Search

Rationale, aims and objectives Developing homogenous low back pain (LBP) classification groups is recommended for enhancing clinical outcomes. However, an important step towards the development of specific subgroups is the selection and consensus agreement among health professionals on the discriminatory clinical items (sings and symptoms) that should be included in the classification process. Thus, this study's objective was to develop a list of clinical features for the assessment of LBP by health care providers within Greece, which are believed to be discriminatory in identifying LBP subgroups. Methods A random sample stratified by geographical region and work status of 150 Greek physiotherapists (PTs) participated in a two-round Delphi study. PTs were asked to obtain consensus and hierarchy, the most important items out of a list of evaluating/diagnostic features believed to be discriminatory for LBP patients. These items included 80 clinical features and were generated in by PTs and doctors previous work. Results Second-round questionnaires were returned by 112 PTs (74.6% response rate). A total of 66 clinical features were rated as important discriminatory items in LBP assessment. Clinical items included characteristics of present symptoms and the history's condition, general medical history, information regarding patient function, patients' attitudes regarding movement, diagnosis, expectations, fear-avoidance beliefs as well as aspects of a physical examination including observation, active and passive movements, neurological and muscular examination. Conclusions This is the first study identifying important clinical items for LBP patients in Greece. It may be that these features are ‘discriminatory’ for different LBP subsets; however, further research is needed.

Background The mechanoreceptors located in anterior cruciate ligament (ACL) constitute an afferent source of information toward the central nervous system. It has been proposed that ACL deficiency causes a disturbance in neuromuscular control, affects central programs and consequently the motor response resulting in serious dysfunction of the injured limb. Purpose The objective of this study was to investigate whether chronic anterior cruciate ligament injury causes plastic changes in brain activation patterns. Study Design Case control study; Level of evidence, 3. Methods Seventeen right leg–dominant male participants with chronic anterior cruciate ligament deficiency and 18 matched healthy male participants with no special sport or habitual physical activity participated in this study. Patient selection criteria comprised a complete right unilateral anterior cruciate ligament rupture ≥6 months before testing. Brain activation was examined by using functional magnetic resonance imaging technique (1.5-T scanner). Results Results show that patients with anterior cruciate ligament deficiency had diminished activation in several sensorimotor cortical areas and increased activation in 3 areas compared with controls: presupplementary motor area, posterior secondary somatosensory area, and posterior inferior temporal gyrus. Conclusion The current study reveals that anterior cruciate ligament deficiency can cause reorganization of the central nervous system, suggesting that such an injury might be regarded as a neurophysiologic dysfunction, not a simple peripheral musculoskeletal injury. This evidence could explain clinical symptoms that accompany this type of injury and lead to severe dysfunction. Understanding the pattern of brain activation after a peripheral joint injury such as anterior cruciate ligament injury lead to new standards in rehabilitation and motor control learning with a wide application in a number of clinical and research areas (eg, surgical procedures, patient re-education, athletic training, etc).

A 67-year-old woman presented with erythema and swelling over her left elbow. She felt pain during palpation of the olecranon, while the range of elbow motion was slightly reduced (02 in circle-302 in circle-1302 in circle). She had been treated conservatively elsewhere for 3 months with nonsteroidal anti-inflammatory drugs and splint immobilization. Radiographs and computed tomography showed an osteolytic area over the olecranon with cortex disruption. She underwent open biopsy of the olecranon, and the histologic features were compatible with tuberculosis. Erythrocyte sedimentation rate was elevated and she had a positive Mantoux test (14 mm). She mentioned no history of pulmonary disease and had a normal chest radiograph. She received antituberculous treatment (isoniazid, rifambin, and pyrazinamide) for 2 months without obvious improvement. She underwent surgical debridement of the olecranon while she continued antituberculous treatment for 12 months, discontinuing pyrazinamide after the third month. After the completion of antituberculous treatment, the patient was pain-free, without local signs of infection and with improved range of motion (02 in circle-202 in circle-1452 in circle). Early diagnosis and treatment of olecranon tuberculosis is of great value, and the prognosis is good when there is no spread in the elbow joint.

The present study was conducted in 10 different communities of prefecture of Larissa, one of the main cotton-productive areas of Greece. Monitoring of Helicoverpa armigera lasted four years from 2002 to 2005. The monitoring system included four locations within each community and three traps in each location. Traps were of the funnel type, a reusable injection-moulded kind of plastic trap. Pheromone was z-11-hexadecenyl aldehyde 0.36% w/w. Insecticide (Vapona) was used for all the four years, but for years 2003 and 2004 double traps were used additionally, without the presence of insecticide (only with pheromone). Traps containing a pheromone and an insecticide had significantly greater number of insects trapped than those containing no insecticide. Fluctuation of insect population was different from year to year. Correlations on data between years (insect populations and cotton production across all communities) revealed that, when cotton production was low, the number of adult male insects of H. armigera captured in pheromone traps was high (r = -0.69). There were no statistically significant correlations between cotton production and number of trapped insects when data from all communities (across the four years) were used. Local conditions within each area have been proved important and these results were completely different compared to data concerning specific years. Prediction models must be used for average estimations within great areas that include data from many locations.

