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Biomedical subjects

Christos K Yiannakopoulos

Publications and source records attributed to Christos K Yiannakopoulos.

18 recordsLinked to original sources
PubMed2006

Closed, locked intramedullary nailing of pediatric femoral shaft fractures through the tip of the greater trochanter.

BACKGROUND: Closed femoral nailing is universally accepted as the treatment of choice in almost all diaphyseal femoral fractures in adults. Numerous authors reported favorable results applying the same surgical technique in the adolescent patient group. Nevertheless, reports of complications such as avascular necrosis and alteration of the proximal femoral anatomy have dampened the initial enthusiasm. The purpose of this paper was to evaluate the possible effect of closed intramedullary nailing through the greater trochanter on the proximal femoral anatomy. METHODS: We report the results of intramedullary nailing in 20 skeletally immature patients (13 men and 7 women) with a mean age of 14.4 years (range, 11-16 years). All were treated with closed, reamed, percutaneously performed nailing, using the tip of the greater trochanter as the nail insertion point. The patients were followed for 29 months in average (range, 19-37 months). RESULTS: No major complication (limb length discrepancy, avascular necrosis, coxa valga) occurred during the observation period. All fractures healed clinically and radiographically within 9 weeks in average (8-13 weeks) and all patients returned to the preinjury activity level. The mean ATD difference was 1.10 +/- 3.51 (range, -5-7 mm, 95% CI -0,54/2,74, p = 0.177). The mean LTA distance difference was 0.3 mm (range, -6-5 mm, p = 0.158), the mean femoral length difference was 1.9 mm (-9-12 mm, p = 0.122) and the overall limb length difference was 1.4 mm (-25-20 mm, p = 0.178). The mean neck-shaft angle difference was 0.20 +/- 1.74 (range, -3-4, p = 0.612) and the mean neck width was 0.60 +/- 1.50 (range, -3-3, p = 0.09). Fourteen nails (70%) were removed within 13 months in average (range, 10-18 months) without any complications. CONCLUSION: This study showed that with strict adherence to a surgical technique that respects the growing proximal femur and its vascular anatomy, using the tip of the greater trochanter as an entry point to the femoral canal, the proven advantages of closed, intramedullary nailing can safely be offered to the adolescent patient population as well.

Adolescent↗
PubMed2005

Revision anterior cruciate ligament surgery using the over-the-top femoral route.

Primary anterior cruciate ligament (ACL) reconstruction is considered a successful surgical procedure, but the results reported for revision ACL surgery are less satisfactory. The most common cause of technical failure in primary reconstruction is tunnel misplacement, particularly on the femoral side, although an anterior placement of the tibial tunnel may lead to graft impingement and failure. Several technical problems are encountered during revision procedures. We describe a technique for revision ACL surgery using a special jig for preparing the tibial tunnel that references the apex and roof of the intercondylar notch and an over-the-top routing for proximal femoral placement. This combination avoids graft impingement at the tibial tunnel exit and circumvents the problems associated with further femoral tunnel preparation.

Anterior Cruciate Ligament↗
PubMed2005

Intraoperative arthroscopic suture anchor reloading.

The success of an arthroscopic procedure depends considerably on the successful and secure tying of arthroscopic knots, which reapproximate and stabilize avulsed or torn soft tissues to their original bed. Failure to perform appropriate knot tying may jeopardize the success of the operation. We describe a simple and reliable technique for intraoperative arthroscopic replacement of the suture through the eyelet of an already-inserted bone anchor. This technique allows for replacement of a fretted suture or a loose knot with a new suture, offering the opportunity to repeat the knot tying procedure with a new intact suture.

Arthroscopy↗
PubMed2005

Arthroscopic anterior cruciate ligament reconstruction using quadriceps tendon autograft and bioabsorbable cross-pin fixation.

