Papers by Vasileios Kontogeorgakos
Cancer genetics, Nov 1, 2022
PubMed, Nov 7, 2019
Purpose: This retrospective case series assessed the results of a treatment protocol for patients... more Purpose: This retrospective case series assessed the results of a treatment protocol for patients with infected para-articular knee nonunions. The aim was to demonstrate that knee function and quality-of-life (QoL) can be improved. Case series: Between January 2001 and December 2011, eleven patients with septic proximal tibial nonunion and seven with septic distal femoral nonunion were managed at our institution. The treatment protocol included extensive debridement, skeletal stabilization, culture-specific antibiotic administration, and soft-tissue and bone-deficit reconstruction. Knee function was evaluated with the Knee Society Score (KSS) while the Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-12 were used for QoL assessment at a mean follow-up of 37.2 (range: 12-149) months. Seventeen nonunions healed at a mean of 21.9 weeks. One patient needed above knee amputation. Knee Society function and knee scores were improved significantly, from 16.7 and 33.8, to 75.0 and 84.9 respectively (p <0.001). KOOS outcome and SF-12 physical and mental components scores confirmed the QoL improvement. Conclusions: Staged management can improve QoL and functional knee outcome. HIPPOKRATIA 2018, 22(4): 183-187.
PubMed, Apr 1, 2021
Background: Tenosynovial giant-cell tumor (GCT) arising from cruciate ligaments consists a rather... more Background: Tenosynovial giant-cell tumor (GCT) arising from cruciate ligaments consists a rather rare entity. Predominantly areas where this tumor appears are the palmar sides of fingers and toes. The involvement of larger joints such as the knee or the ankle is rather rare, but, in the case of synovial joints, the knee joint is particularly affected. Furthermore, rare seems to be the intra-articular localization of the tenosynovial GCT of the tendon sheath. Hereby, we present an arthroscopic approach of treatment with two cases. Case reports: The first case was a 32-year-old male with a GCT arising from the anterior cruciate ligament (ACL). The second case was a 26-year-old male with a GCT arising from the posterior cruciate ligament (PCL). In the first case, a round-shaped mass with a reddish-brown color was located just anterior to the ACL and impeded the full extension of the knee joint, while, in the second case, a well-circumscribed oval-shaped mass was found with a peduncle attached to the synovium of the PCL. After arthroscopic excision, both patients became asymptomatic, with complete lack of pain and full ROM. Conclusions: There is a lack of clinical features for the GCT of the knee, and thus, a thorough clinical examination is prudent. Usually, the diagnosis is set after an investigation based on suspicion. This entity can present with symptoms of instability and patients may present signs of mechanical derangement. With the knee joint, meniscal symptoms and locking are often present. The best non-invasive technique to diagnose this tumor has been reported to be the magnetic resonance imaging. Arthroscopic excision has been reported as a safe and effective procedure for treatment.
Orthopedics, Sep 1, 2019
Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Its diagnosis i... more Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Its diagnosis is based on clinical symptoms and neurophysiological evaluation. Recently, ultrasonography has been introduced as a promising noninvasive diagnostic alternative. In this study, the authors compared ultrasonography with neurophysiological findings for the diagnosis of CTS in 96 patients/hands with clinical symptoms of CTS. The latency, amplitude, distance, and velocity of the median and ulnar nerves were measured. Needle electromyography was performed in the abductor pollicis brevis, in addition to muscles of the arm and forearm, to exclude proximal median nerve, brachial plexus, or radicular abnormalities. Ultrasonography was based on the morphologic/anatomic changes of the median nerve cross-sectional area in the sagittal plane of the wrist at the level of the pisiform bone, the changes of its regional echogenicity, and the identification of coexisting pathologies, such as tenosynovitis, space-occupying lesions, supplementary muscles, and vessels, that may provoke indirectly an increase of the pressure in the carpal tunnel. Eighty-seven (90%) of the 96 patients/hands with clinical symptoms of CTS showed positive findings in both ultrasonography and nerve conduction studies. Six (6%) patients showed positive findings only in nerve conduction studies, and 3 (3%) patients showed positive findings only in ultrasonography; the difference was not statistically significant. The sensitivity and the specificity of nerve conduction studies compared with ultrasonography was 97% and 89% compared with 94% and 55%, respectively. A positive correlation and proportional increase of the ultrasonography measurements compared with the increase of the nerve conduction studies severity was observed. [ Orthopedics . 2019; 42(5):e460–e464.]