Background: The mechanoreceptors located in anterior cruciate ligament (ACL) constitute an afferent source of information toward the central nervous system. It has been proposed that ACL deficiency causes a disturbance in neuromuscular control, affects central programs and consequently the motor response resulting in serious dysfunction of the injured limb. Purpose: The objective of this study was to investigate whether chronic anterior cruciate ligament injury causes plastic changes in brain activation patterns. Study Design: Case control study; Level of evidence, 3. Methods: Seventeen right leg-dominant male participants with chronic anterior cruciate ligament deficiency and 18 matched healthy male participants with no special sport or habitual physical activity participated in this study. Patient selection criteria comprised a complete right unilateral anterior cruciate ligament rupture =6 months before testing. Brain activation was examined by using functional magnetic resonance imaging technique (1.5-T scanner). Results: Results show that patients with anterior cruciate ligament deficiency had diminished activation in several sensorimotor cortical areas and increased activation in 3 areas compared with controls: presupplementary motor area, posterior secondary somatosensory area, and posterior inferior temporal gyrus. Conclusion: The current study reveals that anterior cruciate ligament deficiency can cause reorganization of the central nervous system, suggesting that such an injury might be regarded as a neurophysiologic dysfunction, not a simple peripheral musculoskeletal injury. This evidence could explain clinical symptoms that accompany this type of injury and lead to severe dysfunction. Understanding the pattern of brain activation after a peripheral joint injury such as anterior cruciate ligament injury lead to new standards in rehabilitation and motor control learning with a wide application in a number of clinical and research areas (eg, surgical procedures, patient re-education, athletic training, etc). © 2009 The Author(s).

Background Spinal cord injury without radiographic abnormalities (SCIWORA) is thought to represent mostly a pediatric entity and its incidence in adults is rather underreported. Some authors have also proposed the term spinal cord injury without radiologic evidence of trauma, as more precisely describing the condition of adult SCIWORA in the setting of cervical spondylosis. The purpose of the present study was to evaluate adult patients with cervical spine injuries and radiological-clinical examination discrepancy, and to discuss their characteristics and current management. Methods During a 16-year period, 166 patients with a cervical spine injury were admitted in our institution (Level I trauma center). Upper cervical spine injuries (occiput to C2, 54 patients) were treated mainly by a Halo vest, whereas lower cervical spine injuries (C3-T1, 112 patients) were treated surgically either with an anterior, or posterior procedure, or both. Results Seven of these 166 patients (4.2%) had a radiologic-clinical mismatch, i.e., they presented with frank spinal cord injury with no signs of trauma, and were included in the study. Magnetic resonance imaging was available for 6 of 7 patients, showing intramedullary signal changes in 5 of 6 patients with varying degrees of compression from the disc and/or the ligamentum flavum, whereas the remaining patient had only traumatic herniation of the intervertebral disc and ligamentum flavum bulging. Follow-up period was 6.4 years on average (1-10 years). Conclusion This retrospective chart review provides information on adult patients with cervical spinal cord injuries whose radiographs and computed tomography studies were normal. It furthers reinforces the pathologic background of SCIWORA in an adult population, when evaluated by magnetic resonance imaging. Particularly for patients with cervical spondylosis, special attention should be paid with regard to vascular compromise by predisposing factors such as smoking or vascular disease, since they probably contribute in the development of SCIWORA.

The literature discussing the management of adults with late sequelae of knee-joint septic arthritis is rather sparse. This is in marked contrast to the plethora of references regarding reconstructive hip surgery for the late sequelae of joint infection during childhood. Appropriate and timely treatment of septic arthritis seldom results in devastating complications such as joint destruction with concomitant dislocation. Such complications are currently rare in countries with well-developed health systems, possibly because there is a high index of suspicion and the appropriate treatment is highly effective. We report a case of the management of a neglected posterior knee dislocation as a late sequela of septic arthritis in adolescence. The apparent rarity of such a devastating complication and the fact that it represents a challenging therapeutic problem could be of significant educational value for an orthopedic surgeon confronted with a similar case, enabling him to accurately assess the patient preoperatively and plan the treatment stages using the Ilizarov device to enhance a valuable functional outcome.

Introduction A patient with a neglected, compound acutely ruptured false aneurysm of the brachial artery which developed after a periprosthetic fracture of the right humerus, is reported. Case presentation An 84-year-old Greek woman underwent right shoulder hemiarthroplasty 2 years before a periprosthetic fracture which was treated conservatively in another hospital. After removing the U-slab herself, she noticed the development of an ulcer on the mid-humerus, with continuous oozing but no fever. This led to above-elbow amputation in an attempt to save the patient's life. Conclusion It is hoped that by awareness of such a possibility coupled with an early diagnosis based on the clinical picture and imaging modalities, such unfortunate results can be avoided in the future. In case of increasing displacement at the fracture site and excessive local swelling, the possibility of the presence of a false brachial aneurysm should be ruled out despite the presence of normal perfusion of the hand and palpable radial and ulnar pulses.

