfragmentary screw was used. 

Full weight bearing was allowed 3 months after injury 

when the device was removed. 

Follow up ranged from 1 to 10 years (mean 5 years). 

All fractures were united and there was no infection. 

Full range of the knee motion was achieved in 23 

patients while 2 needed an open arthrolysis. There were 

2 malunions which were treated with one valgus osteotomy 

and one TKR. Asymptomatic arthritis appeared 

in 6 patients. According to Knee Society Score (KSS) the 

results were classifi ed as excellent in 12, good in 8, fair 

in 3 and poor in 2 patients. 

Circular frames are a satisfactory alternative method 

for the treatment of tibial plateau fractures either in 

severe soft tissues injuries or in very complex cases 

130 TREATMENT OF OPEN TIBIA SHAFT 

FRACTURES WITH SIMULTANEOUS 

EXTERNAL FIXATION AND ALLOGRAFT 

APPLICATION 

I. Nikolopoulos, S. Kalos, G. Krinas, D. 

Kypriadis, A. Elias, G. Skouteris 

2nd Orthopaedic Department G.H. “Asclepeion 

Voulas” 

The use of external fi xation in open tibia fractures with 

severe soft tissue injury is the most preferred and safe 

treatment. The primary allograft application is doubtful 

due to high infection risk. 

The evaluation of the results of open tibia fractures 

type II and III according Gustillo-Anderson that were 

treated with simultaneous external fi xation and allograft 

application. 

From 2005-2007, twenty nine open tibia shaft fractures 

in 27 patients (2 bilateral) with mean age of 35 

years-old were treated. 

According Gustillo-Anderson classifi cation, there 

were 20 GII, 6GIIIa and 3GIIIb open tibia shaft fractures 

without severe bone loss. All patients were treated 

with thorough and extensive surgical debridment, external 

fi xation and simultaneous application of allograft 

and double antibiotic scheme. The patients were followed 

up initially weekly till stitches removal and every 

second week till the external fi xation removal without 

developing any signs of infection. 

Overall, there were uncomplicated union in 23 cases 

(18 GII, 3GIIIa and 2GIIIb) whereas in 5 cases we had 

to change method of treatment (3 GII and 2GIIIa) due 

to union delay or non acceptable fracture angulations. 

There were also a case that developed deep infection 

and septic pseudarthrosis. 

The simultaneous external fi xation and allograft 

application seems to provide a small advantage in open 

fracture consolidation despite the established wisdom 

for allograft use on a later stage. The proper initial 

open fracture estimation, the right surgical treatment, 

the surgeon’s experience and a strict patient’s follow up 

schedule are fundamental for a good fi nal outcome 


131 ANTEGRADE INTRAMEDULLARY 

NAILING FOR THE TREATMENT OF THE 

PROXIMAL AND DISTAL THIRD OF THE 

HUMERUS 

D. Katsenis, A. Louris, V. Triantafyllis, A. 

Stathopoulos, H. Eikonomou, K. Pogiatzis 

Argos General Hospital, Orthopaedic Clinic 

Our objective was to investigate the adequacy of the 

antegrade intramedullary nailing for the treatment of 

proximal and distal humeral fractures. 

From January 2004 to April 2008, 28 proximal 

humerus fractures and 9 distal humerus fractures were 

treated with intramedullary nailing. Mean age of the 

patients was 69-year-old (39-82). 26 patients were 

males. All fractures of the fi rst group were treated with 

closed static intramedullary nailing whereas in the 

second group closed static intramedullary nailing was 

achieved in 7 fractures. The clinical and radiological 

outcomes were evaluated. 

All the proximal humerus fracture – but one – 

obtained bone-union at an average of 3 months (from 

2 to 4 months). The mean follow up was 22 months 

(6-40). Functional outcome measured by Constant score 

showed 22 patients with an excellent and good result 

and 6 with a poor result. One case with osteonecrosis of 

the humeral head was recorded. Malunion of the greater 

tuberosity was recorded in 7 fractures. Only 5 distal 

humerus fractures united at an average of 5 months 

(from 4 to 7 months). Functional outcome measured by 

Burri – Lob score showed 3 patients with an excellent 

and good result and 6 with a poor result. Failure of the 

distal locking was noticed in 5 patients and 3 fractures 

united in valgus position 

The antegrade closed intramedullary nailing is an 

effective treatment method for the proximal humerus 

fractures. However the role of the nailing for the distal 

humerus fractures is humeral nail is effective for the 

treatment of proximal humeral fractures remains 

132 A PROSPECTIVE RANDOMISED 

STUDY ABOUT TWO INTRAMEDULLARY 

DEVISES FOR TREATING TROCHANTERIC 

FRACTURES 

K. Makridis, M. Georgoussis, V. Mandalos, N. 

Daniilidis, S. Kourkoubellas, L. Badras 

Orthopaedic Clinic, General Hospital of Volos 

Early and safe mobilization remains the mainstay of 

treatment for the intertrochanteric fractures. Many 

implants have been used but the intramedullary 

implants seem to provide maximum stability in unstable 

fractures. The aim of this study was to compare two 

intramedullary devices which have different philosophy 

and modes of action. 

Between 01.07.2005 to 30.06.2007, 110 patients with 

trochanteric fractures treated with the intramedullary 

hip screw (IMHS, Smith & Nephew) nail and 105 with 

the ENDOVIS (Citieffe) nail. The data recorded were 

the fracture’s type, preoperative hemoglobin level, prefracture 

walking ability. Postoperatively were recorded 

the operative time, the level of hemoglobin on the fi rst 

day, mobility status, complications and 12 months mortality 

rate. The results were comparable regarding blood 

loss, operative time, and mortality rate. However, the 

rehabilitation and functional outcome were superior in 

the IMHS group. This probably was attributed to the 

higher number of complications of the ENDOVIS nail. 

IMHS is a valuable tool for the treatment of stable 

intertrochanteric fractures, offering also excellent results 

in the management of reverse obliquity, comminuted 

fractures and those with a subtrochanteric extension. 

Further investigations are necessary to prove which the 

ideal intramedullary implant is. However, it seems that 

devices combining the principles of the sliding hip screw 

with those of an intramedullary nail present safe and 

accurate fi xation, fewer mechanical failures and exceptional 

functional outcomes 



133 NAILED-CEMENTOPLASTY: A 

SALVAGE TECHNIQUE FOR RORABECK 

TYPE II PERIPROSTHETIC FRACTURES IN 

OCTOGENARIANS 

P. Bobak, I. Polyzois, I. Pagkalos, E. Tsiridis 



George Street, Leeds, UK 

Periprosthetic femoral fractures around total knee 

arthroplasty present a challenge in octogenarians with 

advanced osteoporosis. We describe a salvage technique 

combining retrograde intramedullary nailing augmented 

with polymethylmethacrylate (PMMA) cement in fi ve 

patients followed up for a median time of 12 months. 

The nail/cement construct bridges the femoral canal 

tightly and behaves like a stemmed cemented revision 

component. All patients had an uncomplicated recovery 

and returned to their pre-injury functional status within 

four months. This procedure does not disrupt the soft 

tissue envelope facilitating periosteal callus formation, 

is easy to perform and permits immediate full range of 

movement. When standard retrograde nailing or plating 

alone is inadequate in maintaining severely osteoporotic 

fracture reduction in octogenarians unfi t for lengthy 

procedures, nailed cementoplasty is proposed as a salvage 

procedure. 

134 S1 ANATOMICAL VARIATIONS IN 

RELATION TO FIXATION OF POSTERIOR 

PELVIC RING INJURIES. A MODERN 

IMAGING STUDY ON NORMAL SUBJECTS 

Th. Karachalios, A.H. Zibis, E. Zintzaras, K. 

Bargiotas, A.H. Karantanas, K.N. Malizos 


Thessalia, School of Health Studies, Department 

of Medicine, Larisa, Hellenic Republic; 

Department of Radiology, University of Crete, 

School of Medicine, Heraklion, Hellenic Republic 

Percutaneous fi xation with iliosacral screws has been 

shown to be a safe and reproducible method for the 

management of certain posterior pelvic injuries. However, 

the method is contraindicated in patients with 

sacral anatomical variations and dysmorphism. The 

incidence and the pattern of S1 anatomical variations 

were evaluated in 61 volunteers (35 women and 26 

men) using MRI scans of the sacrum. S1 dimensions 

(12 parameters) in both the transverse and coronal 

planes were recorded and evaluated. Individuals were 

divided in four groups based on the S1 body size and the 

asymmetry of dimensions on the transverse and coronal 

planes. In 48 (78.6%) patients, dimensions in both 

planes were symmetrical despite the varying size of the 

S1 body. In 9 (14.8%) patients, coronal plane dimensions 

were disproportionally smaller compared to those 

of the transverse plane with a varying size of S1 body 

making effective iliosacral screw insertion a diffi cult 

task. In 2 (3.3%) patients there was a combination of 

large transverse plane and small coronal plane dimensions, 

with large S1 body size. A preoperative imaging 

study of S1 body size and coronal plane dimensions and 

an intraoperative fl uoroscopic control of S1 dimensions 

on the coronal plane are suggested for safe iliosacral 

screw fi xation 

135 PROSPECTIVE BLIND STUDY OF 

PERCUTANEOUS DISKECTOMY- CLINICAL 

CONSIDERATION 

D. Erginoussakis, A. Kostakos, D. Filipiadis, A. 

Kelekis, N. Keramaris, A. Gouliamos 

Orthopaedic Clinic, Hospital of IKA 

Radiology Department, University of Athens, 

Attikon Hospital 

Purpose of this study is to compare the reduction of 

discogenic pain associated with disk herniation in two 

groups. Group A (31 patients) with lumbago, with/ 

without sciatica, with no neurologic defi cit followed 

consernative treatment (antifl ammatory drugs, physio- 

therapies) and the group B (31 patients) with the same 

symptoms submitted in percutaneous disc decompression 

after six weeks consernative treatment with poor 

results. Follow up had a period of six months, one year 

and two years in two groups. All patients in both groups 

evaluated clinically and the symptoms registrated in special 

protocol that included pain distribution, sensation, 

muscle strength and refl ections (ahilleus and patellar). 

All of them submitted in X-ray and MRI so that the 

two groups have the presuppositions for percutaneous 

decompression of disc (absense of a free, non-contained 

or sequestered fragment, remained disc height >50%, no 

neurologic defi cit, no arthritis in facets). An AVS scale 

on a questionnaire adapted to Greek population helped 

assessing pain relief degree, life quality and mobility 

improvement. The method that we used is t-test for 

small independent patterns. 

