B. 14
THE ROLE OF TOTAL ELBOW ARTHROPLASTY IN THE MANAGEMENT OF THE YOUNG RHEUMATOID ELBOW
P. Givissis
Ανακοινώθηκε στο International Congress Hand-Upper Limb and Microsurgery,
Σάμος 7-10 Σεπτεμβρίου 2005
We divided 309 patients with an inflammatory arthritis who had undergone primary elbow replacement using the Souter-Strathclyde implant into two groups according to their age. The mean follow-up in the older group (mean age 64 years) was 7.3 years while in the younger patients (mean age 42 years) it was 12 years. Survivorship for three different failure end-points (revision, revision because of aseptic loosening of the humeral component, and gross loosening of the humeral implant), was compared in both groups.Our findings showed that there was no significant difference in the incidence of loosening when young rheumatoid patients were compared with an older age group.
B. 15
ELBOW ARTHROSCOPY
P. Givissis
Ανακοινώθηκε στο συμπόσιο του International Congress Hand-Upper Limb and Microsurgery,
Σάμος 7-10 Σεπτεμβρίου 2005
Indications:
Limitation of motion is a common presenting symptom.
Causes:
• dislocations
• fractures
• ligament injuries
• immobilization
• repetitive trauma (work, sports)
• osteochondritis dissecans
• loose bodies (free or fixed)
• osteophytes
• previous surgery (adhesions)
The future outlook of elbow arthroscopy holds great promise.
B. 16
EFFICACY OF CONSERVATIVE TREATMENT OF THE NECK FRACTURE OF THE 5TH METACARPAL
E. Balabanidou, T. Totlis, E. Haindani, P. Givissis, K. Ditsios,
A. Christodoulou, J. Pournaras
Ανακοινώθηκε στο International Congress Hand-Upper Limb and Microsurgery,
Σάμος 7-10 Σεπτεμβρίου 2005
Εισαγωγή – Σκοπός: To κάταγμα του αυχένα του πέμπτου μετακαρπίου αποτελεί ένα συχνό τραυματισμό
(51-68% των καταγμάτων των μετακαρπίων οστών), ιδιαίτερα σε άνδρες. Η αντιμετώπισή του είναι, συνήθως, συντηρητική
Σκοπός της μελέτης αυτής είναι η εκτίμηση των λειτουργικών, ανατομικών και αισθητικών αποτελεσμάτων της συντηρητικής θεραπείας που εφαρμόσθηκε σε ασθενείς με τέτοιο κάταγμα.
Υλικό- Μέθοδος : Τριάντα τρεις ασθενείς με κάταγμα αυχένα του 5ου μετακαρπίου αντιμετωπίστηκαν στην κλινική μας με επίδεση τύπου boxing glove τη χρονική περίοδο 2000-2003. Οκτώ ασθενείς (6 άνδρες , 2 γυναίκες) προσήλθαν για επανεξέταση μετά από χρονικό διάστημα 3,5 ετών κατά μέσο όρο από την αρχική τους αντιμετώπιση, που σε κάθε περίπτωση δεν ήταν μικρότερο από 2 έτη.
Οι ασθενείς ερωτήθηκαν σχετικά με το βαθμό ικανοποίησης τους για το θεραπευτικό αποτέλεσμα και το βαθμό παραμονής μακροχρόνιου πόνου. Η εκτίμηση της` παραμόρφωσης έγινε επισκοπικά και ακτινολογικά με τρεις προβολές, ενώ το εύρος κάμψης, έκτασης, προσαγωγής και απαγωγής του πέμπτου δακτύλου μετρήθηκε με γωνιόμετρο. Ο έλεγχος για την ύπαρξη αισθητικών διαταραχών έγινε με το όργανο διακριτικής ικανότητας ενώ η μυϊκή ισχύς εκτιμήθηκε με τη χρήση του jamar. Tέλος έγινε έλεγχος για πόνο στη χειραψία.
