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358 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 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 general, 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. J BONE JOINT SURG [BR] 2011; 93-B:SUPP III
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. J BONE JOINT SURG [BR] 2011; 93-B:SUPP III HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 359 120 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.
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