We found a statisticasignifi cant decrease on terms of 

pain relief, mobility and life improvement during the 

one and two years follow-up in group B which submitted 

in percutaneus decompression of intervertebral disks 

comparetively with A 

136 THORACIC SPINE AND MR FINDINGS IN 

ASYMPTOMATIC MALE ADULTS BETWEEN 

35 AND 65 YEARS OF AGE 

O. Kiritsi, K. Tsitas, G. Mikroulis, F Tsivikis 

Hippokration General Hospital Thessaloniki; 

Kozani General Hospital,”Mamatsio”; 2nd 

Hospital IKA-ETAM Thessaloniki 

The aim of the present study was to record the MRI 

characteristics of the thoracic spine in asymptomatic 

adult males and their correlation with age and thoracic 

level. 

A cross sectional retrospective study was designed in 

order to record MRI thoracic spine fi ndings in asymptomatic 

adult males, 35 to 65 years of age. All study 

participants were evaluated by MRI. The qualitative 

and quantitative assessed MRI parameters were as follows: 

disc degeneration (disk signal intensity), bulging, 

herniation, disc height, Modic changes, endplate irregularities, 

osteophytes. 

Intervertebral disc signal was decreased more in the 

lower thoracic spine (T6-T12 level). In addition there 

was a strong correlation between disc degeneration 

(disc signal loss) and the age of the study participants. 

Disc bulging was most frequently observed anteriorly 

than posteriorly with the prevalence increased caudally. 

Modic changes were not so frequent and there were 

most commonly seen in the lower thoracic spine (T11- 

T12 level). In addition osteophytes were larger anteriorly 

than posteriorly and their prevalence increased 

caudally. Endplate irregularities (Schmorl nodes) were 

more common in the upper endplates and in the lower 

thoracic spine (T6-T12 level). Finally strong positive 

correlation was noted between osteophytes, anterior 

and posterior and disc bulging. 

This study documents the mild to moderate grade of 

degenerative changes especially in the lower thoracic 

spine (T6-T12 level) of asymptomatic adult males, 35 

to 65 years of age 

137 DYNAMIC STABILIZATION SYSTEM 

(DYNESYS) FOR TREATMENT AND 

DECOMPRESSION OF SPINAL STENOSIS AND 

DEGENERATIVE SPONDYLOLISTHESIS 

V. Tsiampa, I. Tepetzis, Z. Zaharopoulos, T. 

Lakkos, P. Hantzidis, C. Dimitriou, P. Hantzidis, 

C. Dimitriou; General Hospital of Thessaloniki, 

Hippokration 

To estimate the outcomes after posterior dynamic stabilization 

in situ with Dynesys (Zimmer Spine, Minneapolis, 

MN) for treatment of symptomatic spinal 

stenosis and degenerative spondylolisthesis in long-term 

follow-up. 

28 patients(mean age 73 years old) with symptomatic 

spinal stenosis and spondylolisthesis underwent interlaminar 

decompression and stabilization with Dynesys. 

Patients were evaluated clinically and radiologically 

after a follow-up from 6 months to 4 years.


Pain on VAS and walking distance improved signifi - 

cantly at less than 2 years and remained unchanged at 4 

years follow-up. Radiographically, spondylolisthesis did 

not progress and the motion segments remained stable. 

2 patients showed screw-loosening at 1 year follow-up 

and underwent revision. Overall, patient satisfaction 

remained high as 93% and would undergo the same 

procedure again. 

In elderly patients with spinal stenosis and degenerative 

spondylolisthesis, decompression and dynamic 

stabilization lead to excellent clinical and radiologic 

results. It maintains enough stability to prevent progression 

of spondylolisthesis. Because no bone grafting is 

necessary, donor site morbidity, which is one of the main 

drawbacks of fusion is eliminated 

138 FUNCTIONAL GENOMICS: REVISITING 

THE LINK BETWEEN SCOLIOSIS AND 

CONGENITAL HEART DISEASE 

I. Drosdov, R.J. Macfarlane, C.A. Ouzounis, E. 

Tsiridis, M.A. Gatzoulis 

Centre for Bioinformatics, School of Physical 

Sciences & Engineering, King’s College London, 

Strand, London, UK; Cardiovascular Division, 

British Heart Foundation Centre, James Black 

Centre, King\’s College London, Denmark Hill, 

London, UK; Academic Orthopaedic Unit, Leeds 

General Infirmary & Chapel Allerton Teaching 

Hospitals, Leeds, UK; School of Medicine, Section 

of Musculoskeletal Disease, Institute of Molecular 

Medicine, University of Leeds, Leeds, UK; 

Cardiovascular Division Congenital Heart Centre 

& Centre for Pulmonary Hypertension, The Royal 

Brompton Hospital and National Heart & Lung 

Institute, Imperial College, London, UK 

Although previous lnks have been made between congenital 

heart disease (CHD) and scoliosis, the molecular 

mechanisms involved in this association are poorly 

understood. During development, it appears that 

embryos exhibiting spine deformations resulting in scoliosis 

also suffer from an array of cardiac defects. Additionally, 

idiopathic scoliosis in patients with CHD is 

thought to be a response to a physiological phenomenon 

such as an enlarged size or abnormal thrust of the heart. 

Despite the fact that molecular omics data have been 

accumulated that are relevant to these two independent 

phenotypes, there appears to be a gap in the literature of 

over two decades on this matter and no clear correlations 

of the omics data have been provided. To identify genes 

involved in CHD and scoliosis, we have performed an 

analysis of genomic annotations, functional genomics 

data and text mining, and derived an inferred network 

of 123 human genes and 175 known gene interactions. 

Of these, 20 genes are unique to CHD, 11 to scoliosis 

and 5 genes are common to both abnormalities. These 

genes are known to be involved in molecular signaling 

cascades that affect the development of the musculoskeletal 

system in humans and have been associated with 

disorders such as the Marfan or CHARGE syndromes. 

Our analysis sets the basis upon which investigations of 

this association can be performed at the molecular level, 

in order to both further understand the pathology and, 

in the future, develop suitable therapies for CHD/idiopathic 

scoliosis patients 

139 CORRELATION OF THE VOLUME 

OF INJECTED CEMENT USING CEMENT 

AUGMENTED PEDICLE SCREWS WITH 

THEIR PULLOUT STRENGTH. A CADAVER 

STUDY 

P. Diaremes 1 , MC Kokkinakis 2 , A.A. Kurth 3 , K 

Kafchitsas 3 

Klinikum Aschaffenburg, Aschaffenburg, 

Germany; Stoke Mandeville Hospital, Oxford, 

United Kingdom; Department of Orthopaedics 

and Orthopaedic Surgery, Johannes Gutenberg 

University Mainz, Germany 

The radiological and biomechanical assessment using 

cement augmented cannulated pedicle screw (Biomet ® , 

Omega 21 ® ) and the correlation of the cement volume 

to the pullout strength needed for each screw 

Cadaveric vertebrae of different lumbar levels were 

used. Through cannulated pedicle screw a defi nite volume 

of cement was applicated. The bone volume occupied 

by cement was assessed by means of segmentation after 

Computer Tomography. Biomechanical Pullout tests and 

statistical correlation analysis were then performed 

The maximum pullout strength was 1361 N and 

the minimum pullout strength was 172 N (SD 331 N). 

The maximum cement volume was 5,29 cm3 and the 

minimum 1,02 cm3 (SD 1,159).The maximum cement 

diameter was 26,6 cm and the minimum cement diameter 

was 20,7 cm (SD 1,744). There is statistically signifi 

cant correlation between the pullout strength and the 

injected cement volume (p

the presence of multi-level degenerative disease and 

the correction of cervical lordosis on the pre-operative 

dynamic radiographs. Patient demographics, co-morbidities 

and post-operative complications were recorded 

and analysed. Functional outcome was assessed by using 

the Japanese Orthopaedic Association (JOA) score. 

There were 37 male and 31 female patients with an 

average age 67.4 years. The average follow up period 

was 18 months. The mean pre-operative JOA score was 

8.7, whereas the mean post-operative score was 12.1 on 

the latest follow-up visit. 9 patients had unsatisfactory 

clinical results and consequently underwent anterior 

procedures with signifi cant improvement. Complications 

included 1 epidural haematoma, 2 superfi cial 

infections and 4 cases of myofascial pain. In three cases 

there was mild dysfunction of the C5 nerve root which 

resolved spontaneously with conservative measures. 

In the present series of patients posterior decompression 

with laminectomies is an effective method for the 

management of cervical spondylotic myelopathy. 

144 QUALITY OF LIFE OF THE SURGICALLY 

TREATED DEGENERATIVE LUMBAR SPINAL 

STENOSIS PATIENTS 

C. Copuroglou, M. Ozcan, B. Aykac, B. Yilmaz, Y. 

Gorgulu, E. Yalniz 

Department of Orthopaedic & Traumatology, 

Univesity of Trakya; Department of Neurology & 

Neurosurgery, Research & Training Hospital for 

Psychiatry Turkey 

Degenerative lumbar spinal stenosis is one of the most frequent 

surgical indications of spinal surgery in the elderly 

patient group. Because of the progression of the disease 

and neurologic defi ciencies, patients’ quality of life is 

affected. We aimed to evaluate the postoperative quality 

of life of the surgically treated spinal stenotic patients. 

Between 1998 and 2009, 38 patients, who were surgically 

decompressed and enstrumentated in our clinic 

were included to the study. The patients were preoperatively 

and postoperatively evaluated with Visual 

Analogue (Scale (VAS) and Japanese Orthopaedics 

Association (JOA) criterias. The same patient group 

were re-evaluated on the postoperative 6th month with 

Hamilton anxiety and depression scale, on the 12th 

month with short form-36 and Oswestry pain scoring 

scales to measure the quality of life. 

Mean age of 38 patients (31 female, 7 male) was 59.6 

(range 44 to 82). Mean preoperative VAS was 7.97 and 

postoperative VAS was 2.28. The pain decreased 56.9%. 

According to JOA criterias, in 3 patients (7.89%) no 

recovery, in 13 patients (34.2%) less than 50% recovery 

and in 22 patients (57.8%) more than 50% recovery 

was obtained. On the 6th month, according to Hamilton 

anxiety and depression scale, in 12 patients anxiety 

and in 3 of these patients depression which needs treatment 

was observed. The pain of all the patients with 

anxiety recovered meaningfully (42.3%) but according 

to JOA, less than 50% recovery could be obtained. 

