المؤلفون: Grigorios Kastanis MD, Anna Pantouvaki MSC, PT, Mikela-Rafaella Siligardou MD, Constantinos Chaniotakis MSC, MD, Emmanouil Kroustalakis MSC, MD, Ioannis Stavrakakis MD, MSC, Petros Kapsetakis MD, MSC

المصدر: Journal of Investigative Medicine High Impact Case Reports, Vol 12 (2024)

مصطلحات موضوعية: Medicine (General), R5-920, Pathology, RB1-214

الوصف: Pubic rami fractures in the geriatric population are usually osteoporotic fractures resulting from low energy trauma and are characterized as stable injuries. Established treatment of these injuries is conservative, including rest, analgesic medication, and progressive active mobilization. These injuries are life-threatened when pubic rami fractures are accompanied by acute bleeding, either from an injury to a vessel (corona mortis) or from medication (anticoagulant or antiplatelet) for comorbidities, then. In this case study, we present the unusual case of an 82-year-old woman admitted to the emergency department 24 hours after a simple fall, causing nondisplacement osteoporotic pubic rami fracture, who, after 48 hours, developed a hematoma on the contralateral side of the pelvis, with progressive anemia and acute abdominal pain. This study has 2 objectives: to increase awareness of this life-threatening injury in the emergency department and to describe diagnosis and treatment modalities.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2324-7096Test

الوصول الحر: https://doaj.org/article/45b49058fefb4b8499f016360b4e67edTest

المؤلفون: Grigorios E Kastanis, Pantouvaki A, Kapsetakis P, Stavrakakis I, Siligardou MK, Bitados P, Georgali E, Andriopoulos C, Manolaraki M

المصدر: International Journal of Innovative Research in Medical Science. 8:113-119

مصطلحات موضوعية: General Medicine

الوصف: Hand fractures are a common injury in emergency department, and the majority of these are stable injuries that can be treated conservatively with excellent functional results. When respective injuries are characterized as unstable, surgical reduction and stabilization is necessary. Generally, these operations are conducted under regional or general anesthesia to avoid pain and tourniquet for bloodless surgical fields. Wide Awake local anesthesia no tourniquet (WALANT) procedure is described as a local injection of anesthetic agent and epinephrine without tourniquet application, with scope to allow local anesthesia without other sedation and at the same time hemostasis. The purpose of the study is to compare the functional assessment of the hand function during a period of three months after surgical intervention for unstable metacarpal and phalangeal fractures under WALANT versus Biers block. Material &Methods: Between May 2021 to October 2022, 43 patients with unstable metacarpal and phalangeal fractures underwent open reduction and internal fixation, 21 cases with Biers block(BB) anesthesia and rest with WALANT technique. Metacarpal fractures appeared in 29 cases and phalangeal fractures in 14 patients. Patients were operated within the first week from the injury. According to implants they employed locking plates, screws and Kirschner wires in two groups. Results: At three months postoperatively, Quick Dash Score is better in WALANT group while patients’ satisfaction does not differ between two groups. In WALANT group immediate postoperative median VA Score appeared 2/10, while in the Biers block group appeared 6/10. Patients which underwent WALANT technique were discharged on the same day after operation, while the patients with regional anesthesia the next postoperative day. Mean duration of analgesic use was sorter in WALANT group (2,3 days) than in BB group (5,7 days). Conclusion: Οbjective of surgical treatment of unstable hand fractures (metacarpal-phalangeal) is early mobilization and enhance hand functionality to avoid stiffness and tendon adhesions. Wide Awake local anesthesia no tourniquet technique is an alternative sedative procedure which immediately offers postoperative numerous advantages (low-cost technique, no complication from tourniquet, decrease sensation of intra or postoperative pain) compared with Bier’s block anesthesia. Based on our results we believe that WALANT technique offers many benefits in surgical treatment of hand fractures and is suggested as first choice anesthesiologist procedure.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::3a5609800f2abddb56c764514b4ee18aTest
https://doi.org/10.23958/ijirms/vol08-i03/1646Test

المؤلفون: Grigorios E Kastanis, Kapsetakis P, Trachanatzi E, Chaniotakis C, Siligardou M. K., Andriopoulos C, Pantouvaki A

المصدر: International Journal of Innovative Research in Medical Science. 7:771-776

