Vasileios Athanasiou

Background: Unstable pelvic ring injuries often require surgical stabilization to restore pelvic ring integrity. The anterior subcutaneous internal fixator, or pelvic INFIX, has emerged as an alternative to external fixation and open anterior fixation. This study evaluated the functional, radiographic, and complication-related outcomes of INFIX fixation for unstable anterior pelvic ring injuries. Methods: We retrospectively reviewed 21 adult patients treated with anterior pelvic INFIX for unstable anterior pelvic ring fractures, with or without posterior fixation, at a Level 1 Trauma Center between 2017 and 2024. Fractures were classified according to the AO/OTA system. Functional outcomes were assessed using the Iowa Pelvic Score and Short Form-12 questionnaire. Radiographic outcomes were evaluated according to Tornetta and Matta criteria. Complications were recorded throughout follow-up. The INFIX device was routinely removed 6 months postoperatively. Results: The cohort included 15 males and six females, with a mean age of 42.5 ± 11.1 years. Mean Injury Severity Score was 25.3 ± 9.6, and mean follow-up after implant removal was 31 (IQR 28–34) months. The mean Iowa Pelvic Score was 80.2 ± 7.4, indicating an overall good functional outcome. Mean SF-12 physical and mental scores were 49.2 ± 3.5 and 48.3 ± 7.9, respectively. Radiographic outcomes were excellent in eight patients, good in 11, and fair in two. Complications included postoperative hemorrhage, implant loosening, heterotopic ossification, and three cases of lateral femoral cutaneous nerve (LFCN) injury. Conclusions: INFIX fixation appears to be a reliable minimally invasive option for unstable anterior pelvic ring injuries, providing satisfactory mid-term functional and radiographic outcomes with an acceptable complication profile.

Purpose Anterior hip fracture-dislocation is a rare high energy injury with poor long-term prognosis. A Hill–Sachs-like hip fracture-dislocation is only scarcely described in the literature. Case We report the case of a 57-year-old suffering an anterior hip fracture-dislocation after a self-inflicted collision with his motorcycle. Knee impaction on the ground with hip abduction and external rotation led to a Hill–Sachs type of lesion in the hip and anterior wall fracture of the acetabulum. Relocation of the hip was possible only under general anesthesia, and gross persistent instability was revealed after reduction. Poor post-operative outcomes by non-operative solutions or ORIF are widely described in the literature, and thus, we performed a total hip arthroplasty in the primary setting, with excellent post-operative outcome in 1-year follow-up and a forgotten joint. Conclusion In the rare occurrence of Hill–Sachs-like fracture-dislocation lesion of the hip, we recommend an operative solution in the primary setting, taking into consideration patient’s age, intraoperative stability and defect’s depth, with total hip arthroplasty being the mainstay of treatment.

A 23-year-old woman suffered a posterior elbow dislocation, distal radius intraarticular fracture, distal radioulnar joint subluxation, and coronoid process fracture, suggesting an Essex-Lopresti injury variant. Closed reduction for the elbow dislocation was performed, and the limb was immobilized at a 90-degree angle with the forearm in a neutral position with a long posterior splint. Three months later complete fracture healing was noted radiologically. One year post-injury full range of motion regarding flexion, pronation, and supination was achieved with only 10 degrees of extension deficit remaining, suggesting a case of Essex-Lopresti injury managed conservatively with excellent results.

Osteochondral lesions of the femoral head are rare. For the treatment of these lesions, various joint-preserving procedures, particularly in young, active patients, have been developed. Mosaicplasty is a well-established surgical procedure for the knee. However, there is little evidence that this method can also be used to treat osteochondral lesions in the hip. The indication for cartilage procedures continues to evolve for the knee, and a similar strategy may be adopted for the hip joint. Due to limited evidence and a lack of experience, mosaicplasty treatment of these lesions remains challenging, especially in young patients. This study shows that open and arthroscopic management using the knee and femoral head as donor sites yielded good to excellent short- to mid-term outcomes. For osteochondral lesions of the femoral head, mosaicplasty may be a new alternative treatment option, although this needs to be proven with longer follow-ups and in a larger sample of patients.

