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1.  Which Patients Are at Risk for Kidney Dysfunction After Hip Fracture Surgery? 
Kidney dysfunction (KD) after hip fracture surgery is a major complication. However, the incidence and risk factors of KD in this population are unclear.
We therefore (1) determined the incidence of KD in a large cohort of fracture patients, (2) identified preoperative risk factors predisposing to KD, and (3) determined the effect of KD on length of stay and subsequent function.
Between April 2011 and June 2012, 450 patients (263 women) with a mean age of 73 years (range, 67–96 years) underwent surgery for hip fracture in our institution. We calculated incidence and retrospectively reviewed suspected predisposing risk factors. We report followup at 6 months.
The overall incidence of KD was 11% (n = 52). Forty-five patients (86%) developed acute KD and seven patients developed acute-on-chronic KD. Three of the 52 patients died during the followup time. Thirty-eight of the 52 patients (73%) regained their prior kidney function after treatment. An increased risk of KD was found in those with diabetes, shock during or after surgery, age, and preexisting KD. Mean length of stay was higher for patients with KD compared to those without: 9.6 versus 7.4, respectively. At 6 months, 39 of the 49 surviving patients (80%) were fully weightbearing.
Many patients at risk for postoperative KD can be identified and treated. Most patients recover from their KD and the majority return to full weightbearing.
Level of Evidence
Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
PMCID: PMC3825871  PMID: 23775570
3.  Combined use of Ilizarov external fixation and Papineau technique for septic pseudoarthrosis of the distal tibia in a patient with diabetes mellitus 
Diabetic Foot & Ankle  2014;5:10.3402/dfa.v5.22841.
The surgical treatment of open pilon fractures has a high complication rate especially in diabetic patients. In this article, we present a case of an infected tibial non-union after an open reduction and internal fixation in a diabetic patient, treated with Ilizarov external fixation combined with Papineau technique. Combined use of external fixation and Papineau technique can provide an alternative option for the treatment of septic pseudoarthrosis of the distal tibia.
PMCID: PMC3926991  PMID: 24563728
tibia; infection; non-union; Ilizarov; external fixation; Papineau technique
4.  Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures? 
Proximal femoral nail antirotation devices (PFNAs) are considered biomechanically superior to dynamic hip screws for treating unstable peritrochanteric fractures and reportedly have a lower complication rate. The PFNA II was introduced to eliminate lateral cortex impingement encountered with the PFNA. However, it is unclear whether the new design in fact avoids lateral cortex impingement without compromising stability of fixation and fracture healing.
We therefore asked whether the PFNA II: (1) eliminates the lateral cortex impingement and fracture displacement experienced with PFNA; and (2) provides stable fracture fixation with a low major complication rate for unstable fractures in European patients.
We retrospectively reviewed 108 patients with an unstable peritrochanteric fracture, 58 treated with PFNA and 50 with PFNA II. We compared nail positioning, major and minor complication rates, operative and fluoroscopy time, blood transfused, time to mobilization, hospital stay, fracture union, and Harris hip score. The minimum followup was 12 months (mean, 13 months; range, 12–18 months).
In the PFNA II group we encountered no impingement on the lateral cortex and no patients with lateral fragment or loss of reduction at insertion, whereas with the PFNA group, we had 10 and five cases, respectively. Fracture union occurred in all patients treated with PFNA II without mechanical failures. PFNA II cases were associated with a slightly shorter surgical time than PFNA cases (23 minutes versus 27 minutes, respectively).
PFNA II avoided lateral cortex impingement experienced with PFNA, providing fast and stable fixation of the unstable peritrochanteric fractures.
Level of Evidence
Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.
PMCID: PMC3462868  PMID: 22760601
5.  Thyroid Hormones and Peripheral Nerve Regeneration 
Journal of Thyroid Research  2013;2013:648395.
Peripheral nerve regeneration is a unique process in which cellular rather than tissue response is involved. Depending on the extent and proximity of the lesion and the age and type of the neuronal soma, the cell body may either initiate a reparative response or may die. Microsurgical intervention may alter the prognosis after a peripheral nerve injury but to a certain extent. By altering the biochemical microenvironment of the neuron, we can increase the proportion of neurons that survive the injury and initiate the reparative response. Thyroid hormone critically regulates tissue growth and differentiation and plays a crucial role during organ development. Furthermore, recent research has provided new insight into thyroid hormone cellular action. Thyroid hormone regulates stress response intracellular signaling and targets molecules important for cytoskeletal stability and cell integrity. Changes in thyroid hormone signaling occur in nerve and other tissues, with important physiological consequences. The interest in thyroid hormone in the context of nerve regeneration has recently been revived.
PMCID: PMC3628215  PMID: 23607046
6.  Analysis of kidney dysfunction in orthopaedic patients 
BMC Nephrology  2012;13:101.
