Papers by Emmanuel Apergis
BACKGROUND Repair of the dorsal component of the scapholunate ligament alone is the usual surgica... more BACKGROUND Repair of the dorsal component of the scapholunate ligament alone is the usual surgical treatment for scapholunate injuries. Recent literature has suggested that additionally repairing the palmar component of the scapholunate ligament leads to improved and lasting clinical outcomes. The aim of this study was to determine the biomechanical properties of both portions of scapholunate ligaments derived from the same wrist and compare them with the whole scapholunate ligament. The goal was to further elucidate the importance of the palmar portion of the scapholunate ligament from a biomechanical perspective. METHODS Scapholunate ligaments and their components were harvested from the same fresh frozen cadaveric wrists. Force at failure and stiffness were measured. FINDINGS The mean maximum loads to failure for the entire scapholunate ligament, dοrsal and palmar portions were found to be 147 (SD 54)N, 83 (SD 18)N and 86 (SD 16)N respectively. No statistical difference was found between the mean maximum load and stiffness for palmar and dorsal components (P=0.05). Mean maximum load and stiffness, of the intermediate portion, were 36 (SD 15)N and 25 (SD 23)N/mm. INTERPRETATION Our biomechanical findings on the dorsal and palmar portions of the scapholunate ligament suggest that each portion contributes approximately 50% to the whole ligament tensile force. These results appear to agree with other reports about the stabilizing role of the palmar portion of the scapholunate ligament and suggest that the palmar portion of the ligament should be considered for surgical repair.
Springer eBooks, 2013
Palmar perilunate dislocations are very rare injuries constituting about 3% of all perilunate inj... more Palmar perilunate dislocations are very rare injuries constituting about 3% of all perilunate injuries. There is ambiguity in the literature regarding the mechanism of injury. Like their more common dorsal counterpart, palmar perilunate dislocations develop progressively, finally leading to dorsal dislocation of the lunate. They are often manifested as fracture-dislocation injury with the most frequent fracture being that of the scaphoid and the next most common fracture that of the lunate. Like other perilunate injuries, proper diagnosis is likely to be missed. Since these injuries are inherently unstable, open reduction and internal fixation constitutes the treatment of choice.
Springer eBooks, 2013
Perilunate injuries, although rare, constitute the most frequent category of wrist dislocations. ... more Perilunate injuries, although rare, constitute the most frequent category of wrist dislocations. The terminology and classification of the acute type of perilunate injuries are being analyzed, while great emphasis is given to the disruption mechanisms of the wrist and to the potential paths of injury. Additionally, the choices available and the methods offered for the treatment of these injuries are being studied, while open reduction and internal fixation comprise the main body of this chapter. Through combined approach, a detailed assessment of the injuries both palmarly and dorsally can be performed, whereas their recommended, gradual reconstruction is described. Emphasis is also given to the existing differences between lesser and greater arc injuries. In order to complete the full description of these injuries, apart from the acute form of perilunate dislocations and fracture-dislocations, the scaphocapitate syndrome, the palmar perilunate dislocations and the delayed or chronic form of these injuries, are also studied and described in separate sub-chapters.
Springer eBooks, 2013
The increasing number of industrial accidents, especially when security measures are not strict, ... more The increasing number of industrial accidents, especially when security measures are not strict, renders rare axial injuries more frequent. In this type of injuries, the wrist is being divided into two or more columns with the respective metacarpals. Among fracture dislocations of the wrist, axial dislocations are more frequently associated with soft tissue damage, which is the main determining factor for the outcome; on the other hand, the functional results of the hand are usually unpredictable. The biomechanics of the transverse plane of the distal carpal row, as well as the incidence, the mechanism of injury and the clinical presentation of this rare type of injuries are also examined. In addition, these injuries result in mainly three types of axial dislocations, but the high-energy nature of the injuries could also produce unusual patterns of carpal derangement, which renders them difficult to classify. The management, outcome and complications of axial dislocations are also studied in this chapter.
