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Biomedical subjects

C P Charalambous

Publications and source records attributed to C P Charalambous.

17 recordsLinked to original sources
PubMed2006

Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures.

INTRODUCTION: The aim of this study was to describe early results of a new internal locking system, PHILOS, used for the treatment of proximal humeral fractures. MATERIALS AND METHODS: A chart and radiographic review of 25 cases that had proximal humeral internal locking system (PHILOS) plate for the treatment of proximal humeral fractures was performed. RESULTS: Of the 25 cases, 20 went to union with a mean neck/shaft angle of 127.2 degrees . Five cases required or were considered for revision surgery for non-union or implant failure. Of the 25 implants, 4 had screw protrusion into the gleno-humeral joint, 4 had screw loosening and backing out, and 1 plate broke without further trauma. CONCLUSIONS: Our results suggest that PHILOS is an effective system for providing fracture stabilisation to bony union but awareness of potential hardware complications is essential.

Adult↗
PubMed2006

Radial head fracture in the medial collateral ligament deficient elbow; biomechanical comparison of fixation, replacement and excision in human cadavers.

A widely used clinical recommendation is that in the presence of medial collateral ligament injuries, two-part radial head fractures should be fixed rather than excising or replacing the radial head. Direct biomechanical data comparing fracture fixation, radial head replacement and excision in a human cadaveric elbow model, have not been previously described. Such comparison is clinically important as with the increasing availability of radial head implants and promising follow up results, the role of radial head replacement in fracture management may have to be redefined. In this study, five fresh cadaveric elbows had radial head fracture creation and medial collateral ligament division, fracture fixation, radial head replacement and excision. Valgus and varus laxity were determined using an electromagnetic tracking system. Radial head replacement leads to a similar valgus (P=0.80) [corrected] laxity as compared to radial head fixation. Radial head excision resulted in a significantly greater valgus laxity as compared to radial head fixation (P=0.02) or replacement (P=0.03). Both radial head excision and replacement led to a greater varus laxity as compared to fixation. Our results suggest that in the elbow with medial collateral ligament injury and two-part radial head fracture, fixation is overall biomechanically superior as compared to replacement and excision.

Aged↗
PubMed2005

Operating out of hours in acute orthopaedics: variations amongst surgeons and regions in the United Kingdom.

It is recommended that out of hours, surgery should be confined to emergency cases. What constitutes an emergency in orthopaedic surgery is not well defined. This study presents the results of a postal survey sent to orthopaedic surgeons practicing in the United Kingdom, asking them what is the time frame they would recommend operating upon, and whether they would operate out of hours for common acute orthopaedic presentations. Our results demonstrate variability both amongst individual surgeons as well as amongst different regions in the United Kingdom.

Acute Disease↗
PubMed2005

Casting versus surgical fixation for grade IIIA open tibial diaphysial fractures in children: effect on the rate of infection and the need for secondary surgical procedures to promote bone union.

We evaluated 39 grade IIIA open tibial fractures presenting in children younger than 13 years of age, to determine if the mode of fracture stabilization (casting vs. surgical fixation) was related to the rate of infection or the need for secondary surgical procedures to promote bone union. All fractures had wound debridement in the operating room. Thirty patients had manipulation and casting, and nine surgical internal or external fixation. There were two cases of infection in the cast-treated group and two in the surgical fixation group (P=0.17). None of the fractures required a secondary surgical procedure to promote bone union. Three of the fractures treated by manipulation and casting displaced; two required re-manipulation and casting and one was converted to external fixation. In two cases the applied external fixator had to be re-aligned. Our results suggest that manipulation and casting is a reliable treatment for open tibial fractures in children.

Adolescent↗
PubMed2005

Early versus delayed surgical treatment of open tibial fractures: effect on the rates of infection and need of secondary surgical procedures to promote bone union.

The purpose of this study was to evaluate whether there was any significant difference in the rates of infection and of secondary surgical procedures to promote bone union, between early(6 h or less after arrival to hospital) and delayed(more than 6 h) surgical treatment of open tibial fractures. Three hundred and eighty-three open tibial fractures were evaluated. 184 fractures had early and 199 had delayed surgical treatment. The rates of infection and secondary surgical procedures to promote bone union of the two groups were compared with univariate and multivariate statistical methods. There was no statistically significant difference between early and delayed treatment groups with respect to overall infection (53/184 versus 51/199 infection rates, P = 0.96), deep infection (8/184 versus 8/199 infection rates, P = 1.0), and rates of secondary surgical procedures to promote bone union (24/184 versus 20/198, P = 0.77). We were unable to demonstrate any significant difference in infection rates or need of secondary procedures to promote bone union, between early and delayed surgical treatment of open tibial fractures.