Orthopaedic Proceedings, Feb 1, 2004
Complex hand injuries are those which involve more than one functionally significant anatomic str... more Complex hand injuries are those which involve more than one functionally significant anatomic structure of the hand (i.e vessels, nerves, tendons, bones). The epidemiologic and management characteristics of these injuries, encountered in a specialized center covering an urban and agricultural population, were recorded and studied. Between 1997 and 2002 the Orthopaedic Department of the University of Ioannina surgically treated 211 complex hand injuries in 190 patients with a mean age of 35 year (range 2.5–73). The majority of patients were male (89%). The incidence of these injuries was low at the extremes of the age distribution (children and adults over 60 years old). The greatest incidence was in the 15–30 year old age group. The mechanism of the injury was found to be clean cut trauma in 31% and avulsion or crushing in 69%; with the later being frequent agricultural injuries. Fifty-nine per cent of the injuries were viable, while 41% where non-viable (complete amputation in 63% and incomplete in 37%). Of the non viable injuries 66% eventually underwent stump configuration. Primary repair of only one anatomical structure was performed in 58%, most commonly osteosynthesis and tendon suturing. In 42% primary repair of more than one structure was performed, most commonly osteosynthesis and tendonorrhaphy in avulsion injuries and neuroraphy combined with tendonorrhaphy in clean cut injuries. Complex hand injuries are frequently seen in young male adults and the most common mechanism of injury is avulsion-crushing. Most of them are work-related accidents, so prevention should focus on adherence to safety guidelines. Management of such injuries requires special surgical techniques and expertise, necessary for staged reconstruction.
Journal of Shoulder and Elbow Surgery, Jul 1, 2016
This study was approved by the Institutional Review Board/Ethics Committee of the authors' instit... more This study was approved by the Institutional Review Board/Ethics Committee of the authors' institutions. Written informed consent was obtained from the patient to be included in this study.
The journal of hand surgery, May 3, 2016
Fibro-osseous pseudotumor of digits (FOPD) is an uncommon histological diagnosis. Clinical and im... more Fibro-osseous pseudotumor of digits (FOPD) is an uncommon histological diagnosis. Clinical and imaging findings may resemble high-grade sarcoma or infection. We describe a patient with progressive pain and swelling at the dorsal surface of the first web space. MRI and CT imaging revealed an intramuscular heterogenous soft tissue mass defined by a mineralized peripheral ring. Core needle biopsy diagnosed FOPD. Eight months later a matured ossified nodule that was quite smaller than the initial soft tissue mass was excised. The patient is symptom free without local recurrence at 1 year follow up. Soft tissue masses of the hand pose a challenging diagnostic and therapeutic issue. An in depth interpretation of clinical, imaging and histology findings is important to avoid erroneous diagnosis and treatment.
Springer eBooks, 2020
Tumors and tumor like lesions are a rare cause of peripheral neuropathy at the upper extremity. B... more Tumors and tumor like lesions are a rare cause of peripheral neuropathy at the upper extremity. Because of the rarity of the disease, the diagnosis is often delayed. In cases of atypical clinical presentation, a high index of suspicion and a detailed neurologic examination, along with the palpation of a mass are necessary to differentiate idiopathic, metabolic, inflammatory or traumatic neuropathy from a tumor related peripheral neuropathy. These lesions may be intra- or extra-neural, benign or malignant, and usually belong to one of the following categories: lipomatous tumors, ganglion and synovial cysts, reactive and inflammatory lesions, peripheral nerve sheath tumors, compression from lymph nodes and nerve lymphomatosis, metastatic disease to brachial plexus and peripheral nerves, and sarcomas. The treatment of these lesions includes decompression of the entrapped nerve and subsequent procedures according to the characteristics (location, extent, aggressiveness) of the lesion.
In the present study, we studied the effect of apolipoprotein A-1 (APOA1) on the spatial and mole... more In the present study, we studied the effect of apolipoprotein A-1 (APOA1) on the spatial and molecular characteristics of bone marrow adipocytes, using well-characterized ApoA1 knockout mice. APOA1 is a central regulator of high-density lipoprotein cholesterol (HDL-C) metabolism, and thus HDL; our recent work showed that deficiency of APOA1 increases bone marrow adiposity in mice. We found that ApoA1 deficient mice have greatly elevated adipocytes within their bone marrow compared to wild type counterparts. Morphologically, the increased adipocytes were similar to white adipocytes, and displayed proximal tibial-end localization. Marrow adipocytes from wild type mice were significantly fewer and did not display bone-end distribution pattern. The mRNA levels of the brown/beige adipocyte-specific markers Ucp1, Dio2, Pat2, Pgc1a, and the expression of leptin were greatly reduced in the ApoA1 knock-out in comparison to the wild-type mice. In the knock-out mice adiponectin was remarkably elevated. In keeping with the close ties of hematopoietic stem cells and marrow adipocytes, we found that the elevated adiposity in the ApoA1 knock out mice is associated with a significant reduction of the hematopoietic stem cells and common myeloid, but not common lymphoid, progenitors. Moreover, the "beiging"-related marker osteopontin and the angiogenic factor VEGF were also reduced in the ApoA1 knock-out mice, further supporting the notion that APOA1, and most probably HDL-C, regulate bone marrow microenvironment, favouring beige/brown adipocyte characteristics.