We describe a technique for arthroscopic anterior cruciate ligament (ACL) reconstruction using the middle third of the quadriceps tendon without a patellar bone block and absorbable tibial and femoral cross-pin fixation. The central part of the quadriceps tendon is harvested through a 5-cm long anterior skin incision without a patellar bone block. Tibial and femoral tunnels are prepared, the graft is passed up the tunnels, and is fixed both in the femur and the tibia using absorbable cross pins (Rigid Fix; Mitek, Johnson & Johnson, Norwood, MA). In this way, the graft is stabilized near the joint line, providing outlet fixation. In our practice, very good results have been obtained with the use of this technique.

Absorbable Implants↗
PubMed2005

The triad knot: a new sliding self-locking knot.

Tying secure knots is essential in arthroscopic surgery. A new slip knot for arthroscopic shoulder surgery is described. Locking of the knot is accomplished by pulling the post strand. Knot tying is simple and a low-profile, secure knot is produced.

Arthroscopy↗
PubMed2005

Distal intramedullary nail interlocking: the flag and grid technique.

Distal interlocking in intramedullary nailing of long bone fractures accounts for a significant proportion of the total fluoroscopy and operative time. We describe a modification of the "perfect circles" freehand technique employing a metallic grid temporarily attached to the skin of the lateral surface of the femur or to the medial surface of the tibia that acts as a fixed "navigational" aid. The position of the distal nail holes in relation to the grid is fluoroscopically ascertained. Subsequently, under fluoroscopic control, a modified Steinmann pin with a metallic handle attached to its blunt end ("flag") is used to accomplish targeting and to create the screw holes, affording improved visualization. This technique was compared with the traditional freehand technique in 2 groups of patients. Use of the modified technique led to reduction of radiation exposure and total distal interlocking time, and there were no significant complications related to the technique.

Adolescent↗
PubMed2005

Flexible intramedullary nailing of pediatric unstable forearm fractures.

In the pediatric population, the majority of displaced 2-bone forearm fractures can be reduced and stabilized by conservative means. In this article, we report on a retrospective study of 23 patients with unstable or open forearm fractures treated with closed reduction and percutaneous stabilization with flexible titanium nails. All fractures healed without complication, and final functional results were excellent.

Adolescent↗
PubMed2004

A simplified arthroscopic outside-in meniscus repair technique.

A simple and reproducible technique for meniscus tear repair is described. The technique requires the use of a 16-gauge intravenous catheter, a suture hook, and a knot pusher. The catheter is used for perforation of the meniscus and the tear site in two adjacent locations, then the two free suture ends are retrieved and passed along a small arthroscopic cannula placed at the ipsilateral joint space, and finally a sliding arthroscopic knot is tied and advanced to the meniscus surface with a knot pusher. This simple technique provides secure fixation of the meniscus tear during the healing period and has been proven successful and without complications in the patients in whom it has been used.

Adult↗
PubMed2004

Prevention of posttraumatic hypoxaemia in isolated lower limb long bone fractures with a minimal prophylactic dose of corticosteroids.

The efficacy of a minimum dose of methylprednisolone for the prevention of posttraumatic hypoxaemia and fat embolism syndrome (FES) was prospectively studied in 87 patients with isolated, closed or grade I open, femoral and tibial fractures. On admission, the patients were randomly allocated either to a control group given placebo (40 patients) or to a methylprednisolone-treated group (47 patients). A total dose of 6 mg/kg BW methylprednisolone (SoluMedrol, Upjohn) was administered intravenously, divided in six equal doses at 8 h intervals. Six patients (12.8%) in the control group and one patient (2.5%) in the trial group developed FES (P = 0.079) but the difference is not statistically significant. Twenty-four hours after admission, the steroid-treated patients displayed statistically significant higher p(O2) values compared to the control group (P = 0.035) and this difference persisted on the second and the third post-admission day as well (P = 0.008). No corticosteroid-related side-effects were noticed in any of the patients during hospitalisation. Our results support the prophylactic administration of methylprednisolone in small dosage to prevent posttraumatic hypoxaemia and probably FES in patients with isolated lower limb long bone fractures, especially when early fracture stabilisation is not possible.

