The purpose of this study was to illustrate the usefulness of ultrasound in the early diagnosis o... more The purpose of this study was to illustrate the usefulness of ultrasound in the early diagnosis of occult scaphoid fractures. Forty-eight patients with clinical symptoms of scaphoid fracture and negative initial X-rays were examined. All patients underwent ultrasonography in the emergency room (ER). After 14 days, a computed tomography (CT) scan was performed, which confirmed or not the initial suspicion of fracture. Twenty-two patients were found with subperiosteal hematoma, while six also had cortical discontinuity. The sensitivity of ultrasound in the diagnosis of occult scaphoid fractures was 90% and the specificity was 85.7%. The positive prognostic value was 81.8%. The authors support the use of the scaphoid ultrasound only under strict circumstances. If subperiosteal hematoma or cortical discontinuity is present, there is a high likelihood of scaphoid fracture. On the contrary, if the ultrasound is negative and symptoms persist, the patient will require a CT scan or magnetic resonance imaging for definitive diagnosis. (Journal of Surgical Orthopaedic Advances 28(1):1-9, 2019).
To the Editor I t was our pleasure to read the article by Saito et al, who investigated the poten... more To the Editor I t was our pleasure to read the article by Saito et al, who investigated the potential of an intraoperative threedimensional hologram with mixed reality (MR) techniques in liver surgery. The authors defined MR as ‘‘the result of blending the physical world with the digital world,’’ citing the articles by Condino et al and Tepper et al. However, supposing that this definition is correct, what is the difference between MR and augmented reality (AR)? In the article by Condino et al it was stated that MR was used for developing a simulator of orthopedic open surgery. However, a clear definition of MR was not given and, moreover, in the figure describing the flowchart of the experiment, the authors used the term ‘‘AR’’ and not ‘‘MR.’’ Tepper et al did not also provide a clear definition of MR to describe its specific characteristics, but simply stated that it combines AR with virtual reality. The authors also argued that AR does not permit interaction with 3-dimensional data packets. However, AR is a technology which superimposes digital with real objects and does permit interaction with both types of objects. MR also superimposes digital with real content, but, in contrast with AR, enables users to perceive depth and perspective of the virtual elements. Sauer et al published a paper in Annals of Surgery, according to which MR was implemented in visceral surgery. Gheza and Raimondi commented on this paper, stating that Sauer et al had in fact experienced ‘‘AR’’ and not ‘‘MR.’’ As a response to this comment, it was stated that, in the paper by Sauer et al, the difference between AR and MR was visualized: the former technology overlays digital content on real world, whereas the latter permits coexistence of digital with real world, along with interaction. These definitions also disagree with the 4–6
Objectives: The aim of this study was to analyze the association of knee OA with bone mineral den... more Objectives: The aim of this study was to analyze the association of knee OA with bone mineral density (BMD) and vitamin D serum levels in postmenopausal women. Methods: A cross-sectional study including 240 postmenopausal women with knee OA was conducted. Demographic data were recorded along with balance and functionality scores. Knee OA severity was assessed by the radiological Kellgren & Lawrence scale. BMD and T-scores were calculated in hips and lumbar spine. Serum levels of vitamin D were also measured. Results: High BMI (p<0.005), high number of children (p=0.022) and family history of hip fracture (p=0.011) are significantly associated with knee OA severity. Lumbar spine OP is negatively associated with knee OA (p<0.005). A significant difference was detected between vitamin D deficiency and severe knee OA, adjusted for BMD [OR (95%CI); 3.1 (1.6-6.1), p=0.001]. BMD does not affect the relationship of vitamin D levels in relation to OA and vitamin D levels do not affect the relationship of BMD with OA. Conclusions: Low BMD has a protective role against knee OA while vitamin D deficiency contributes significantly to knee OA severity. However, the association between OA and OP is not affected by vitamin D deficiency and the association of OA and vitamin D serum levels is not affected by BMD.