Adolescent↗
PubMed2005

Availability of orthopaedic trauma lists in the United Kingdom.

National guidelines recommend that hospitals dealing with acute orthopaedic trauma should have daily, consultant led trauma lists, performed in dedicated trauma theatres. This study examined the availability and organisation of orthopaedic trauma lists in the United Kingdom using a postal survey. Of 228 responding hospitals, only 29% had daily trauma lists. In 17%, elective cases were cancelled to accommodate trauma whilst up to 20% of hospitals had a high proportion of their trauma lists not being consultant led. Twenty-one percent of responding hospitals did not have a dedicated trauma theatre. Our results suggest that most units have a long way to go in meeting national standards regarding the availability of orthopaedic trauma lists.

Adult↗
PubMed2004

Superficial branch of the radial nerve piercing the brachioradialis tendon to become subcutaneous: an anatomical variation with clinical relevance.

We dissected 20 preserved Caucasian cadaveric upper limbs looking at the relation of the superficial branch of the radial nerve (SBRN) to the brachioradialis tendon. SBRN emerged from deep to superficial position by piercing the brachioradialis tendon near its dorsal border in four limbs. The resulting dorsal tendinous band compressed the nerve and prevented longitudinal gliding movement during ulnar flexion. This is likely to increase the risk of chronic compression neuropathy (Wartenberg's syndrome). In two of these four limbs, there was a communication between the SBRN and lateral cutaneous nerve of the forearm. No such communication was found in the remaining 16 forearms. This communication could contribute to the minimal area of sensory loss observed in Wartenberg's syndrome. We recommend that this anatomical anomaly is looked for and if present dealt with during surgical treatment of Wartenberg's syndrome, as it is likely to predispose to chronic compression neuropathy.

Cadaver↗
PubMed2003

Septic arthritis following intra-articular steroid injection of the knee--a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee.

Septic arthritis is a potential catastrophic complication of intra-articular steroid injection. There is lack of evidence regarding the precautions that should be taken to avoid such a complication, as well as how often it is encountered. The aim of this study was to evaluate the antiseptic precautions taken during intra-articular steroid injection of the knee in the United Kingdom (UK), and estimate how often septic arthritis is encountered by health professionals in the UK following steroid injection of the knee. A questionnaire was posted to 100 orthopaedic surgeons, 100 rheumatologists and 50 general practitioners (GPs), asking them about the cases of septic arthritis following intra-articular steroid injection of the knee that they encountered during their practice and the precautions they take when injecting knees. The response rate was 76.4%; 57.6% of the respondents used alcohol swabs to clean the skin, and the remaining 42.4% used chlorhexidine or Betadine. Only 16.3% used sterile towels to isolate the injection site. There were 32.5% of respondents who routinely used sterile gloves when injecting, and a total of 46.6% used either sterile or non-sterile gloves. Also, 91.1% changed needles between drawing the steroid and injecting it into the joint. Only 24 respondents (12.6%) had encountered septic arthritis after steroid injection of the knee (18 once, 3 twice, 2 three times, 1 several times). We concluded that septic arthritis post intra-articular steroid injection of the knee is probably rare. There is a wide variation in the precautions taken to avoid such a complication. However, the trend seems to be towards minimal use of antiseptic techniques. Further large prospective studies are needed to determine how frequently septic arthritis of the knee is encountered post steroid injection, and the exact precautions that should be taken to avoid it.

Adult↗
PubMed2003

Soft tissue infections of the extremities in an orthopaedic centre in the UK.

OBJECTIVES: To determine the spectrum, and clinical impact of acute extremity soft tissue infections, encountered in the Orthopaedic service of an inner city hospital in UK. METHODS: Patients requiring admission for an acute limb soft tissue infection to the Orthopaedic unit of the Manchester Royal Infirmary, UK, between July 1996 and 2001 were identified from our database. Infections involving the groin and axilla, those developing within 30 days of a surgical procedure, and patients with chronic soft tissue ulcers or infections were not considered. RESULTS: Of 142 infections the majority were cellulitis (50%) and superficial abscesses (34.5%). Most were secondary to trauma (31.6%), human or animal bites (20%) and intravenous drug abuse (17.6%). Although most patients were young and otherwise healthy, ten developed significant complications: myonecrosis requiring below knee amputation (1), acute carpal tunnel syndrome (1), osteomyelitis (6), extensive skin loss requiring reconstruction (1), deep vein thrombosis (1). Seven hundred and eighty four hospital inpatient days and 143 operative interventions were devoted to these patients. The estimated cost for each episode of soft tissue infection was pound 1011. In 25% of cases earlier referral to a surgical service would have been more appropriate. CONCLUSIONS: Soft tissue infections of the extremities confer significant morbidity and impose an important burden on medical resources.

