Osteochondritis Dissecans of the knee, stage 3 – MRI findings
Vafiadis E, Papachristodoulou A, Bismpa K, Pilavaki M, Givissis P, Palladas P.
Δημοσιεύθηκε στο Eurorad, 2009 Jan.
Impact Factor: –
An 18 years old patient with a recent history of injury at the medial aspect of the knee during athletics was referred to the Radiology Department by his GP. He also complained of occasional locking and
limitation of movement. MRI was performed.On T1 weighted image (fig 1) there was a hypointense lesion of approximately 1 cm in diameter at the lateral aspect of medial femoral condyle. On T2 and T2 fat suppressed weighted images (Fig 2) the lesion had a zonal morphology and was of low signal intensity with a surrounding rim of high signal
intensity. PD sequences (fig 3) demonstrated an osteochondritis lesion of approximately 1 cm with fluid signal intensity between the fragment and the donor site. Additionally, subchondral edema was noted at
the surrounding bone tissue.
ESTABLISHMENT OF AN ANIMAL MODEL FOR WALDENSTRÖM’S MACROGLOBULINEMIA.
A. Tsingotjidou, C. Emmanouilides, E. Siotou, T. Poutahidis,
A. Xagorari, P. Loukopoulos, D.Sotiropoulos, C. Bekiari,
M. Doulmperis, P.Givissis, A.Fassas, A.Anagnostopoulos.
Δημοσιεύτηκε στο Exp Hematol. 2009 Apr;37(4):469-76
Impact Factor: 3,198
Background and Objectives. Waldenström macroglobulinemia (WM) is a low-grade lymphoplasmacytoid lymphoma characterized by the production of monoclonal Immunoglobulin M (IgM). The development of in vivo animal models will enable the preclinical evaluation of the disease.
Design and Methods. In this study, we developed an animal model for WM in non-obese-severe combined immunodeficient (NOD-SCID) mice. Human bone fragments from adults undergoing arthroplasty were implanted into the muscles of one hindlimb of NOD-SCID mice. Freshly obtained bone marrow (BM) core biopsies from WM patients were implanted in the contralateral hindlimb of the same animals (NOD-SCID-hu mice).
Results. Three out of ten mice implanted with the BM core biopsies showed an increasing level of serum IgM at 3 months following the implantation. This was preceded by a transient IgM reduction immediate post-implantation. Eventually the IgM levels reached above baseline. Histopathologic analysis was performed using antihuman reagents for expression of CD20 and IgM. Positive cells for both CD20 and IgM were found in the BM core biopsies from the WM patients as well as in the human bone graft opposite to the implanted site in all cases, suggestive of WM cell metastasis to the normal human bone graft,. Occasional IgM posistive cells were also found in the murine bone marrow.
Interpretation and Conclusions. Not only BM core biopsies from WM patients survived in the murine environment, but B-cells were able to metastasize to the human bone at the opposite side as well as to the murine marrow. This SCID-hu WM model closely resembles the human disease by providing the human marrow microencvironment, and may enable the study of the biology of the malignant cells in their native BM milieu.
MID-TERM RESULTS OF HYDROXYAPATITE-COATED THREADED CUP IMPLANTED WITHOUT SUPPLEMENTARY SUPPORTING SCREWS.
Trapotsis SJ, Petsatodis GE, Antonarakos PD, Givissis PK, Christodoulou AG, Pournaras JD.
Δημοσιεύτηκε στο Hip Int. 2009 Apr-Jun;19(2):102-8.
Impact Factor: 0,786
We retrospectively reviewed the clinical, radiographic, and survivorship outcomes in a series of 180 patients that underwent 204 primary Total Hip Arthroplasties with the use of a second generation threaded hydroxyapatite-coated acetabular cup that was implanted without any supplementary supporting screws. At an average follow-up period of 10.2 (range: 8-14) years, one hundred and seventy-four patients (198 cups) were available for assessment. All patients underwent detailed physical and radiographic examination; their functional status was evaluated according to the Harris Hip Score (HHS). Following their digitization, all radiographs were further reviewed in order to determine the existence of any migration of the acetabular cup. Osteolytic lesions, radiolucent lines or zones of increased bone density were also recorded and classified according to the system of DeLee & Charnley. The modified Engh’s criteria were used in order to evaluate the stability of the prosthesis. The patients’ mean HHS at their latest follow-up visit (97.24 points) was statistically significantly better than the preoperative mean score of 40.31 points (p<0.001). Radiographic analysis showed "stable with bone ingrowth" fixation (modified Engh’s criteria) of all implants with no significant migration of the cup (mean cranial migration: 0.597 mm, mean horizontal migration: 0.607 mm, mean observed difference of the cup’s inclination angle: 0.26 degrees). No areas of significant osteolysis were found. The cumulative survival rate of the implants was 97.05%. Our results suggest that second generation hydroxyapatite-coated threaded acetabular cups can be successfully implanted (and achieve excellent results) without the use of any supplementary supporting screws.
