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Mitrogiannis L, Mitrogiannis G, Melaki K, Karamitros A, Karantanas A, Paxinos O. An Early Functional Unsupervised Rehabilitation Protocol Allows Safe Return to Function After Achilles Tendon Repair. Cureus 2024; 16:e52477. [PMID: 38371156 PMCID: PMC10873818 DOI: 10.7759/cureus.52477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE Acute Achilles tendon tears in young active individuals are often treated surgically with prolonged rehabilitation, with the leg initially immobilized in plantar flexion in serial non-weight bearing casts and gradually progressing to full weight bearing. This study aimed to evaluate the safety of an early functional unsupervised rehabilitation protocol. METHODS The medical records of 25 patients treated with open repair were available for follow-up. In 10 patients, an early functional unsupervised rehabilitation protocol was used with a removable cast, active range of motion exercises of the ankle from the first postoperative day, and full weight bearing in a walking boot with the foot plantigrade after the second week. Another 15 patients who followed the classic rehabilitation protocol were used as controls. The patients were evaluated with the Victorian Institute of Sports Assessment-Achilles (VISA-A) and an ultrasound examination-based score. A Wilcoxon test was used to compare the scores between the groups. RESULTS The mean VISA-A score was 90.1 (SD = 9.87) for the early functional rehabilitation protocol group, while it was 83.8 (SD = 17.06, p = 0.624) for the control group. The mean ultrasound score was 7.75 (SD = 1.71) for the early functional rehabilitation protocol group, while it was 7.60 (SD = 3.05, p = 0.414) for the control group. There were no intra- or early postoperative complications in the groups, and all patients were satisfied with the results of their operation. CONCLUSIONS An early unsupervised functional rehabilitation protocol after open Achilles repair may allow for safe early mobilization and minimize the need for physiotherapy. The small number of participants is a limitation of this study, and further evaluation with more patients is necessary to document the efficacy.
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Affiliation(s)
| | - George Mitrogiannis
- Orthopedics Department, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - Kalliopi Melaki
- Radiology Department, General Hospital of Piraeus "Tzaneio", Athens, GRC
| | | | | | - Odysseas Paxinos
- Orthopedics Department, 251 Hellenic Air Force General Hospital, Athens, GRC
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Koutserimpas C, Kotzias D, Chronopoulos E, Naoum S, Raptis K, Karamitros A, Dretakis K, Piagkou M. Suggestion of a Novel Classification Based on the Anatomical Region and Type of Bilateral Fatigue Femoral Fractures. Medicina (Kaunas) 2023; 59:1572. [PMID: 37763691 PMCID: PMC10534755 DOI: 10.3390/medicina59091572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
Purpose: Bilateral fatigue femoral fractures (BFFF) represent an extremely rare clinical entity. The present study introduces a novel classification, in order to categorize the BFFFs and provide a thorough review of all these, so far in the literature, reported cases. Methods: The BFFF were classified taking into account the anatomical region of the femoral fracture; (fh): femoral head, (sc): sub-capital, (pt): peri-trochanteric, (st): sub-trochanteric, (s): shaft, (d): distal femur and the fracture type (complete or incomplete); type I: bilateral incomplete fractures, type II: unilateral incomplete fracture, and type III: bilateral complete fractures. Type III was further subdivided into type IIIA: bilateral non-displaced fractures, type IIIB: unilateral displaced fracture, and type IIIC: bilateral displaced fractures. Furthermore, a meticulous review of the PubMed and MEDLINE databases was conducted to locate all articles reporting these injuries. Results: A total of 38 patients (86.8% males), with a mean age of 25.3 years, suffering BFFFs were identified from the literature search. The mean time interval from symptoms' onset to diagnosis was 54 days. According to the proposed classification, 2.6% of the fractures were categorized as type I (h), 36.8% as type I (sc), 2.6% as type I(st/s), 7.9% as type I (s), 2.6% as type I (d), 5.4% as type II (fh), 26.3% as type II (sc), 2.6% as type IIIA (st), 2.6% as type IIIA (d), 5.4% as type IIIB (sc), 2.6% as type IIIB (d) and 2.6% as type IIIC (sc). Surgery was performed in 52.6%, while non-operative treatment was followed in 47.4% of the population. Regarding the fracture type, 75% of type I fractures were conservatively treated, while 91.7% and 66.6% of type II and III fractures were surgically treated. For patients treated conservatively, the mean time from diagnosis to return to previous status was 260 days, while for patients treated surgically, 343 days. Conclusions: BFFFs, although rare, may pose a diagnostic and therapeutic challenge. The present classification offers valuable information and may act as a guide for the management of these patients.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
- 2nd Department of Orthopaedics, “Hygeia” General Hospital of Athens, 15123 Athens, Greece;
| | - Dimitrios Kotzias
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