Background To determine if double needle ultrasound-guided hydrodissolution and aspiration of int... more Background To determine if double needle ultrasound-guided hydrodissolution and aspiration of intratendinous calcification is more effective treatment than blind subacromial corticosteroid injection. Methods A prospective randomised comparative clinical study of 32 patients suffering from chronic symptomatic calcific tendinosis of the supraspinatous tendon. Group A (16 patients) received a double needle ultrasound-guided aspiration of the calcification, while group B (16 patients) underwent a blind subacromial betamethazone injection. As far as group A, we attached a syringe in the first needle, including 10cc. of normal saline (N/S), that we injected targeting the calcium deposit. Then we tried to achieve consecutive aspirations through the second needle. Results Patients were evaluated by an independent researcher who measured the visual analogue scale (VAS) 100/100 and the range of motion (ROM): a. before, b. 10 days and c. 6 months after the injection. In most cases of group A, we observed a noticeable amount of aspirated milky or mixed white-red coloured fluid at the bottom of the syringe. This fact proves right and effective guidance of the ultrasound. After six months, we documented full –or almost full- decline (VAS: 0–20/100) of the symptoms in 62.75 % of the group A patients and in 43.75% of the group B patients. The 6 month9s mean VAS fall rate was 45/100 in group A and 33/100 in group B. Corticosteroid injected patients proved to have better outcome inside the first 10 days. The mean abduction of the humerus in the 6 month9s follow-up was 110 degrees (from 77.5 degrees prior to aspiration) for the group A and 85 degrees for group B (from 72.5 degrees -prior). Conclusion Double needle dissolution -and aspiration- with N/S represents better long-term results (regarding ROM and pain release) than blind corticosteroid injection in the treatment of chronic symptomatic calcific tendinosis. Level I
Back pain is a common and debilitating disorder with largely unknown underlying biology. Here we ... more Back pain is a common and debilitating disorder with largely unknown underlying biology. Here we report a genome-wide association study of back pain using diagnoses assigned in clinical practice; dorsalgia (119,100 cases, 909,847 controls) and intervertebral disc disorder (IDD) (58,854 cases, 922,958 controls). We identify 41 variants at 33 loci. The most significant association (ORIDD = 0.92, P = 1.6 × 10−39; ORdorsalgia = 0.92, P = 7.2 × 10−15) is with a 3’UTR variant (rs1871452-T) in CHST3, encoding a sulfotransferase enzyme expressed in intervertebral discs. The largest effects on IDD are conferred by rare (MAF = 0.07 − 0.32%) loss-of-function (LoF) variants in SLC13A1, encoding a sodium-sulfate co-transporter (LoF burden OR = 1.44, P = 3.1 × 10−11); variants that also associate with reduced serum sulfate. Genes implicated by this study are involved in cartilage and bone biology, as well as neurological and inflammatory processes.
Journal of Bone and Joint Surgery-british Volume, 2017
Background We searched -in transverse ultrasound view- the value of the difference (Delta) betwee... more Background We searched -in transverse ultrasound view- the value of the difference (Delta) between -proximal to the tunnel- CSA (a) and -in the tunnel9s inlet- CSA (b) for separating normal from abnormal median nerves. Methods 51 patients –suspicious for CTS- underwent Phalen and Tinnel tests. After that, we used a high frequency ultrasound to measure CSAa, CSAb and Delta CSA in both hands. 33 of our 51 patients did not experience any clinical symptoms at the contralateral hand, so that we could perform a comparative study of normal and pathological median nerves (on the same patients). Then, all of them completed a Q-DASH questionnaire and a visual analogue scale (VAS 100/100) and they carried through with a nerve conduction study (NCS). Results We found that a CSAb more than 0,010 and a Delta CSA > 0,003 are both very sensitive findings for CTS, but only DeltaCSA has good specificity. Comparing to NCS the Delta CSA>0,003 had no statistical difference in sensitivity, specific...
Journal of Bone and Joint Surgery-british Volume, 2017
Introduction We investigated whether grey scale early ultrasonography could be used for the accur... more Introduction We investigated whether grey scale early ultrasonography could be used for the accurate initial diagnosis of non displaced occult scaphoid fractures. Methods This is a prospective blind clinical study that includes 36 patients that came to the emergency room with suspected clinical symptoms for scaphoid fracture but negative initial X-ray9s. After that, a high resolution ultrasonography (without Doppler) was performed. Both wrists of each patient were examined, for comparison. After 14 days, new X-rays were performed, which compared to the early sonographic results of the patients. Results 25 out of the 36 patients that were included in the study found with subperiosteal hematoma, while 11 of them had also cortical discontinuity. Besides, follow-up X-rays were diagnostic of fracture in 22 patients. 7 patients were ultrasound-positive for fracture but their late X-ray9s remained negative, while 4 patients were ultrasound-negative with positive X-ray9s. We performed a CT ...