Surgically treated spinal stenosis patients improved 

clinically and radiologically and this affected the 

patients’ quality of life positively 

145 SURGICAL TREATMENT OF KYPHOTIC 

DEFORMITY FOLLOWING OSTEOPOROTIC 

FRACTURES 

K. Zachariou, A. Morakis, M. Tsafantakis, A. 

Bountis, P. Agourakis, A. Kalabokis 

Scoliosis and Spine Department GNA ‘KAT’ 

To evaluate our results of treatment of kyphosis following 

osteoporotic fractures of the last 3 years. 

28 women with a mean age of 63,2 years were treated 

for a painful kyphotic deformity of a mean Cobb angle 

76,1°. They all had posterior fusion with pedicular 

screws and rods enhanced with autologous bone graft 

as well as allografts. Cement augmentation was used 

in a number of screws. A cell saver for auto transfusion 

and continuous neurophysiological monitoring was 

used intraoperatively in all cases. All patients fi tted with 

a thoracolumbar brace for 3 months. 



The postoperative mean Cobb angle was 45,2° (40,6% 

improvement). Pain questionnaires at a mean postoperative 

follow up of 16 months showed excellent results in 10 

patients (35,71%), good in 8 patients (28,57%), satisfactory 

in 6 patients (21,42%) and poor results in 4 patients 

(14,28%). All patients were satisfi ed with the cosmetic 

result. 2 patients presented a postoperative infection that 

was treated with debridement and antibiotics. 

Kyphotic deformity following osteoporotic fractures 

may treated satisfactory with rods and pedicular screws 

with cement augmentation 

146 COMPARISON OF THE RESULTS 

BETWEEN STANDARD DISCECTOMY AND 

MICRODISCECTOMY FOR LUMBAR DISK 

HERNIATION 

A. Hatzigiammakis, D. Kotzamitelos, E. Baburda, 

H. Sali, K. Tilkeridis, C. Boyiatzis 

Orthopaedic Department 

University General Hospital of Alexandroupolis 

We estimated the long term results of the different methods 

in chirurgical treatment of lumbar disk herniation in 

consideration with the presence or absence of degenerative 

changes and the grade in witch these factors infl uence 

the result of this kind of treatment. 

Seventy eight patents with lumbar disk herniation 

have been submitted in partial discectomy. The men 

were 42 and 36 women. The patients were separated in 

tow groups. In the fi rst group [48 patients,31 of them 

(A1) without degenerative changes, while the 17 (A2) 

with degenerative changes], was applied macrodiscectomi. 

In the second group [30 patients, 18 of them (B1) 

without degenerative changes and the 12 (B2) with 

changes], was applied microdiscectomi with use of magnifying 

lenses. The mean age during operation was 44 

years (18-67) and 38years (24-62) respectively for the 

tow groups, and the mean time of follow-up was 7 years 

and 8 months (18 months-13years). For all patients, the 

operation was executed from the same surgeon. The elements 

that were evaluated were the Visual analog scale 

(VAS, O-10), the Oswestry Disability Index (ODI), as 

well as the complications during and after the operation 

and the cases that required a reoperation. 

In the fi rst group VAS score was improved from 9.1 

to 3.1 and the ODI score was improved from 86% to 

24.2%. In the second group VAS score was improved 

from 9 to 2.6 and the ODI score was improved from 

84.2% to 19.2%. From all patients, subgroup B1 

without degenerative changes, which was submitted in 

microdiscectomy presented the biggest improvement. 

We have had to reoperate 6 patients (7.8%). 

In cases of lumbar disk hernia both methods are 

appropriate and lead to a considerable improvement 

of the symptoms. Degenerative changes of the lumbar 

spine is a factor that leads in less satisfactory results 

147 HYBRID INSTRUMENTATION FOR 

ADOLESCENT IDIOPATHIC SCOLIOSIS 

P. Krallis, I. Kosmidis, S. Thoma, Ch. 

Chatziantonioy, A. Koutrouphinis, I. Hager 

Orthopaedic Clinic, “Penteli” General Hospital 

of Children 

Although pedicle screw instrumentation for the treatment 

of idiopathic scoliosis is very popular, hybrid constructs 

remain a safe and effective method of scoliotic 

curve correction. This retrospective study was undertaken 

to assess the outcomes of hybrid instrumentation 

in the treatment of idiopathic scoliosis. 

Forty three children underwent surgical correction for 

idiopathic scoliosis. Patients were evaluated at a minimum 

2-year follow-up (range 2-9 years). Clinical and radiographic 

assessment was performed for all patients preoperatively, 

immediately postoperatively, one year after surgery 

and at the fi nal follow up. Radiographic parameters 

assessed included Cobb’s angle, coronal balance, translation 

of the apex vertebra, kyphosis, lordosis, angle in the 

T10 – L2 region and sagittal balance. Idiopathic scoliosis 

was classifi ed according to the King classifi cation system. 

All patients underwent posterior spinal fusion using hybrid 

instrumentation while 6 received, prior to the posterior 

fusion, anterior thoracic discectomies. 

Postoperatively overall Cobb’s angle correction was 

59.5%. At the fi nal follow-up an average loss of the correction 

of 9.5% was recorded. Nevertheless, there was 

an overall correction of the translation of the apex vertebra 

and a satisfactory coronal balance improvement 

at the fi nal follow up compared to the immediate postoperative 

follow-up. Although a trend toward improved 

sagittal balance was noted, it was not statistically signifi 

cant. The surgical complications included 2 cases of 

deep wound infection. In addition one patient required 

revision and a longer fusion distally. 

Operative treatment of adolescent idiopathic scoliosis 

with hybrid instrumentation yields satisfactory clinical 

and radiological results. Therefore, it can be considered 

as a safe and effective method of treatment of adolescent 

spinal deformity 

148 MELATONIN HORMESIS AND ITS 

ROLE IN IDIOPATHIC SCOLIOSIS AND 

OSTEOPOROSIS PATHOGENESIS. 

T.B. Grivas, E.S. Vasiliadis, A. Kaspiris, G. 

Triantafyllopoulos, R.G. Burwell 

Department of Trauma and Orthopaedics, 

“Tzanio” General Hospital; Department of 

Trauma and Orthopaedics, “Thriasio” General 

Hospital; The Centre for Spinal Studies & Surgery, 

Nottingham University Hospitals Trust, Queen\’s 

Medical Centre Campus, Nottingham NG7 2UH, 

UK 

Melatonin’s concentration is high in early childhood 

and declines gradually thereafter. In the elderly serum 

melatonin levels are very low. Melatonin, the “light of 

night”, among other functions is involved in human 

sexual maturation and in osteogenesis. 

Hormesis is the response of cells or organisms to an 

exogenous (eg drug or toxin) or intrinsic factors (eg hormone), 

where the factor induces stimulatory or benefi - 

cial effects at low doses and inhibitory or adverse effects 

at high doses [bimodal dose-response] or vice versa. 

At the age around 10 years, when idiopathic scoliosis 

may appear, the circulating melatonin level is about 120 

pg/ml – positive hormesis for menses – and menarche 

appears. Melatonin defi ciency may result in a delay of 

the age at menarche and consequently the girl is susceptible 

to scoliosis. In these terms melatonin could be certainly 

involved in the scoliosis pathogenesis. Around the 

age of 45 years when the circulating melatonin levels are 

about 20 pg/ml – negative hormesis for menses, menopause 

starts and the woman has an increased risk for 

osteoporosis and fractures. 

It is documented the bone-protecting effect of melatonin 

in ovariectomized rats which can depend in part on 

the free radical scavenging properties of melatonin. Additionally, 

melatonin may impair development of osteopenia 

associated with senescence by improving non-rapid 

eye movement sleep and restoring GH secretion. Whether 

modulation of melatonin blood levels can be used as a 

novel mode of therapy for scoliosis and augmenting bone 

mass in diseases deserves to be studied 

149 THE “THREE JOINT COMPLEX” 

MODEL FOR PROGRESSION OF IDIOPATHIC 

SCOLIOSIS 


Triantafyllopoulos 




Hospital 

It was previously postulated that the IV disc wedging is 

a signifi cant progressive factor for mild IS curves. The 

present report introduces an innovative comprehensive 

model of IS curves progression based on intervertebral 

disc (IV) diurnal variation and the subsequent pathobiomechanics 

of the deforming “three joint complex”, 

where vertebral growth occurs.


Throughout day and night, due to sustained loading 

and unloading, the scoliotic wedged IV disc expels 

fl uid and imbibes it more convex-wise. The convex side 

of the IV sustains a greater amount of cyclic expansion 

than the concave side. Consequently the imposed, 

convex-wise, asymmetrical concentrated cyclical loads 

to the adjacent immature vertebral end plates and posterior 

elements of the spine lead to asymmetrical vertebral 

growth. More specifi cally the loading on the two 

facet-joins asymmetrically increases during the day, as 

the wedged IV space narrows due to expelled water and 

it asymmetrically decreases during the night, as the IV 

space swells due to imbibed water. 

This 24 hour period cyclic asymmetric loading leads 

both to asymmetric growth of the end plates and wedging 

of the vertebral bodies, and to similarly asymmetric 

growth of the pedicles and arches posteriorly as an 

effect of Hüeter-Volkmann law. This model explains the 

well described anatomical fi ndings of the more elongated 

pedicles and the larger facet joints in the convex 

side than in the concave in scoliotic spines 

150 HUMAN EVIDENCED BASED STUDY ON 

IDIOPATHIC SCOLIOSIS AETIOLOGY 






Hospital 

The aim of school screening is to identify most or all the 

individuals with unrecognized idiopathic scoliosis (IS) 

at an early stage when a less invasive treatment is more 

effective. The present study summarises the contribution 

of school screening in research of IS epidemiology, natural 

history and aetiology. In addition, school screening 

is a unique tool for research of IS in humans, as in most 

published articles, all aetiopathogenetic factors are studied 

in animals and not in humans. 

Such contribution is beyond the original aim of school 

screening but is very important to expand our knowledge 

and adequately understand the pathogenesis of IS. 

The role of biological factors such as the menarche, the 

lateralization of the brain, the handedness, the thoracic 

cage, the intervertebral disc, the melatonin secretion, 

as well as the role of environmental factors such as the 

light and the impact of the geographical latitude in IS 

prevalence were studied in children referred from school 

screening. The present study provides evidence to support 

that school screening programs should be continued 

not only for early detection of IS but also as a basis 

for epidemiological surveys until we learn much more 

about the aetiology of IS 

151 NEUROLOGIC EVALUATION IN 

PATIENTS WITH LOWER CERVICAL SPINE 

INJURIES 

C. Matzaroglou, P. Zoumboulis, A. Saridis, P. 

Spinos, D. Costantinou,P. Bougas, A. Barba, P. 

