Sotiris Plakoutsis - Academia.edu (original) (raw)

Papers by Sotiris Plakoutsis

Global Spine Journal

Study Design Global cross-sectional survey Objective To develop and refine the techniques for web... more Study Design Global cross-sectional survey Objective To develop and refine the techniques for web-based international validation of fracture classification systems. Methods A live webinar was organized in 2018 for validation of the AO Spine Subaxial Injury Classification System, consisting of 35 unique computed tomography (CT) scans and key images with subaxial spine injuries. Interobserver reliability and intraobserver reproducibility was calculated for injury morphology, subtype, and facet injury according to the classification system. Based on the experiences from this webinar and incorporating rater feedback, adjustments were made in the organization and techniques used and in 2020 a repeat validation webinar was performed, evaluating images of 41 unique subaxial spine injuries. Results In the 2018 session, the AO Spine Subaxial Injury Classification System demonstrated fair interobserver reliability for fracture subtype (κ = 0.35) and moderate reliability for fracture morpholog...

Mædica, Mar 15, 2024

Hip dislocations are traumatic injuries that commonly derive from high energy trauma such as traf... more Hip dislocations are traumatic injuries that commonly derive from high energy trauma such as traffic accidents or falls from great heights. In addition, these injuries present an increased incidence after partial or total hip arthroplasty in elderly patients. Associate literature dictates that in case of a native hip dislocation, early reduction is crucial for avoidance of further complications such as avascular necrosis of the femoral head and post traumatic arthritis. In this article, we present a rare case of a native pure posterior hip dislocation after low-energy trauma. We also demonstrate the treatment and follow-up algorithm concerning this kind of injury.

Curēus, Apr 4, 2024

Introduction Vitamin D deficiency (VDD) is considered one of the leading causes of poor bone qual... more Introduction Vitamin D deficiency (VDD) is considered one of the leading causes of poor bone quality. It may also be related to severe muscular weakness, especially in the elderly, which leads to frequent falls. Thus, VDD might be associated with fragility fractures of the hip, wrist, and spine in this age category. In this crosssectional study, our goal was to present vitamin D levels in an elderly Mediterranean population with hip fractures and to assess whether its levels are related to the incidence or prevention of such injuries. Methods Between January and December 2021, 140 patients aged 65 years or older were hospitalized in our department with a fracture involving the hip joint. Serum calcium and vitamin D level control was performed upon admission, as well as recording whether anti-osteoporosis medication had been prescribed. Only patients with low-energy fractures were included, whereas oncologic patients and those with high-energy trauma were excluded. Results Thirty-eight men and 102 women, with a mean age of 83.12 and 84.88 years, respectively, participated in our study. Intertrochanteric fractures were the most common injuries (50.72%). Low vitamin D levels (<30 ng/mL) were observed in 132 patients (94.28%). A bone density scan during the last year had been conducted by only seven patients (5%), whereas in 136 patients (97.14%), no anti-osteoporotic medication was given. Conclusion There is an excessive percentage of aged patients with hip fractures in Greece, demonstrating a significant vitamin D insufficiency despite the high annual frequency of sunny days in this Mediterranean region. Presumably, most of these patients neither perform the routine bone density scan nor do they take any kind of preventive pharmaceutical treatment, which might reveal devaluation of osteoporosis from this age group due to contingent comorbidities.

Hand Surgery and Rehabilitation, Nov 30, 2023

Injury-international Journal of The Care of The Injured, Feb 1, 2013

The purpose of this study was to investigate the outcome after surgical therapy of patients suffe... more The purpose of this study was to investigate the outcome after surgical therapy of patients suffering from HO of the hip after treatment in ICU. We retrospectively examined 39 patients with heterotopic ossification of the hip (18 bilateral and 21 unilateral). All patients have had history of ICU treatment for several reasons, such as craniocerebral injury (35 patients-90%), 2 patients with Guillain-Barre syndrome (5%), 1 patient with pulmonary druse (2.5%), and 1 patient with inflammatory bowel disease (2.5%). They all underwent surgical removal of HO and postoperative irradiation therapy. On the basis of plain radiographic findings, we evaluated the recurrent ossification after an 18-month follow-up period. The evaluation of the average 18-months follow-up period showed relief of pain and clear improvement of range of motion in most of our patients. Specifically, improvement in the range of movement was observed in 41 hip joints (71.93%) in contrast to 16 hip joints (28.07%) that did not show any alteration post-operatively. No lesion re-occurrence was observed. There was only one complication of peroneal nerve paresis following HO excision. The majority of our patients that were treated with surgical excision of the ectopic bone around the hip joint significantly improved their range of joint movement and were relieved from pain. Surgical excision seems to provide a superior quality of life in these patients, as they have a high risk for major complications due to their poor level of mobility.

