Christos K. Yiannakopoulos

The effect of quadriceps contraction during weight-bearing on four patellar height indices

The effect of weight-bearing on the height of the patellar using four radiological indices was studied in 25 healthy men using lateral radiographs of the knee in 30 degrees of flexion non-weight-bearing and weight-bearing. The position of the patella was quantified using the Insall-Salvati, the modified Insall-Salvati, the Blackburne-Peel and the Caton indices. The contraction of the quadriceps on weight-bearing resulted in statistically significant proximal displacement of the patella with all four indices studied. The mean Insall-Salvati index was 0.919 (SD 0.063) before and 1.109 (SD 0.042) after weight-bearing (p = 0.001), while the mean modified Insall-Salvati index was 0.734 (SD 0.039) before and 0.896 (SD 0.029) after weight-bearing (p = 0.041). Similarly, the Blackburne-Peel index was 0.691 (SD 0.09) before and 0.807 (SD 0.137) after weight-bearing (p = 0.012). The mean Caton index was 0.861 (SD 0.09) before and 0.976 (SD 0.144) after weight-bearing (p = 0.023). The effect of quadriceps contraction should be considered in clinical studies where the patellar position indices are reported.

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.

Distal intramedullary nail interlocking: the flag and grid technique.

Summary: 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.

Mechanical Stability of Total Hip Replacement Using Pressurization of Bone Cement During Curing: Push-out Tests in Cadaver Femora

An experimental model was used to assess the mechanical stability of a cemented hip prosthesis, comparing the result from applied pressurization versus its absence during the curing process. Twelve pairs of cadaveric femora underwent simulated total hip replacement. The right femurs were pressurized for 10 minutes in the upper surface of the construct. The applied pressure was 325.4 KPa. All the femurs were osteotomized 30 days postoperatively and push-out tests were performed. The mean failure load at the cement-bone interface was found to be 58% higher with the pressurization technique (7.619 KN versus 4.817 KN) (P <.001). The amount of pressure we used proved advantageous, however the required physical effort proved exhausting. The design of a new surgical instrument could possibly resolve the problem.

Arthroscopic Treatment of the First Anterior Shoulder Dislocation in Young Skiers

The purpose of this paper was to describe the results of arthroscopic shoulder stabilization in skiers following the first episode of anterior dislocation. Between 1999 and 2001, 18 patients aged 19-27 years were treated arthroscopically following an acute, primary anterior shoulder dislocation. All patients were active skiers and were injured during skiing. The detached anterior labrum was reattached on the glenoid articular surface using 2-5 bone anchors, mainly metallic. Postoperative evaluation was per- formed with the Rowe-Zarins scale with a mean follow up of 31 months. There have been no recurrences and all patients returned to their preinjury level. According to the Rowe-Zarins scale the outcome was excellent in 15/17 cases. Arthroscopic shoulder stabilization in selected, active patients provides good mid-term functional results. The quality of glenohumeral ligaments was better compared to patients with chronic instability and the secondary injuries were less common.

Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients. A Preliminary Report

To The Editor: We read the article, “Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients. A Preliminary Report” (2003;85:1255-63), by A.F. Anderson. Clearly, the author is attempting to address a difficult problem in relation to the anterior cruciate-deficient knee in early adolescence. The mean age in his series was 13.3 ± 1.4 years, which is three to four years prior to epiphyseal closure in the femur and tibia in boys. By the same token, the epiphysis also has the potential for growth during this period, and therefore, with time, the consequences for the graft will be either stretching or, if stretching is not encountered, gradual tunnel enlargement, particularly on the femoral side. Also, the need to avoid violation of the physis will make tunnel placement that avoids impingement on the tibial side and anatomic siting on the femoral side extremely difficult to perform and certainly, on the femoral side, it is unlikely that the tunnel siting will be reproducible. We noted with particular interest that the guide wire placement illustrated by a lateral view of the tibia (Fig. 2) in the article is only 25% of the anteroposterior diameter of the tibial plateau and therefore would be highly likely to produce an anterior tunnel placement, which would subsequently produce graft impingement. The opinion that isometric ligament placement either can be achieved or indeed is desirable is open to question, and, given that the over-the-top route has … Corresponding author: Christos K. Yiannakopoulos, MD Byzantiou 2 171 21 Nea Smyrni Athens Greece cky{at}ath.forthnet.gr