Objective Although anterior surgery for cervical spine injuries is a widespread procedure, articles regarding its overall complications are infrequently published in the literature. In the current study we focus on the complications encountered after anterior instrumented stabilization of cervical spine injuries and we discuss ways to minimize them. Patients and methods Patients with unstable lower cervical spine injuries who underwent anterior surgery over a 15-year period were identified and 74 patients with adequate follow-up were included in the study. Indication for surgery was set by the instability criteria of White and Panjabi. Demographic information, initial neurological examination, surgical reports, imaging findings and follow-up records were evaluated. Results Complications were classified as intraoperative (technique-related) and postoperative. Although radiological “complications” were noted, they had no or minor clinical consequences for the patient. We identified 9 patients with clinically significant complications: no purchase of the screws, late angulation deformity, screw breakage, backout of the screws and postoperative hematoma. Overall, 3 out of 74 patients (4%) were reoperated due to significant screw backout causing dysphagia, no purchase of the screws being completely in the adjacent disc and screw breakage, respectively. Conclusion Anterior surgery for cervical spine injuries can present several complications, yet the technique is in a way permissive, even during the learning curve. Considering the significant morbidity of these patients, the reported rate of clinically significant complications is considered acceptable, and it could be further minimized by good preoperative planning, careful surgical technique and the use of modern implants and instrumentation.

The growing importance of the service economy during the last 40 years has raised the need for new tools for designing and managing services. As a result, several authors have developed service classification systems, in order to better understand the nature of service operations and provide methods and tools to improve service efficiency and quality. This paper exploits the work resulting from service classification systems and identifies the principal attributes to be considered in service management. The tool introduced for this purpose is the Service Attribute-Process Matrix (SAPM), which uses selected results from existing service classification schemes to investigate the importance of the significant service attributes to major processes of the service life cycle.

Few studies have determined the effects of a heavy resistance training on vertical jump performance in older adults. The purpose of the present study was to evaluate the effects of a 12 week heavy resistance training in vertical jump and functional performance in healthy, inactive, older women.Seventeen sedentary older women (aged 53-69 years) were assigned either to a control (C, n=8), or to a heavy resistance training (RT, n=9). The RT group trained knee extensors and flexors at 80% of 1-repetition maximum (1-RM), 3 days per week for 12 weeks. Both groups were evaluated in 1-RM lower body strength, squat jump (SJ) and countermovement jump (CMJ) height, and chair rising time, before and after the training period.After the training period, RT significantly improved (P0.001) the 1-RM lower body strength, SJ, CMJ height, and chair rising by 68.9%, 24.5%, 21.7%, and 13%, respectively. Significant correlations were observed among the percent (%) change in 1-RM lower body strength and SJ (r=0.849, P0.001), CMJ height (r=0.797, P0.001), and chair rising time (r=-0.917, P0.001).Muscle power improved after a short-term heavy resistance training, as measured by vertical jump and chair rising performance, in inactive older adults. The gains in muscle strength may contribute to the gains in chair rising time, SJ and CMJ height.

We evaluated the outcome in 10 young patients, ages ranging from 15 to 26, with types III and IV osteochondritis dissecans of the knee, treated with Herbert screws fixation and reverse guided drillings. The disease involved the medial femoral condyle in eight patients and the lateral in two. Diagnosis and preoperative planning based on plain radiographs (AP, lateral and tunnel view) and MRI (in seven patients). Fixation of the fragment with Herbert screws using a mini-arthrotomy technique and additional reverse drillings behind the crater of the lesion using the ACL aiming devise were performed in all patients. Post-operatively, no weight bearing was recommended for at least three months. The follow-up ranged from 15 months to 38 months (mean 27 months). According to the subjective questionnaire of the International Cartilage Repair Society (ICRS) scale, seven patients had normal knees, two had nearly normal knees and one abnormal. The Lysholm Knee score ranged 65-96 points (mean 88 points). All patients except one returned to their previous activities and they were satisfied with the result. Radiological union of the fragment was found in 9/10 patients (six grade III, three grade IV). Progressive flattening of the injured femoral condyle was noticed in two patients (grade III). Securing the lesion using Herbert screws in combination with reverse guided drillings seems to be an effective treatment choice for detached or displaced osteochondral fragments.

An 86 year old man presented with subtrochanteric fracture (AO classi®cation type 31 A3) following a fall (Fig. 1). There was an undisplaced fracture of the lesser trochanter but no obvious involvement of the femoral neck. Operative stabilization was undertaken using the AO UFN with a spiral blade used for proximal locking. Post operative X-rays were satisfactory with no evidence of iatrogenic femoral neck fracture (Fig. 2). The patient mobilized by partial weight bearing for 6 weeks. Two months after surgery the patient developed increasing left hip pain and was unable to weight bear. There was no history of further trauma to the hip. Repeat X-rays revealed proximal migration of the spiral blade to the upper third of the femoral head and neck. There was also a fracture at the base of the femoral neck associated with breakage of spiral blade (Fig. 3).