Dimakopoulos, E. Panagiotopoulos 

Orthopaedic Department, University of Patras; 

Neurosurgery Department, University of Patras 

Aim of our study was the investigation and the crosscorrelation 

of various neurologic scales to estimate, 

comparatively with the functional results of patients 

after damage of spinal cord injuries. 

Between 1989 – 2005, 115 patients were submitted 

in stabilization of Lower Cervical Spine that was judged 

unstable. 

The neurologic situation was certifi ed with the scales: 

Frankel, ASIA motor score, NASCIS motor score, FIM 

scale, and MBI scale. 

In the protocol took part the 94 patients for that 

existed in neurologic details and long follow-up for at 

least two years. 

From the study of course of scores of all scales was not 

found statistically important difference between ASIA, 

NASCIS and other motor scales. However 12 patients 

with important improvement of mobility at ASIA motor 

score and NASCIS motor score they have not difference 

in Frankel scale, despite the make that the MRP (Motor 

Percentage Recovery) was improved: 21.5% 

Also 8 patients with relatively big improvement in 

their total scores did not have corresponding functional 

improvement (FIM scale, and [MBI] scale) 

A lot of neurologic methods – scales were used and 

are used today. However for the essential and modern 

follow-up of patients with spinal cord injuries, it needs 

certifi cation with a scale of classic team of (measurement 

of mobility) and a scale of functional faculties of 

the patient 

152 WHIPLASH VERTIGO SYNDROME. OUR 

EXPERIENCE 

C. Matzaroglou, P. Zoumboulis, A. Saridis, P. 

Spinos, E. Panagiotopoulos, D. Costantinou, E. 

Heristanidu, D. Kouzoudis, A. Chatziantoniou, P. 

Dimakopoulos 

Orthopaedic Department of Patras University, 

Greece; Neurosurgery Department of Patras 

University, Greece; ENT Department of Patras 

City Hospital, Engineering Sciences, University of 

Patras 

Whiplash vertigo syndrome is often seen in victims of 

rear-end vehicle collisions. These patients commonly 

complain of headache, vertigo, tinnitus, poor concentration, 

irritability, and sensitivity to noise and light. 

Sixteen patients (medium age, 39,5 years) that they 

refered in orthopaedic examination because of longlasting 

subjective complaints after cervical spine injury 

underwent clinical, laboratorial and psychometric 

examinations. The mean posttraumatic interval was 43 

months. Ten patients were injured in road accidents, 5 

during sports and one at work, all with mechanism trial 

of whip. Each patient was evaluated with otorhinolaryngologic 

examination, audiometry tests, CT: petrus 

– internal auditory meatus and cerebellopontine corner. 

Also each patient was evaluated with neurologic examination, 

psychological well-being scale (sf-36), and personality 

profi le scale. 

None of the patients had neurologic symptoms, and 

no lesions of the cervical spine were identifi ed. All the 

patients had negative clinical, radiological and standard 

laboratorial control, but may be is a critical point that the 

eleven of these patients had pathologic OGTT (Oral Glucose 

Tolerance Test). Also did not exist differentiations 

from the mean values in psychological well-being scale 

(SF-36), and personality profi le scale of healthy population. 

Test results were unrelated to the length of the posttraumatic 

interval. However, 2 distinct syndromes were 

identifi ed. Ten patients had cervicoencephalic whiplash 

type syndrome (CES), characterized by headache, vertigo, 

tinnitus poor concentration, and disturbed adaptation to 

light intensity. Six patients had the lower cervical spine 

whiplash type syndrome (LCSS), characterized by vertigo, 

tinnitus cervical and cervicobrachial pain. 

The verifi cation of Whiplash Vertigo syndrome require 

more objective clinical means. This article proposes that 

exists an organic base for the syndrome, but does not 

promote that whiplash injury certainly cause it 

153 RELATIVELY LOWER BODY MASS 

INDEX IS ASSOCIATED WITH AN EXCESS 

OF SEVERE TRUNCAL ASYMMETRY IN 

HEALTHY ADOLESCENTS. DO BODY 

FAT, LEPTIN, HYPOTHALAMUS AND 

SYMPATHETIC NERVOUS SYSTEM 

INFLUENCE TRUNCAL GROWTH 

ASYMMETRY? 

Theodoros B. Grivas, R.G. Burwell, C. Mihas, 

E.S. Vasiliadis, G. Triantaffylopoulos, A. Kaspiris 

“Thriasio” Hospital, The Centre for Spinal 

Studies & Surgery, Nottingham University 

Hospitals Trust, Queen’s Medical Centre Campus, 

Nottingham UK 

This paper evaluates severe normal trunk asymmetry 

(TA) by higher and lower body mass index (BMI) values 

in 5953 adolescents age 11-17 years (boys 2939, girls 

3014) whilst standing forward bending (FB) and sitting 

FB during screening for scoliosis. TA was measured as 

angle of trunk inclinations (ATIs) across the back (thoracic, 

thoracolumbar and lumbar) with abnormality 

defi ned as 2 standard deviations or more. The fi ndings 

for sitting FB position are reported because the readings 

express TA free from any leg-length inequality. Relatively 

lower BMIs are associated statistically with (1) excess of 

abnormal TAs, and 2) later menarche. BMI is known to 

be linked to puberty timing and energy balance but not 

to TAs in healthy students. Similar to girls with adolescent 

idiopathic scoliosis, we suggest that severe TA is 

caused by a genetically-determined selectively increased 

hypothalamic sensitivity to leptin with asymmetry as an 

adverse hormetic response, exacerbated by presumed 

lower circulating leptin levels associated with relatively 

lower BMIs. The asymmetry is expressed bilaterally via 

the sympathetic nervous system to produce left-right 

asymmetry in ribs and/or vertebrae leading to severe TA 

when beyond the capacity of postural mechanisms of 

the somatic nervous system to control the shape distortion 

of the trunk 

154 DEFORMITIES IN CHILDREN WITH 

NEUROMUSCULAR DISEASES 

I. Flieger, O. Leonidou, K. Antonis, M. Katsalouli, 

A. Kiriazi, A. Hatzis 

A’ Orthopaedic Department of the Children’s 

Hospital “Agia Sophia”; Neuromuscular Unit of 

the Children’s Hospital “Agia Sophia” 

Since the commencement of the Neuromuscular-Unit 

in the Children’s-Hospital “Agia Sofi a”, from December2002 

until December2008, 306patients were examined 

suffering from different neuromuscular diseases 

(ND). In the present study we examined a)the frequency 

of spine deformities, b)the management in correlation 

with the poor general health of these patients, analyzing 

the most frequent presenting disease, that is Duchenne’smuscular-dystrophy,c) 

cases of surgical management of 

our Unit are presented. 

From the analysis of our material we found that 152 

patients were suffering from Duchenne’s-Becker muscular-dystrophy, 

59 patients from spinal-muscular-atrophy 

I-III, 13patients from fascioscapulohumeral musculardystrophy, 

15patients from hereditary motorsensoryneuropathies, 

5patients from Friedreich’s Ataxia and 

62patients from different types of dystrophinopathies– 

myopathies.The ages of the patients varied between 8 

months and 37 years. 

From the total, 89% of the patients above 10years 

presented with spine deformities. Most of them were 

managed with wheelchairseating modifi cations and 33 

patients were fi tted with braces in an attempt to slow 

curve progression. Surgically were managed 24 patients 

with spine arthrodesis, 5 of them abroad (USA-England-France). 

The older patients (> 17 years wheelchairbound) 

were frequently, because of impaired general 

health, not suitable candidates for surgery. 

Pulmonary function was examined in 84 patients suffering 

from Duchenne’s muscular dystrophy. The crucial 

age, were pulmonary function has fallen dramatically 

(FVC

Of those 7 presented with a benign primary tumor and 

21 with malignancies of which 15 were metastatic. 16 

patients had a neurologic defi cit but met the international 

criteria for surgical intervention. The staging of 

the tumors and their postoperative care was undertaken 

by a tumor centre. All patients underwent posterior 

decompression with laminectomy, resection of all posterior 

elements including part of the pedicle, excision of 

the tumor and posterior stabilization. This was followed 

at the same operative session by an anterior approach 

(transthoracic, transperitoneal or anterior cervical) 

corpectomy of the affected vertebrae and implantation 

of interbody cages secured with an anterior plate and 

screws in the healthy vertebrae. 

7 patients improved neurologically following the 

operation while 9 had no change of their clinical condition. 

Perioperative complications were recorded in 5 

patients. In 3 cases a dural tear was dealt with direct 

closure and 3 infections had to have surgical debridement 

at another stage and antimicrobial therapy. 

The treatment of spinal tumors with combined anterior-posterior 

approach in one session for a radical excision 

of the tumor is a demanding procedure 

156 RELIABILITY AND VALIDITY OF 

THE ADAPTED GREEK VERSION OF 

SCOLIOSIS RESEARCH SOCIETY-22 (SRS-22) 

QUESTIONNAIRE 

P.D. Antonarakos, L.Katranitsa, L. Angelis, A. 

Paganas, E.M. Koen, E.A. Christodoulou, A. G. 

Christodoulou 

1st Orthopaedic Department, Aristotle’s 

University of Thessaloniki,General Hospital G. 

Papanikolaou 

The SRS-22 is a valid instrument for the assessment of the 

health related quality of life of patients with Idiopathic 

scoliosis. The purpose of this study is to evaluate the reliability 

and validity of the adapted Greek version of the 

refi ned Scoliosis Research Society-22 Questionnaire. 

Following the steps of cross – cultural the adapted 

Greek version of the SRS-22 questionnaire and a validated 

Greek version of the SF-36 questionnaire were 

mailed to 68 patients treated surgically for Idiopathic 

Scoliosis with a mean age at the time of operation 16.2 

years and a mean age at the time of evaluation 21.2 years 

respectively. A 2nd set of questionnaires was mailed in 

30 patients within 30 days from the 1st set. Reliability 

assessment was determined by estimating Cronbach’s a 

and intraclass correlation coeffi cient (ICC) respectively. 

Concurrent validity was evaluated by comparing SRS- 

22 domains with relevant domains in the SF-36 questionnaire 

using Pearson’s Correlation Coeffi cient (r). 

The calculated Cronbach’s a of internal consistency 

for three of the corresponding domains (pain 0.85; 

mental health 0.87; self image 0.83) were very satisfactory 

and for two domains (function/activity 0.72 and 

satisfaction 0.67) were good. The ICC of all domains 

of SRS-22 questionnaire was high (ICC>0.70). Considering 

concurrent validity all correlations demonstrated 

high correlation coeffi cient. 