This retrospective study was undertaken to determine the incidence of kidney dysfunction (KD) and to identify potential risk factors contributing to development of KD in orthopaedic population following an elective or emergency surgery.
A total of 1025 patients were admitted in our institution over a period of one year with various indications. Eight hundred and ninety-three patients (87.1%) had a surgical procedure. There were 42 (52.5%) male and 38 (47.5%) female with a mean age of 72 years (range: 47 to 87 years). We evaluated the following potential risk factors: age, comorbidities, shock, hypotension, heart failure, medications (antibiotics, NSAIDs, opiates), rhabdomyolysis, imaging contrast agents and pre-existing KD.
The overall incidence of KD was 8.9%. Sixty-eight patients developed acute renal injury (AKI) and 12 patients developed acute on chronic kidney disease (CKD). In sixty-six (82.5%) patients renal function was reversed to initial preoperative status. Perioperative dehydration (p = 0.002), history of diabetes mellitus (p = 0.003), pre-existing KD (p = 0.004), perioperative shock (p = 0.021) and administration of non-steroid anti-inflammatory drugs (NSAIDs) (p = 0.028) or nephrotoxic antibiotics (p = 0.037) were statistically significantly correlated with the development of postoperative KD and failure to gain the preoperative renal function.
We conclude that every patient with risk factor for postoperative KD should be under closed evaluation and monitoring.
PMCID: PMC3483193  PMID: 22943390
Kidney dysfunction (KD); Orthopaedic population; Surgical procedure
7.  Osseous integration in porous tantalum implants 
Indian Journal of Orthopaedics  2012;46(5):505-513.
Porous tantalum is a biomaterial that was recently introduced in orthopedics in order to overcome problems related to implant loosening. It is found to have osteoconductive, and possibly, osteoinductive properties hence useful in difficult cases with severe bone defects. So, it is of great interest to shed light on the mechanisms through which this material leads to new bone formation, after being implanted. Porous tantalum is biologically relatively inert, with restricted bonding capacity to the bone is restricted. In order to overcome this obstacle, it undergoes thermal processing in an alkaline environment. This process leads to extensive hydroxyapatite formation on its surface, and thus, to better integration of porous tantalum implants. Apart from this, new bone tissue formation occurs inside the pores of the porous tantalum after its implantation and this new bone retains the characteristics of the normal bone, that is, bone remodeling and Haversian systems formation. This finding is enhanced by the observation that porous tantalum is an appropriate substrate for osteoblast adherence, proliferation, and differentiation. Furthermore, the finding that osteoblasts derived from old women (> 60 years old) and cultivated on porous tantalum may grow faster than osteoblasts taken from younger women (< 45 years old) and cultivated on other substrates, can partially explain porous tantalum's good performance in cases of patients with severe bone defects. In conclusion, porous tantalum's chemical and mechanical properties are those that probably define the already noticed good performance of this material. However, further research is needed to totally clarify the mechanisms.
PMCID: PMC3491782  PMID: 23162141
Bone ingrowth; osseous integration; osteoblast; osteoconductive; porous tantalum; scaffold
8.  Treatment of a femoral shaft fracture in a patient with congenital hip disease: a case report 
We present a rare case of two concomitant morbidities treated in one operation. To our knowledge, this is the first report of its kind in the literature.
Case presentation
A 57-year-old Greek woman was admitted to the emergency department having sustained a spiral mid-shaft femoral fracture. She also suffered from an ipsilateral hip congenital dysplasia with ankylosed hip joint due to severe arthritis. She was treated with a total hip arthroplasty using a long stem performing as an intramedullary nail.
We undertook a complex operative treatment of both co-morbidities in a one stage procedure with a satisfactory clinical result.
PMCID: PMC2917441  PMID: 20649964
9.  Treatment of Unstable Thoracolumbar Burst Fractures by Indirect Reduction and Posterior Stabilization: Short-Segment Versus Long-Segment Stabilization 
In order to compare short-segment stabilization with long-segment stabilization for treating unstable thoracolumbar fractures, we studied fifty patients suffered from unstable thoracolumbar burst fractures. Thirty of them were managed with long-segment posterior transpedicular instrumentation and twenty patients with short-segment stabilization. The mean follow up period was 5.2 years. Pre-operative and post-operative radiological parameters, like the Cobb angle, the kyphotic deformation and the Beck index were evaluated. A statistically significant difference between the two under study groups was noted for the Cobb angle and the kyphotic deformation, while, as far as the Beck index is concerned, no significant difference was noted. In conclusion, either the long-segment or the short-segment stabilization is able for reducing the segmental kyphosis and the vertebral body deformation postoperatively. However, as time goes by, the long-segment stabilization is associated with better results as far as the radiological parameters, the indexes and the patient’s satisfaction are concerned.
PMCID: PMC2822149  PMID: 20177428
Transpedicular instrumentation; short-segment; long-segment; radiological parameters; spine.

Results 1-9 (9)