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REDUCTION OF POSTOPERATIVE SPINAL INFECTIONS BASED ON AN ETIOLOGIC PROTOCOL
Cristodoulou A.G., Givissis P., Symeonidis P.D., Karataglis D.,
Pournaras J.
Δημοσιεύθηκε στο Clin. Orthop. Relat. Res. 2006 Mar, Vol. 444,
pp. 107-113
Impact Factor: 2.533
Acute postoperative spinal infections are serious complications. We saw a sudden increase in the infection rate in our unit during a 6-month period. This led us to construct an assessment protocol combining risk factors into a mnemonic we named the “Nine Ps Protocol” (patient-related factors, personnel, place, preoperative length of stay, procedure, prosthetics, prophylaxis, packed red blood cells, and pus cultures). We reviewed 102 consecutive patients having spine surgery in three sequential 6 month periods: Group A included 34 patients before the outbreak of infection and Group B included 26 patients during the outbreak of infection. We prospectively applied the protocol in 26 patients (Group C) after the outbreak. After the implementation of the protocol the infection rate dropped from 16.7% (Group B) to 3.6% (Group C). Increased risk factors for postoperative infection included advanced age, posterior instrumented fusion, high allogenic blood transfusion rates, and suboptimal sheet and dressing changing conditions. We propose the Nine Ps Protocol as a useful clinical tool for the etiologic assessment and prevention of spinal infections. Level of Evidence: Prognostic study, Level II (Lesser quality prospective study [eg, patients enrolled at different points in their disease or < 80% followup]). Please see Guidelines for Authors for a complete description of levels of evidence.
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NEGLECTED TRANS-SCAPHOID TRANS-STYLOID VOLAR DISLOCATION OF THE LUNATE . LATE RESULT FOLLOWING OPEN REDUCTION AND K-WIRE FIXATIO
Givissis P., Christodoulou A., Chalidis B., Pournaras J.
Δημοσιεύθηκε στο J Bone Surg. Br. 2006 May, Vol. 88(5), pp. 676-680
Impact Factor: 2.832
A rare case of radiocarpal dislocation is presented. The lunate and proximal pole of the scaphoid were displaced in a volar and proximal direction. The injury was missed initially and the patient was subsequently operated on six weeks later. Open reduction and internal fixation of the scaphoid was performed and this was followed by an uneventful postoperative period, with a satisfactory functional outcome at the eight-year follow-up, despite carpal instability non-dissociative-dorsal intercalated segmental instability configuration of the carpus. We believe that although open reduction in neglected cases carries the potential risks of avascular necrosis and nonunion of the affected carpal bones, an attempt should be made to restore the anatomy of the carpus.
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MENISCAL TEAR CHARACTERISTICS IN YOUNG ATHLETES WITH A STABLE KNEE: ARTHROSCOPIC EVALUATION
Terzidis I.P., Christodoulou A., Ploumis A., Givissis P., Natsis K., Koimtzis M.
Δημοσιεύθηκε στο AM J Sports Med 2006 July, Vol. 34(7), pp. 1170-1175.
Impact Factor: 3,792
BACKGROUND: There has been great interest in the literature regarding meniscal tears in unstable knees, but there is not as much information available on stable knees. PURPOSE: To report the characteristics of isolated meniscal tears (type and location) in athletes with intact cruciate ligaments. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Arthroscopic surgery was performed on 314 (83.1%) knees in the acute phase ( < 6 weeks) of injury and on 64 (16.9%) knees more than 6 weeks after injury for a total of 364 athletes (378 knees). Cooper’s classification was used to classify the meniscal tears according to the type and location. RESULTS: Overall, 262 of 378 tears (69.3%) were located in the medial meniscus and 116 (30.7%) in the lateral meniscus. Vertical tears (77.5%) were significantly more frequent than were horizontal tears (22.5%; chi(2) test, P < .001). A total of 23.2% of tears involved the peripheral zones (zone 0 or 1), and tears that extended into the posterior horn accounted for 75.7%. Regarding the tear shape between male and female athletes, on both sides there were no statistically significant differences in the percentage of horizontal, bucket-handle, longitudinal, or radial tears. CONCLUSION: The characteristics of isolated meniscal tears differ with regard to the sport, sex, and tear location and type from those seen in unstable knees. This knowledge is useful in knee injury management.
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SOFT-TISSUE MYOEPITHELIOMA OF THE HYPOTHENAR REGION: A CASE REPORT.
Pilavaki M, Givissis P, Tzarou V, Palladas P, Pournaras J.
Δημοσιεύθηκε στο J Hand Surg [Am]. 2007 May-Jun;32(5):674-6
Impact Factor: 1,354
Myoepithelial tumors only recently have been recognized as occurring primarily in soft tissue, and only a few cases have been described in the literature. The occurrence of these tumors in the hand is even more limited. In this article, we review the clinical, radiologic, and histologic features of a benign myoepithelioma of the hypothenar region of the left hand.
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PSEUDOANEURYSM OF THE POPLITEAL ARTERY COMPLICATED BY PERONEAL MONONEUROPATHY IN A 4 YEAR-OLD CHILD: A CASE REPORT
Megalopoulos A., Vasiliadis K., Siminas S., Givissis P.,Vargiami E., Zafeiriou D., Botsios D., Betsis D.