$Research paper thumbnail of F2.5 Clinical outcomes after surgical versus conservative treatment of acetabular fractures$

Injury-international Journal of The Care of The Injured, Feb 1, 2013

World Journal of Orthopedics, 2013

We report a case of a 32 year-old male, admitted for a lytic lesion of the distal femur. One mont... more We report a case of a 32 year-old male, admitted for a lytic lesion of the distal femur. One month after the first X-ray, clinical and imaging deterioration was evident. Open biopsy revealed fibrous dysplasia. Three months later, the lytic lesion had spread to the whole distal third of the femur reaching the articular cartilage. The malignant clinical and imaging features necessitated excision of the lesion and reconstruction with a custom-made total knee arthroplasty. Intraoperatively, no obvious soft tissue infiltration was evident. Nevertheless, an excision of the distal 15.5 cm of the femur including 3.0 cm of the surrounding muscles was finally performed. The histological examination of the excised specimen revealed central low-grade osteosarcoma. Based on the morphological features of the excised tumor, allied to the clinical findings, the diagnosis of low-grade central osteosarcoma was finally made although characters of a fibrous dysplasia were apparent. Central low-grade osteosarcoma is a rare, well-differentiated sub-type of osteosarcoma, with clinical, imaging, and histological features similar to benign tumours. Thus, initial misdiagnosis is usual with the condition commonly mistaken for fibrous dysplasia. Central low-grade osteosarcoma is usually treated with surgery alone, with rare cases of distal metastases. However, regional recurrence is quite frequent after close margin excision.

Injury, 2013

$Research paper thumbnail of F2.5 Clinical outcomes after surgical versus conservative treatment of acetabular fractures$

Curēus, Mar 9, 2024

Post-traumatic compartment syndrome in the lower extremity has been commonly associated with frac... more Post-traumatic compartment syndrome in the lower extremity has been commonly associated with fractures of the tibia. Only in rare cases, this critical condition might be related to isolated fibular fractures. We present a rare case of delayed onset of acute compartment syndrome after a solitary fracture of the fibula. A 40-year-old man with a history of coagulation disorders due to hepatic cirrhosis was admitted to a neighboring hospital after a car accident with left-sided fractures to ribs 9 and 10 and a transverse fracture in the mid-shaft of the left fibula. He was discharged from the hospital five days later with a posterior long leg splint and anticoagulant therapy. However, three days after discharge, he was seen in the emergency department of our hospital with severe pain and extensive swelling in the left leg. Weak posterior tibial and dorsalis pedis pulse in the right foot were detected. Moreover, sensory disturbances were found in the tibia and foot. Passive hallux dorsiflexion and plantar flexion were causing acute intense pain. A triplex ultrasound was negative for deep vein thrombosis. Apart from the clinical findings, the diagnosis of compartment syndrome was confirmed after evaluating intracompartment pressure measurements. The patient was taken emergently to the operating room for four-compartment fasciotomies. A large intramuscular hematoma was evacuated. Skin closure was accomplished in two stages within two weeks. Six weeks postoperatively, there was no sign of compartment syndrome sequelae and the patient was free of symptoms without any neurovascular deficiency in the operated limb and walked without crutches. Ten weeks later, he returned to his pre-injury daily activities. Although the majority of compartment syndrome cases are reported after high-energy trauma, patients with both coagulation disturbances and anticoagulation treatment are at higher risk of developing compartment syndrome secondary to simple fracture patterns.

International Journal of Science and Research Archive, Sep 30, 2021

Finger injuries to the hand with extensive soft tissue defects might be challenging to treat. Typ... more Finger injuries to the hand with extensive soft tissue defects might be challenging to treat. Typically, the first dorsal metacarpal artery (DMA) flap is used for reconstruction, whereas closure of the donor site is routinely performed with a split-thickness skin graft. The aim of the current study is to present a surgical technique that reports a modified incision, which allows elevation of the first DMA flap for the management of the soft tissue defects of the thumb without requiring a skin graft for coverage of the donor site. A 65-year-old man presented to the emergency department with a crush injury to the thumb. The patient had an extensive skin defect on the dorsal side of the thumb extending circumferentially to the ipsilateral thenar without tendon damages, whereas sensation of the finger was found intact. Surgical intervention was performed within six hours and involved DMA flap transfer through a modified skin incision, which allowed coverage of the donor defect in the index finger with a second DMA perforator flap. 3 months postoperatively, patient's satisfaction, sensation and range of motion (ROM) of the fingers were assessed using The Michigan Hand Outcomes Questionnaire (MHQ) and the 2-point discrimination (2-PD) test. The patient regained active ROM of the thumb and index along with complete preservation of sensation, while the final cosmetic outcome was satisfactory. The application of this technique allows coverage of both trauma defect and donor site with a single skin incision, providing a successful clinical outcome.

