Pathologic fracture of the scaphoid due to enchondroma: treatment with vascularized bone grafting. report of a case.

Enchondroma of the scaphoid has been rarely reported. A young male manual worker presented with a pathologic fracture on the lesion. It was successfully managed with a vascularized bone graft from the dorsum of the distal radius.

Blood salvage after total hip and total knee arthroplasty.

We performed a prospective study to determine the effect of postoperative collection and reinfusion of unwashed, filtered, salvaged blood alone and in combination with preoperative predeposited blood on the transfusion requirements of 375 patients treated with a total hip or total knee replacement. 208 patients were managed with postoperative blood salvage with use of the CBC ConstaVac autotransfusion system and closed suction drainage. Another 50 patients predeposited 1-4 units of autologous blood, before the operation, in addition to postoperative blood salvage.

Surgical management of tibial plateau fractures.

From 1992 to 1996, 49 patients with 49 tibial plateau fractures underwent operative treatment at the First Orthopaedic Department of the General Hospital of Athens. There were 3 type I fractures, 12 type II, 5 type III, 9 type IV, 5 type V and 15 type VI according to Schatzker's classification. 7 of the type VI fractures were open (5 grade II and 2 grade IIIA).

Knee dislocations and their management. A report of 16 cases.

We retrospectively studied the outcome of 16 knee dislocations. 11 patients had surgical treatment, 4 were managed nonoperatively and 1 patient died. In the elderly the outcome was poor, regardless of the type of treatment.

Bridge plating osteosynthesis of 20 comminuted fractures of the femur.

We retrospectively studied the outcome of 20 comminuted fractures (20 patients, 15 men) of the femur treated in accordance with the principles of indirect reduction and biological osteosynthesis technique. The patients were followed for mean 1.5 (1-4.

Scaphoid nonunion treated with bone graft and Herbert screw. 23 of 28 fractures healed.

We retrospectively reviewed 28 patients with symptomatic, established nonunion of the waist of the scaphoid who were treated with bone grafting and Herbert screw fixation. A volar approach was used in 20 patients, and a dorsal in 8. Grafting was performed with cancellous bone from the radius in 16 patients and a iliac wedge graft in 12 patients.

Two-stage treatment of flexor tendon ruptures. Silicon rod complications analyzed in 109 digits.

Complications during two-stage flexor tendon reconstruction may jeopardize the function of the repaired tendons. We reviewed complications encountered in 89 patients (109 digits) treated with a two-stage flexor tendon reconstruction using either silicone or Hunter rods. The complications could be distinguished according to the stage of reconstruction in which they occurred.

Anterior cruciate ligament reconstruction with the press-fit technique. 2-5 years followed-up of 42 patients.

42 patients underwent anterior cruciate ligament (ACL) reconstruction with the press-fit technique. The ACL was reconstructed with a bone-tendon-bone graft from the medial third of the patellar tendon. The graft was stabilized without screws in the femur and tibia by press-fit.

Bone grafting in total hip arthroplasty for insufficient acetabulum.

We assessed the effectiveness of total hip arthroplasty (THA) supplemented with autologous bone grafts in patients with congenital disease of the hip (CDH). 2 groups of patients were evaluated: In Group A, 33 patients with a mean age of 54 years underwent arthroplasties using a threaded ceramic conical acetabular cup without cement (Autophor). In Group B, 85 patients with a mean age of 55 years underwent arthroplasties using a threaded, noncemented, titanium cup (CST).

Versatility of TSRH spinal instrumentation system. Experience in 67 patients with trauma and spinal deformities.

We evaluated the effectiveness of the TSRH (Texas Scottish Rite Hospital) spinal instrumentation system in treating patients with spinal deformities and trauma to the spine. 38 patients (29 women) with spinal deformities and 29 (13 women) with trauma to the spine underwent fusion using the TSRH implant system. In patients with idiopathic scoliosis, the amount of curve correction achieved varied depending on the curve pattern, where patients with single thoracic (type III) or single extended thoracic (type IV) curves showed an improvement of 54% and 63%, respectively, compared to patients with King type II curves in which correction averaged only 45%.

School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece.

A two-year prospective study was done to assess the prevalence and distribution of various parameters associated with scoliosis in schoolchildren in northwestern and central Greece. A total of 82,901 children (41,939 boys and 40,962 girls) who were nine to fourteen years old were screened for scoliosis. Five thousand eight hundred and three children had clinical signs of scoliosis and, of these, 4185 were referred for posteroanterior radiographs (to be made with the patient standing) because they had a positive result on the forward-bending test (a difference of more than five millimeters between the two sides of the torso as measured in the thoracic or thoracolumbar region with use of a ruler and a level plane) at the time of a second screening.

Reflex sympathetic dystrophy of the upper extremity. Clinical features and response to multimodal management.

The weight of available evidence suggests that reflex sympathetic dystrophy (RSD) is a complex clinical entity that (1) occurs predominantly in young adult women; (2) has five clinical types but presents most frequently as minor traumatic dystrophy; (3) has primary signs and symptoms (e.g., pain, edema, stiffness, and discoloration) that are expressed highly in each clinical type, whereas secondary signs and symptoms are variable; (4) responds well to treatment, regardless of its clinical type; and (5) is managed best when treatment is started early.

Surgical treatment of malleolar fractures. A review of 144 patients.

