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

356 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY
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
Academic Department of Trauma and
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
University of Thessaloniki, General Hospital
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
E. Mataragas, C. Vassos, N. Tzanakakis, G.
Mouzopoulos, C.K. Yiannakopoulos, Emm.
Antonogiannakis
Arthroscopy and Shoulder Unit, IASO
GENERAL Hospital
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
J BONE JOINT SURG [BR] 2011; 93-B:SUPP III