| | - Efstathios Chronopoulos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 14561 Athens, Greece;
| | - Symeon Naoum
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
| | - Konstantinos Raptis
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
| | - Athanasios Karamitros
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
| | - Konstantinos Dretakis
- 2nd Department of Orthopaedics, “Hygeia” General Hospital of Athens, 15123 Athens, Greece;
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Koutserimpas C, Piagkou M, Karaiskos I, Karamitros A, Raptis K, Kourelis K, Christodoulou N. Modified Anterolateral Minimally Invasive Surgery (ALMIS) for Total Hip Replacement: Anatomical Considerations, Range of Motion and Clinical Outcomes. Medicina (Kaunas) 2023; 59:1520. [PMID: 37763639 PMCID: PMC10533114 DOI: 10.3390/medicina59091520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: In the modified anterolateral minimally invasive surgery (ALMIS) for total hip arthroplasty (THA), the intermuscular plane between the tensor fasciae latae and the gluteus maximus (GM) is exposed, while the anterior ¼ of the GM is detached. There are scarce data regarding this surgical approach. The purpose of the present study is to thoroughly describe this approach, encompassing the anatomical background, and to present the results of a retrospective two-center study of 603 patients. Materials and Methods: The present study includes a two-center retrospective observational cohort of 603 patients undergoing the ALMIS technique with minimum 5-year follow-up. Demographics were recorded, while range of motion (ROM) of the hip joint and the Harris Hip Score (HHS) were evaluated preoperatively, at 1, 3 and 12 months postoperatively and at the final follow-up (>5 years). Surgery-related complications were also recorded. Results: The studied population's mean age was 69.4 years, while most of them were females (397; 65.8%). The mean follow-up was 6.9 years. The median HHS at the 1-month follow-up was 74, compared to the 47 preoperatively (p-value < 0.0001). At the final follow-up, median HHS was 94. At the 1-month follow-up, mean adduction was 19.9° (compared to 15.4° preoperatively; p < 0.0001), mean abduction 24.3° (18.2° preoperatively; p < 0.0001), mean flexion 107.8° (79.1° preoperatively; p < 0.0001), mean external rotation 20.1° (12.1° preoperatively; p < 0.0001) and mean internal rotation 15.3° (7.2° preoperatively; p < 0.0001). ROM further improved until the final follow-up; mean adduction reached 22°, mean abduction 27.1°, mean flexion 119.8°, mean external rotation 24.4° and mean internal rotation 19.7°. Regarding complications, 1.3% of the sample suffered anterior traumatic dislocation, in 1.8% an intraoperative femoral fracture occurred, while 1.2% suffered periprosthetic joint infection. Conclusions: The modified ALMIS technique exhibited excellent clinical outcomes at short-, mid- and long-term follow-up, by significantly improving hip ROM and the HHS. Careful utilization of this technique, after adequate training, should yield favorable outcomes, while minimal major complications should be expected.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Ilias Karaiskos
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Athanasios Karamitros
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Konstantinos Raptis
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Konstantinos Kourelis
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
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Karatzas A, Karamitros A, Paraskevopoulos I, Papachristou DJ, Koureli O, Mantzari V, Panagopoulos N, Spiliopoulos S. Haematocrit and haemoglobin decrease following image-guided percutaneous core needle biopsies. Clin Radiol 2020; 75:158.e9-158.e14. [PMID: 31718788 DOI: 10.1016/j.crad.2019.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023]
Abstract
AIM To determine the clinical significance of variation in haematocrit (Ht) and haemoglobin (Hb) values before and after image-guided percutaneous core needle biopsies (PCNBs) and evaluate its clinical significance. MATERIALS AND METHODS This single-centre, retrospective study included all the patients who underwent image-guided PCNBs between November 2012 and September 2018. In total, 105 cases (56 male; 53.3%; mean age 72±8 years) were available for analysis. Biopsies included lesions of the liver, lung, kidney, bone, paravertebral and soft-tissue masses, peritoneal implantations, and retroperitoneal neoplasms. The study's primary outcome was to compare the pre- and post-procedural Ht and Hb values and to evaluate their clinical significance. RESULTS A significant decrease of the mean Hb and Ht values was detected post-biopsy (12.79±1.85 g/dl versus 12.03±1.72 g/dl and 38.75±4.93% versus 36.49±4.73%; p<0.0001). A decrease in the Ht and/or Hb level was noted in 93/105 (88.6%) and 94/105 (89.5%) of the patients; respectively. Four minor bleeding complications were noted (4/105; 3.8%), which resolved without any further treatment. An >4% decrease in Ht value was noted in 17/105 cases (16.2%) and an Hb decrease of ≥1.5 mg/dl was noted in 10/105 cases (9.5%), all without any haemodynamic compromise. CONCLUSIONS A moderate post-PCNB decrease in Ht and Hb values compared to baseline should be expected, but should not raise concerns regarding an ongoing bleeding event, if not correlated with haemodynamic and clinical signs of haemorrhage.
