Acta Orthopaedica Et Traumatologica Hellenica

Entering a new editorial era in ACTA Orthopaedica et Traumatologica Hellenica

2024-06-25T10:27:28+00:00

Writing for ACTA Orthopaedica et Traumatologica
Hellenica
Writing a scientific paper that will get published is one of the most rewarding achievements in a medical career. Once the privilege of few scholars, medical writing currently is feasible for anyone, and a must for career advancement and personal reputation. Writing a paper provides intellectual stimulation, generates discussion, advances discipline, and enhances authors’ reputation. However, medical writing should include medical knowledge, expertise in writing, and special considerations and rules, including formal writing and easiness to understand.
Writing and publishing depends not only on the methodology used and quality of data analysis, but also on how the paper is written. A clear and concise language will help Editors and Reviewers concentrate on the scientific content of the paper and thus facilitate the peer review process. English language grammar and syntax is usually edited by the office and the assistant Editors. Occasionally, English language editing is extremely difficult, and substantial work may be required, mainly in cases where the authors’ English proficiency is low. In those cases, we recommend manuscript editing by a professional or a native speaker prior to submission.

Significance of quadrilateral plate in surgical treatment of complex bi-columnar acetabular fractures: descriptive analysis through three cases. Fotios V. Nikolopoulos, Ioannis V. Papachristos, Konstantina Solou, Georgios Gourtzelidis, Dimitrios Samar

2024-06-25T10:39:32+00:00

Complex acetabular fractures affecting both columns remain one of the hardest challenges to trauma orthopaedic surgeons with high morbidity and often poor outcomes. Treatment dilemmas arise especially in both column fractures where the fracture line dissociates acetabulum in different directions and sizes resulting in quadrilateral plate (Quad) fragments of various sizes. This plate serves as a vertical girder-wall structure for the acetabulum. Order of fixation along with selection of its associated surgical approach are the cornerstones of operative strategy in such injuries and are driven by various factors one of the most important being quadrilateral plate involvement. A traditional rule of thumb dictates to first fix the column that can be addressed easier and more directly. Then the second column can be addressed. As the quad is the connection girder between the two columns, the fragmental condition of this plate, is one of the most decisive factors influencing decision making. The fracture line which crosses the quad plate is crucial and if there is a multifragmentary component it dictates the chosen plate. We will try to illustrate, discuss and explore this topic exemplifying three difficult cases dealt with three approaches: Ilioinguinal (ILO), Stoppa-Anterior Intrapelvic (AIP)-ILO modification and Kocher-Langenbeck (K-L) either in isolation or combined. Pearls, pitfalls and lessons learned are offered in a vivid illustrative way.

Calcified tendonitis of the rotator cuff. A review of this common shoulder pathology Chrissovalantis Tsikrikas,1 Ioannis K. Triantafyllopoulos2 1Postgraduate Program “Metabolic Bone Diseases’’, National and Kapodistrian University of Athens , School o

2024-06-25T10:41:43+00:00

Calcified tendonitis is an acute or chronic painful condition due to the presence of calcium phosphate crystals within or around the tendons that form the rotator cuff.
The precise mechanism leading to the deposition of calcium crystals remains unclear. Factors that appear to contribute to this pathology are metabolic diseases (diabetes, thyroid hormone abnormalities), medication factors (e.g., corticosteroids), genetic predisposition of the individual, and overuse injuries.
Clinically, calcified tendonitis is usually asymptomatic. However, in some cases it is characterized by severe pain, which is more addressed in the morning. Many times, the intensity of the pain is so high that it inhibits movements, resulting in stiff shoulder joints. A simple x-ray is the most appropriate imaging method to diagnose the disease. As far as concerns the course of the disease, in many cases, an automatic resorption of calcium is observed while the symptoms recede. The precise mechanisms associated with absorption are unknown.
Numerous treatment options have been reported in the literature that are applied on a case-by-case basis and vary in efficacy.