Δημοσιεύθηκε στο Surgery Today; Surg Today (2007) 37:798–801
Impact Factor: 1,224
Pseudoaneurysms of the popliteal artery (ΡΡΑ) are very rare in the pediatric population, as only 10 similar cases have been reported to date. We present the case of a 4-year-old boy, who presented a painful palpable mass in the right popliteal fossa and a wild painless drop foot as well as difficulties in toe walking on the same side. The diagnosis of a ΡΡΑ was established employing triplex ultrasound, and CT-angiography. The mechanism responsible for the lesion was presumably a blunt trauma, occurring two years previously. Thorough preoperative evaluation excluded the possibility of a self-immune process or a bone tumor in the region. Neurological examination demonstrated a mild, isolated, peripheral mononeuropathy of the right peroneal nerve. Surgical repair was therefore carried out, employing an autologous reversed great saphenous vein graft. Postoperative course was uneventful, peripheral neuropathy along with the drop foot, resolved completely one month after surgery and after 3 years of follow-up, the patient has a patent graft and a fully functioning limb. PPAs are rare entities, especially in children, and trauma is the predominating mechanism. PPAs should be treated immediately after diagnosis, because complications of these lesions are related to high rates of functional impairment or even limb loss.
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Pulsatile bleeding during closed vertebral biopsy
A Christodoulou, E Samoladas, P Givissis, J Pournaras.
Δημοσιεύθηκε στο Acta Orthop Belg. 2007, N° 6 (Vol 73/6) p.778-779
Impact Factor:0,403
Needle biopsy of the spine yields a higher diagnostic
accuracy when large bore instruments are used. The
Harlow Wood vertebral biopsy needle, for instance,
has an internal diameter of 3 mm. However, pulsatile
bleeding may occur, especially when a tumoral lesion
is biopsied. The authors noted 9 pulsatile bleedings
in 238 needle biopsies (3.8%). A piece of Surgicel‚,
brought in with the trephine guide and the obturator,
was an efficient treatment. A second piece of
Surgicel‚, soaked in 1:10.000 adrenaline, was sometimes
necessary.
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Late Results of Absorbable Pin Fixation in the Treatment of Radial Head Fractures
.
Givissis PK, Symeonidis PD, Ditsios KT, Dionellis PS, Christodoulou AG.
Δημοσιεύθηκε στο Clin Orthop Relat Res. 2008 May;466(5):1217-24
Impact Factor: 2,533
The use of bioabsorbable pins with prolonged degradation periods for fracture fixation has raised concerns about adverse soft tissue reactions, including seromas, discharging sinuses, or osteolytic changes. We asked whether bioabsorbable pins of self-reinforced polylactic acid polymer used in radial head fractures resulted in such reactions. We retrospectively reviewed 21 patients followed a minimum of 36 months (mean, 81 months; range, 36-136 months). There were nine Mason II, 10 Mason III, and two Mason IV fractures, which were evaluated clinically and radiographically. All fractures healed well with no radiographic signs of osteolysis. The mean Mayo Elbow Performance score was 93.8 (range, 20-100), which is comparable to the outcome of historical groups with radial head arthroplasty. The mean range of flexion of the elbow was 9 degrees to 132 degrees , with 79 degrees pronation and 77 degrees supination. The grip strength of the operated arm was not affected in comparison to the contralateral arm (mean range, 38.6 versus 40.9 kg). No material-related adverse effects were observed during and beyond the degradation period. Our data suggest concerns about soft tissue or bony reactions from these materials in radial head fractures are not justified.
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INTERPOSITION ARTHROPLASTY OF THE FIRST MTP JOINT WITH A FASCIA LATA ALLOGRAFT
P Givissis, P Symeonidis , A Christodoulou , J Pournaras
Δημοσιεύθηκε στο J Am Podiatr Med Assoc. 2008 Mar-Apr;98(2):160-3. Review.
Impact Factor: 0,598
A new technique for interposition arthroplasty of the first metatarsoplalangeal joint is described. It involves minimal resection of the base of the proximal phalanx and the use of a fascia lata allograft. The method is simple, safe, and easily reproducible. In selected cases it can offer restoration of pain-free motion in a nonsalvable joint.
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SUCTION DURING ORTHOPAEDIC SURGERY. HOW SAFE IS THE SUCTION TIP?
Givissis P, Karataglis D, Antonarakos P, Symeonidis PD, Christodoulou A.
Δημοσιεύθηκε στο Acta Orthop Belg. 2008 Aug;74(4):531-3.
Impact Factor: 0,401
The use of a suction system is mandatory in most orthopaedic procedures. In the unlikely event of contamination of the system, deep wound infection could occur, jeopardising the operation. We have prospectively studied 50 patients who underwent elective and orthopaedic trauma procedures during which a suction system was used. At the end of each procedure the suction catheter tip was sent for culture and microbiology. The suction tips showed bacterial contamination in 27 cases (54%). Staphylococcus species were responsible in 21 cases (77.8%). The tip was contaminated in only 1/11 procedures lasting less than one hour (9.1%), as compared with 26/39 procedures when operative time exceeded one hour (66.7%). However, deep wound infection was recorded in only one case. We believe that despite the low risk of deep wound infection, changing the suction tip every hour in long orthopaedic procedures or using the on/off switch is well justified in an effort to minimise the chances of deep wound infection.