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Affiliation(s)
- A Karatzas
- Department of Radiology/Interventional Radiology, "Olympion" Hospital, Patras, Greece.
| | - A Karamitros
- 2nd Department of Radiology, Interventional Radiology Unit, "Attikon" University General Hospital, Athens, Greece
| | - I Paraskevopoulos
- Department of Interventional Radiology, Aberdeen Royal Infirmary Hospital, Aberdeen, Scotland, UK
| | - D J Papachristou
- Department of Anatomy-Histology-Embryology, University of Patras, School of Medicine, Patras, Greece; Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - O Koureli
- Department of Microbiology, "Olympion" Hospital, Patras, Greece
| | - V Mantzari
- Department of Microbiology, "Olympion" Hospital, Patras, Greece
| | - N Panagopoulos
- Department of Thoracic Surgery, "Olympion" Hospital, Patras, Greece
| | - S Spiliopoulos
- Department of Radiology/Interventional Radiology, "Olympion" Hospital, Patras, Greece; 2nd Department of Radiology, Interventional Radiology Unit, "Attikon" University General Hospital, Athens, Greece
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Besiris GT, Koutserimpas C, Karamitros A, Karaiskos I, Tsakalou D, Raptis K, Kourelis K, Paxinos O, Kotsirakis A, Vlasis K. Topical use of tranexamic acid in primary total knee arthroplasty: a comparative study. G Chir 2020; 41:126-130. [PMID: 32038024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Perioperative blood management represents a major issue in knee arthroplasty. The aim of the present observational study is to compare two different methods of topical tranexamic acid (TXA) administration (periarticular and intraarticular) in primary knee arthroplasty. PATIENTS AND METHODS The present is an observational comparative study. A total of 66 consecutive patients receiving topical injection of TXA after unilateral primary knee arthroplasty due to osteoarthritis were recorded. Patients were divided into two groups: group 1; periarticular injection of TXA and group 2; intraarticular injection. RESULTS Transfusion rate in group 1 was found to be 15%, compared to 44% in group 2 (p-value= 0.015). In transfused patients the mean received blood units were 1.2 (SD=0.44) in group 1, compared to 1.06 (SD=0.24; p-value=0.34) in group 2. The mean hospital stay of group 1 patients was 7.94 days (SD=2.79), compared to 9.58 days (SD=3.26; p-value=0.03) in group 2. DISCUSSION The main findings of the study are that statically significant higher transfusion rates, as well as longer in-hospital stay were found in the intraarticular group, when compared to the periarticular group. According to these two parameters the present study has shown that the topical periarticular TXA injection is superior to the intraarticular one. Further research is of utmost importance in order to conclude to the optimum combination of knee arthroplasty perioperative blood management.
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Gourgiotis S, Triantafyllou C, Karamitros A, Thinnes K, Thüringen W, Schmidt R. The results of the three-month co-operation between a German and a Greek surgical team in a role II military hospital in Afghanistan. J Emerg Trauma Shock 2012; 5:36-41. [PMID: 22416153 PMCID: PMC3299152 DOI: 10.4103/0974-2700.93110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 11/15/2010] [Indexed: 11/29/2022] Open
Abstract
Background and Aim: There are a lot of unique challenges for the military medical personnel assigned to Afghanistan. We evaluate the results of the co-operation between a German and a Greek surgical team during a 3-month period in a role II hospital. Materials and Methods: Patients who were admitted to the role II German hospital of Kunduz were evaluated. We reviewed the type of diseases, mechanism and location of injuries, management, types of surgical procedures, blood supply, and outcome. Results: The data included 792 ISAF patients, 18 NGOs patients, and 296 local patients. Out of them, 71.6% of the patients were ISAF personnel; 51 patients underwent a surgical operation; 35 of them were operated in an emergency base. Fifty-five surgical procedures were performed. In 22 (43.1%) of these patients, orthopedic procedures were performed, while in the rest 29 (56.9%) patients the operations were of general surgery interest. Gunshot injuries were the main mechanism of injury for locals, whereas ISAF personnel were usually presented with injuries after IEDs and rocket attacks. A total number of 11 patients were transferred to role III military hospitals for further treatment within 24 hours. Conclusions: The co-operation between surgical teams from different countries, when appropriately trained, staffed, and equipped, can be highly effective in a combat environment.