Cureus, Feb 23, 2023

Carpometacarpal (CMC) dislocations without associated fractures of the adjacent bones are extreme... more Carpometacarpal (CMC) dislocations without associated fractures of the adjacent bones are extremely infrequent injuries. Dorsal or volar dislocations occur after high-energy injuries and may lead to early posttraumatic arthritis and carpal instability. The purpose of this study was to present a case of dorsal dislocation of both the fourth and fifth CMC joints that were treated with closed reduction and casting. A 31-year-old man developed severe acute pain, functional limitation, and deformity of the wrist after falling from a height. The clinical examination revealed intense localized tenderness, swelling, and palpable prominence over the fourth and fifth metacarpals. Standard anteroposterior and lateral views demonstrated dislocations of the examined CMC joints without any accompanied fracture. The injury was treated with anatomic closed reduction and cast immobilization for overall five weeks followed by early mobilization. Twelve weeks after injury, the patient had regained grip strength, and six months posttraumatically he satisfactorily returned to his previous hard labor-intensive activities without any functional deficits or chronic pain. Conclusively, CMC dislocations can be treated conservatively in case of early diagnosis and stable anatomic closed reduction.

International Journal of Science and Research Archive, May 30, 2021

The pseudoaneurysm of the radial artery is an infrequent complication mainly after iatrogenic pro... more The pseudoaneurysm of the radial artery is an infrequent complication mainly after iatrogenic procedures, with an increased incidence over the last years. The aim of the current study was to present a rare case of a radial artery pseudoaneurysm that projected through the skin after a single arterial puncture for blood-gas analysis. A 79-year-old man, with a history of atrial fibrillation and coronary heart disease on anticoagulants, was admitted to the cardiological intermediate care unit, with pulmonary oedema due to heart failure deregulation. On the next day, his left radial artery was punctured for blood-gas analysis. No other catheterization of the vessel was executed in the following days. Six days later a pulsatile, palpable mass on the skin surface, over the site of puncture, was recognized. Subsequently a Doppler ultrasound that was performed, confirmed the diagnosis of pseudoaneurysm. The pseudoaneurysm was surgically removed under general anesthesia. The patient was hospitalized for four days for trauma monitoring and intravenous antibiotics and afterwards he was discharged from the Hospital. Three months postoperatively, no sign of recurrence was observed. The pseudoaneurysm of the radial artery is an uncommon complication that might occur even after simple iatrogenic procedures, like after a direct arterial puncture for blood-gas analysis. Therefore, specialists should always be aware of this complication in similar cases.

Cureus

International Journal of Scientific Research Updates

Developmental dysplasia of the hip (DDH) is one of the most common congenital defects with an inc... more Developmental dysplasia of the hip (DDH) is one of the most common congenital defects with an incidence of around 2 cases per 1000 births, affecting the development of the acetabulum and the femoral head. Etiopathogenesis remains unclear but certain risk factors have been associated with DDH including the female gender, postmaturity, primiparity, oligohydramnios and breech presentation. If left untreated, hip dysplasia is considered a main cause of early osteoarthritis. Reviewing the literature, the purpose of the current study is to present current evidence regarding the anatomical abnormalities of DDH during infancy, childhood and adulthood. Using the searching tools on the internet, a thorough search, evaluation and selection of recent published articles in reliable international electronic libraries was conducted regarding the anatomical variations in developmental dysplasia of the hip. The results, extracted from these manuscripts, were the basic source of the current study. It...

Cureus, 2021

Crush injuries of the foot and ankle are uncommon and they have a poor prognosis leading to some ... more Crush injuries of the foot and ankle are uncommon and they have a poor prognosis leading to some form of disability. Degloving injuries of the heel and foot after crush injuries are rare and very challenging to manage due to the need for reconstruction of both osseous and soft tissue architecture. We present a salvage strategy for an open injury to the foot with extensive soft tissue detachment from the plantar and dorsal surface. A 30-year-old man was transferred to the Emergency Department from a neighboring hospital with a crush injury to the foot that had resulted in a degloving injury of the heel pad, after a motorcycle accident. The patient had a 20 cm circumferential wound that was extending from dorsal to the plantar surface along with rupture of the extensor digitorum longus (EDL) tendons and transection of the superficial peroneal nerve. There was an extensive detachment of soft tissues from the deep fascia and bones, whereas the posterior tibial artery was intact. In radiographic imaging, a small inferior avulsion fracture of the calcaneus along with fractures of the cuneiform bones was revealed. The initial management involved thorough surgical debridement, removal of necrotic tissues, repair of EDL tendons and fracture stabilization. Negative-pressure wound therapy was also applied for six weeks. Subsequently, a split-thickness skin graft was used to cover the skin defect. Six months after injury, the patient had a normal range of motion, intact sensation over the sole and could ambulate independently. Although the majority of heel pad degloving injuries have a poor prognosis, there are positive prognostic factors as presented in the current case for a satisfying functional final outcome, which include vascular intergrity, fracture stabilization, soft-tissue reconstruction with negative pressure wound therapy, and application of skin grafts.