Αποτέλεσμα: Oι προαναφερόμενοι παράμετροι βαθμολογήθηκαν. Η αποτελεσματικότητα της θεραπείας εκτιμήθηκε με βάση το σκορ που συγκέντρωσαν οι ασθενείς σε: 0-2: Αριστη, 3-7: Καλή, 8-15: Πτωχή. Το αποτέλεσμα ήταν άριστο σε πέντε ασθενείς (62,5%) , καλό σε δύο (25%) ενώ πτωχό μόνο σε έναν (12,5%).
Συμπεράσματα: Η αποτελεσματικότητα της συντηρητικής θεραπείας για το κάταγμα του αυχένα του 5ου μετακαρπίου είναι ικανοποιητική, εκτός από ειδικές περιπτώσεις.
B. 17
ISOLATED INJURY OF THE POSTERIOR INTEROSSEOUS NERVE COMPLICATING. A DEEP LACERATION OF THE PROXIMAL FOREARM DORSOLATERAL MUSCLES
SI. Stavridis, PD Symeonidis, P. Givissis, K. Ditsios, A. Christodoulou, J. Pournaras
Έκθεμα στο International Congress Hand-Upper Limb and Microsurgery,
Σάμος 7-10 Σεπτεμβρίου 2005
Isolated injuries of the posterior interosseous nerve (PIN), caused by extensive laceration injuries without damage of the superficial sensory branch of the radial nerve are not only extremely rare, but also carry the risk of a potential diagnostic and therapeutic fraud.
We report a 55-year-old man, who was injured by a glass plate that had fallen on the dorsal side of the forearm, just below the elbow, causing an extensive laceration wound of 5 cm in length.
On admission, the patient was unable to extend the wrist and fingers, while sensation over the whole area of the radial nerve distribution was unaffected.
Intraoperatively, the extensor muscles of the posterior compartment as well as the muscles of the mobile wad were found to be completely severed through the muscle belly. The PIN was also identified to be completely dissected, in contrast to the intact superficial, sensory branch of the radial nerve.
Following a thorough surgical preparation, a standard epineurial suture of the PIN was performed under no tension using 8/0 prolene, while the injured muscles were treated by placement of end-to-end absorbable sutures.
Recovery of carpal extension was obtained after 6 weeks, following muscle healing, while finger extension recovered gradually and was restored completely after 6 months, thus being in accordance with the prerequisite axonal regeneration of the PIN.
Conduction studies confirmed the complete functional recovery of the muscles innervated by the PIN, and the patient was able to return to his prior activities.
This case report aims at stressing out the potential risk of an easily misleading lesion, where the preservation of sensation due to the intact sensory branch can mask the underlying motor branch injury, as the clinical picture could by easily attributed solely to the more striking muscle trauma.
B. 18
TRANSIERT OCCLUSION OF THE AXILLARY ARTERY COMPLICATING A THREE PART SUBCAPITAL FRACTURE OF THE HUMERUS
P. Givissis, D. Karataglis, SI. Stavridis, A. Papanikolaou, PD. Symeonides, J. Pournaras
Έκθεμα στο International Congress Hand-Upper Limb and Microsurgery,
Σάμος 7-10 Σεπτεμβρίου 2005
This is a case report of an 83-old man, who sustained a 3-part humeral subcapital fracture leading to severe upper limb ischaemia due to axillary artery compression by the medially displaced humeral shaft. Following surgical decompression and a shoulder hemiarthroplasty the upper limb circulation was restored and the good patency of the axillary artery was confirmed by angiography
B. 19
ΑΡΘΡΙΤΙΔΑ ΤΗΣ ΒΑΣΙΚΗΣ ΑΡΘΡΩΣΗΣ ΤΟΥ ΑΝΤΙΧΕΙΡΑ ΚΑΙ ΤΕΝΟΝΤΙΤΙΔΕΣ ΤΟΥ ΑΝΤΙΧΕΙΡΑ
Π. Γκιβίσης
Ανακοινώθηκε στο διεθνές συνέδριο για την Ιατρική των Μουσικών, Θεσσαλονίκη 7-9 Απριλίου 2006
The Thumb is the most valuable contributory member of the hand. A great deal of what the rest of man’s body does is to place the hand with its thumb at a chosen site to manipulate the environment.