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Affiliation(s)
- Stavros Gourgiotis
- Department of Second Surgical, 401 General Army Hospital of Athens, Greece
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Soultanis K, Pyrovolou N, Karamitros A, Konstantinou V, Lenti A, Soucacos PN. The use of thoracoplasty in the surgical treatment of idiopathic scoliosis. Stud Health Technol Inform 2006; 123:327-33. [PMID: 17108447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Rib prominence on the convex side results from vertebral rotation. The cosmetic deformity of the back in scoliosis is only partially corrected by operations on the spine itself, whilst costoplasty addresses the problem directly, and improves the cosmesis. PURPOSE Our experience in convex and concave side thoracoplasty is discussed. PATIENTS AND METHODS The selection of the patients for thoracoplasty was done primarily taking into consideration the cosmetic disturbance of the rib hump and the consequences to the psychism of the patient. A total of 35 scoliotic patients (32 females and 3 males) with mean age 18.8 years underwent thoracoplasty in combination with posterior spinal fusion. In 23 patients (3 males and 20 females) convex side thoracoplasty (rib resection at the site of the hump) was done as a first stage procedure (18 patients) or a second stage procedure (5 patients). In the patients with spinal fusion at the same time, the resected ribs were used as bone graft. 12 female patients were treated with concave side thoracoplasty (osteotomies of the medial part of the ribs and elevation of the ribs on the instrumentation rod) as a first stage procedure combined with spinal fusion, while in one 22 female patient both side thoracoplasty was done as a second stage procedure. CONCLUSION Either form of thoracoplasty was an effective and impressive way to improve the patient's appearance although it was not possible to quantify the results. The complications that were presented viz. 4 haemopneumothorax, 2 pneumothorax, 2 pneumonia) were treated successfully.
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Affiliation(s)
- K Soultanis
- 1rst Orthopaedic Department, University of Athens, ATTIKON Hospital, Greece
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Soultanis K, Pyrovolou N, Karamitros A, Konstantinou V, Liveris J, Soucacos PN. Instrumentation loosening and material of implants as predisposal factors for late postoperative infections in operated idiopathic scoliosis. Stud Health Technol Inform 2006; 123:559-64. [PMID: 17108487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Instrumentation loosening and metal corrosion are predisposal factors under investigation for late Postoperative infections. PURPOSE OF THE STUDY To investigate the contribution of the instrumentation material (stainless steel versus titanium implants) and the mechanical loosening in the development of late postoperative spinal infection. PATIENTS AND METHODS The first group of patients involves 50 idiopathic scoliotic patients who were treated with first generation posterior stainless steel spinal segmental multihook instrumentation. The minimum post operative follow up was 4 years. Five patients presented with late infections 1 to 5 years post operatively. Removal of instrumentation was the effective solution to this problem. Common intraoperative findings were some degree of instrumentation loosening and corrosion. The second group involves 40 idiopathic scoliotic patients who were treated with newer generation posterior titanium spinal segmental multihook-multiscrew instrumentation system. More extensive use of pedicle screws was performed to the second group resulting in a more stable mechanical construct. Follow up ranged from 2 to 5 years. None of those patients presented late postoperative infection or any evidence of instrumentation loosening or failure. CONCLUSION We believe that newer multihook-multiscrew titanium spinal instrumentation systems have smaller incidence of late postoperative infections because they provide a more stable construct (pedicle screws) with fewer tendencies for micro motion or failure, and they may give the advantage of greater bone adhesion on the implant resulting in the production of thinner biofilm, thus decreasing the chances of infection.
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Affiliation(s)
- K Soultanis
- 1rst Orhopaedic Department, University of Athens, ATTIKON Hospital, Greece
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