مصطلحات موضوعية: General Medicine

الوصف: Reconstruction of flexor tendons of the hand injuries is performed under general or regional anesthesia and tourniquet, in general. During the Covid-19 pandemic period the insufficiency of anesthesiologists created the need to find alternative methods of anesthesia with similar results of the existing ones. Wide awake, local anaesthetic, no-tourniquet technique (WALANT) started to be more popular, and based on the advantages (low cost, no tourniquet, no access of anaesthetic support, intraoperative collaboration to control active motion of flexor tendon reparation) gradually appeared to be a safe technique. Combination of lidocaine and adrenaline allows to ensure local anesthesia and at the same time vasoconstriction. The aim of this study is to estimate the evidence of effectiveness and secure of the WALANT technique in a case series from our hand reconstruction unit according to patient’s satisfaction, complications, and functional outcomes. Material & Method: During the period from April 2021 to September 2022, 34 patients with traumatic lesion of flexor tendon of the hand were treated with tenorrhaphy under WALANT procedure. The flexor tendon zone of traumatic injury was I,II,III, and T1,T2,T3. All patients were operated within 24 hours from the injury and were able to be discharged on the same day. The majority of the operations were performed in a second operative theatre and all performed without anaesthetic support. Results: Overall, Visual Analogue Scores were 0/10, mean rate of patient’s satisfaction was very satisfied in 82.3%, while mean Quick DASH score was 1.38. There were no cases with peri-postoperative complication during the WALANT technique. In all cases there was no need to administrate phentolamine as antidote to adrenaline vasoconstriction or other procedure of anesthesia. Conclusions: WALANT procedure is a safe method in which you can control pain and blood loss from the combination of lidocaine and adrenaline. The absence of tourniquet avoid the intra- postoperative discomfort of the patient, while intraoperative collaboration of the patient offers immediate restoration of active motion of flexor tendon and avoid postoperative complications from tenorrhaphy. Furthermore, patients̓ satisfaction continues to exist high and rate of postoperative complication nonentity.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::506f858310745e2791d055f3c0cda4eeTest
https://doi.org/10.23958/ijirms/vol07-i12/1591Test

المؤلفون: Kastanis G, Pantouvaki A, Trachanatzi E, Stavrakakis I, Chaniotakis C, Siligardou M. K., Kapsetakis P.

المصدر: International Journal of Innovative Research in Medical Science. 7:528-533

مصطلحات موضوعية: General Medicine

الوصف: Trapeziometacarpal joint (TMCJ) of the thumb is an unstable joint anatomically and depends on the integrity and normal functionality of the ligaments to prevent dislocation. Dislocation or subluxation of trapezio-metacarpal joint generally appears more often as injuries accompanied with intraarticular fracture of base of first metacarpal or trapezium. Isolated dorsolateral subluxation of trapeziometacarpal joint appears more often with osteoarthritis of the joint rather than as traumatic lesion and is an unstable injury because ligaments of the joint present some degree of impairment. Suspicions to diagnose the injury and precocious therapeutic management avoid complications which lead to impairment of hand function quality. Therapeutic procedures for TMCJ dislocation is controversial in literature. The aim of this study is to present a case of a 28 year-old man, who after a direct impact with a heavy object (hummer) over the base of the thumb, presented in the emergency department with an anterolateral subluxation of trapeziometacarpal joint and based on this case, to recall the modalities of the adequate treatment of the respective injury in literature.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::2e30ae5f57fbc4010da266b3a8cab49eTest
https://doi.org/10.23958/ijirms/vol07-i09/1510Test

المؤلفون: Kastanis G, Kapsetakis P, Chaniotakis C, Stavrakakis I, Pantouvaki A

المصدر: Acta Scientific Orthopaedics. :33-42

مصطلحات موضوعية: General Medicine

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::9a5636a54d837b2ea918e73044a39d4dTest
https://doi.org/10.31080/asor.2022.05.0525Test

المؤلفون: Kastanis G., Trachanatzi E., Kapsetakis P., Lazanaki E., Chaniotakis C., Stavrakakis I., Pantouvaki A.