Shoulder instability: a brief review

2024-06-25T10:44:47+00:00

Shoulder instability is a condition in which the humeral head partially or completely dislocates from the glenoid fossa. This can occur due to a traumatic injury (traumatic instability), repetitive strain on the joint, or generalized ligamentous laxity (atraumatic instability). In the majority of cases, glenohumeral instability is associated by a labral tear which prevents the humeral head from fitting properly into the glenoid fossa, causing it to shift out of place. Anterior shoulder dislocations comprise the majority of cases of glenohumeral instability.
Symptoms of shoulder instability may include a feeling of looseness or instability in the joint, pain or discomfort in the shoulder, weakness or loss of strength, and a sensation of the shoulder “popping out” or “slipping.” In severe cases, the humeral head may completely dislocate from the glenoid fossa, causing intense pain and disability. Diagnosis of shoulder instability usually involves a thorough physical exam and imaging studies such as x-rays, computed tomography (CT) and magnetic resonance imaging (MRI).
Treatment of shoulder instability depends on the severity of the instability and the underlying cause. Conservative treatment for shoulder instability may include rest, ice, physical therapy, and anti-inflammatory medication. Physical therapy is especially important in cases of multidirectional instability, as strengthening exercises can help improve stability in the joint. If conservative treatment fails to relieve symptoms, surgery may be necessary. Absolute indications of surgical management are contradictory. Operative treatment is reserved after failed conservative management, recurrent dislocation at a young age, irreducible dislocation, open dislocation, post-reduction instability of the shoulder and first-time dislocation in young elite athletes. Surgical options for shoulder instability include arthroscopic procedures and open surgeries. Arthroscopic procedures are less invasive and may have fewer complications, but may not be appropriate for all types of instability. The choice of surgery depends on the underlying cause of the instability, the patient’s age and activity level, and other factors. For traumatic instability, the most common surgical procedure is an arthroscopic Bankart repair, where the torn labrum is reattached to the glenoid fossa using sutures or anchors. In cases of atraumatic instability, surgery may involve tightening the capsule and ligaments around the joint, or transferring a portion of the coracoid process to the anterior aspect of the glenoid (Latarjet procedure).
Recovery from shoulder stabilization may take several months, and may involve a period of immobilization, followed by physical therapy to regain strength and range of motion in the joint. Patients should avoid activities that put stress on the shoulder, such as lifting heavy weights or participating in contact sports. Overall, shoulder instability can be a debilitating condition that affects many people, especially those involved in sports or other activities.

Imaging and clinical approaches in the management of patients with spinal cord injury without radiographic abnormality (sciwora)

2024-06-25T10:35:23+00:00

CIWORA is a syndrome that defines posttraumatic SCI in patients with abnormal clinical neurological examination and apparently normal radiological findings in plain X-rays and CT. Under the suspicion of SCIWORA, early MRI is recommended for definitive diagnosis while prompt neuroprotective measures have to be taken to prevent secondary SCI that may cause further neurological deterioration.
Introduction. SCIWORA (Spinal Cord Injury Without Radiographic Abnormalities) is a syndrome that defines posttraumatic SCI in patients with abnormal clinical neurological examination and apparently normal radiological findings in plain X-rays and CT. This syndrome most commonly affects children, but can be also found in adults, with a predilection for the cervical spine. The aim of this study is to review the imaging and clinical approaches in the management of SCIWORA patients.
Materials & Methods. A literature review was conducted based on the Pubmed internet database, following the PRISMA Guidelines. Article titles were searched with the use of the keywords: “Spinal Cord Injury without Radiographic Abnormality” OR “SCIWORA”. The search included only clinical studies evaluating SCIWORA in adults. Studies published in non-English language, animal studies, experimental studies, case reports, reviews, and commentary studies were excluded. Moreover, studies in children and adolescents were also excluded.
Results. Initially, 207 studies were identified after primary search on Pubmed electronic database. After screening of titles and abstracts, 15 articles were excluded. Among the remaining 192 studies, 167 were rejected for various reasons (figure 1). After checking the references lists of the included studies, 2 more studies were added, leaving 29 studies for final analysis. The total number of patients was 1418 (78.2%

Abstract
SCIWORA is a syndrome that defines posttraumatic SCI in patients with abnormal clinical neurological examination and apparently normal radiological findings in plain X-rays and CT. Under the suspicion of SCIWORA, early MRI is recommended for definitive diagnosis while prompt neuroprotective measures have to be taken to prevent secondary SCI that may cause further neurological deterioration.
Introduction. SCIWORA (Spinal Cord Injury Without Radiographic Abnormalities) is a syndrome that defines posttraumatic SCI in patients with abnormal clinical neurological examination and apparently normal radiological findings in plain X-rays and CT. This syndrome most commonly affects children, but can be also found in adults, with a predilection for the cervical spine. The aim of this study is to review the imaging and clinical approaches in the management of SCIWORA patients.
Materials & Methods. A literature review was conducted based on the Pubmed internet database, following the PRISMA Guidelines. Article titles were searched with the use of the keywords: “Spinal Cord Injury without Radiographic Abnormality” OR “SCIWORA”. The search included only clinical studies evaluating SCIWORA in adults. Studies published in non-English language, animal studies, experimental studies, case reports, reviews, and commentary studies were excluded. Moreover, studies in children and adolescents were also excluded.
Results. Initially, 207 studies were identified after primary search on Pubmed electronic database. After screening of titles and abstracts, 15 articles were excluded. Among the remaining 192 studies, 167 were rejected for various reasons (figure 1). After checking the references lists of the included studies, 2 more studies were added, leaving 29 studies for final analysis. The total number of patients was 1418 (78.2% men) with a mean age of 53.5 years. The incidence of SCIWORA among all SCI cases varies from 1.3 – 12%. The most common cause of SCIWORA is fall from a height (53%), followed by motor vehicle accidents (33.6%), sports injuries (6.4%), occupational injuries (2.8%) and other injuries (4.6%). 94.4% of the SCIWORA occurred in the cervical spine, while the rest 5.2% occurred in the thoracic spine. The most common mechanism of injury is hyperflexion of the cervical spine especially in patients with preexisting cervical spondylosis. 12% of patients were AIS grade A, 20% AIS grade B, 35% AIS grade C and 33% AIS grade D. In 14.2% of patients, no MRI abnormalities were detected, while 85.8% of patients had abnormal MRI scan results. Among them, 57.0% had extraneural, 36.3% had intraneural and 6.6% of patients had combined extraneural and intraneural MRI abnormalities. Initial treatment is conservative. Indications for surgical management include MRI findings of cord compression and instability, along with deterioration of neurological symptoms. Prognosis of SCIWORA depends on the initial neurological deficit and magnitude of SCI on MRI; however, neurological improvement is expected in at least 75% of patients.
Conclusions. SCIWORA is an underestimated clinical condition in adult SCI patients. In the suspicion of SCIWORA, early MRI is recommended for definitive diagnosis and prompt neuroprotective measures have to be taken to prevent secondary SCI that may cause further neurological deterioration for a better prognosis. According to MRI findings, surgical treatment is indicated in patients with cord compression and instability and worsening neurological symptoms. More high quality studies are needed to fully elucidate the optimal imaging and clinical approaches in the management of SCIWORA patients.