The adapted Greek version of the SRS-22 questionnaire 

is valid and reliable and can be used for the assessment 

of the outcome of the treatment of the Greek 

speaking patients with idiopathic scoliosis 

157 25-YEAR EXPERIENCE IN MANAGING 

DIAPHYSEAL HUMERAL FRACTURES USING 

THE SARMIENTO BRACE” 

S. Kyritsis, Chr. Simos, S. Kleanthous, A. 

Economou, E. Giakoumakis, A. Antonopoulos 

3rd Orthopaedic Dept, KAT Hospital Athens 

We present the results of the use of a functional brace 

(Sarmiento) for the treatment of diaphyseal humeral 

fractures. 

576 patients with humeral fractures (AO classifi cation 

A1, 2, 3 and B1, 2) were treated in the period from 1984 

to 2009. None of them had neurovascular damage. 

Initially the patients were treated with a U-shape 

slab or a “Velpeau” bandage. After three weeks The 



Sarmiento brace was applied, provided that the reduction 

was acceptable (anterior angulation


3 with CA. Conclusions: It appears that the immediate 

surgical intervention of patients with hip fracture has 

positive effect in the duration of hospitalization, morbidity 

and mortality 

162 ACETABULAR FRACTURES WITH 

MARGINAL IMPACTION: CLINICAL RESULTS 

P.V. Giannoudis, N.K. Kanakaris, P. Stavlas, V.S. 

Nikolaou, N. Prevezas 


Orthopaedics, Leeds Teaching Hospitals, 

School of Medicine, University of Leeds, UK; 

Orthopaedic Department of General Hospital of 

Nikea, Greece 

The purpose of this study was to investigate the outcome 

of acetabular fractures treated in our institution 

with marginal impaction. 

Over a 5 year period consecutive acetabular cases 

treated in our institution with marginal impaction were 

eligible for inclusion in this study. Exclusion criteria were 

patients lost to follow up and pathological fractures. A 

retrospective analysis of prospectively documented data 

was performed. Demographics, fracture types according 

to the Judet-Letournel classifi cation, radiological criteria 

of intra-operative reduction (Matta) and secondary 

collapse, complication rates, and the EuroQol-5D 

questionnaire were documented over a median period 

of follow-up of 40months (12-206). 

Out of 400 cases, eighty-eight acetabular fractures 

met the inclusion criteria. The majority (93.2%) 

involved males with a median age of 40.5years (16-80). 

Half of them were posterior-wall fractures, 21.6%bicolumn, 

14.7%posterior-wall and column, 6.8%transverse, 

5.7%anterior-column, 1.1%anterior-column posterior 

hemi-transverse. In 75% of the cases anatomical intraoperative 

reduction was achieved. Structural-bone-graft 

was used in 73.9%, and two-level reconstruction in 

61%. At the last follow-up, the originally achieved anatomical 

reduction was lost in 17/66 (25.8%), (10 PW, 

4 PC+PW, 1 PC, 1 Transverse, 1 Bicolumn fracture). 

Avascular necrosis developed in 9.1% and heterotopic 

ossifi cation in 19.3%. Full return to previous activities 

was documented in 48.9% of cases, the EuroQol general 

heath state score had a median of 80% (30-95%), 

full recovery was recorded as to the patients’ mobility in 

51.1%, as to pain in 47.7%, as to self-care in 70.5%, 

as to work-related activities in 55.7%, and as to emotional 

parameters in 65.9%. Reoperation (heterotopicossifi 

cation excision, total-hip-arthroplasty, removal of 

metalwork) was necessary in 19.2% of cases. 

Utilising different techniques of elevation of the articular 

joint impaction leads to joint preservation with satisfactory 

overall functional results. Secondary collapse 

was noted in 25.8% of the patients predisposing to a 

poorer outcome 

163 MEDIUM TO LONG TERM RESULTS 

OF ACETABULAR RECONSTRUCTION 

FOLLOWING ANTERIOR COLUMN & 

ANTERIOR WALL FRACTURES 

N.K. Kanakaris, R.K. Mallina, P. Stavlas, G. 

Kontakis, P.V. Giannoudis 


Orthopaedics, Leeds Teaching Hospitals, NHS 

Trust, Leeds, UK 

Anterior wall and/or column acetabular fractures (AW/ 

C) have a low incidence rate. Paucity of information 

exists regarding the clinical results of these fractures. 

We present our experience in treating AW/C at a tertiary 

referral centre. 

Between Jan-2002 and Dec-2007, 200 consecutive 

patients were treated in our institution with displaced 

acetabular fractures. All AW/C fractures according to 

the Letournel classifi cation were included in the study. 

All patients underwent plain radiography and CT investigations. 

Retrospective analysis of the medical notes 

and radiographs was performed for type of associated 

injuries, operative technique, peri-operative complications. 

Radiological assessment of fracture healing was 

determined by Matta’s criteria and functional hip scores 

were assessed using Merle-d’-Aubigne scoring. The 

mean follow up was 44.5 months (28-64). 

15 patients (10 males) met the inclusion criteria 

(mean age 55.5years). Four had associated anterior dislocation. 

Associated injuries included pneumothorax, 

splenic rupture, tibial and distal radius fractures. Five 

were treated by percutaneous methods, 8 with platescrew 

fi xation, and 2 with circlage wire, (10 ilioinguinal 

approaches). Mean time-to-surgery was 14days(10- 

21days). The average operative time for the percutaneous 

group was 75min vs. 190min in the orif group. 

Mean postoperative-in-patient-stay was 4 days(3- 

7days), and 21days(14-37days). One patient developed 

chest infection post-operatively, two loss of sensation 

over the distribution of lateral cutaneous nerve. None of 

them developed incisional hernia, deep venous thrombosis 

and pulmonary embolism. At the last follow-up 

radiological outcome was excellent in 11 and good in 4 

patients; clinical outcome was excellent in 12 and good 

in 3 patients, and none of the patients has developed 

heterotopic calcifi cation or early osteoarthritis. 

Our results on management of these fractures are comparable 

to the early results reported by Letournel. Operative 

treatment for the rare anterior wall and anterior 

column fractures yields a favourable outcome resulting in 

early mobilization with limited patient morbidity 

164 EFFECTIVENESS OF PHILOS PLATE IN 

TREATMENT OF HUMERUS PROXIMAL END 

FRACTURES 

E. Athanaselis, I. Gliatis, P. Bougas, M. Tyllianakis 

Orthopaedic Department, University Hospital of 

Patras 

The study of effectiveness of PHILOS plate in the internal 

osteosynthesis of humeral head fractures. 

Since 2006 23 patients with 24 humeral head fractures 

ere treated in our clinic. 10 of them were men 

(43,48%) and 13 women (56,52%). The average age 

was 50,4 years (range 16-89 years). Fractures of the 

surgical neck of humerus were 8 of these (33,33%), 12 

were 3 parts fractures according to Neer classifi cation 

(50%) and fi nally in 3 cases there was a 4 part fracture 

(16,66%). Shoulder of dominant upper limb was 

injured in most of the cases (68%). 

19 patients (82,6%) were examined periodically in 

an average follow-up period of 19 months (range 13- 

26 months). All the fractures were healed. In 4 cases 

(16,66%) insuffi cient reduction was detected postoperatively. 

Constant score was calculated 12 months 

post-operatively up to 82,05 by mean (range 62-100). 

Differentiation was observed between the patients of 

age less than 60 years (12 patients with average constant 

score 91,25 with range from 78 until 100) and these of 

age of 60 years or more (7 patients with average constant 

score 71,43 with range from 62 until 81). 

Internal osteosynthesis humeral head fractures with 

PHILOS plate is a reliable method of treatment not only 

for simple head fractures but also for them of 3 or even 

4 parts, without complications and with very good functional 

results 

165 ATLS AND PELVIC RADIOGRAPHY 

GUIDELINES. HOW GOOD IS CLINICAL 

EXAMINATION COMPARED TO 

CONVENTIONAL RADIOGRAPHY? 

D.S. Evangelopoulos, M. Hilty, L.M. Benneker, H. 

Zimmermann and A.K. Exadaktylos 

Department of Orthopaedic Surgery, Inselspital, 

University of Bern, Switzerland; Department of 

Emergency Medicine, Inselspital, University of 

Bern, Switzerland 

Pelvic x-ray is a routine part of the primary survey of 

Advanced Trauma Life Support (ATLS) guidelines. However, 

pelvic CT is the gold standard in the diagnosis of 

pelvic fractures. This study aims to confi rm the safety 

of a modifi ed ATLS algorithm omitting pelvic x-ray in 

hemodynamically stable polytraumatized patients with 

clinically stable pelvis, in favour of later pelvic CT scan. 

A retrospective analysis of polytraumatized patients 

in our emergency room was conducted between 2005 

and 2006. Inclusion criteria were blunt abdominal 

trauma, initial hemodynamic stability and clinically 

stable pelvis. We excluded patients requiring immediate 

intervention. 

We reviewed the records of 452 patients. 91 fulfi lled 

inclusion criteria (56% male, mean age 45 years). 43% 

were road traffi c accidents and 47% falls. In 68/91 

(75%) patients, both pelvic x-ray and CT examination 

were performed; the remainder had only pelvic CT. 

In 6/68 (9%) patients, pelvic fracture was diagnosed 

by pelvic x-ray. None false positive pelvic x-ray was 

detected. In 3/68 (4%) cases a fracture was missed in 

the pelvic x-ray, but confi rmed on CT. 5 (56%) were 

classifi ed type A fractures, and another 4 (44%) B 2.1 

in computed tomography (AO classifi cation). One A 

2.1 fracture was found in a clinically stable patient who 

only received CT scan (1/23). 

In hemodynamically stable patients with clinically 

stable pelvis, x-ray sensitivity is only 67% and it may 

safely be omitted in favor of a pelvic CT examination. 

The results support the safety and utility of our modifi ed 

ATLS algorithm 

166 QUALITY OF LIFE AFTER TIBIAL 

PLATEAU FRACTURES 

E. Myriokefalitakis, K. Papanastasopoulos, Th. 

Krithymos, I. Giannoulias, K. Kateros, K. Sarantos 

A’ Orthopaedic Department, General Hospital of 

Athens “G. Gennimatas” 

Tibial plateau fractures are common fractures which 

most of the times require surgery. Recovery can take 

several months. The aim of our study was to estimate 

the effect of tibial plateau fractures in quality of life of 

patients one year after the surgery. 