MANAGEMENT OF POSTTRAUMATIC ARTHRITIS OF THE WRIST WITH RADIOLUNATE FUSIOM ENHANCED WITH A SLIDING AUTOGRAFT. A case report and description of a
P. Givissis, P. Antonarakos, E. Vafiades, A. Christodoulou
Δημοσιεύτηκε στο Tech Hand Up Extrem Surg. 2009 Jun;13(2):90-3. Review.
Impact Factor: –
Although in rheumatoid cases radiolunate fusion presents with satisfying results, in cases with posttraumatic carpal distortion the variability of injury pattern can influence the type of fixation and the rate of bony union. In this case report we present an alternative technique of radiolunate fusion for the management of posttraumatic arthritis, which combines the traditional procedure with a cortico-cancellous autograft, created from the dorsal side of the radius that slides over the bones
to be fused. That procedure provides the best environment for the bones to heal and an additional stabilizing effect on the radiolunate construct thus better preserving the normal intercarpal relationships and wrist height. Patient’s clinical and radiological outcome was very satisfactory until the last follow-up.
ABUSE OF GROWTH HORMONE INCREASES THE RISK OF PERSISTENT DE QUERVAIN TENOSYNOVITIS.
Τ. Pagonis, K. Ditsios, P.Givissis, A. Pagonis, A. Christodoulou.
Δημοσιεύτηκε στο Am J Sports Med. 2009 Nov;37(11):2228-33.
Impact Factor: 3,605
Background: De Quervain’s tenosynovitis (DQT) usually responds well to non-surgical treatment.
Hypothesis: Growth Hormone (GH) abuse is associated with increased DQT incidence in weight-training individuals.
Study Design: Cohort study
Methods: We treated 19 individuals diagnosed with DQT. Nine were abusing GH (Group A), 10 were not (Group B). Four Group A patients selected to cease GH abuse. Treatment was stratified into 3 grades: 1st. Splinting and NSAIDs, 2nd. Same as 1st grade with addition of cortisone injections (CI), 3rd. Surgical decompression (after failure of 1st and 2nd grade). Follow up was in three, nine and twenty-four months.
Results: First follow up: of those using GH (Group A), only 33.3% responded to splinting and NSAIDs compared to 90% in Group B. Six patients (66.6%) in Group A experienced persistent symptoms and received 2nd grade treatment compared to one patient in Group B (10%). Second follow up: in Group A, four patients (44.4%) moved on from 2nd to 3rd grade treatment, one symptoms-free patient (11.1%) relapsed and received 2nd grade treatment while two (22.2%) requested conservative treatment declining surgery. Group B (100%) were symptoms-free. Final follow up: in Group A, six patients were operated on (66.6%) and one (11.1%) suffered from persistent DQT, declining surgery. In Group B one patient relapsed and was started on 2nd grade treatment.
Conclusions: Our results suggest that GH abuse is associated with a more recalcitrant form of DQT that does not respond well to non-surgical treatment thus leading to increased use of surgical decompression.
ONE-STAGE THUMB LENGTHENING WITH USE OF AN OSTEOCUTANEOUS 2ND METACARPAL FLAP.
Givissis P, Stavridis SI, Ditsios K, Christodoulou A.
Δημοσιεύτηκε στο Strategies Trauma Limb Reconstr. 2009 Nov 26.
Impact Factor: 0,053
Traumatic thumb amputation represents an extremely disabling entity, thus rendering its reconstruction a procedure of paramount importance. A case of a patient, who sustained a traumatic amputation of his left index finger at the metacarpophalangeal joint and of his left thumb in the middle of the proximal phalanx 4 months ago and was initially treated elsewhere, is described. For the thumb reconstruction, an osteocutaneous flap of the radial side of the 2nd metacarpal, which consisted of a 3, 5-cm bony segment with the overlying skin and its blood and nerve supply was used. The flap was transferred and fixed with a plate and screws to the palmar-medial side of the stump of the thumb, while the 1st web space was deepened by removing the rest of the second metacarpal, while a partial skin graft was used to cover a remaining gap. Thumb functionality was restored immediately postoperatively, and the overall result was satisfactory.
Electronic letter published
THE SITE OF SCIATIC NERVE PRESSURE
Panagiotis K. GIvissis, Stavros I Stavridis, Anastasios G. Christodoulou.
