Papers by Ioannis Vossinakis
Cureus, 2022
Dislocation and instability of primary total hip arthroplasty (THA) is the leading cause for revi... more Dislocation and instability of primary total hip arthroplasty (THA) is the leading cause for revision surgery, linked with significant financial burden and patient dissatisfaction. It is a multifactorial complication and requires accurate diagnosis and identification of the causative factors, as well as good preoperative planning for revision surgery. Despite all the best efforts, revision can lead to disappointing and frustrating results. We present a complex case of recurrent THA instability that required multiple operations before the identification of the main cause led to a satisfactory outcome. In addition, this is, to our knowledge, the first report of an Aesculap Plasmacup (Aesculap, Tuttlingen, Germany) liner dissociation and the first case where a previously well-united intertrochanteric fracture has been directly linked to recurrent instability. We aim to raise awareness of the complexity of such complications and the need for careful assessment of all the possible causes.
Injury, 2001
One hundred patients above 80 years of age (mean age 88.20 years) with 101 fractures in the area ... more One hundred patients above 80 years of age (mean age 88.20 years) with 101 fractures in the area of the trochanters were managed with an external fixation (Orthofix pertrochanteric fixator, OPF) from October 1995 to March 2000. Osteosynthesis was performed under radiology control and especially after a satisfactory closed reduction had been obtained. Accompanying diseases, duration of surgery, the transfused blood units, duration of hospitalization, complications, walking ability, time to union and mortality rate were recorded pre-operatively and post-operatively for a year. The results were: fast operation time (19.6 min at average), minimal blood loss (no blood transfusion was needed for 85 patients whereas for the remaining 15 patients 29 blood units were administrated due to a pre-existing anemia and not to compensate blood loss during surgery) and short duration of post-operative hospitalization (5.27 days at average). The main complications that were recorded were sore wounds in 15%, inflammation in the entrance of the screws in 9%, and aseptic loosening of the femoral screws/loss of reduction in varus >10 degree in 8%. These complications did not prevent the union of the fracture to a satisfactory level (13.91 weeks at average). There were no revisions. Within the first post-operative semester, the majority of the patients (57.69%) returned to the walking condition they had before the fracture. Post-operative mortality during the first month was 15% whereas during the first post-operative semester the rate increased by 7%. Due to the design of the device, the method is simple, fast, does not derange the patients and requires short time of hospitalization. These advantages are especially useful for the treatment of elderly patients with aggravated general condition.
Acta Scientific Orthopaedics, 2022
Arthroscopic knee surgery is considered to be safe. A recent large study reported a 1.1% risk of ... more Arthroscopic knee surgery is considered to be safe. A recent large study reported a 1.1% risk of complications, although earlier reports had significantly higher numbers, up to 8%. Complications are more common with ACL reconstruction, meniscal repair and meniscectomy. One of the most common complications is the breakage of arthroscopic instruments into the joint. Most of them are identified and dealt with intraoperatively, sometimes with the aid of fluoroscopy. In some occasions, however, the breakage is not noticed during surgery and the broken instrument part is seen in postoperative radiographs. Some authors recommend immediate removal of foreign bodies, especially sharp ones, while others tend to leave those in place if they are asymptomatic. We present a broken tip of an all-inside meniscal repair instrument that remained undetected during surgery, and was eventually removed 15 months postoperatively, when it became symptomatic. To our knowledge, such a case has not been previously reported in the literature.
The Journal of Bone and Joint Surgery-American Volume, 2003
To The Editor: We welcomed Dr. Baumgaertner's analysis of our paper1 in his commentary to “Th... more To The Editor: We welcomed Dr. Baumgaertner's analysis of our paper1 in his commentary to “The Pertrochanteric External Fixator Reduced Pain, Hospital Stay, and Mechanical Complications in Comparison with the Sliding Hip Screw” (2002;84:1488) in the Evidence-Based Orthopaedics section of The Journal. However, certain questions raised in that commentary need to be answered. Exclusion of reverse obliquity and intertrochanteric fractures with a subtrochanteric extension should not be considered a limitation of our study. Since the sliding hip screw is known to perform … Corresponding author:, Ioannis C. Vossinakis, MD, 34 Kassaveti Street, 382 21 Volos, Greece, vossinakis{at}panafonet.gr
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2004
This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium ... more This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium bicarbonate for reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. Twenty-one patients undergoing bilateral open carpal tunnel decompression received, in a randomized manner, lidocaine 1% with adrenaline (1:200,000) in one hand and the same local anaesthetic buffered with 8.4% NaHCO 3 at a 5:1 ratio in the other hand. Pain, especially its burning element, was evaluated on a visual analogue scale and was significantly reduced with the buffered solution. The buffering was effective for all patients and no adverse effects were noted. This is a safe, easy and quick method for making open carpal tunnel surgery less uncomfortable to patients.
International Orthopaedics, 2001
In 44 surgical high-risk patients (ASA grade 3 or 4) pertrochanteric fractures were treated with ... more In 44 surgical high-risk patients (ASA grade 3 or 4) pertrochanteric fractures were treated with a newly developed external fixator; all fractures healed within 14 weeks. Seven patients had a superficial pin tract infection and in 12 patients the fracture united with a shortening of 18 (5-30) mm. No implant failures or limitation of knee movements were recorded. Nine patients died during the first 6 months. The "pertrochanteric fixator" is a valuable alternative for treating high-risk, elderly patients.
