Petros Antonarakos

Reliability and validity of the adapted Greek version of scoliosis research society – 22 (SRS-22) questionnaire

BackgroundThe SRS-22 is a valid instrument for the assessment of the health related quality of life of patients with Idiopathic scoliosis. The SRS-22 questionnaire was developed in USA and has been widely used in the English speaking countries. Recently it has been translated and validated in many other languages. The purpose of this study is to evaluate the reliability and validity of the adapted Greek version of the refined Scoliosis Research Society-22 Questionnaire.MethodsFollowing the steps of cross – cultural adaptation the adapted Greek version of the SRS-22 questionnaire and a validated Greek version of the SF-36 questionnaire were mailed to 68 patients treated surgically for Idiopathic Scoliosis. 51 out of the 68 patients returned the 1st set of questionnaires, while a second set was emailed to 30 randomly selected patients of the first time responders. 20 out of the 30 patients returned the 2nd set. The mean age at the time of operation was16,2 years and the mean age at the time of evaluation was 21,2 years. Descriptive statistics for content analysis were calculated. Reliability assessment was determined by estimating Cronbachs α and intraclass correlation coefficient (ICC) respectively. Concurrent validity was evaluated by comparing SRS-22 domains with relevant domains in the SF-36 questionnaire using Pearsons Correlation Coefficient (r).ResultsThe calculated Cronbachs α of internal consistency for three of the corresponding domains (pain 0.85; mental health 0.87; self image 0.83) were very satisfactory and for two domains (function/activity 0.72 and satisfaction 0.67) were good. The ICC of all domains of SRS-22 questionnaire was high (ICC>0.70), demonstrating very satisfactory or excellent test/retest reproducibility. Considering concurrent validity all correlations were found to be statistically significant at the 0.01 level among related domains and generally demonstrated high correlation coefficient.ConclusionThe adapted Greek version of the SRS-22 questionnaire is valid and reliable and can be used for the assessment of the outcome of the treatment of the Greek speaking patients with idiopathic scoliosis.

Condylar Buttress Plate versus Fixed Angle Condylar Blade Plate versus Dynamic Condylar Screw for Supracondylar Intra-Articular Distal Femoral Fractures

Purpose. To compare outcomes of 3 fixation techniques for intra-articular distal femoral fractures. Methods. Records of 59 men and 49 women aged 16 to 80 (mean, 47) years who underwent internal fixation for 116 type-C (complete intra-articular) distal femoral fractures were retrospectively reviewed. According to the AO classification, 25 fractures were type C1 (23 closed and 2 open), 71 type C2 (69 closed and 2 open), and 20 type C3 (16 closed and 4 open). Based on implant availability at the time, all surgeries were performed by a single surgeon using a condylar buttress plate (n=38), a fixed angle (95°) condylar blade plate (n=24), or a dynamic condylar screw (n=54). The mean follow-up period was 11 (range, 4–19) years. At the latest follow-up, functional outcome was classified according to Schatzker and Lambert criteria. Results. Functional outcomes were excellent in 64 (55%) of the fractures, good in 37 (32%), moderate in 9 (8%), and poor in 6 (5%). Outcomes in patients treated by the dynamic condylar screw were significantly superior to those treated by the condylar buttress plate (p=0.016) or condylar blade plate (p=0.001). Good-to-excellent results were achieved in 96% vs 84% vs 71% of these patients, respectively. Complication rates were lower in the dynamic condylar screw group than the other 2 groups (pseudarthrosis, 5% vs 11% vs 25%; varus deformity, 4% vs 26% vs 25%; knee stiffness, 0% vs 5% vs 8%, respectively). No implant failure was encountered. Conclusion. Dynamic condylar screw fixation for distal femoral fractures achieves better functional outcomes and lower complication rates.

Management of posttraumatic arthritis of the wrist with radiolunate fusion enhanced with a sliding autograft: a case report and description of a novel technique.

Although in rheumatoid cases radiolunate fusion presents with satisfying results, in cases with posttraumatic carpal distortion, the variability of injury pattern can influence the type of fixation and the rate of bony union. In this case report, we present an alternative technique of radiolunate fusion for the management of posttraumatic arthritis, which combines the traditional procedure with a corticocancellous autograft, created from the dorsal side of the radius that slides over the bones to be fused. That procedure provides the best environment for the bones to heal and an additional stabilizing effect on the radiolunate construct, thus better preserving the normal intercarpal relationships and wrist height. Patients clinical and radiological outcome was very satisfactory until the last follow-up.