During the time period 2004-2007 we treated 86 

patients, with a mean age of 44 years (23-68). Fracture 

classifi cation was according to Schatzker, hence, there were 

9 patients with type I, 14 with type II, 20 with type III, 22 

with type IV, 13 with type V and 8 with type VI. In 45 

(52.3%) patients the articular surface was reduced with 

limited use of internal fi xation and bone grafts, whereas 

the remaining patients had syndesmotaxis performed. In 

all patients stabilization was achieved with hybrid external 

fi xators. Sixty four patients returned in one year postoperative 

for the study, at which time they completed the 

Short Form-36 (SF-36) general health surveys. 

Compared to the standardized SF-36 categorical and 

aggregate scores there was no statistically signifi cant 

difference between the healthy age-matched population 

and young patients with Schatzker I, II, III and 

IV fractures. But in 16 patients over 40 years old with 

Schatzker V and VI fracture, SF-36 score was lower in 

all categories, despite that 13 of them had full or partial 

return to pre-injury levels of functioning 

We conclude that the age of patients and the complexity 

of tibial plateau fractures infl uence the quality of 

their life one year post-operative 

167 USE OF ILIZAROV TYPE FIXATOR 

FOR SEVERELY COMMINUTED INTRA- 

ARTICULAR CALCANEAL FRACTURES. 

PRELIMINARY RESULTS 

Ch. Konstantoulakis, G. Grigorakis, C. 

Manimanakis, G. Poulios, V. Petroulakis 

Orthopaedic Department, Chania General 

Hospital 

We reviewed in retrospect the preliminary results of 

ilizarov type fi xator for the treatment of severely comminuted 

calcaneal fractures. 

Between February 2006 and December 2008 we 

dealt with six severely comminuted calcaneal fractures 

in six patients. Two of which were open type Gustillo 

IIIa. Mean age was 43 years old(28-56 years old) two 

of which were female and four male. Preoperatively all 

fractures were checked by x-ray and computed tomography 

and were all rated as Sanders type IV. The open 

fractures were treated within 6 hours and the closed 


ones the following day. After the positioning of the 

ilizarov tibial and foot frame, an indirect reduction was 

achieved using the Ilizarov olive wires. 

Mean follow up was 20 months (9 to 36 months). 

Results were rated as very good in two patients (33%), 

good in three patients (50%) and fair in one (17%). 

So far no re-operation has been required and four of 

the patients are back to work. 

We conclude that the ilizarov system, even with indirect 

reduction can give very promising results in severely 

comminuted and complex calcaneal fractures whereas 

internal fi xation has questionable success and many 

complications 

168 OPERATIVE TREATMENT OF BLOUNT 

DISEASE WITH TSF (TAYLOR SPATIAL 

FRAME) EXTERNAL FIXATOR 

Xh. Tsibidakis, V.I. Sakellariou, G. Karaliotas, V. 

Tsouparopoulos, G. Mazis, A. Kanellopoulos 

1st Orthopaedic Department, University of 

Athens, ATTIKON University General Hospital, 

Greece 

To evaluate the operative treatment of Blount disease using 

the TSF external fi xator and to evaluate the system. 

During January 2004 and August 2008, 8 males and 

2 females with Blount disease (16 limbs) were treated 

using TSF system. For the radiological assessment we 

obtained standard long-leg standing radiographs and 

we measured the anatomic medial proximal tibial angle 

(aMPTA), the diaphyseal-metaphyseal tibial angle 

(Drennan), and the femoro-tibial angle. 

The mean follow-up was 29 months (15 to 45). No 

patient had pain around the knee, medial or lateral instability. 

The range motion of the knee immediately after frame 

removal was 10° to 90° of fl exion in two patients while 

in the other it was from 0° to 110°.The mean leg-length 

discrepancy was reduced postoperatively from mean 

1,9 cm (1,7-3,2) to 0,9 cm (0- +1,5). The aMPTA angle 

increased from mean 73° (59°- 83°) to 94° (107°- 90°), 

Drennan angle from 17° (14°- 22°) to 3° (0°- 7°), and 

femoro-tibial angle from 17° (10°- 30°) varus to 7° (2°- 

10°) valgus. The frame was removed at mean 9 weeks (7- 

14). Two patients had delayed union, two presented with 

loss of correction (due to dissociation of struts and secondary 

to medial physeal bar), two patients had pin track 

infection. No neurologic complications were referred. 

Accurate corrections of multiplanar deformities as 

varus, internal rotation and shortening of the limb that 

coexist in Blount disease may be accomplished using 

TSF system 

169 TREATMENT OF PILON FRACTURES 

WITH ILIZAROV FRAME 

K. Tilkeridis, A. Khaleel, D. Kotzamitelos, A. 

Hadzigiannakis, D. Elliott, R. B. Simonis 

University Hospital of Alexandroupolis; St. Peter’s 

Hospital, Chertsey, Surrey 

We treated 60 patients with type III Pilon fractures 

(Ruedi and Allgower Classifi cation) between 1996 and 

2005. The fractures were distracted and then fi xed with 

an Ilizarov circular ring fi xator, without the use of open 

surgery. No internal fi xation was used for the tibia or 

fi bula. No bone grafting was performed. 

The average time from injury to frame application 

was four days. The patient stayed ib frame for a mean 

time of 15 weeks. No second operative procedure was 

needed. All cases united in good alignment. 

The patients were reviewed from ten years to nine 

months after frame removal. Four separate evaluations 

were performed (functional, objective, radiological and 

an SF-36). The function and the range of movement 

were better than the radiological assessment suggested. 

This method of treatment gives better results with 

fewer complications than open surgery with internal 

fi xation 



170 THE ILIZAROV METHOD FOR THE 

TREATMENT OF COMPLEX TIBIAL 

FRACTURES AND NON-UNIONS IN A 

MASS CASUALTY SETTING: THE 2005 

EARTHQUAKE IN PAKISTAN 

K. Tilkeridis, N. Cheema, A. Khaleel 

Rowley Bristow Orthopaedic Unit, St. Peter’s 

Hospital, Chertsey, Surrey 

We report our experience in treating victims of the 

recent Earthquake Disaster in Pakistan. Our experience 

was based on 2 humanitarian missions to Islamabad. 

First in October 2005, 16 days after the earthquake and 

the second in January 2006, three months later. The 

mission consisted of a team of orthopaedic and a second 

team of plastic surgeons. The orthopaedic team bought 

all the equipment for application of Ilizarov External 

Fixators (IEF). We treated patients who had already 

received basic treatment in the region of the disaster and 

subsequently had been evacuated to Islamabad. 

During the fi rst visit we treated 12 injured limbs in 11 

patients. 7 of these were children (ages 6 – 14). All the 

cases were complex and severe multifragmentary fractures 

associated with crush injuries. All of the fractures 

involved the tibia, which were treated with IEF. 

Nine fractures were type 3b open injuries. Eight were 

infected requiring debridement of infected bone and 

acute shortening of the limb segment. After stabilization, 

the plastic surgeons provided soft tissue cover. 

During the second, we reviewed all patients treated 

during our fi rst mission. In addition we treated 13 new 

patients [Table 3] with complex non – unions. Eight 

out of 13 non-unions were deemed to be infected. All 

patients had previous treatment with monolateral fi xators 

(AO type) as well as soft tissue coverage procedures, 

except one patient who had had a circular fi xator 

(Ilizarov) applied by another team. All these patients 

had revision surgery with circular frames 

171 DELAYED TREATMENT OF LONG BONE 

FRACTURES IN POLYTRAUMA PATIENTS 

WITH THE USE OF RING TYPE EXTERNAL 

FIXATOR 

D. Louverdis, S. cPlessas, P. Kontos, N. 

Baxevanos, V. Petroulias, N. Prevezas 

Orthopaedic Depart.of General Hospital Nikaia 

Peirea 

The defi nite treatment of closed or compound fractures 

of the long bones in polytrauma patients, who had been 

treated by bridging external fi xation during the damage 

control phase is challenging, especially if it is performed 

delayed when the risk of infection is increased. In such 

cases the use of ring type external fi xators seems to be 

a good choice. 

During the last two years (mean FU 16 months), 22 

Polytrauma patients with fractures of the long bones 

were treated with the use of ring type external fi xators 

as the defi nite method. Multiplanar reduction at the 

fracture site could be achieved with this method. 14 

patients had a high ISS score in the emergency department. 

14 had sustained fracture of the femur while the 

remaining 8 patients had suffered a tibial fracture. 

In all but one patient the bone union was achieved 

in a mean time of 19 months. In a patient with a tibial 

fracture where a bone defect the bone union was accomplished 

with bone grafting and the use of growth factors. 

No complications or loss of reduction were seen, 

while local signs of infection at the site of half pins insertion 

in three patients were subsided with administration 

of local antibiotics. 

The defi nite treatment with ring type external fi xators 

of long bone fractures in polytrauma patients seems to 

be a very good choice. Bone consolidation with no evidence 

of bone infection was achieved in all patients. 

while low rate of complications were seen 

172 MANAGEMENT OF INTRAARTICULAR 

CALCANEAL FRACTURES WITH ILIZAROV 

EXTERNAL FIXATOR 

A. Saridis, C. Matzaroglou, A. Kallivokas, M. 

Tyllianakis, P. Dimakopoulos 

Orthopaedic Department, Medical School, 

University Hospital of Patras 

Our purpose was to evaluate the use of indirect and 

closed reduction with Ilizarov external fi xator in intraarticular 

calcaneal fractures. 

In a period of 3 years, 16 patients with 18 intra-articular 

fractures of calcaneus (eleven type III and seven type 

IV according to Sanders classifi cation) were treated with 

the Ilizarov fi xator. Twelve patients were male and four 

female. The average age was 42 years (range 25 – 63 

years). Three fractures were open. Fractures were evaluated 

by preoperative radiographs and CT scans. Restoration 

of the calcaneal bone anatomy was obtained by 

closed means using minimally invasive reduction technique 

by Ilizarov fi xator. Arthrodiatasis and ligamentotaxis, 

and closed reduction of the subtalar joint were 

performed in 14 cases. In 4 cases the depressed posterior 

calcaneal facet was elevated by small lateral incision and 

stabilized in frame by wires. Postoperatively, partial, 

early weight bearing was encouraged in all patients. 

The mean follow-up period was 1,5 years (range 1 – 3 

years). The AOFAS Ankle – Hindfoot Score, and physical 

examination were used in functional evaluation. The 

average score was 79,8 (range 72 – 90). Six patients had 

limited degenerative radiological fi ndings of osteoarthrosis 

about the subtalar joint and three of them had 

painful subtalar movement. One of the patients complained 

of heel pad pain. Nine (6.25%) grade II pin tract 

infections were detected from a total of 144 wires. No 

secondary reconstructive procedures, including osteotomies, 

subtalar fusions, or amputations, have been done. 

