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

344 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY
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.
J BONE JOINT SURG [BR] 2011; 93-B:SUPP III