Knee Joint Effusion following Ipsilateral Hip Surgery

Purpose. To correlate patellar reflex inhibition with sympathetic knee joint effusion. Methods. 65 women and 40 men aged 45 to 75 (mean, 65) years underwent hip surgery. The surgery entailed dynamic hip screw fixation using the lateral approach with reflection of the vastus lateralis for pertrochantric fractures (n=49), and hip hemiarthroplasty or total hip replacement using the Watson-Jones approach (n=38) or hip hemiarthroplasty using the posterior approach (n=18) for subcapital femoral fractures (n=28) or osteoarthritis (n=28). Knee joint effusion, patellar reflex, and thigh circumference were assessed in both legs before and after surgery (at day 0.5, 2, 7, 14, 30, and 45). Time-sequence plots were used for chronological analysis, and correlation between patellar reflex inhibition and knee joint effusion was tested. Results. In the time-sequence plot, the peak frequency of patellar reflex inhibition (on day 0.5) preceded that of the knee joint effusion and the thigh circumference increase (on day 2). Patellar reflex inhibition correlated positively with the knee joint effusion (r=0.843, p=0.035). These 2 factors correlated significantly for all 3 surgical approaches (p<0.0005). All 3 approaches were associated with patellar reflex inhibition on day 0.5 (p=0.033) and knee joint effusion on day 2 (p=0.051). Conclusion. Surgical trauma of the thigh may cause patellar reflex inhibition and subsequently knee joint effusion.

Lumbar Discectomy: Generic Outcome Measures for Specific Outcome Prediction: A Short-term, Observational, Pilot Study.

Study Design: We followed a longitudinal observational design with 2 assessment points, presurgery and postsurgery, in 83 consecutive patients undergoing single-level lumbar discectomy. Objective: Prognostic data can be gathered from commonly used generic outcome measures to identify patients at risk of persistent leg pain–associated chronicity, following lumbar discectomy Summary of Background Data: Suboptimal results observed, following open lumbar discectomy, have been connected to the interplay among presurgery pain characteristics, functional and psychosocial adaptations like persistent pain, disability, and depression. Outcome predictive qualities have been recently attributed to well-known outcome measures. However, most studies on prognostic indicators use multiple tools designs, inhibiting clinical application. Here we elaborate on predictive indications identified in 2 generic patient-rated questionnaires, Short Form-36 (SF-36) and McGill Pain, as many of their domains can evaluate factors related to unfavorable outcomes. Methods: For the prognostic value calculations, multivariate logistic [Short-Form McGill Pain Questionnaire (SF-MPQ)] and linear regression models (SF-36) were fitted to investigate the association between presurgery and postsurgery scores. In all models, the presurgical score at question was assigned as the dependent variable while age, sex and presurgery score at question were the independent variables. Results: Overall, a statistically significant amelioration in both SF-MPQ and SF-36 scores was observed postsurgically. For the SF-MPQ leg cramping, gnawing, burning, and aching pain symptoms, when present presurgically, were the least responsive to treatment. For the SF-36, mental scores overall were less responsive than physical equivalents postoperatively, while general health perception improved only marginally. Differences in pain level scores did not correlate with an equivalent reduction in postsurgery anxiety and depression indices. Conclusions: SF-MPQ and SF-36 can assist in treatment decision, as they can readily identify patients at risk of unfavorable outcomes even in primary/clinical settings. The above findings additionally suggest a wider scope of clinical use for the above questionnaires allowing parallel processing and interpretation of the same patient data. Levels of Evidence: Level I.

Iliac Crest Regeneration. A Retrospective Study of 14 Years Follow-up.

Study Design: This is a retrospective study analysis. Objective: The purpose of our study was to evaluate the healing process of the ilium after being used as a bone graft donor site in the treatment of adolescent idiopathic scoliosis. Summary of Background Data: Iliac crest bone grafts have been proven to be the most reliable means for solid fusion in spine surgery. Nevertheless, few reports in the literature describe the ability of the iliac crest to regenerate. Methods: Thirty-one patients with a mean age of 15.1 years had undergone posterior spinal fusion for idiopathic scoliosis. An autogenous bone graft was harvested from the right posterior iliac crest in all cases. Computed tomography scans of the pelvis were performed preoperatively and shortly after operation to evaluate the presence of any deformity and the size of the defect formed during surgery, respectively. All patients were reexamined 14 years postoperatively, and computed tomography scans were performed to evaluate the status of ossification at the donor site. Results: In 21 cases (67.74%), bone deficits were fully restored (mean volume 12.053 cm3), whereas partial regeneration was present in the remaining 10 cases (mean volume 8.766 cm3). Hounsfield units (HUs) revealed that cancellous bone quality had been restored in 21 cases, whereas cysts with sclerotic bone margins were present in the remaining 10 cases. Immature patients [Risser sign (RS) 3, 4] have greater ability in restoring bone stock compared with patients with almost complete growth (RS 5; P<0.001). In addition, the gluteus maximus muscle preserved its volume and quality in cases with complete bone restoration (volume 51.3 cm3, HU 55.9) compared with cases with partial regeneration (volume 43.43 cm3, HU 38.35; P<0.001). Conclusions: The iliac wing of skeletally immature patients has considerable ability to fully regenerate and could probably be used as a graft donor site again.