C. Christoforidis, Panagiotis Lepetsos, S. Papadakis, Anastasios Gketsos, Theodoros Balfousias, G. Macheras
Objective: To present the diagnostic and clinical features including management of acute compartment syndrome of the foot and to create a sense of emergency amongst orthopaedic surgeons of this rare and dangerous condition. Clinical features: A 19-year old young man presented at the emergency department referring a twisting injury of his left ankle presented with swelling and pain after an acute second-degree lateral ankle sprain. The patient was treated with the RICE protocol (rest, ice, compress and elevate). Two days later, the patient returned at the emergency department, late at night with severe swelling, paresthesia, reffering an excruciating pain at his left foot and inability to walk. A diagnosis of foot compartment syndrome was made. Intervention and outcome: An emergency fasciotomy of the lateral and medial compartment (dual dorsal incision) of the foot was performed and necrotic muscle parts were removed. Summary: Foot compartment syndrome is a rare but existent complication of ankle injuries. Every patient with ankle sprain should be informed about potential complications and advised to be immediately examined in case of suspicious symptoms. This article discusses the key components of presentation, diagnosis, and management of foot compartment syndrome.
{"title":"Acute compartment syndrome of the foot after an ankle sprain: a case report","authors":"C. Christoforidis, Panagiotis Lepetsos, S. Papadakis, Anastasios Gketsos, Theodoros Balfousias, G. Macheras","doi":"10.22540/jrpms-02-067","DOIUrl":"https://doi.org/10.22540/jrpms-02-067","url":null,"abstract":"Objective: To present the diagnostic and clinical features including management of acute compartment syndrome of the foot and to create a sense of emergency amongst orthopaedic surgeons of this rare and dangerous condition. Clinical features: A 19-year old young man presented at the emergency department referring a twisting injury of his left ankle presented with swelling and pain after an acute second-degree lateral ankle sprain. The patient was treated with the RICE protocol (rest, ice, compress and elevate). Two days later, the patient returned at the emergency department, late at night with severe swelling, paresthesia, reffering an excruciating pain at his left foot and inability to walk. A diagnosis of foot compartment syndrome was made. Intervention and outcome: An emergency fasciotomy of the lateral and medial compartment (dual dorsal incision) of the foot was performed and necrotic muscle parts were removed. Summary: Foot compartment syndrome is a rare but existent complication of ankle injuries. Every patient with ankle sprain should be informed about potential complications and advised to be immediately examined in case of suspicious symptoms. This article discusses the key components of presentation, diagnosis, and management of foot compartment syndrome.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"19 1-2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114122555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Military static line parachuting (SLP) is one of the main activities performed in Hellenic Armed Forces. A static line is a cord attached between the aircraft and the jumper’s Deployment Bag (D-Bag), which contains the canopy. As the parachutist falls from the aircraft the static line becomes tight and pulls the D-Bag out of the container on the jumper’s back. The static line and D-Bag stay with the aircraft as the jumper goes down, and is pulled back into the aircraft by the dispatcher. Without its D-Bag, the canopy should distend as the jumper continues to descend. Actually, the jumper drags the parachute placed on his back, so the canopy is forced to open and inflate by the wind. However, given the difficulty of the task, it may be accompanied by several injuries. Patients suffering injuries from parachuting are a significant burden for military hospitals. Indeed, many of them require surgical treatment, lengthy rehabilitation and may face future disability. To our knowledge, this is the first retrospective study of this kind , which has ever been conducted at a national level in the Greek Military. Our purpose was to study the incidence of fractures after SLP and also to assess their anatomical distribution, in comparison with other studies and to assist in improving the safety of parachuting, in accordance with the protective equipment proposed by international literature.