Adolescent↗
PubMed2003

Acute carpal tunnel syndrome: two rare cases.

Acute carpal tunnel syndrome is an orthopaedic emergency that requires prompt surgical treatment. We describe two rare cases of this condition, one secondary to pyogenic infection and one secondary to prolonged pressure on the upper limb brought on by overdose.

Acute Disease↗
PubMed2003

The development of a protocol in using day surgery for minor orthopaedic trauma patients.

We examined all minor orthopaedic trauma patients requiring surgical intervention at Manchester Royal Infirmary over a 6-month period to determine whether minor trauma patients meet the day surgery requirements in terms of medical fitness, analgesia requirements and postoperative complications. A total of 83 patients had surgery for minor orthopaedic trauma in the defined period. Of these patients, 79 (95.2%) were medically fit, 45 (70%) were admitted to a hospital ward and 19 (30%) were brought back to day surgery. None of the patients attending day surgery developed postoperative complications or required return to hospital. The majority of patients admitted to a ward required simple or no analgesia pre- (95.5%) and postoperatively (100%), and most were discharged on the same (55.6%) or next (35.6%) day of their operation. We suggest a protocol whereby patients with minor trauma are brought back to day surgery. This could potentially reduce pressures on bed availability.

Adolescent↗
PubMed2003

Factors delaying surgical treatment of hip fractures in elderly patients.

BACKGROUND: Published guidelines recommend early surgical treatment of hip fractures in elderly patients. Understanding the factors that delay surgical intervention is essential in order to introduce changes that will facilitate early treatment. AIM: To determine the factors delaying surgical treatment of hip fractures in elderly patients for more than 24 h. PATIENTS AND METHODS: Assessment of 163 consecutive patients undergoing surgery for hip fractures at the trauma unit of Manchester Royal Infirmary. RESULTS: Only 72/163 (44.2%) patients had their operation within 24 h of presenting to hospital. The remaining 91 patients had a total of 239 days delay (in excess of the initial 24 h) for surgical treatment. Active medical problems (56.5%) and a wait for medical investigations (19.7%) caused most delays. Lack of operating theatre time and Sunday trauma lists caused 23.8% of delays. CONCLUSIONS: Medical problems account for most delays of surgical treatment of hip fractures. A multidisciplinary approach, with early input by medical and anaesthetic teams, is essential in managing such patients. Established protocols may reduce waiting times for essential investigations.

Aged↗
PubMed2003

Reduced delays in A&E for elderly patients with hip fractures.

Published guidelines recommend early transfer of patients with hip fractures to hospital wards and avoidance of unnecessary delays in A&E. We describe a protocol whereby the liaison of an orthopaedic trauma co-ordinator with A&E reduced A&E-to-ward transfer times by 43%. Following introduction of the new protocol, 39% of hip fracture patients were in a ward bed within 3 h of admission to A&E compared to 4% previously. The new protocol also reduces administrative workload for the on-call orthopaedic SHOs.

Aged↗
PubMed2002

Management of osteoporosis in an orthopaedic department: audit improves practice.

Patients presenting with an osteoporosis-related fracture are at increased risk of further fractures. We performed a retrospective survey to determine if elderly patients presenting to the orthopaedic unit at Manchester Royal Infirmary with low energy hip or distal radius fractures were being managed appropriately with regards to assessment, investigation and treatment for possible osteoporosis. The initial survey demonstrated that only 16% of elderly female patients with low energy hip fractures and none of those (0%) with distal radius fractures were started on treatment or referred for further investigations for possible osteoporosis. After changes in our practice, 76% (p < 0.00001) of patients with hip fractures and 81% (p < 0.00001) of those with distal radius fractures were investigated, started on treatment or referred to a consultant physician for the management of osteoporosis.

Aged↗
PubMedDate not supplied

Case report: managing fractures in non-compliant alcoholic patients--a challenging task.

AIMS: To investigate whether there are extractable conclusions for limb fracture management in dependent alcoholics. METHODS: We discuss four cases of dependent alcoholics who presented in our department over a 12-month period, and who developed significant complications owing to non-compliance with treatment. RESULTS: Initial treatment, although appropriate, failed because of non-compliance. This led to further admissions, wound infections and surgery to enable cure. CONCLUSIONS: Our case reports indicate that for upper limb fractures of the middle third of the humerus, non-operative treatment or internal fixation with out-patient detoxification is appropriate. Lower limb fractures, on the other hand, should be dealt with by external fixation and in-patient detoxification. It is imperative that the alcohol dependence is addressed if we are to decrease non-compliance.

Adult↗