Δημοσιεύθηκε στο J Bone Surg. Br. 2009 Dec, Vol. 91-B(2), pp. 253-257
Impact Factor: 2,832
Comment on: J Bone Joint Surg Br 2009; 91-B: 253-257
N. Manidakis, N. K. Kanakaris, V. S. Nikolaou, and P. V. Giannoudis
Early palsy of the sciatic nerve due to heterotopic ossification after surgery for fracture of the posterior wall of the acetabulum.
OPERATIVE STABILIZATION OF SKELETAL CHEST INJURIES SECONDARY TO CARDIOPULMONARY RESUSCITATION IN A CARDIAC SURGICAL PATIENT.
Ananiadou O, Karaiskos T, Givissis P, Drossos G.
Δημοσιεύτηκε στο Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):478-80.
Impact Factor: 2,106
Chest injury, including sternal and rib fractures, is the most common complication of cardiopulmonary resuscitation (CPR) that usually heals spontaneously. However, a small subset of patients has fractures that need mechanical treatment. We present a case of flail chest with sternum and left anterior rib fractures secondary to CPR in a cardiac surgical patient, which was mechanically ventilated due to respiratory complications. Open reduction and operative fixation with titanium osteosynthesis plates and locking screws in sternum and ribs was performed by a thoracic surgeon assisted by an orthopaedic surgeon. Anterior plating achieved chest stability and facilitated weaning from mechanical ventilation. The patient had an uneventful postoperative course, painfree, and experienced no sternal instability or infection throughout a six-month follow-up period. Sternal instability after cardiac surgery occurs infrequently but can be challenging to manage. Titanium plate fixation is an effective method to stabilize complicated flail chest, with clinical utility in a cardiothoracic practice.
ISOLATED INJURY OF THE POSTERIOR INTEROSSEOUS NERVE COMPICATING A DEEP LASERATION OF THE PROXIMAL FOREARM DORSOLATERAL MUCLES. A CASE REPORT.
P Givissis, S Stavridis, K Ditsios, A Christodoulou
Δημοσιέυτηκε στο J Trauma. 2009 Dec;67(6):E194-6
Impact Factor: 2,63
We report a case of wrist and all five fingers drop, caused by an extensive forearm laceration at the level of the radial neck without any sensory loss of the hand. The main feature of the injury was the PIN damage before its division to its major branches, which was diagnosed by careful clinical examination on musculoskeletal and neurological basis and treated immediately post injury.
CONDYLAR BUTTRESS PLATE VERSUS FIXED ANGLE CONDYLAR BLADE PLATE VERSUS DYNAMIC CONDYLAR SCREW FOR SUPRACONDYLAR INTRA-ARTICULAR DISTAL FEMORAL FRACTURES.
Petsatodis G, Chatzisymeon A, Antonarakos P, Givissis P, Papadopoulos P, Christodoulou A.
Δημοσιεύτηκε στο J Orthop Surg (Hong Kong). 2010 Apr;18(1):35-8.
Impact Factor: 0,653
To compare outcomes of 3 fixation techniques for intra-articular distal femoral fractures.
Records of 59 men and 49 women aged 16 to 80 (mean, 47) years who underwent internal fixation for 116 type-C (complete intra-articular) distal femoral fractures were retrospectively reviewed. According to the AO classification, 25 fractures were type C1 (23 closed and 2 open), 71 type C2 (69 closed and 2 open), and 20 type C3 (16 closed and 4 open). Based on implant availability at the time, all surgeries were performed by a single surgeon using a condylar buttress plate (n=38), a fixed angle (95 degrees) condylar blade plate (n=24), or a dynamic condylar screw (n=54). The mean follow-up period was 11 (range, 4-19) years. At the latest follow-up, functional outcome was classified according to Schatzker and Lambert criteria.
Functional outcomes were excellent in 64 (55%) of the fractures, good in 37 (32%), moderate in 9 (8%), and poor in 6 (5%). Outcomes in patients treated by the dynamic condylar screw were significantly superior to those treated by the condylar buttress plate (p=0.016) or condylar blade plate (p=0.001). Good-to-excellent results were achieved in 96% vs 84% vs 71% of these patients, respectively. Complication rates were lower in the dynamic condylar screw group than the other 2 groups (pseudarthrosis, 5% vs 11% vs 25%; varus deformity, 4% vs 26% vs 25%; knee stiffness, 0% vs 5% vs 8%, respectively). No implant failure was encountered.
Dynamic condylar screw fixation for distal femoral fractures achieves better functional outcomes and lower complication rates.