{"title":"ncidence and anatomic location of fractures resulting from static line parachuting in the Greek Army Forces: A retrospective study","authors":"Filippos Zigras, S. Dellis","doi":"10.22540/JRPMS-02-058","DOIUrl":"https://doi.org/10.22540/JRPMS-02-058","url":null,"abstract":"Military static line parachuting (SLP) is one of the main activities performed in Hellenic Armed Forces. A static line is a cord attached between the aircraft and the jumper’s Deployment Bag (D-Bag), which contains the canopy. As the parachutist falls from the aircraft the static line becomes tight and pulls the D-Bag out of the container on the jumper’s back. The static line and D-Bag stay with the aircraft as the jumper goes down, and is pulled back into the aircraft by the dispatcher. Without its D-Bag, the canopy should distend as the jumper continues to descend. Actually, the jumper drags the parachute placed on his back, so the canopy is forced to open and inflate by the wind. However, given the difficulty of the task, it may be accompanied by several injuries. Patients suffering injuries from parachuting are a significant burden for military hospitals. Indeed, many of them require surgical treatment, lengthy rehabilitation and may face future disability. To our knowledge, this is the first retrospective study of this kind , which has ever been conducted at a national level in the Greek Military. Our purpose was to study the incidence of fractures after SLP and also to assess their anatomical distribution, in comparison with other studies and to assist in improving the safety of parachuting, in accordance with the protective equipment proposed by international literature.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117310440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christos Apergis, G. Bekas, Christos P. Zafeiris, T. Koureta, K. Raptis
Stress fractures are common in military population. They were first reported in Prussian soldiers’ metatarsals by Breithaupt in 1855 as “march fractures” and their radiographic characteristics were described by Stechow in 1897. Stress fractures occur generally due to bone fatigue and there is a clear distinction be made between fatigue and insufficiency fractures. A repetitive abnormal load upon a normal bone causes a fatigue fracture while a normal load upon a weak and structurally abnormal bone causes an insufficiency fracture. Although the military recruits being usually young and in good general condition are more susceptible to fatigue rather than insufficiency fractures, when diagnosed with a stress fracture it is nevertheless necessary to exclude other causes of bone fragility. Diagnosis may be difficult because the symptoms are non specific and radiographic signs are often absent or subtle. Pelvis is one of the less frequent areas where the fatigue fractures are presented. Moreover, bilateral stress fractures are extremely rare; in the current literature there have been reports for bilateral pedicle, pubic, ischial, femoral, tibial, fibular, calcaneal, scapular, ulnar and scaphoid fractures, but there is no report about an iliac one so far. Case report
{"title":"Bilateral iliac stress fracture in a young male military cadet: report of an unusual case","authors":"Christos Apergis, G. Bekas, Christos P. Zafeiris, T. Koureta, K. Raptis","doi":"10.22540/JRPMS-02-062","DOIUrl":"https://doi.org/10.22540/JRPMS-02-062","url":null,"abstract":"Stress fractures are common in military population. They were first reported in Prussian soldiers’ metatarsals by Breithaupt in 1855 as “march fractures” and their radiographic characteristics were described by Stechow in 1897. Stress fractures occur generally due to bone fatigue and there is a clear distinction be made between fatigue and insufficiency fractures. A repetitive abnormal load upon a normal bone causes a fatigue fracture while a normal load upon a weak and structurally abnormal bone causes an insufficiency fracture. Although the military recruits being usually young and in good general condition are more susceptible to fatigue rather than insufficiency fractures, when diagnosed with a stress fracture it is nevertheless necessary to exclude other causes of bone fragility. Diagnosis may be difficult because the symptoms are non specific and radiographic signs are often absent or subtle. Pelvis is one of the less frequent areas where the fatigue fractures are presented. Moreover, bilateral stress fractures are extremely rare; in the current literature there have been reports for bilateral pedicle, pubic, ischial, femoral, tibial, fibular, calcaneal, scapular, ulnar and scaphoid fractures, but there is no report about an iliac one so far. Case report","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"147 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125937469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joint arthroplasty has increased over the last decades as an effective treatment option for hip and knee osteoarthritis. Significant evolution in techniques and materials offer a better quality of life and long-lasting improvement in wellselected patients. Metal on metal (MoM) hip arthroplasty and especially resurfacing arthroplasty has gained a wide interest and the main reason is the increased head-neck implant ratio which provides an increased range of motion and decreased femoral neck impingement and dislocation rate. Despite the fact that many surgeons tend to use implants like ceramic heads and High-density crosslinked polyethylene, the MoM articulation remains still appreciable. Adverse effects can been seen to all types MoM arthroplasties, Including Total Hip Arthroplasty (THA) with small (<36 mm) or large (≥36 mm) head diameter and Resurfacing Hip Arthroplasty (HRA). The incidence of local reactions is higher in articulations with large diameter heads. Some of these reactions include metallosis, aseptic lymphocytic vasculitis associated lesion (ALVAL) and pseudotumors. The term pseudotumor has been used to describe non neoplastic cystic or solid mass around a MoM hip arthroplasty. These masses form as a result of a reaction to metal debris from the implants surfaces. Second and third generation MoM hip implants use new articulation surfaces made by improved materials and have been associated with only minimal problems concerning durability like wear which can lead to aseptic loosening and revision surgery. Nonetheless side effects still exist. Metal ions release from the articulation surfaces especially when larger heads (larger loads) used lead on to local reactions which can present clinically in many ways. In 2012 Natu et al. made an effort to investigate the Adverse Reactions to Metal Debris (ARMD) after MoM hip arthroplasty. This umbrella term includes conditions like metallosis ALVAL (perivascular inflammatory infiltration of lymphocytes), granulomatous inflammation and pseudotumors. In this review are included only articles referring in the term pseudotumor and not the other reactions mentioned above.