Journal of Bone and Joint Surgery-british Volume, 2017
Introduction We compared ultrasound guided methylprednizolone-lidacaine infiltrations around infl... more Introduction We compared ultrasound guided methylprednizolone-lidacaine infiltrations around inflammatory area of plantar aponeurosis with systematic use of NSAID9S. Also, we investigated the reliability of the sonographic criteria (a. swelling of aponeurosis more than 20% in comparison to the healthy foot, b. effusion around aponeurosis, c. calcium deposits) most used to identify plantar fasciitis in clinically suspicious patients. Methods A prospective randomised controlled clinical trial, including 28 patients (mean age: 47 years, range: 36–65 years, 85% females) with typical clinical symptoms of plantar fasciitis. All of these patients undertook a soft tissue ultrasonography of the plantar aponeurosis, without Doppler. Then, we randomly divided our sample in 2 groups, group A (14 patients) and group B (14 patients). In group A patients we performed an ultrasound guided injection –in transverse view- around the swollen part of aponeurosis, while we managed group B patients with p...
The purpose of this study is to classify the pitfalls, obstacles and complications that occur dur... more The purpose of this study is to classify the pitfalls, obstacles and complications that occur during distraction histogenesis and also to evaluate the risk factors likely to lead to these problems. In this study we have retrospectively and prospectively studied the difficulties occurring during distraction histogenesis since 2003. We studied 74 patients (mean age 19,2 years, age range 11–60 yrs) whose 97 limbs segments were lengthened. 21 patients underwent angular correction, 42 patients limb lengthening, 17 patients both angular correction and limb lengthening and 14 non-union correction. In 46 cases, we used the Ilizarov fixator, in 38 the Taylor Spatial Frame and in 10 cases the monolateral external fix-ator Orthofix LRS. Difficulties that occured during limb lengthening were subclassified into pitfalls, obstacles, and complications. For all cases we have recorded the time of appearance of all these difficulties and have associated them with the severity of the initial deformity...
Between 1986 and 1999, 94 patients (96 hips) including 31 male and 63 female (mean age 59.5 years... more Between 1986 and 1999, 94 patients (96 hips) including 31 male and 63 female (mean age 59.5 years), with massive bone loss had a revision hip arthroplasty using an allograft-prosthesis composite (APC). A previous history of infection was present in 21 of these cases. At an average follow-up of 11 years (range, 8 to 20 years), 72 patients were alive, 21 patients died, and 1 patient was lost to follow-up. Major complications occurred in 33 cases: femoral stem loosening (12); dislocation (15); periprosthetic fracture (10); and infection (7). Further revision surgery was performed in 21 of the 96 cases including revision of the acetabular component (3), femoral APC (16) or both (2). The 10 year survival of the APCs was 68.8% (95% CI 58.6%–79%, 26 cases remaining at risk). There was no statistically significant difference in survival time between gender, age, indication for APC (including infection), surgical approach and APC technique. Statistically significant factors negatively impact...
Journal of Bone and Joint Surgery-british Volume, 2017
Background To investigate the new theory of hydroneurolysis and hydrodissection in the treatment ... more Background To investigate the new theory of hydroneurolysis and hydrodissection in the treatment of carpal tunnel syndrome (CTS). Independently of the fluid hydrodissolution works due to mechanical forces and it may have some positive effects in patients with ischemic damage caused by scar tissue pressure at the nerve9s surface. Methods A prospective blind clinical study of 31 patients suffering from carpal tunnel syndrome, established by nerve conduction studies and clinical tests. 14 patients (out of 29), who refused to undergo an open operation as a treatment to their disease at this point of time, were treated with a simple ultrasound-guided injection at the proximal carpal tunnel. In order to exclude the biochemical influence of the fluid in the treating disease we choosed to infiltrate 3 cc. of normal saline 0,9%. In the follow-up period our group was asked to answer to a new Q-DASH score and visual analogue scale (VAS) 100/100 in 2, 4 and 8 weeks. Results At the end of the se...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
The authors present the results of 57 revisions in 54 patients performed for aseptic loosening of... more The authors present the results of 57 revisions in 54 patients performed for aseptic loosening of cemented total hip arthroplasties. The Charnley technique and implants were used in all cases. The mean follow-up was 8 years and 6 months with a minimum of 5 years. The failure rate for the femoral component was 15% and for the acetabular component it was 19.1%. The cumulative success rate at 8 years was 81.7% for the femoral component and 83.4% for the acetabular component.The Charnley technique and implants were found efficient for revision of cemented total hip arthroplasties in the long term, but there are limitations to their use in the presence of severely compromised bone stock.