Injury-international Journal of The Care of The Injured, Dec 1, 2021
INTRODUCTION Among various patterns of complex injuries of the wrist and forearm, "spaghetti... more INTRODUCTION Among various patterns of complex injuries of the wrist and forearm, "spaghetti wrist" refers to an extensive volar forearm laceration, in which several of the 12 tendons, 2 major nerves and 2 major arteries are transected, leading to lifelong disability and psychological, social and economic consequences. The aim of the study is to emphasize the keynote principles for the management of these injuries through retrospective review of a large group of patients treated by a team of experienced hand surgeons. MATERIAL-METHODS Data were retrospectively obtained for 61 patients (49 males and 12 females with average age of 34.7 years) treated for spaghetti wrist lacerations and followed for a minimum period of two years, in two accredited Orthopaedic / Hand-Upper Extremity Surgery and Microsurgery Departments in Greece. All patients were treated within 16 hours of injury and underwent primary, layered reconstruction of all injured structures through an axial forearm exposure. RESULTS The most frequent mechanism of injury was glass-related lacerations. Overall, 541 structures were reconstructed, of which 417 were tendons, 76 nerves, and 48 arteries. An average of 8.86 structures were injured per patient, including 6.83 tendons, 1.24 nerves, and 0.79 arteries. The majority of the patients (28/61) had ≥10 structures injured (45.9%), while 32.7% (20/61) and 21.3% (13/61) of patients had 6-9 and 3-5 injured structures respectively. Almost 80% (49/61) of patients had excellent/good grading in all six tests used for the functional assessment post-operatively. DISCUSSION Spaghetti wrist injuries usually occur in a transverse wound pattern and necessitate timely and definitive operative reconstruction of all injured structures in layers, through an axial approach, by experienced hand surgeons to maximize outcome and to avoid complications. The most important prognostic factor of functional recovery is not the number of transected tendons, but the involvement of ulnar and/or median nerve injury.
International Journal of Molecular Sciences
In the present study, we studied the effect of apolipoprotein A-1 (APOA1) on the spatial and mole... more In the present study, we studied the effect of apolipoprotein A-1 (APOA1) on the spatial and molecular characteristics of bone marrow adipocytes, using well-characterized ApoA1 knockout mice. APOA1 is a central regulator of high-density lipoprotein cholesterol (HDL-C) metabolism, and thus HDL; our recent work showed that deficiency of APOA1 increases bone marrow adiposity in mice. We found that ApoA1 deficient mice have greatly elevated adipocytes within their bone marrow compared to wild type counterparts. Morphologically, the increased adipocytes were similar to white adipocytes, and displayed proximal tibial-end localization. Marrow adipocytes from wild type mice were significantly fewer and did not display a bone-end distribution pattern. The mRNA levels of the brown/beige adipocyte-specific markers Ucp1, Dio2, Pat2, and Pgc1a; and the expression of leptin were greatly reduced in the ApoA1 knock-out in comparison to the wild-type mice. In the knock-out mice, adiponectin was rema...
Journal of Shoulder and Elbow Surgery, May 1, 2023
Journal of Long-Term Effects of Medical Implants
Trauma is a problem of global public health with economic, social and political extensions. It is... more Trauma is a problem of global public health with economic, social and political extensions. It is constantly growing due to road accidents. The cost of hospitalization and the loss of working hours for those who managed to reach the hospital are huge for the national economy of each country. The purpose of the present study is to record the polytrauma patients of road accidents and to search for their economic cost. A total of 68 injured people were the study sample during the period 2014-2017. The study was conducted in a University hospital in Athens (Greece). The mean age of the patients was 36.67 years. The mortality was 13.2% and the mean cost of every polytrauma patient was 14.272 Euros. Nearly half of them had an infection, which increased the cost. Accident prevention, proper and timely treatment of injuries, monitoring, recording and controlling infections and reducing the length of hospitalization are some of the ways to reduce the financial cost of a traumatized person.
