Antonios G. Angoules

Treatment and outcomes of pelvic malunions and nonunions: a systematic review.

Although acute management of pelvic fractures and their long-term functional outcome have been widely documented, important information regarding malunion and nonunion of these fractures is sparse. Despite their relative rarity, malunions and nonunions cause disabling symptoms and have major socioeconomic implications. We analyzed the factors predisposing a pelvic injury to develop malunion/nonunion, the clinical presentation of these complications, and the efficacy of the reported operative protocols in 437 malunions/nonunions of 25 clinical studies. Treatment of these demanding complications appeared effective in the majority of the cases: overall union rates averaged 86.1%, pain relief as much as 93%, patient satisfaction 79%, and return to a preinjury level of activities 50%. Nevertheless, the patient should be informed about the incidence of perioperative complications, including neurologic injury (5.3%), symptomatic vein thrombosis (5.0%), pulmonary embolism (1.9%), and deep wound infection (1.6%). For a successful outcome, a thorough preoperative plan and methodical operative intervention are essential. In establishing effective evidence-based future clinical practice, the introduction of multicenter networks of pelvic trauma management appears a necessity.Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Effectiveness of Electromyographic Biofeedback in the Treatment of Musculoskeletal Pain

Electromyographic biofeedback is a therapeutic modality used along with other interventions in the treatment of pain. This article presents a brief review of the effectiveness of electromyographic biofeedback in treating musculoskeletal pain. Electromyographic biofeedback may provide pain relief for chronic musculoskeletal pain due to cumulative trauma, and may be proposed as an additional intervention to exercise in patellofemoral pain syndrome and acute sciatic pain. Electromyographic biofeedback is comparable to cognitive behavioral treatment and relaxation techniques. When added to an exercise program in patients with patellofemoral pain or acute sciatic pain, no further pain reduction is achieved. Electromyographic biofeedback promotes active participation and thus may motivate patients to adopt an active role in establishing and reaching goals in rehabilitation. Further research is required to investigate its effect on musculoskeletal pain.

Evidence-based evaluation and current practice of non-operative treatment strategies for lumbar stenosis.

Evidence-Based Evaluation and Current Practice of Non-Operative Treatment Strategies for Lumbar Stenosis Objective: A number of non-operative treatment protocols have been proposed in the literature for lumbar stenosis. However, the available primary research describes inadequately the employed protocol. This causes difficulties in distinguishing which interventions are more effective in reducing symptoms. Methods: We reviewed existing studies in order to promote the construction of an evidence-based strategy for non-operative treatment rehabilitation of lumbar stenosis patients. Randomized controlled trials describing insufficiently the non-operative treatment rehabilitation protocols were excluded since the results may not direct this review towards a favorable treatment plan. Results: A protocol has been outlined to inform the clinician and to elucidate the effectiveness of non-operative treatment through randomized controlled trials. The results of this study indicate that a comprehensive exercise and manual therapy protocol is more effective in reducing symptoms than a less intensive exercise program. Conclusions: A comprehensive non-operative treatment comprising of flexion exercises, manual therapy and treadmill exercises appears to be more beneficial in reducing symptoms than a less vigorous program comprising of flexion exercises, treadmill training and home exercise. Доказательственно базированная оценка и современные подходы к лечению люмбального стеноза Цель: В медицинской литературе сообщается о наличии нескольких протоколов относительно лечения люмбалъного стеноза. Первичные исследования однако недостаточно хорошо описаны в литературе, что со своей стороны создает трудность при определении эффективности данного подхода для решения проблем заболевания. Методы: С целью определить доказательствен-но базированную стратегию при консервативном лечении пациентов с люмбальным стенозом авторы ознакомились с имеющимися исследованиями в этом направлении. В работу не включены рандо-мизированные- контролированные- исследования, которые подробно не описывают терапевтические протоколы реабилитации, так как их результаты не способствуют изготовлению хорошего плана лечения. Протокол, определенный авторами в резуль-тате исследования, структурирован так, чтобы информировать клинициста и определить эффек-тивность неоперабельного лечения посредством рандомизированных контролированных исследований. Полученные результаты показывают, что протокол, при котором применяются целотелесная нагрузка и мануальная терапия более эффективен при лечении симптомов, чем программа физических упражнений с меньшей нагрузкой. Выводы: Консервативное лечение, при котором включены флексионные физические упражнения, мануальная терапия и беговая дорожка, более эффективно справляется со симптомами заболевания, чем программа с меньшей нагрузкой, влючающая флексионные упражнения, беговую дорожку и фи-зическую нагрузку в домашних условиях.

Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid

Transforaminal Percutaneous Endoscopic Discectomy (TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.

Synthesis of evidence for the treatment of intersection syndrome

Intersection syndrome is a rare sports overuse injury occurring through friction at the intersection of the first and second compartment of the forearm. Differential diagnosis must be carefully made, especially from De Quervain tendonsynovitis. Clinical examination provides with the necessary information for diagnosis, still magnetic resonance imaging scans and ultrasonography may assist in diagnosis. Treatment consists mainly of rest, use of a thumb spica splint, analgetic and oral nonsteroidal anti-inflammatory drugs and after 2-3 wk progressive stretching and muscle strengthening. Should symptoms persist beyond this time, corticosteroid injections adjacent to the site of injury may be useful. In refractory cases, surgical intervention is warranted.

The Role of Taylor Spatial Frame in the Treatment of Blount Disease

Abstract Background: Alteration of the posteromedial part of the proximal tibia is the main characteristic of Blount’s disease and if left untreated, leg alignment and normal development of the lower limbs may be compromised. Aim: To report treatment outcomes in children with Blount’s disease using the Taylor Spatial Frame (TSF). Materials and methods: From January 2007 to December 2014, 16 young children (24 tibia) with a mean age of 7.5 years (range of 3-14 yrs) and severe Blount’s disease were treated using TSF. Preoperative long standing radiographs were performed and anatomic medial proximal tibial angle (MPTA), diaphyseal-metaphyseal tibial angle (Drennan), femoro-tibial angle and leg length discrepancy (LLD) were measured. Results: Post-operative improvement of all measurements was observed. MPTA increased from a mean of 71.8° (58° - 79°) to 92.5° (90° - 95°), the Drennan decreased from 16.6° (14° - 18°) to 3.6° (0° - 6°), the F-T angle changed from 15.4° (10° - 25°) of varus to 5.9° (2° - 10°) of valgus and the LLD decreased from 208 mm (150-320) to 69 mm (0- +120). Mean follow-up was 45.6 months. According to Paley’s criteria pin track infection was present in 6 tibiae, while in 5 patients software changes were necessary. Recurrence was observed in 3 patients (triplets). Complete restoration of the mechanical axis was obtained at the end of the treatment. Conclusions: In the last decades, different surgical treatments have been proposed for Blount’s disease (tension band plate, staples, osteotomies using external or internal fixation). External fixation using the TSF allows gradual safe correction of multiplanar deformities and is a well-tolerated technique by patients with Blount’s disease.

An Epidemiological Study of Non-specific Low Back Pain in Non-professional Female Greek Classic Ballet Dancers

Abstract Aim: Epidemiological study of the incidence of mechanical low back pain (LBP) in non-professional female Greek classic ballet dancers over a year and therapeutic interventions required to address symptoms. Materials and methods: Forty-six female classic ballet dancers members of preprofessional schools, aged 16-37 years (mean 28.8 ±5.44 yrs) practicing and training in classic dance for 6-40 hours/week (mean 10.8±6.68) and 2-27 years experience (mean 11.9±4.20 yrs) participated in an epidemiological study concerning the incidence of LBP episodes within the last year, the treatment they received, as well as the period of absence of training and performance due to LBP. A selfadministered questionnaire was employed. Information regarding incidence, duration, and intensity of mechanical low back pain was gathered as well as length of time away from practice or performance. A secondary aim was to investigate the type of conservative treatment that participants in this study received. Results: Thirty-one (67.4%) participants in the study experienced 1-10 (mean 3.26±1.7) episodes of mechanical LBP in the previous 12 months. They had to refrain from dancing activities from 2 to 90 days (mean 16.9±16.22). Twenty one of the participants received some kind of conservative treatment. Conclusion: The incidence of LBP was found to be high among Greek amateur classic ballet dancers resulting in absence from dancing activities for a considerable length of time and raising the need for therapeutic intervention for a considerable percentage of the studied population. Effective prevention strategies of LBP are of vital importance, particularly in younger dancers.

A Review of the Effectiveness of Aerobic Training in Increasing Endurance inSubacute Stroke Patients

Purpose: The purpose of this study was to review the effectiveness of aerobic training in increasing endurance in subacute stroke patients. Methods: A review of available research was selected. Electronic databases searched online were Medline- Pubmed, Cumulative Index in Nursing and Allied Health Literature (CINAHL) and Excerpta Medica Database (EMBASE). Results: Aerobic training appears to have a positive effect on endurance and oxygen consumption. Conclusion: Further research studying the effect of endurance training in subacute stroke patients, is required in order to reach a clearer image of the effect of aerobic training in stroke patients in the subacute phase.