Malleolar fractures are one of the most common fractures faced in orthopaedic surgery. The results from a consecutive series of 144 malleolar fractures during a 10-year period that were classified and treated according to the AO system are presented. Assessment of outcome was done using the scoring system of Baird and Jackson, which is based on subjective, objective, and radiographic criteria.

Idiopathic osteonecrosis of the medial femoral condyle. Classification and treatment.

Idiopathic osteonecrosis of the medial femoral condyle is a well recognized cause of spontaneous, sudden onset of severe pain, usually at the anteromedial aspect of the knee joint. At the Department of Orthopaedic Surgery of the University of Ioannina, 105 knees in 101 patients were evaluated and treated for idiopathic osteonecrosis of the medial femoral condyle. The disease was found to follow a four-stage course, which consisted of a progression from no radiographic findings (Stage I), to a slight flattening of the medial condyle (Stage II), followed by the appearance of a radiolucent lesion (Stage III), and finally, articular cartilage collapse (Stage IV).

Total hip arthroplasty for avascular necrosis and degenerative osteoarthritis of the hip.

Although several studies of various treatment modalities have been reported during the past decade, osteonecrosis of the femoral head remains a difficult therapeutic problem. Total hip replacement which is reserved for patients showing collapse of the femoral head, usually shows poorer results in patients with osteonecrosis compared with those with osteoarthritis. Uncemented total hip arthroplasty was performed on 29 patients with avascular necrosis of the femoral head and 29 patients with degenerative osteoarthritis.

Neuromas and gaps of sensory nerves of the hand: management using vein conduits.

This study analyzed the efficacy of an interposed vein conduit graft in eliminating symptoms of painful neuroma of sensory nerves of the hand and preventing recurrence after excising the pathologic tissue and bridging the concomitant gap with the distal nerve segment. Twenty-three patients underwent reconstruction of 25 palmar sensory nerve gaps ranging from 12 mm to 28 mm, as well as 2 dorsal gaps of 32 mm and 35 mm, respectively. Eighteen patients had symptomatic painful neuromas.

Total knee arthroplasties infected by Brucella melitensis: a case report.

A 74-year-old man with bilateral knee arthroplasties developed Brucella arthritis in both joints after a total joint arthroplasty in his left knee. This complication is the second case reported in the literature to date.

Two-level dorsal dislocation of the little finger.

The case of an elderly man who suffered simultaneous interphalangeal joint dislocation in one finger as a result of a hyperextension force on both the distal and proximal interphalangeal joints is presented. This case differs from the few reports of this type of injury in the literature both in its mechanism of injury and time to reduction. Most reports have been in athletes who are actively involved in a sport, whereas the present case was the result of a fall.

Neglected congenital dislocation of the hip. Role of computed tomography and computer-aided design for total hip arthroplasty.

Computed tomography (CT) provides important three-dimensional anatomic details in congenital dislocation of the hip that are useful for total hip arthroplasty (THR) and are not obtainable with conventional radiographic evaluation. In this study, 84 patients (119 hips) with congenital dislocation of the hip were evaluated with CT before surgery. Specifically, both the acetabulum and the femur were analyzed to make the best selection of the prosthesis.

Scoliosis elasticity assessed by manual traction: 49 juvenile and adolescent idiopathic cases.

We assessed preoperative curve elasticity in 49 consecutive patients with juvenile or adolescent idiopathic scoliosis who were operated on with Harrington distraction rods. Preoperatively, the curve was determined from posteroanterior radiographs taken in the standing position and in the supine position, with traction. In the latter, the radiographs were taken at the moment of maximal traction when one technician applied traction to the ankles and another to the wrists.

Functional assessment of the rat sciatic nerve following intraoperative expansion: the effect of recovery duration on behavioural, neurophysiological, and morphological measures.

The purpose of this study was to investigate the feasibility of rapid intraoperative elongation of the rat sciatic nerve with the use of tissue expander and to assess its functional recovery. Out of 51 rats 43 had their right sciatic nerve expanded with a 5-ml intraoperative expander over 1 hr and 8 were sham-operated controls. The functional recovery of the nerve was assessed at intervals up to 4 months using the Sciatic Functional index (SFI), neurophysiological indices, and histology.

Major ablative procedures in orthopaedic surgery.

In the presence of the notable progress in limb-sparing techniques afforded by the developments in microsurgery and musculoskeletal oncology, major ablative surgery of the extremities still remains a last-resort, yet powerful tool in managing patients with primary tumors in whom wide excision is not possible, as well as in cases with severe trauma to the limbs. During the last thirteen years, eight major ablative procedures were performed at the Department of Orthopaedic Surgery of the University of Ioannina Medical School. Seven out of the eight procedures were performed in patients with primary malignant tumors either because the anatomical location or multiple recurrences of the tumor did not allow removal by wide local excision or by amputation at a lower level.

Load tolerance of tibial plateau depressions reinforced with a cluster of K-wires.

The efficacy of subchondral Kirschner wires in enhancing load tolerance of the tibial plateau articular cartilage was examined in a biomechanical study of cadaveric tibias. Seven patterns of K-wires were evaluated under axial loading equivalent to the maximum loading of the knee during normal gait. Subchondral K-wire reinforcement of tibial plateau depressions significantly enhanced load tolerance.