The purpose of this study was to illustrate the usefulness of ultrasound in the early diagnosis o... more The purpose of this study was to illustrate the usefulness of ultrasound in the early diagnosis of occult scaphoid fractures. Forty-eight patients with clinical symptoms of scaphoid fracture and negative initial X-rays were examined. All patients underwent ultrasonography in the emergency room (ER). After 14 days, a computed tomography (CT) scan was performed, which confirmed or not the initial suspicion of fracture. Twenty-two patients were found with subperiosteal hematoma, while six also had cortical discontinuity. The sensitivity of ultrasound in the diagnosis of occult scaphoid fractures was 90% and the specificity was 85.7%. The positive prognostic value was 81.8%. The authors support the use of the scaphoid ultrasound only under strict circumstances. If subperiosteal hematoma or cortical discontinuity is present, there is a high likelihood of scaphoid fracture. On the contrary, if the ultrasound is negative and symptoms persist, the patient will require a CT scan or magnetic resonance imaging for definitive diagnosis. (Journal of Surgical Orthopaedic Advances 28(1):1-9, 2019).
To the Editor I t was our pleasure to read the article by Saito et al, who investigated the poten... more To the Editor I t was our pleasure to read the article by Saito et al, who investigated the potential of an intraoperative threedimensional hologram with mixed reality (MR) techniques in liver surgery. The authors defined MR as ‘‘the result of blending the physical world with the digital world,’’ citing the articles by Condino et al and Tepper et al. However, supposing that this definition is correct, what is the difference between MR and augmented reality (AR)? In the article by Condino et al it was stated that MR was used for developing a simulator of orthopedic open surgery. However, a clear definition of MR was not given and, moreover, in the figure describing the flowchart of the experiment, the authors used the term ‘‘AR’’ and not ‘‘MR.’’ Tepper et al did not also provide a clear definition of MR to describe its specific characteristics, but simply stated that it combines AR with virtual reality. The authors also argued that AR does not permit interaction with 3-dimensional data packets. However, AR is a technology which superimposes digital with real objects and does permit interaction with both types of objects. MR also superimposes digital with real content, but, in contrast with AR, enables users to perceive depth and perspective of the virtual elements. Sauer et al published a paper in Annals of Surgery, according to which MR was implemented in visceral surgery. Gheza and Raimondi commented on this paper, stating that Sauer et al had in fact experienced ‘‘AR’’ and not ‘‘MR.’’ As a response to this comment, it was stated that, in the paper by Sauer et al, the difference between AR and MR was visualized: the former technology overlays digital content on real world, whereas the latter permits coexistence of digital with real world, along with interaction. These definitions also disagree with the 4–6
Objectives: The aim of this study was to analyze the association of knee OA with bone mineral den... more Objectives: The aim of this study was to analyze the association of knee OA with bone mineral density (BMD) and vitamin D serum levels in postmenopausal women. Methods: A cross-sectional study including 240 postmenopausal women with knee OA was conducted. Demographic data were recorded along with balance and functionality scores. Knee OA severity was assessed by the radiological Kellgren & Lawrence scale. BMD and T-scores were calculated in hips and lumbar spine. Serum levels of vitamin D were also measured. Results: High BMI (p<0.005), high number of children (p=0.022) and family history of hip fracture (p=0.011) are significantly associated with knee OA severity. Lumbar spine OP is negatively associated with knee OA (p<0.005). A significant difference was detected between vitamin D deficiency and severe knee OA, adjusted for BMD [OR (95%CI); 3.1 (1.6-6.1), p=0.001]. BMD does not affect the relationship of vitamin D levels in relation to OA and vitamin D levels do not affect the relationship of BMD with OA. Conclusions: Low BMD has a protective role against knee OA while vitamin D deficiency contributes significantly to knee OA severity. However, the association between OA and OP is not affected by vitamin D deficiency and the association of OA and vitamin D serum levels is not affected by BMD.