Indirect closed reduction of calcaneal bone anatomy 

and arthrodiatasis of subtalar joint with Ilizarov external 

fi xator is a viable surgical alternative for intra-articular 

calcaneal fractures 

173 PITFALLS, OBSTACLES AND 

COMPLICATIONS DURING DISTRACTION 

HISTOGENESIS 

P. Liantis, AF. Mavrogenis, AD. Kanellopoulos, G. 

Babis, PN. Soucacos 

1st Department of Orthopaedics, University of 

Athens Medical School, “ATtIKON” 

The purpose of this study is to classify the pitfalls, 

obstacles and complications that occur during distraction 

histogenesis and also to evaluate the risk factors 

likely to lead to these problems. 

In this study we have retrospectively and prospectively 

studied the diffi culties occurring during distraction histogenesis 

since 2003. We studied 74 patients (mean age 19,2 

years, age range 11-60yrs) whose 97 limbs segments were 

lengthened. 21 patients underwent angular correction, 42 

patients limb lengthening, 17 patients both angular correction 

and limb lengthening and 14 non-union correction. 

In 46 cases, we used the Ilizarov fi xator, in 38 the Taylor 

Spatial Frame and in 10 cases the monolateral external fi xator 

Orthofi x LRS. Diffi culties that occured during limb 

lengthening were subclassifi ed into pitfalls, obstacles, and 

complications. For all cases we have recorded the time of 

appearance of all these diffi culties and have associated 

them with the severity of the initial deformity. 

The total number of diffi culties in distraction histogenesis 

was 20%. The number of presenting problems 

was estimated 5.4% and involved knee subluxation, pin 

breakage and malalignments. Obstacles presented in 

9.5% and included cases with poor bone regeneration, 

peroneal nerve palsy, premature consolidation and heel 

cord lengthening. Finally complications were noted in 

5.4% of the cases. These consisted of infection, fracture, 

non-union and loss of range of knee motion. 

The problems, obstacles and complications that occur 

during distraction histogenesis can all impact on the 

optimal therapeutic target. Extensive surgical experience, 

and optimal pre-operative planning in conjunction 

with the type of the original deformity may all contribute 

in minimising these diffi culties


174 TREATMENT OF COMPLEX TIBIAL 

PLATEAU FRACTURES BY THE ILIZAROV 

CIRCULAR FIXATOR 

E. Kessidis, K. Anagnostidis, B. Makris, G. 

Michailidis, I.M. Kirkos, G. Kapetanos 

3rd Orthopaedic Department, Aristotelian 

University of Thessaloniki, “Papageorgiou” 

General Hospital 

To determine the effectiveness of Ilizarov external fi xator 

in the treatment of complex fractures of the tibial plateau. 

From July 2006 to April 2009, we treated 10 patients 

with the Ilizarov fi xator. Six men and four women ranging 

in age from 31 to 70 (mean age 56.3 years) were 

evaluated. All patients were preoperatively evaluated 

with Computed Tomography scans for better preoperative 

planning. Eight cases had fractures type VI according 

to Schatzker Classifi cation and 2 cases type V. 

In all patients fi xation included pushing olive wires 

or simple wires and 2 to 4 frames. In 4 patients minimal 

invasive open reduction was performed with use of 

bone allograft. In 2 fractures, we combined the treatment 

with minimal internal fi xation 

There was no major complication trans- or postoperatively. 

The mean follow-up was 16 months (4-30). 

The mean hospitalization was 8 days and there were no 

cases of blood transfusion. Mobilization with no weightbearing 

was immediately allowed, with partial weight 

bearing after 2 months and full weight bearing after 3 

months. Three patients had minor pin tract complications. 

The average duration of external fi xation was 120 

days. All the fractures united and patients achieved full 

extension with more than 110 degrees of fl exion. 

Ilizarov circular fi xation is an alternative method of 

treatment for these fractures when internal fi xation is 

contraindicated due to trauma to the soft tissue, defi - 

ciency of bone stock, and bony comminution 

175 INFECTION INCIDENCE IN 

BILATERALLY OPERATED TOTAL KNEE 

ARTHROPLASTY PATIENTS WITH SINGLE 

ANESTHESIA 

M.Ozcan, C. Copuroglu, N. Heybeli, E. Yalniz 

Orthopaedic Surgery and Traumatology, 

University of Trakya 

In this study we aimed to identify infection rates in 

arhroplasty patients which were operated bilaterally 

with single anesthesia and to discuss the reasons of 

infections in these patients. 

We evaluated 163 knees of 82 patients (Follow up: 

12 to 60 months). Mean age was 66.8. Right knees were 

operated fi rst followed by left knees. 16 of the patients 

had diabetes mellitus, 4 of them had rheumatoid arthritis, 

and 1 of them had systemic lupus erithmatosus. All 

patients were evaluated according to operation time, 

wound healing, laboratory fi ndings, clinical presentation 

and X rays. We had 7 infections (6 deep, 1 superfi 

cial infection). When we evaluate operation times, no 

statistically signifi cant difference was obtained between 

the infected knees and non infected knees (p=0,275). 

Two of the infected knees had urinary track infection 

and dental abscess after the opertaion. Five of seven 

infected knees were left sided. Six of the infected knees 

were treated with debridement irrigation and antibiotics 

successfully. But one had two staged revision. 

Bilaterally operated knee arthroplasty increases operation 

time signifi cantly. This increase of operation time 

decreases the sterility of surgical fi eld, and may increase 

infection rates. The increased infection rates in left sided 

knees may explain this. Postoperative dental and urinary 

tract infections may also increase infection rates. 

There is no correlation between infection and other 

systemic diseases like diabetes mellitus, systemic lupus 

erithematosus or rheumatoid arthritis 

176 MANAGEMENT OF KNEE 

OSTEONECROSIS WITH 

UNICOMPARTMENTAL KNEE 

ARTHROPLASTY 

I. Kouvaras, S. Dagkas, S. A. Psarakis, A. Kaspiris, 

G. Besiris, E. Vasiliadis 


Elefsis “Thriasio”, Magoula, Attica 

The osteonecrosis of the medial femoral condyle, depending 

on the area occupied, causes pain and may progress 

into osteoarthritis. For the management of osteonecrosis 

numerous treatment methods have been described, as 

conservative, drilling, osteotomy and others. 

The aim of our study is to evaluate the results of management 

of knee osteonecrosis with unicompartmental 

arthroplasty. 

We studied 16 knees in 15 patients (all women) with 

osteonecrosis of the medial femoral condyle. The size of 

osteonecrosis was greater than 3.5 cm, as revealed by 

MRI. The mean age of patients was 72 years (range 64- 

80 years). The time elapsed from the onset of symptoms 

to surgical treatment ranged from 3 to 10 months. 

All patients were followed clinically and by X-ray 1 to 6 

years post-operatively and scored with Knee Society Score. 

The result in 14 patients was excellent and in 1 was good. 

In conclusion, unicompartmental knee arthroplasty 

is a satisfactory method of treatment of osteonecrosis, 

which provides immediate relief from pain, long-term 

satisfactory outcome and avoids multiple operations 

177 ADVANCE MEDIAL PIVOT TOTAL KNEE 

REPLACEMENT 

D. Giotikas, G.Karydakis, Th. Karachalios, N. 

Roidis, K. Bargiotas, K.N. Malizos 

Orthopaedic Department, University of Thessaly, 

Larissa 

Advance medial pivot total knee replacement has been 

designed to refl ect contemporary data regarding knee kinematics. 

We report the clinical outcome of 284 replacements 

in 225 consecutive patients. All patients were prospectively 

followed for a mean of 7.6 years (5 to 9) using validated 

rating systems, both objective and subjective. 

All patients showed a statistically signifi cant improvement 

(p~0.01) on the Knee Society clinical rating 

system, WOMAC questionnaire, SF-12 questionnaire, 

and Oxford knee score. The majority of patients (92%) 

were able to perform age appropriate activities with a 

mean knee fl exion of 117° (85 to 135). Survival analysis 

showed a cumulative success rate of 99.1% (95% CI, 

86.6 to 100) at fi ve years and 97.5% (95% CI, 65.6 

to 100) at seven years. Two (0.7%) replacements were 

revised due to aseptic loosening, one (0.35%) due to 

infection and one (0.35%) due to a traumatic dislocation. 

In only two (0.7%) replacements, progressive 

radiological lucent lines (combined with beta angle of 

85°) were observed 

178 CORRELATION OF SERUM AND 

SYNOVIAL FLUID LEVELS OF AGGRECAN 

IN PATIENTS SUFFERING FROM END STAGE 

KNEE OSTEOARTHRITIS 

M. Potoupnis, J. Iakovou, E. Kenanidis, St. 

Pellios, N. Karatzas, G. Kapetanos 

3rd Orthopaedic Clinic, Aristotle University of 

Thessaloniki, Papageorgiou General Hospital 

3rd Nuclear Medicine Department, Aristotle 

University of Thessaloniki, Papageorgiou General 

Hospital 

Aggrecan is a major constituent of joint cartilage. A 

prominent feature in joint disease is loss of Aggrecan. 

The aim of this study was to assess the relation between 

the concentration of Aggrecan in the synovial fl uid of 

knee joint and this of the peripheral blood in patients 

suffering from end stage knee osteoarthritis 

37 postmenopausal women suffering from end-stage 

idiopathic knee osteoarthritis, scheduled to undergo 

Total Knee Arthroplasty (TKA), were enrolled in this 

study. Their mean age was 69.8 years (range: 49-81 

years). The serum levels of Aggrecan were evaluated one 

day pre-operatively whether synovial fl uid levels from 

fl uid taken during the operation day. 

Patients suffering from any endocrine disorder, rheumatoid 

or other secondary arthritis or any other disease 

that could interfere with the cartilage homeostasis were 

excluded from the study. Concentrations of aggrecan 

turnover were measured with appropriate assays. 

Moderate correlation between serum and synovial 

fl uid concentrations of aggrecan was revealed (r= 0, 

337, p=0,197) 

Serum levels of aggrecan may be related to the synovial 

concentration of Aggrecan in patients suffering from 

end stage knee osteoarthritis. The possible signifi cant 

relationship between these markers may be of value in 

assessing cartilage degradation in patients with involvement 

of a single joint with a blood sample. However this 

correlation needs to be further investigated 

179 PATELLAR RESURFACING IN TOTAL 

KNEE ARTHROPLASTY. DOES DESIGN 

MATTER? A META-ANALYSIS OF 8006 CASES 

G. Pavlou, J. Pagkalos, I. Polyzois, E. Tsiridis, R. 

West 



George Street, Leeds 

Controversy still remains as to whether patella resurfacing 

in total knee arthroplasty (TKA) should be conducted 

as a matter of routine. Some authors recommend 

routine resurfacing of the patella and advocate this due 

to the reduction in post-operative anterior knee pain 

and the reduction in requirement for revision surgery. 