Journal of Musculoskeletal Surgery and Research
Objectives: Hip fractures in the elderly are common injuries that need timely surgical management... more Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no s...
Cancers, 2021
Background: An endoprosthetic reconstruction in musculoskeletal oncology patients is associated w... more Background: An endoprosthetic reconstruction in musculoskeletal oncology patients is associated with significant blood loss. The purpose of this study is to evaluate the safety and efficacy of tranexamic acid (TXA) for these patients and to assess any changes in their hemostatic profile using rotational thromboelastometry (ROTEM). Methods: A retrospective observational study was performed including 61 patients with primary or metastatic bone tumors who underwent surgery. Group A (n = 30) received both intravenous and local TXA whereas Group B (n = 31) was the control group. The primary outcomes were perioperative blood loss and blood unit transfusions and the secondary outcomes included the incidence of thromboembolic complications and a change in blood coagulability as reflected by ROTEM parameters. Results: The median difference in blood loss between the two groups was 548.5 mL, indicating a 29.2% reduction in the 72 h blood loss following TXA administration (p < 0.001). TXA al...
Objectives/Interrogation: Amputation of the fingertip with loss of the pulp, exposed bone and nai... more Objectives/Interrogation: Amputation of the fingertip with loss of the pulp, exposed bone and nail bed injury is a common problem, not infrequently neglected. Fingertip reconstruction requires new pulp glabrous skin coverage with sensitivity buttressed by the nail. Traditional management techniques[for full text, please go to the a.m. URL]
Ancient schwannomas are benign long standing schwannomas of the neural sheaths. Histological find... more Ancient schwannomas are benign long standing schwannomas of the neural sheaths. Histological findings are these seen as in conventional schwannomas, but ancient schwannomas additionally demonstrate cystic hemorrhagic changes and degenerative nuclei with pleomorphism and hyperchromasia. Due to the nuclear atypia, and cystic degeneration, ancient schwannomas might be confused with malignant tumors on histology and imaging, leading to a radical surgical approach. The median nerve is rarely affected. We present a rare case of an ancient schwannoma involving the median nerve at the mid humerus. The tumor slowly grew up within ten years and become symptomatic with local pain, mild numbness in the distribution of the median nerve in the palm and Tinel’s test. The tumor was successfully removed by separating it from the nerve fas-cicles to negative margins. Post-operatively local symp-toms relieved but minor sensory loss in the median nerve distribution in the palm was noticed which improve...
Cureus, 2022
Introduction A critical question is the causal relationship between hip or knee osteoarthritis (O... more Introduction A critical question is the causal relationship between hip or knee osteoarthritis (OA) and disordered spinal and pelvic morphology. The aim of this study is to examine this correlation. Therefore, we studied the effect of total hip or knee arthroplasty (THA/TKA) on truncal parameters to determine the causal relationship between these two situations. Materials and methods This is a prospective study of the effect of THA or TKA in patients with hip or knee OA on truncal morphological parameters. Patients with one-sided hip or knee OA who chose to undergo THA or TKA were enrolled and surveyed. A control group (CG) was also surveyed for comparison with the patients. The patients were preoperatively examined for truncal parameters using the Diers Formetric four-D analysis system (surface topography technique) to calculate several truncal parameters in all planes at four months and 12 months postoperatively. Measurable examinations were performed using the Statistical Package for the Social Sciences (SPSS) version 17.00 (SPSS Inc., Chicago), and statistical significance was set at a p-value of <0.05. Results The study examined 34 patients who underwent THA, including 19 women and 15 men with a mean age of 67.62 ± 8.28 years. The study also examined 45 patients who underwent TKA, including 34 women and 11 men, with a mean age of 72.42 ± 7.0 years. These patients were also compared with a CG that consisted of 25 normal individuals, including 12 women and 13 men, with a mean age of 69.28 ± 10.11 years. The results of this study from four months after THA revealed that the lordotic angle, trunk torsion, pelvic inclination, pelvic obliquity, and pelvis rotation were improved to normal levels. At 12 months after THA, only the pelvic obliquity was improved to normal levels. At four months after TKA the lordotic angle, pelvic inclination, and pelvic obliquity were improved to normal levels. However, the fleche cervicale and vertebral rotation were worse. At 12 months after TKA, only the pelvic obliquity was improved to normal levels. Conclusions THA and TKA to correct hip and knee OA do not correct the disordered morphology of the trunk in the long term. Thus, hip or knee OA does not seem to be responsible for disordered trunk morphology. However, it cannot be ruled out whether the disturbed morphology is responsible for the appearance of the hip and knee OA.
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Papers by Vasileios Kontogeorgakos