Painful instability of the joint before the onset of arthritis has been relatively ignored, probably because the arthritic CMC joint has drawn so mach attention in the literature. The etiology of the instability is:
Trauma, Rheumatoid arthritis, Paralytic conditions, Ehlers – Danlos syndrome, Bennett’s fracture, Rolando fracture, Trapezium fracture, Injuries to the ligaments may be complete or partial.
The more extensive the tear the greater the displacement.
Accurate diagnosis is the most difficult aspect. There may be minimal detectable abnormality on clinical and radiographic examination.
The differencial diagnosis for instability is: De Qurvain tenosynovitis ,Occult scaphoid fracture,MP joint sprain, Carpal tunnel syndrome
The purpose of treatment is to restore joint stability, so we can, kill the pain, correct mechanical imbalance of the tendons and avoid early degenerative change
Β. 20
DEVELOPMENT OF A NOD-SCID -HU ANIMAL MODEL TO INVESTIGATE WALDENSTRÖM’S MACROGLOBULINEMIA.
S. Tsingotjidou, S.E. Siotou, E. Emmanouilides, S.D. Sotiropoulos, P.T. Poutahidis, X.A. Xagorari, P. Givissis, F.A. Fassas, A.A.Anagnostopoulos
Ανακοινώθηκε στο 11th Congress of the European Hematology Association.
Amsterdam, June 15-18, 2006
Waldenstrom’s macroglobulinemia (WM) is a B-cell lymphoproliferative disorder characterized by predilection for bone marrow involvement and secretion of IgM paraprotein. The purpose of this study is to establish an animal model mimicking closely the disease in humans. Recently, an in vivo model for WM was created by inoculating bone marrow (BM) cells from WM patients directly into fetal bone chips pre-implanted into SCID mice (Tassone et al., 2005). We implanted into NOD-SCID mice human cancellous bone obtained from adults undergoing total hip arthroplasty or hemiarthroplasty. Cancellous bone was harvested in compact cores from the femoral head and was implanted in the hindlimb muscles of ten NOD-SCID mice. Mice were used when 6 to 8 weeks of age (25 – 30 grams). The size of the bone implant was between 16 and 22 mm3. Eight to twelve weeks after the bone implantation, 3-5 X 106 WM cells freshly harvested from a WM patient were injected i.m. very close to the bone implant into 4 mice, and 1X 106 cells from the same WM patient were injected i.v. into the tail vein of 2 mice bearing human bone implants. Also, two freshly harvested BM core biopsies from a patient with active WM were implanted as described. All animals had a human bone fragment from non WM individuals in the opposite hindlimb. Tumor progression was determined by monitoring human immunoglobulin M (IgM) levels in murine plasma. Immunohistopathologic evaluation was performed on the human bone grafts, and murine tissue including the femurs, and tibia, the brain, liver, spleen, lung and kidney. One out of four mice injected i.m. into the bone fragment vicinity with WM cells showed elevated levels of human IgM indicative of the development of the disease. One out of two i.v. injected mice had elevated IgM one month following the injection of the WM cells. Both mice implanted with the bone marrow core biopsies showed a declining level of IgM directly after the implantation of the biopsy, but 3 months following the implantation IgM started increasing. 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 and the human bone graft opposite to the injected/implanted site. The stain was present in the cytoplasm and/or the surface of the positive cells. Mice may need to be followed for more extended periods of time to fully assess the pattern of WM growth in this model. In conclusion, this SCIC-hu WM model more closely resembles the human disease and allows us to study the biology of the malignant cells in their native BM microenvironment.