The Journal of Bone and Joint Surgery, 2002
Journal of Orthopaedic Trauma, 2004
We present a salvage technique for distal femoral interlocking under direct vision through a wind... more We present a salvage technique for distal femoral interlocking under direct vision through a window in the anterior femoral cortex in a subgroup of six patients, among those presented to our institution during the last 10 years with a femoral shaft fracture treated with reamed, locked intramedullary nailing. The common characteristic of these patients was the performance of distal locking under direct vision through a small window in the anterior femoral cortex because of intraoperative dysfunction of the image intensifier. Screw insertion was successful in all cases. All fractures and all cortical windows healed uneventfully. No postoperative fractures occurred through the cortical defect. This technique, despite being a salvage one, has proven a safe alternative to the common distal targeting techniques. It can be used when an image intensifier is unavailable without jeopardizing the excellent clinical and radiographic outcome of reamed locked nailing of femoral shaft fractures.
Journal of Hand Surgery-british and European Volume, 2004
This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium ... more This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium bicarbonate for reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. Twenty-one patients undergoing bilateral open carpal tunnel decompression received, in a randomized manner, lidocaine 1% with adrenaline (1:200,000) in one hand and the same local anaesthetic buffered with 8.4% NaHCO3 at a 5:1 ratio in the other hand. Pain, especially its burning element, was evaluated on a visual analogue scale and was significantly reduced with the buffered solution. The buffering was effective for all patients and no adverse effects were noted. This is a safe, easy and quick method for making open carpal tunnel surgery less uncomfortable to patients.
Journal of Hand Surgery-british and European Volume, 2004
This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium ... more This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium bicarbonate for reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. Twenty-one patients undergoing bilateral open carpal tunnel decompression received, in a randomized manner, lidocaine 1% with adrenaline (1:200,000) in one hand and the same local anaesthetic buffered with 8.4% NaHCO3 at a 5:1 ratio in the other hand. Pain, especially its burning element, was evaluated on a visual analogue scale and was significantly reduced with the buffered solution. The buffering was effective for all patients and no adverse effects were noted. This is a safe, easy and quick method for making open carpal tunnel surgery less uncomfortable to patients.
The Journal of Laryngology & Otology, 2000
Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by osseous fragility, ... more Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by osseous fragility, blue sclerae and hearing loss. In order to assess the impact of stapedotomy on improving hearing on OI, a retrospective, one-group, pre-test-post-test design was used to compare the pre-operative and postoperative audiograms of nine OI patients, treated with stapedotomy for their mixed hearing loss. Operative findings included fixation or thickening of the stapes footplate with normal superstructure configuration and hypervascularization of the promontory mucosa. Immediate post-operative results showed a significant improvement (p<0.05) from 250–4000 Hz in air conduction and from 250–2000 Hz in bone conduction. A significant closure of the air-bone gap between 250–2000 Hz was also achieved (p<0.05). The long-term results remained satisfactory with a mean threshold shift of 8 dB HL and an almost unchanged air-bone gap. These satisfactory results and the lack of complications make st...
The Journal of bone and joint surgery. American volume, 2003
Although patellofemoral symptoms after patellar-retaining knee arthroplasty are common, no eviden... more Although patellofemoral symptoms after patellar-retaining knee arthroplasty are common, no evidence has been published in the literature on the potential benefit from patellar resurfacing at a later stage. This study evaluates the effect of secondary (delayed) patellar resurfacing using comparisons between 2 case-matched groups of patients with primary and secondary patellar resurfacing. Furthermore, multivariate statistical methods were applied to study factors that may influence the final outcome. Our results suggest that although significant clinical improvement was seen after delayed patella resurfacing, the outcome of secondary patellar resurfacing is inferior to that expected for a similar group of patients with primary resurfacing. Furthermore, the timing (delay period) of the secondary resurfacing procedure appears to negatively affect the final outcome. This suggests that secondary patellar resurfacing, when indicated, should be considered at an early stage.
International Journal of Pediatric Otorhinolaryngology, 1999
Objectives: the early detection of hearing impairment caused by ototoxic drugs, such as aminoglyc... more Objectives: the early detection of hearing impairment caused by ototoxic drugs, such as aminoglycosides, has been the aim of research world-wide. Histopathological studies have shown that the outer hair cells are the most susceptible cochlear components to injury from ototoxic drugs like aminoglycosides. Otoacoustic emissions reflect the functional status of the outer hair cells and constitute the only non-invasive means
Skeletal Radiology, 2008
Objective
The Knee, 2000
Although stress fractures of the tibial diaphysis are common among athletes, the proximal tibial ... more Although stress fractures of the tibial diaphysis are common among athletes, the proximal tibial metaphysis is an unusual location for such injuries. In addition, their proximity to the knee joint can obscure the diagnosis. We present a case of a stress fracture of the medial tibial condyle in a long-distance runner, aiming to increase awareness about this uncommon and interesting differential diagnostic problem. A change in running conditions preceded the fracture and should always raise suspicion of overuse injuries. MRI scan has proved very sensitive for diagnosing stress fractures and provided a definite diagnosis in our case. ᮊ
Journal of Orthopaedic Trauma, 2004
We present a salvage technique for distal femoral interlocking under direct vision through a wind... more We present a salvage technique for distal femoral interlocking under direct vision through a window in the anterior femoral cortex in a subgroup of six patients, among those presented to our institution during the last 10 years with a femoral shaft fracture treated with reamed, locked intramedullary nailing. The common characteristic of these patients was the performance of distal locking under direct vision through a small window in the anterior femoral cortex because of intraoperative dysfunction of the image intensifier. Screw insertion was successful in all cases. All fractures and all cortical windows healed uneventfully. No postoperative fractures occurred through the cortical defect. This technique, despite being a salvage one, has proven a safe alternative to the common distal targeting techniques. It can be used when an image intensifier is unavailable without jeopardizing the excellent clinical and radiographic outcome of reamed locked nailing of femoral shaft fractures.
Uploads
Papers by Ioannis Vossinakis