Adolescent↗
PubMed2004

Innoxious removal of suction drains.

Suction drains are commonly used in orthopedic elective and trauma surgery; however, drain tube removal causes pain, discomfort, and anxiety. A method of drain tube removal is described in patients who underwent total hip replacement and in adolescents who underwent lower extremity surgery. Ten milliliters of lidocaine was injected through the skin wound around the drain tube. The efficiency of this practice was evaluated using a visual analog scale score in two patient groups. Pain during tube removal and pain on post-removal were significantly decreased in the study group compared to the placebo group. Using this technique drain tube removal was painless, comfortable, and safe.

Adolescent↗
PubMed2003

Distal locking of femoral nails under direct vision through a cortical window.

We present a salvage technique for distal femoral interlocking under direct vision through a window in the anterior femoral cortex in a subgroup of six patients, among those presented to our institution during the last 10 years with a femoral shaft fracture treated with reamed, locked intramedullary nailing. The common characteristic of these patients was the performance of distal locking under direct vision through a small window in the anterior femoral cortex because of intraoperative dysfunction of the image intensifier. Screw insertion was successful in all cases. All fractures and all cortical windows healed uneventfully. No postoperative fractures occurred through the cortical defect. This technique, despite being a salvage one, has proven a safe alternative to the common distal targeting techniques. It can be used when an image intensifier is unavailable without jeopardizing the excellent clinical and radiographic outcome of reamed locked nailing of femoral shaft fractures.

Adult↗
PubMed2003

Triplane fracture of the proximal tibia.

We report a case of successful treatment of a very rare triplane fracture of the proximal tibia in an adolescent boy. The fracture was internally fixed using cannulated Herbert screws. The final result was excellent.

Adolescent↗
PubMed2002

Late disengagement of a knotless anchor.

The knotless anchor is a new type of suture anchor that eliminates the need to perform arthroscopic knots, thus facilitating the performance of arthroscopic shoulder surgery. We report our experience in the use of this type of anchor in arthroscopic Bankart repair and discuss a complication related to using this type of fixation device.

Adult↗
PubMedDate not supplied

Closed reduction and percutaneous stabilization of pediatric T-condylar fractures of the humerus.

T-condylar fractures of the humerus are a rare fracture pattern in children. The usual recommendation is to treat them with open reduction and internal fixation, in accordance to the usual practice in adult fracture patterns. This involves extensive surgical approach to the elbow to allow anatomic reduction and placement of hardware for rigid fixation. The authors present a technique of closed reduction of the intra-articular component of the T-condylar fracture that is stabilized with partially threaded pins that afford interfragmentary compression, followed by the use of two elastic titanium intramedullary nails to stabilize the supracondylar component of the fracture as well. Two adolescents (12 and 14 years of age) with a T-condylar elbow fracture were treated with the described technique. Both fractures healed without complications. Hardware was removed in the outpatient clinic after 4 weeks, and both patients returned to sports with full range of elbow motion 6 weeks postoperatively.

Accidental Falls↗
PubMedDate not supplied

Percutaneous reaming of simple bone cysts in children followed by injection of demineralized bone matrix and autologous bone marrow.

The authors report the successful treatment of 19 patients (mean age 10 years) with active unicameral bone cysts using a combination of percutaneous reaming and injection of a mixture of demineralized bone matrix and autologous bone marrow. Follow-up ranged from 12 to 42 months (mean 28 months). All patients were asymptomatic at the latest follow-up. Two required a second intervention to accomplish complete cyst healing. Radiographic outcome was improved in all patients according to the Neer classification at the latest follow-up. There were no significant complications related to the procedure, nor did any fracture occur after initiation of the above regimen.

Adolescent↗