المصدر: International Journal of Innovative Research in Medical Science. 7:376-379

مصطلحات موضوعية: General Medicine

الوصف: Superficial peroneal nerve (SPN) is one of the terminal branches of the common peroneal nerve which innervates muscles of the lateral compartment of the leg. It is reported in literature in cadaveric studies, that there is anatomic variation of the SPN according to course and distribution and how important this finding is in many surgical interventions around leg, ankle, and foot, with scope to avoid iatrogenic damage of the respective nerve. The aim of this study is to present a woman of 67 years old who presented in emergency department after a fall with a bimalleolar fracture of the left ankle and paresthesia distribution of superficial peroneal nerve (dorsal surface of the foot, and 3rd to 5th toes) and based on this case to analyze if this anatomic variation of SPN has an essential role in lateral approach for internal fixation of lateral malleolar fractures.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::cbb0b8d756a88f8fb5824d19de977545Test
https://doi.org/10.23958/ijirms/vol07-i07/1466Test

المؤلفون: Kastanis G, Kapsetakis P, Chaniotakis C, Stavrakakis I, Pantouvaki A

المصدر: International Journal of Innovative Research in Medical Science. 7:140-145

مصطلحات موضوعية: musculoskeletal system

الوصف: Introduction: When Extensor Pollicis Longus (EPL) spontaneously ruptures, two major risk factors are present: rheumatoid arthritis and distal radius fracture. The gold standard treatment is the transfer of Extensor Indicis Proprius (EIP) to restore the functionality of the thumb. Utilization of Extensor Pollicis Brevis (EPB) was used initially, in patients with rheumatoid arthritis. The aim of this study is to ascertain if the EPB transfer technique is the most competent and efficient surgical method for rupture of EPL, analyzing functional outcomes, complications and final patient`s satisfaction. Material & Methods: Eighteen patients (14 female and 4 men) with an average age of 43 years old were introduced in this study. All cases reported no history of trauma. From the derived clinical history, 8 cases suffered from rheumatoid arthritis, 4 patients reported initial corticosteroid injection in radial side of wrist, one case was revised surgery and in rest cases the etiology was unknown. Radiographic investigation was normal in all cases, while magnetic resonance studies detect EPL ruptures. All patients were operated in a mean time of 3, 4 weeks (ranging from 2 to 6 weeks) after the diagnosis and in all cases the tendon applied was the EPB. After surgery all patients followed the same rehabilitation program. Results: The mean follow-up was 20,5 months (range from 15 months to 36 months). None of patients missed the last re-examination. Results were evaluated according to complications, range of motion of the thumb (elevation deficit, opposition distance, difference flexion-extension deficit), Quick Dash Score, EQ-5D-5L, and satisfaction of the patients. No intra-or extra-operative complications or re-ruptures were noted. At the final follow up the mean range of elevation deficit was0,7(from 0,5 to 1,5), opposition distance was 0,8(range from 0,5 to 1,8) and difference flexion-extension deficit was 1,6˚ (from 0˚ to 5˚). The Quick Dash score was 1.38 (varied from 0.0- 6.8) and the EQ-5D-5L was 92. Finally, the majority of patients appeared to be very satisfied (66,7%) or satisfied (27,8%). Conclusion: Extensor Pollicis Longus tendon spontaneously ruptures due to specific factors. Restore of thumb functionality is achieved only with tendon transfer technique and the use of Extensor Indicis Proprius tendon has been described as the gold standard. Extensor Pollicis Brevis tendon transfer is an alternative technique with significant advantages which preserves good functionality of the thumb and excellent patient satisfaction.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::4d3d146f8089ad34b651b792e99e7c97Test
https://doi.org/10.23958/ijirms/vol07-i03/1367Test

المؤلفون: Grigorios Kastanis MD, Petros Kapsetakis MD, George Velivasakis MD, Manolis Spyrantis MD, Anna Pantouvaki PT, MSc

المصدر: Journal of Investigative Medicine High Impact Case Reports, Vol 7 (2019)