Background To determine if double needle ultrasound-guided hydrodissolution and aspiration of int... more Background To determine if double needle ultrasound-guided hydrodissolution and aspiration of intratendinous calcification is more effective treatment than blind subacromial corticosteroid injection. Methods A prospective randomised comparative clinical study of 32 patients suffering from chronic symptomatic calcific tendinosis of the supraspinatous tendon. Group A (16 patients) received a double needle ultrasound-guided aspiration of the calcification, while group B (16 patients) underwent a blind subacromial betamethazone injection. As far as group A, we attached a syringe in the first needle, including 10cc. of normal saline (N/S), that we injected targeting the calcium deposit. Then we tried to achieve consecutive aspirations through the second needle. Results Patients were evaluated by an independent researcher who measured the visual analogue scale (VAS) 100/100 and the range of motion (ROM): a. before, b. 10 days and c. 6 months after the injection. In most cases of group A, we observed a noticeable amount of aspirated milky or mixed white-red coloured fluid at the bottom of the syringe. This fact proves right and effective guidance of the ultrasound. After six months, we documented full –or almost full- decline (VAS: 0–20/100) of the symptoms in 62.75 % of the group A patients and in 43.75% of the group B patients. The 6 month9s mean VAS fall rate was 45/100 in group A and 33/100 in group B. Corticosteroid injected patients proved to have better outcome inside the first 10 days. The mean abduction of the humerus in the 6 month9s follow-up was 110 degrees (from 77.5 degrees prior to aspiration) for the group A and 85 degrees for group B (from 72.5 degrees -prior). Conclusion Double needle dissolution -and aspiration- with N/S represents better long-term results (regarding ROM and pain release) than blind corticosteroid injection in the treatment of chronic symptomatic calcific tendinosis. Level I
Back pain is a common and debilitating disorder with largely unknown underlying biology. Here we ... more Back pain is a common and debilitating disorder with largely unknown underlying biology. Here we report a genome-wide association study of back pain using diagnoses assigned in clinical practice; dorsalgia (119,100 cases, 909,847 controls) and intervertebral disc disorder (IDD) (58,854 cases, 922,958 controls). We identify 41 variants at 33 loci. The most significant association (ORIDD = 0.92, P = 1.6 × 10−39; ORdorsalgia = 0.92, P = 7.2 × 10−15) is with a 3’UTR variant (rs1871452-T) in CHST3, encoding a sulfotransferase enzyme expressed in intervertebral discs. The largest effects on IDD are conferred by rare (MAF = 0.07 − 0.32%) loss-of-function (LoF) variants in SLC13A1, encoding a sodium-sulfate co-transporter (LoF burden OR = 1.44, P = 3.1 × 10−11); variants that also associate with reduced serum sulfate. Genes implicated by this study are involved in cartilage and bone biology, as well as neurological and inflammatory processes.
Journal of Bone and Joint Surgery-british Volume, 2017
Background We searched -in transverse ultrasound view- the value of the difference (Delta) betwee... more Background We searched -in transverse ultrasound view- the value of the difference (Delta) between -proximal to the tunnel- CSA (a) and -in the tunnel9s inlet- CSA (b) for separating normal from abnormal median nerves. Methods 51 patients –suspicious for CTS- underwent Phalen and Tinnel tests. After that, we used a high frequency ultrasound to measure CSAa, CSAb and Delta CSA in both hands. 33 of our 51 patients did not experience any clinical symptoms at the contralateral hand, so that we could perform a comparative study of normal and pathological median nerves (on the same patients). Then, all of them completed a Q-DASH questionnaire and a visual analogue scale (VAS 100/100) and they carried through with a nerve conduction study (NCS). Results We found that a CSAb more than 0,010 and a Delta CSA > 0,003 are both very sensitive findings for CTS, but only DeltaCSA has good specificity. Comparing to NCS the Delta CSA>0,003 had no statistical difference in sensitivity, specific...
Journal of Bone and Joint Surgery-british Volume, 2017
Introduction We investigated whether grey scale early ultrasonography could be used for the accur... more Introduction We investigated whether grey scale early ultrasonography could be used for the accurate initial diagnosis of non displaced occult scaphoid fractures. Methods This is a prospective blind clinical study that includes 36 patients that came to the emergency room with suspected clinical symptoms for scaphoid fracture but negative initial X-ray9s. After that, a high resolution ultrasonography (without Doppler) was performed. Both wrists of each patient were examined, for comparison. After 14 days, new X-rays were performed, which compared to the early sonographic results of the patients. Results 25 out of the 36 patients that were included in the study found with subperiosteal hematoma, while 11 of them had also cortical discontinuity. Besides, follow-up X-rays were diagnostic of fracture in 22 patients. 7 patients were ultrasound-positive for fracture but their late X-ray9s remained negative, while 4 patients were ultrasound-negative with positive X-ray9s. We performed a CT ...