A database search was conducted to identify prospective 

randomized controlled studies only. Eighteen 

prospective randomized trials were identifi ed and found 

eligible for inclusion. A cumulative sample of 8006 

knees were involved, 3418 undergoing resurfacing and 

4588 undergoing no resurfacing. Primary outcome 

data extracted was incidence of secondary operations, 

incidence of anterior knee pain and functional outcome 

scores including subgroup analysis of the type 

of prosthesis used in each study. Der Simonian Laird 

met-analysis was conducted if studies were found to be 

homogenous where statistical signifi cance was defi ned 

as an overall alpha error of

medial border of the patella, where it was fi xed. Knee 

function was assessed preoperatively and postoperatively 

with the use of Kujala, Tegner, Lysholm and International 

Knee Documentation Committee (IKDC) scores. 

There were 60 male and 26 female patients with an 

average age of 29.73 years (median age 28) and range 16- 

54 years. The mean follow-up was 22.4 months (range 

6-78 months). All knee functional scores signifi cantly 

improved postoperatively. Kujala score improved from 

61.3 to 84.8, Tegner score improved from 3 to 5.3, IKDC 

score improved from 52.4 to 73.8 and Lysholm score 

improved from 58 to 76.5. The comparison was made 

between the preoperative and the postoperative values 

at two years after surgery or at the last follow up, if it 

was shorter than two years. All scores showed signifi cant 

improvement after the third postoperative month. One of 

the patients required revision of the MPFL reconstruction 

following traumatic redislocation of the patella. 

Rerouting of the semitendinosus tendon for the 

reconstruction of the MPFL is an effective method for 

the treatment of patellofemoral instability. Signifi cant 

functional improvement is achieved between the third 

and sixth postoperative months 

181 COMPARISON OF ONE-STAGE AND 

TWO-STAGE BILATERAL TOTAL KNEE 

ARTHROPLASTIES FOR OSTEOARTHRITIS 

S. Likoudis, I. Koutroumpas, G. Tzoanos, I. 

Aggelidakis, K. Balalis, P. Katonis 

Orthopaedic Department, University Hospital of 

Heraklion, Crete 

The timing of performing knee arthroplasties in bilateral 

osteoarthritic knees remains controversial. Our aim 

was to compare one-stage with two-stage bilateral knee 

arthroplasties (TKA). 

Between November 2004 and April 2008, 128 patients 

(72 female and 56 male) underwent one-stage bilateral 

TKAs. Another group of 115 patients that underwent 

two-stage procedures during the same period formed 

the control group. All patients received the same type of 

anaesthesia. Study parameters included age, weight, medical 

co-morbidities, length of hospital stay, blood loss, 

post-operative complications and functional outcome. 

There were no signifi cant differences between the two 

groups. Co-morbidities and functional outcome based 

on the Knee Society Score were similar in both groups. 

In the one-stage group the length of hospital stay and 

blood losses were higher than the two-stage group; however 

less than double compared to the two-stage group. 

The early post-operative complications were higher but 

not statistically signifi cant in the one-stage group. 

Despite the fact that the early post-operative complications 

are slightly higher in the one-stage group, this 

particular method is an effective way of dealing with 

bilaterally osteoarthritic knees. It offers excellent functional 

outcome at a reduced cost 

182 PRIMARY TOTAL KNEE REPLACEMENT 

USING A CONDYLAR CONSTRAINED 

IMPLANT 

R.A. Giannakos, K. Bargiotas, G. Tsougias, M. 

Hantes, S. Varitimidis, K.N. Malizos 

University of Thessalia, Department of 

Orthopaedics 

The evaluation of the outcome of CCK prostheses in 

primary TKA 

Between 2002 and 2008 we implanted 34 CCK knees 

in 31 patients. Mean age was 69 (58-79) 10 patients 

were operated because of valgus knee and lateral compartment 

arthritis, 8 because of post-traumatic ligamentous 

laxity and/or bone loss and the remaining patients 

presented with advanced OA and varus deformity 

exceeding 30 degrees. All patients were followed regularly 

with radiographs annually and there were assessed 

clinically with KSS and Womac score. The fi ndings were 

compared with a group of patients with similar characteristics 

and a CR prosthesis. 

Mean follow-up was 3 years (6-1) There was no revision 

in this group neither was any radiological abnor- 



mality. Clinical outcome in terms of KSS and WOMAC 

score was excellent and comparable to the CR group. 

The main indication for a CCK prosthesis is the ligamentous 

insuffi ciency. There is enough evidence to support 

its superiority as a treatment option in valgus knees 

but long term performance is yet unclear. 

CCK prostheses are a reliable solution for unstable 

or imbalanced knees their long term behaviour though, 

is yet unclear 

183 TOTAL KNEE ARTHROPLASTY OF THE 

KNEE AFTER HIGH TIBIAL OSTEOTOMY 

N.Markopoulos,M.Vlagkopoulos,Ch.Lyrtzis,L. 

Oikonomidis,M. Bozoglou,Gh.Krystallis 

B Orthopaedic Department General Hospital 

Kilkis 

If and how closed valgus osteotomy of tibia is possible 

to infl uence intra and post operative results of total knee 

arthroplasty. 

Since 1985 to 2002 196 high tibial osteotomies were 

performed. 57 of them were treated by T.K.A. In 21 of 

196 cases diagnostic arthoscopy performed for evaluation 

of the lesion. All osteotomies were closed wedge. 

Stabilization of the knee was done with plaster clast 

and in 50% of cases staples used. The time interval 

from osteotomy to T.K.A was 2-17 years mean 8 years. 

Follow-up of T.K.A. was 3-20 years. 

Scars,patella Baja, shortens of patellar tendon 

increased operative time and degree of diffi culty. Postoperative 

results of T.K.A, were evaluated according 

the WOMAC (pain, stiffness, function) KSS (function) 

KSRIS (x-ray fi ndings) were the same with those of primary 

T.K.A. 

Postoperative complications: 

1. 11 cases decrease in range of knee movment 

2. 3 fractures of external tibial condyle 

3. 2 mechanical loosening of T.K.A 

4. skin necrosis 

5. rupture of extension complex. 

Intaoperative diffi culties in high valgus tibial osteotomy 

and afterrwords in T.K.A. were increased although 

postoperative results were the same. This is the reason 

that surgical experience is the target point of the result 

184 BIOLOGICAL RESURFACING AT THE 

KNEE FOR YOUNGER AND MIDDLE 

AGED PATIENTS WITH CONCOMITANT 

PROCEDURES, PRELIMINARY RESULTS. 

S. Alevrogiannis, G.A. Skarpas, A. 


“NEO ATHINAION”, General Clinic, Athens, 

Orthopaedic Dept.; BARNET & CHASE FARM 

HOSPITAL, NHS Trust – Orthopaedic Dept., 

London-UK 

To present our experince in the use of different autologous 

cartilage transplantation techniques with concomitant 

procedures. 

The last 30 months we treated 42 patients with chondral 

defect at the knee. Their mean age was 34 y.o. and the 

men to women ratio was 28/14. The defect concerned the 

medial femoral condyle(20), the lateral femoral condyle 

(14), the medial facet of the patella (4) while 4 patients 

demonstrated chodral defects in both femoral condyles. 

The mean area of the defect was 6.5 cm2 while defects 

measuring below 2.5 cm2(10) were treated arthroscopically 

using microfracturing trechnique.20 cases were 

treated for chondral defect alone using either MACI or 

ACT-3D technique for chondrocyte transplantation and 

in 12 cases there was a combination of cartilage transplantation 

with alignment correction procedures. Finally 

a modifi ed rehabilitation protocol was used. 

All the cases were performed uneventfully. We assesed 

the patients 12 months post-operatively using the 

LYSHOLM & GILLQUIST score, FAFA kai Visual Analogue 

Pain Score.The clinical outcome was excellent,the 

follow-up using `MRI showed adequate fi lling of the 

defect without signifi cant bone swelling. 

Our early results using the method are more than 

encouraging.The method continues to evolve and is very 

challenging. As far as we know this the fi rst publication 

concerning 3rd generation autologous chondrocyte transplantation 

in both femoral condyles silmutaneously 

185 COMPARATIVE STUDY OF NAVIGATED 

VS. FREEHAND OSTEOCHONDRAL GRAFT 

TRANSPLANTATION OF THE KNEE. 

CADAVERIC STUDY 

D. Koulalis, D. Kendoff, C. Mustafa, P. Di 

Benedetto, C. Cranchi, D. Mastrokalos, A. Pearle 

1st Orthopaedic Department University of 

Athens; Hospital for Special Surgery, CAS Lab, 

New York, USA 

Measurement of precision in positioning multiple autologous 

osteochondral transplantation in comparison to 

the conventional free hand technique. 

The articular surfaces of 6 cadaveric condyles (medial 

– lateral) were used.The knee was referenced by a navigation 

system (Praxim). The pins carrying the navigation 

detectors were positioned to the femur and to the 

tibia. The grafts were taken from the donor side (measurement 

I) with the special instrument which carried 

the navigation detectors. The recipient site was prepared 

and the donor osteochondral grafts were forwarded to 

the articular surface (II). The same procedure took place 

without navigation. The articular surface congruity was 

measured with the probe (measurement III) 

The angle of the recipient plug removal (measurement 

I) with the navigation technique was 3,27° (SD 2,05°; 

0°-9°). The conventional technique showed 10,73° (SD 

4,96°; 2°-17°). For the recipient plug placement (measurement 

II) under navigated control a mean angle of 

3,6° (SD 1,96°; 1°-9°) was shown, the conventional 

technique showed results with a mean angle of 10,6° 

(SD 4,41°; 3°-17°). The mean depth (measurements III) 

under navigated control was 0,25mm (SD 0,19mm; 

0mm-0,6mm). With conventional technique the mean 

depth was 0,55mm (SD 0,28mm; 0,2mm –1,1mm). 

The application of navigation showed that complications 

like diverging of the grafts leading to breakage or 

loosening as well as depth mismatch which can lead to 

grafts sitting over or under the articular surface can be 

avoided providing better results in comparison to the 

free hand procedure

Procs III 2011.indb - Journal of Bone & Joint Surgery, British Volume ...

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