Prosthetic joint infection following arthroplasty is a serious complication associated with high morbidity and prolonged hospitalization. Treatment consists of a combination of surgical intervention and long-acting antibiotic therapy targeted to the responsible microorganism(s). Brucella species-related prosthetic joint infections are uncommon. Diagnosis can be challenging, especially in non-endemic countries, and is confirmed by serological studies and joint aspiration results. We present a rare case of a 78-year-old man with Brucella melitensis infection in a prosthetic right knee joint, seven years after the primary procedure. The patient was treated with a two-stage surgical intervention and a four-month period of antibiotic therapy. After a follow-up period of 12 months, no clinical or laboratory findings of infection were present and the patient was able to return to his everyday activities.

The anterolateral complex (ALC) of the knee has gained increased interest over the last decades due to the high revision rates of anterior cruciate ligament reconstruction (ACLR). Furthermore, in patients with an ACL tear, the injury of at least one of the ALC’s anatomic structures has been shown to be significantly higher, thus affecting its secondary stabilizing role at the knee joint. As such, ACLR augmentation techniques, that embrace the ALC, have been proposed recently, and indications for these procedures are still evolving. This review aims to present and discuss the most current anatomical, biomechanical, and imaging data, current reconstruction techniques, and the clinical results of ALC reconstruction.

Background: The purpose of the present study was to systematically review the current treatment strategies for the treatment of Neer type IIB distal clavicle fractures in terms of functional outcome and complication rates and to examine the most appropriate surgical method by comparing all the available surgical techniques and implants. Methods: We performed a systematic review of the existing literature (2000–2021) in accordance with the PRISMA statement. We searched PubMed, Scopus, Web of Science, Research Gate and Google Scholar using the general terms ‘distal AND clavicle AND fracture’ to capture as many reports as possible. The MINORS tool was used to assess the risk of bias of the nonrandomized studies. We categorized the reported surgical techniques into four main types: open or arthroscopic coracoclavicular (CC) stabilization, locking plate fixation with or without CC augmentation, hook plate fixation and acromioclavicular joint (ACJ) transfixation. We reported findings for two main outcomes: clinical results and complication rates categorized into major and minor. Results: Our database search yielded a total of 630 records; 34 studies were appropriate for qualitative analysis. There were 790 patients, with a mean age of 40.1 years, a female percentage of 37% and a mean follow-up period of 29.3 months. In total, 132 patients received a hook plate, 252 received a locking plate, 368 received CC stabilization and 41 received transacromial transfixation. All studies were retrospective and had fair MINORS scores. Locking plate, CC stabilization and ACJ transfixation showed similar clinical results but were much better than hook plate fixation; CC augmentation did not significantly improve the outcome of locking plate fixation. The rate of major complications was similar among groups; hook plate and AC joint transfixation had the worst rates of minor complications. Open CC techniques were slightly better than arthroscopic techniques. Conclusions: The present systematic review for the optimal fixation method for Neer type IIB fractures of the distal clavicle showed similar major complication rates among techniques; the hook plate technique demonstrated inferior clinical results to other techniques. Open CC stabilization and locking plate fixation without CC augmentation seem to be the best available treatment options.

Osteitis pubis (OP) is a self-limiting, noninfectious inflammatory disease of the pubic symphysis and the surrounding soft tissues that usually improves with activity modification and targeted conservative treatment. Surgical treatment is required for a limited number of patients. This study aims to investigate the current literature on the surgical treatment of OP in athletes. A systematic review was conducted on two databases (MEDLINE/PubMed and Google Scholar) from 2000 to 2021. The inclusion criteria were adult patients with athletic OP who underwent surgical treatment and studies published in English. The exclusion criteria included pregnancy, infection OP, or postoperative complications related to other surgical interventions, such as urological or gynecological complications. Fifty-one surgically treated cases have been reported in eight studies, which included short-term, mid-term, and long-term studies ranging from one patient to 23 patients. The surgical treatment methods were as follows: (a) pubic symphysis arthrodesis, (b) open or endoscopic pubic symphysectomy, (c) wedge resection of the pubic symphysis, and (d) polypropylene mesh placed into the preperitoneal retropubic space endoscopically. The main indication for surgical intervention was failure of conservative measures and long-lasting pain, disability, and inability to participate in athletic activities. Wedge resection of the pubic symphysis has been the less preferred surgical treatment in the recently published literature. The most common surgical method of treatment of OP in athletes, which entailed the existence of posterior stability of the sacroiliac joint, in the current literature is open pubic symphysis curettage. Recently, there has been a tendency for pubic symphysis curettage to be performed endoscopically.

Neglected Posterior Dislocation Septic Loosening and Prolonged Flexion Contracture of Total Knee Arthroplasty: A Case Report - Article abstract #931857