Journal of Bone and Joint Surgery-british Volume, 2017
Introduction We compared ultrasound guided methylprednizolone-lidacaine infiltrations around infl... more Introduction We compared ultrasound guided methylprednizolone-lidacaine infiltrations around inflammatory area of plantar aponeurosis with systematic use of NSAID9S. Also, we investigated the reliability of the sonographic criteria (a. swelling of aponeurosis more than 20% in comparison to the healthy foot, b. effusion around aponeurosis, c. calcium deposits) most used to identify plantar fasciitis in clinically suspicious patients. Methods A prospective randomised controlled clinical trial, including 28 patients (mean age: 47 years, range: 36–65 years, 85% females) with typical clinical symptoms of plantar fasciitis. All of these patients undertook a soft tissue ultrasonography of the plantar aponeurosis, without Doppler. Then, we randomly divided our sample in 2 groups, group A (14 patients) and group B (14 patients). In group A patients we performed an ultrasound guided injection –in transverse view- around the swollen part of aponeurosis, while we managed group B patients with p...
The purpose of this study is to classify the pitfalls, obstacles and complications that occur dur... more The purpose of this study is to classify the pitfalls, obstacles and complications that occur during distraction histogenesis and also to evaluate the risk factors likely to lead to these problems. In this study we have retrospectively and prospectively studied the difficulties occurring during distraction histogenesis since 2003. We studied 74 patients (mean age 19,2 years, age range 11–60 yrs) whose 97 limbs segments were lengthened. 21 patients underwent angular correction, 42 patients limb lengthening, 17 patients both angular correction and limb lengthening and 14 non-union correction. In 46 cases, we used the Ilizarov fixator, in 38 the Taylor Spatial Frame and in 10 cases the monolateral external fix-ator Orthofix LRS. Difficulties that occured during limb lengthening were subclassified into pitfalls, obstacles, and complications. For all cases we have recorded the time of appearance of all these difficulties and have associated them with the severity of the initial deformity...
Between 1986 and 1999, 94 patients (96 hips) including 31 male and 63 female (mean age 59.5 years... more Between 1986 and 1999, 94 patients (96 hips) including 31 male and 63 female (mean age 59.5 years), with massive bone loss had a revision hip arthroplasty using an allograft-prosthesis composite (APC). A previous history of infection was present in 21 of these cases. At an average follow-up of 11 years (range, 8 to 20 years), 72 patients were alive, 21 patients died, and 1 patient was lost to follow-up. Major complications occurred in 33 cases: femoral stem loosening (12); dislocation (15); periprosthetic fracture (10); and infection (7). Further revision surgery was performed in 21 of the 96 cases including revision of the acetabular component (3), femoral APC (16) or both (2). The 10 year survival of the APCs was 68.8% (95% CI 58.6%–79%, 26 cases remaining at risk). There was no statistically significant difference in survival time between gender, age, indication for APC (including infection), surgical approach and APC technique. Statistically significant factors negatively impact...
Journal of Bone and Joint Surgery-british Volume, 2017
Background To investigate the new theory of hydroneurolysis and hydrodissection in the treatment ... more Background To investigate the new theory of hydroneurolysis and hydrodissection in the treatment of carpal tunnel syndrome (CTS). Independently of the fluid hydrodissolution works due to mechanical forces and it may have some positive effects in patients with ischemic damage caused by scar tissue pressure at the nerve9s surface. Methods A prospective blind clinical study of 31 patients suffering from carpal tunnel syndrome, established by nerve conduction studies and clinical tests. 14 patients (out of 29), who refused to undergo an open operation as a treatment to their disease at this point of time, were treated with a simple ultrasound-guided injection at the proximal carpal tunnel. In order to exclude the biochemical influence of the fluid in the treating disease we choosed to infiltrate 3 cc. of normal saline 0,9%. In the follow-up period our group was asked to answer to a new Q-DASH score and visual analogue scale (VAS) 100/100 in 2, 4 and 8 weeks. Results At the end of the se...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
The authors present the results of 57 revisions in 54 patients performed for aseptic loosening of... more The authors present the results of 57 revisions in 54 patients performed for aseptic loosening of cemented total hip arthroplasties. The Charnley technique and implants were used in all cases. The mean follow-up was 8 years and 6 months with a minimum of 5 years. The failure rate for the femoral component was 15% and for the acetabular component it was 19.1%. The cumulative success rate at 8 years was 81.7% for the femoral component and 83.4% for the acetabular component.The Charnley technique and implants were found efficient for revision of cemented total hip arthroplasties in the long term, but there are limitations to their use in the presence of severely compromised bone stock.
Uploads
Papers by George Babis