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

350 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY
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
5th Orthopaedic Department, Hand Unit,
Asklipeion Hospital of Voula, Athens
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
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.
069 SURGICAL TREATMENT OF RADIAL
HEAD FRACTURES IN COMPLEX ELBOW
INJURIES
V.N. Psychoyios, P. Intzirtzis, S. Thoma, V.
Bavellas, E. Zampiakis
5th Orthopaedic Department, Hand Unit,
Asklipeion Hospital of Voula, Athens
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
5th Orthopaedic Department, Hand Unit,
Asklipeion Hospital of Voula, Athens
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.
J BONE JOINT SURG [BR] 2011; 93-B:SUPP III