مصطلحات موضوعية: Medicine (General), R5-920, Pathology, RB1-214

الوصف: Shoulder dislocation is the most common feature in emergencies, while the anterior dislocation of the glenohumeral joint is the most frequent and requires reduction. Accompanied nerve injury is common with an incidence of 21%, while radial nerve palsy is very rare. We describe the case of a 56-year-old man who presented with an anterior dislocation of the left shoulder due to a fall on an outstretched hand with wrist drop 8 hours after injury. Neurological examination revealed loss of sensation along the radial border of the forearm. Closed reduction with Kocher procedure was performed. Magnetic resonance image demonstrated a rotator cuff tear, and 3 weeks after the injury electromyography showed complete radial nerve palsy. A physiotherapy program was applied to the wrist and fingers with the goal of maintaining a full passive range of motion in all joints affected while shoulder rehabilitation started 6 weeks after his fall. Isolated radial nerve palsy associated with an anterior dislocation of the shoulder is very rare but not impossible to occur. Correct diagnosis of the nerve injury associated with the anterior dislocation is very important because it has serious implications on the management and activity morbidity.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2324-7096Test

الوصول الحر: https://doaj.org/article/266e2704f7fc45cea9cbfbda6e65f015Test

المؤلفون: Stavrakakis Mi, Kapsetakis P, Magarakis G, Pantouvaki A, Grigorios Kastanis

المصدر: Acta Scientific Orthopaedics. 4:09-15

مصطلحات موضوعية: Series (stratigraphy), medicine.medical_specialty, business.industry, Medicine, General Medicine, Surgical treatment, business, Surgery

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::b20fd4fbcb4f221c258fc41556d12019Test
https://doi.org/10.31080/asor.2021.04.0352Test

المؤلفون: Pantouvaki A, Christoforidis C, Kapsetakis P, Spyrantis M, Kastanis G, Magarakis G, I. Stavrakakis

المصدر: International Journal of Innovative Research in Medical Science. 6:358-365

مصطلحات موضوعية: body regions, medicine.medical_specialty, One year follow up, business.industry, medicine, General Medicine, Radius, business, Complication, Locking plate, Surgery

الوصف: Distal radius fractures (DRF) are the most common type of fractures of the upper extremities with an incidence of 44% of all types of forearm and hand fractures. In unstable DRF, the aim of surgical treatment is to restore a functional wrist. Volar locking plate is supported in literature as a promising surgical method in treatment of these fractures. The aim of this study is to analyze the type and complication rate with applied volar locking plate, the percentage of revision surgery and the functional outcomes in a minimum of one year follow up. Material &Methods: 104 fractures in 98 patients with a mean range of 48,5 years-old age underwent for unstable distal radius fractures with volar locking plate. The main cause was simple fall to an outstretched hand. In ten cases the fracture was open while in 28 cases the DRF was accompanied with ulnar styloid. All fractures classified by AO/OTA in A2-3 27 cases, B1-3 in 45 and C1-3 in 32 cases. The majority of patients were operated within 48-72 hours after injury. In all cases an extended flexor carpi radialis approach was performed and a volar locking plate was applied in all DRF’s. In sixteen cases with base of ulnar styloid fractures, low profile locking plates were applied, while in the rest of patients Kirschner wires were used. Postoperatively all patients followed a standard protocol rehabilitation program with passive and active motion of fingers and wrist. Results: Patients were evaluated according to complication (type and rate), time to fracture union, range of motion, Visual analogue pain scale, Quick Dash Score and patients-rated wrist evaluation score. Complications were distinguished in major and minor. Patients under 60 years-old with type fracture A2-3 and B1-3 showed better range of motion and grip strength than patients over 65 years old. In cases with type fractures C1-3 and age over 65 years old, ROM and grip strength decreased compared with the unilateral side. The percentage of complication and reoperation appeared more increased in type C1-3 related to the other two types of fractures. Finally the mean Quick DASH was 11,1±12,8, RPWE was 9.8±13,6 and the range of motion was in extension 75,2±7,3, in flexion 74±8,9, in pronation 85,6±1,9, in supination 88,5±2,4 in radial deviation 9,8±1,2 and in ulnar deviation 41,1±4,6 and grip strength was an average of 84,7% of uninjured hand. Conclusion: Unstable fractures required operative treatment with volar locking plate to be the gold standard in recently years. Unfortunately VPL presents postoperative complications related with plate and screw position with comminuted fracture or soft tissue damage which cannot be ignored, and for these reasons may be inadequate for all types of distal radius fractures.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::82229c39362d44e22386463ec066708bTest
https://doi.org/10.23958/ijirms/vol06-i05/1131Test