{"title":"Clinical consequences of pseudotumors in hip arthroplasty","authors":"G. Karagiannis","doi":"10.22540/jrpms-02-053","DOIUrl":"https://doi.org/10.22540/jrpms-02-053","url":null,"abstract":"Joint arthroplasty has increased over the last decades as an effective treatment option for hip and knee osteoarthritis. Significant evolution in techniques and materials offer a better quality of life and long-lasting improvement in wellselected patients. Metal on metal (MoM) hip arthroplasty and especially resurfacing arthroplasty has gained a wide interest and the main reason is the increased head-neck implant ratio which provides an increased range of motion and decreased femoral neck impingement and dislocation rate. Despite the fact that many surgeons tend to use implants like ceramic heads and High-density crosslinked polyethylene, the MoM articulation remains still appreciable. Adverse effects can been seen to all types MoM arthroplasties, Including Total Hip Arthroplasty (THA) with small (<36 mm) or large (≥36 mm) head diameter and Resurfacing Hip Arthroplasty (HRA). The incidence of local reactions is higher in articulations with large diameter heads. Some of these reactions include metallosis, aseptic lymphocytic vasculitis associated lesion (ALVAL) and pseudotumors. The term pseudotumor has been used to describe non neoplastic cystic or solid mass around a MoM hip arthroplasty. These masses form as a result of a reaction to metal debris from the implants surfaces. Second and third generation MoM hip implants use new articulation surfaces made by improved materials and have been associated with only minimal problems concerning durability like wear which can lead to aseptic loosening and revision surgery. Nonetheless side effects still exist. Metal ions release from the articulation surfaces especially when larger heads (larger loads) used lead on to local reactions which can present clinically in many ways. In 2012 Natu et al. made an effort to investigate the Adverse Reactions to Metal Debris (ARMD) after MoM hip arthroplasty. This umbrella term includes conditions like metallosis ALVAL (perivascular inflammatory infiltration of lymphocytes), granulomatous inflammation and pseudotumors. In this review are included only articles referring in the term pseudotumor and not the other reactions mentioned above.","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123393291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meletis Rozis, Mathaios Bakalakos, V. Polyzois, J. Vlamis, S. Pneumaticos
Total hip replacement (THR) is one of the most common orthopaedic procedures. In the USA, the prevalence of THR was about 0,83% in 2010 corresponding to approximately 2,5 million patients. Complication rates tend to increase as primary THA procedures increase as well, resulting in a high clinical and economic burden Component malposition is a common factor for further complications, regarding joint stability and function. Impingement and dislocation constitute a post-operative complication directly affected by improper component implantation like stem anteversion discrepancy. Femoral stem loosening has been also recognised as an additional complication even in modern stem designs. Data from studies by Hoenders et al and Greenfield et al, regard initial stem micro movement and early stage migration, as an independent negative predictive factor of implant loosening, acting as osteoclast differentiation stimuli. Camine et al have also announced similar results about the negative effects of stem micro motion and migration, using a parametric model. Finally, femoral stem positioning is regarded as a predisposing factor of periprosthetic fractures acting as a “stress riser”. Taking into account the importance of proper stem positioning, sagittal stem balance might play a critical role in these complications, especially on initial implant micro movement. While coronal stem centering has been traditionally controlled in order to avoid a varus or valgus positioning, sagittal centering is less studied in the literature, while its importance remains unknown. Husmann et al examined four femoral canal flare indexes and described the difference between the anteroposterior (AP) and the mediolateral (ML) distances of the proximal femur, indicating Abstract 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
{"title":"Femoral stem sagittal balance - Do we need a new entry point?","authors":"Meletis Rozis, Mathaios Bakalakos, V. Polyzois, J. Vlamis, S. Pneumaticos","doi":"10.22540/JRPMS-02-039","DOIUrl":"https://doi.org/10.22540/JRPMS-02-039","url":null,"abstract":"Total hip replacement (THR) is one of the most common orthopaedic procedures. In the USA, the prevalence of THR was about 0,83% in 2010 corresponding to approximately 2,5 million patients. Complication rates tend to increase as primary THA procedures increase as well, resulting in a high clinical and economic burden Component malposition is a common factor for further complications, regarding joint stability and function. Impingement and dislocation constitute a post-operative complication directly affected by improper component implantation like stem anteversion discrepancy. Femoral stem loosening has been also recognised as an additional complication even in modern stem designs. Data from studies by Hoenders et al and Greenfield et al, regard initial stem micro movement and early stage migration, as an independent negative predictive factor of implant loosening, acting as osteoclast differentiation stimuli. Camine et al have also announced similar results about the negative effects of stem micro motion and migration, using a parametric model. Finally, femoral stem positioning is regarded as a predisposing factor of periprosthetic fractures acting as a “stress riser”. Taking into account the importance of proper stem positioning, sagittal stem balance might play a critical role in these complications, especially on initial implant micro movement. While coronal stem centering has been traditionally controlled in order to avoid a varus or valgus positioning, sagittal centering is less studied in the literature, while its importance remains unknown. Husmann et al examined four femoral canal flare indexes and described the difference between the anteroposterior (AP) and the mediolateral (ML) distances of the proximal femur, indicating Abstract 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","PeriodicalId":348886,"journal":{"name":"Journal of Research and Practice on the Musculoskeletal System","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128355327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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