The art of diagnostic approach of a child

2024-06-25T10:30:54+00:00

While trying to approach a child diagnostically, the child has to be relieved from “white coat anxiety” as well as being in awe of the doctor-ogre. The clinicians need to establish a suitable environment in which the child’s fears will be appeased and the parents will be re assured in order for them to be content and fulfilled. The diagnostic approach of the child is not always easy. Finding the true cause of a child’s symptoms is not as simple as following a cookbook recipe as there are no specific ingredients or measurements that will lead to a safe result.

Psychological support for the patient with spinal cord injury

2024-06-25T10:49:08+00:00

Reality after spinal cord injury (SCI) is a life-long adjustment. Although much of the effort is focused on the motor, sensory, and autonomic dysfunctions, SCI can have very serious psychosocial consequences on affected individuals. Research shows that many with sudden onset SCI will exhibit extreme negative emotions which impair psychological as well as social integration after injury. Also, people with SCI are at a higher risk of developing anxiety, depression, and post-traumatic stress disorder among others, with psychological and social factors playing a major role in incidence and progression. The purpose of this study was to review the common psychosocial consequences for people after SCI and the current psychosocial challenges within the SCI population, as well as to provide considerations that promote quality of life from a biopsychosocial perspective. A review of the current literature was performed using the online Pubmed and Google Scholar databases and the PRISMA guidelines. Relevant analyses helped to derive conclusions that may benefit the psychological rehabilitation of SCI patients. Patients with robust psychological support seem to have better physical rehabilitation rates, less emotional and behavioral problems, less alcohol/drug abuse, higher rates of reintegration and engaging in meaningful activities and less suicide attempts.

The role of electrical stimulation in the management of lower urinary track dysfunction following spinal cord lesions

2024-06-25T10:52:18+00:00

Spinal cord lesions are traumatic or non-traumatic. Spinal cord injuries (SCI) may be complete or incomplete and lead to lower urinary track dysfunction (LUTD) in 95%. Multiple sclerosis is the most frequent cause of non-traumatic spinal cord lesions and leads to LUTD in more than 90% of patients 10 years after diagnosis. LUTD usually presents as neurogenic detrusor overactivity and/or detrusor-sphincter dyssynergia where oral medication is considered to be the first line of treatment and intravesical onabotulinum toxin injections the second, but there are side-effects and refractory cases. In addition, LUTD may present as detrusor underactivity where the above treatment options are not effective.
Clearly there is a need for a third line of treatment. In this review, we discuss the feasibility, safety and efficacy of electrical stimulation for the management of neurogenic LUTD, spanning from historic clinical to recent pre-clinical approaches. Neurostimulation methods are used on complete SCI patients, while neuromodulation methods are mostly used on incomplete spinal lesion patients and can be invasive or non-invasive. There is evidence that neuromodulation inhibits the development of neurogenic LUTD when applied shortly after acute spinal cord lesions. More high-quality studies are needed to prove efficacy of neuromodulation on neurogenic LUTD.

Sexual and reproductive health of patients with spinal cord injuries - Orientation to female fertility and pregnancy

2024-06-25T10:54:55+00:00

This exploratory review focus on the sexual and reproductive health of female spinal cord injury (SCI) patients. This investigation seeks to determine whether or not women with spinal cord impairments can become pregnant. Women with SCI are unable to procreate, contrary to the alternative theory. We searched PubMed and Scopus for relevant articles published between 2003 and 2023. Consideration was given to studies, with an emphasis on the sexual and reproductive health, including reproduction, of women with SCI. Animal studies, studies published in languages other than English, male-focused research, studies on neurological diseases other than SCI, and non-relative studies were all disqualified. The findings of this review shed light on the likelihood of conception among individuals with SCI, while the findings of individual studies contribute to our understanding of female fertility and pregnancy outcomes in this population.