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Volume 2, Issue 2, June 2018

Οriginal Article JRPMS, Vol 2, No 2, June 2018, p.39-45
Femoral stem sagittal balance - Do we need a new entry point?
Meletis Rozis, Mathaios Bakalakos, Vasilios D Polyzois, John Vlamis, Spyros Pneumaticos
Keywords: Femoral stem, Entry point, THA, Sagittal balance
Objectives: Femoral stem positioning is of great importance in hip arthroplasty. Straight stem sagittal balance gains recently more attention in the literature. Methods: We performed a both clinical and cadaveric study in order to identify a possible ideal stem entry point at the level of the proximal femur, that ensures an optimal sagittal stem centering. We compared the sagittal tilt of 52 patients with femoral stem implantation in post-operative x-rays, dividing them in two groups depending on posterior neck cortex perforation. Subsequently, femoral neck osteotomy was performed in 40 cadaveric femurs. After placing an average straight stem, measurements of stem axis and femoral neck were made, in order to identify a possible area that could be used as a landmark, through which an optimal sagittal centering could be achieved. Results: Based on our results, stem sagittal tilt differed significantly when posterior neck was spared. In cadaveric evaluation, when posterior neck cortex was not perforated, the tip of stem was in contact with the posterior diaphysis cortex, thus malpositioned in the sagittal plane. We additionally found a statistically significant difference between neck centre and a) stem posterior boarder and b) neck posterior cortex distance. Conclusions: We conclude that placing the femoral stem just posteriorly to the posterior neck cortex, seems to be a good technique in order to achieve optimal sagittal balance of the femoral component.
Mini Review JRPMS, Vol 2, No 2, June 2018, p.46-52
Prevention of orthopaedic infection in spine surgery
Effrosyni Koutsoumpeli, Nikolaos Koutsoumpelis
Keywords: Prevention, Spine surgery, Surgical site infection
Surgical site infection (SSI) in spine surgery is a complication that increases not only the time of patient-recovery and the mortality but also the duration of hospitalization and subsequently the total hospital costs. The objective of this review is to identify the preventable risk factors, to reduce SSI in spine surgery. There are several factors that are associated with an increased risk of postoperative SSI. Some of them are associated with the health status of patient (ASA score >2, diabetes, obesity, smoking, urinary tract infection or incontinence, hypertension), while others with the surgical procedure (hand and instrument antisepsis, revision surgery, invasiveness, CSF leak, dural tear, blood loss, transfusion) and the compliance of the patient. Preoperative patient optimization and perioperative strategies can minimize the risk of SSI. Understanding the pathogenesis is essential to develop prevention strategies and improve surgical outcomes.
Review Article JRPMS, Vol 2, No 2, June 2018, p.53-57
Clinical consequences of pseudotumors in hip arthroplasty
Georgios I. Karagiannis
Keywords: Total hip arthroplasty, Metal-on-metal, Pseudotumor, Hip revision, Metal ions
The occurrence of pseudotumors currently constitutes an important topic of interest among orthopaedic surgeons who prefer metal on metal arthroplasty and especially hip resurfacing arthroplasty. Adverse reactions to metal ions are associated with the formation of such lesions and the orientation of implants has also been implicated in their pathogenesis. The diagnosis of pseudotumors is as difficult as complex. There is a variety of symptoms and patients with mild or tolerable pain may not seek medical attention. Revision surgeries may be the only solution in some cases. The goal of this article is to review the clinical presentation, prognosis of pseudotumors and associated complications, based on evidence published in the literature.
Οriginal Article JRPMS, Vol 2, No 2, June 2018, p.58-61
Incidence and anatomic location of fractures resulting from static line parachuting in the Greek Army Forces: A retrospective study
Filippos Zigras, Spilios Dellis
Keywords: Parachute, Paratrooper, Parachuting fracture, Ankle brace
Objectives: The incidence and patterns of parachuting fractures were investigated in Greek Armed Forces and compared to those of other studies in an attempt to assess the safety of parachuting. Methods: Data of 26.429 military static line parachute (SLP) jumps on 4019 paratroopers were collected by the official archive of the Greek parachuting military school during a 2 year period. Results: The total number of fractures was 55 in 26.429 SLP jumps. The overall rate was 2,1 fractures per 1000 descents. The fracture rate for the recruits, within the 18-30 year old group (5,3 fractures per 1000 jumps) was significantly higher (P<0,0005) than for the officers, the 30-60 year old group (1,1 fractures per 1000 jumps). Ankle fractures were the most common, accounted for 47,3% of the cases. Fracture - dislocation of the shoulder might be the new “paratroopers’s fracture”, which was encountered in 14,5% of the cases. Conclusion: We conclude that our data compares favorably with other studies except for higher rate of ankle fracture. It is recommended that a parachute ankle brace (PAB) should be worn by all paratroopers, especially those with lack of experience.
Case Report JRPMS, Vol 2, No 2, June 2018, p.62-66
Bilateral iliac stress fracture in a young male Military cadet: report of an unusual case
Christos Apergis, Georgios Bekas, Christos Zafeiris, Terpsithea Koureta, Konstantinos Raptis
Keywords: Bilateral fractures, Iliac fractures, Stress fractures, Fractures in military population
Stress fractures are common in highly active people, such as athletes or the military population and occur more frequently in the tibia and especially the tarsal and metatarsal bones. Concomitant bilateral presentation is rare and especially bilateral iliac bone stress fracture has never been reported in the current English literature. We present a case of a young Air Force cadet with acute onset of bilateral hip pain, while participating in the routine military training program. Clinical examination, radiologic evaluation and MRI established the diagnosis of bilateral iliac bone stress fracture. The patient followed conservative treatment with partial weight bearing using crutches and the symptoms disappeared after a 3 month period.
Case Report JRPMS, Vol 2, No 2, June 2018, p.67-71
Acute compartment syndrome of the foot after an ankle sprain: a case report
Christos Christoforidis, Panagiotis Lepetsos, Stamatios Papadakis, Anastasios Gketsos, Theodoros Balfousias, George Macheras
Keywords: Acute compartment syndrome, Ankle sprain,Fasciotomy, Muscle necrosis, Intracompartmental pressure
The aim of this study is to report the case of a patient with an acute foot compartment syndrome after an ankle sprain, discussing the diagnostic challenges and rarity of such an uncommon complication of a very common and low-trauma event. A 19-year old young man presented at the emergency department for a twisting injury of his left ankle. Physical and radiological evaluation revealed a 2nd degree lateral ankle sprain and the patient was treated conservatively. Two days later, the patient returned to the emergency department, late at night, with worsening and excruciating pain of his left foot and inability to walk. Physical evaluation showed severe swelling of the left foot and decreased range of active and passive motion. X-rays and CT scan were negative for fractures. An emergency fasciotomy of the lateral and medial compartment of the foot was performed and necrotic muscle parts were removed. Postoperatively, patient’s symptoms were controlled and a week later he was discharged from the hospital. Twelve months later, the patient is pain-free with full range of motion of his left ankle and foot.