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

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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 Department of Orthopaedic Surgery, University of 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.
Page 1: Hellenic Association Of Orthopaedic
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Page 11 and 12: 060 COMBINING BIGGER FEMORAL HEADS
Page 13 and 14: 072 THE USE OF VAC SYSTEM IN ORTHOP
Page 15 and 16: 084 THE ROTAGLIDE MOBILE BEARING TO
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Page 21 and 22: 118 EARLY RESULTS OF THE PONSETI ME
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Page 35: medial border of the patella, where

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