Springer eBooks, 2013
Although there are no strict time limits to characterize perilunate injuries as delayed or chroni... more Although there are no strict time limits to characterize perilunate injuries as delayed or chronic, probably the sixth week is roughly the time limit beyond which our operative options must be changed. Since the percentage of patients with perilunate injuries escaping diagnosis is unacceptably high and the delay in diagnosis constitutes the most important factor affecting the long-term result, every effort must be made for a prompt diagnosis in order to achieve the best results. Both patient and injury-related variables influence our decision for the best suited treatment. The contraction of the capsuloligamentous structures, the condition of the articular cartilage and the friability of the dislocated lunate are the main factors to be taken into consideration during operative treatment. Frequently, salvage procedures are the only option in treating chronic perilunate injuries.
Journal of Hand Surgery (European Volume), Jun 1, 2007
PubMed, Oct 1, 2006
The objective of this study was to determine whether hardness of the superficial layer is a usefu... more The objective of this study was to determine whether hardness of the superficial layer is a useful parameter to characterise cartilage produced by periosteal neochondrogenesis, using rabbit knee lesions as a model. A cartilage defect was created in the right hind knee of anesthetised young adult rabbits, and the defect was then covered with an autologous periosteal graft. At one and eight months postsurgery, rabbits were euthanised, and the articular cartilage lesion sites were evaluated for the histological parameters in a modified O'Driscoll scale, which is the current 'gold standard' for new cartilage properties. In addition, a static indentation test was performed, using a Shore-A sclerometer to measure surface hardness of the new cartilage. The hardness values had a statistically significant, positive correlation with the O'Driscoll parameters. This combination of a biomechanical measure and the O'Driscoll scale provided a more definitive indicator of graft quality. The results suggest that a hardness test with some type of sclerometer should be included in the functional characterisation of all engineered or grafted neocartilage.
Journal of Trauma-injury Infection and Critical Care, Oct 1, 1998
Fractures of the humeral shaft associated with median nerve palsy are exceedingly uncommon. A rev... more Fractures of the humeral shaft associated with median nerve palsy are exceedingly uncommon. A review of the literature revealed that on rare occasions median nerve palsy is associated with fractures of the distal third of the humerus, especially in children. We report the case of a young man who sustained a fracture in the middle of the upper third of the humeral shaft associated mainly with an terior interosseous nerve palsy.
Journal of Hand Surgery (European Volume), 2019
Reconstruction of the interosseous membrane has the potential to re-establish a normal loading pa... more Reconstruction of the interosseous membrane has the potential to re-establish a normal loading pattern through the forearm and enhance stability after an Essex-Lopresti lesion. The aim of our study was to assess the capacity of three different techniques, which all use a regionally harvested autograft, to restore longitudinal stability. Simulation of the Essex-Lopresti lesion was done by excising the radial head and sectioning the interosseous membrane in seven cadaveric specimens. Each technique was used in each specimen consecutively, using the pronator teres, the brachioradialis and the flexor carpi radialis tendons, respectively. The specimens were submitted to mechanical testing by applying proximally migratory forces to the radius and radioulnar displacement was assessed fluroscopically at wrist level. The pronator teres tendon achieved the greatest reduction (94% correction with respect to the intact interosseous membrane/radial head out state, followed by brachioradialis (92...
Cureus, Dec 9, 2023
Background and objective The distal oblique bundle (DOB) is nowadays recognized as the thickest c... more Background and objective The distal oblique bundle (DOB) is nowadays recognized as the thickest component of the distal interosseous membrane (DIOM). It is neither thought to be a clear-cut ligament, and nor does it follow the typical configuration of the rest of the DIOM. It is not always present and some studies have raised disputes about its prevalence and a few anatomical features. In this study, we aimed to provide data on the prevalence and anatomical features of the DOB, which are of great importance at this early stage of research into the topic. Our findings have been correlated with current knowledge and are expected to contribute to clinical implementation. Materials and methods Twenty-eight fresh-frozen forearms were utilized for measurements. Specifically, mean length, width, distance from the middle of the bundle's insertion to the ulna to the tip of the styloid process of the ulna, as well as the distance from the midpoint of its insertion to the radius to the tip of the radiuses' styloid process were calculated. The prevalence was described with a cutoff thickness point of 0.5 mm. Early results based on three cases of DOB reconstruction with the "Riggenbach" technique due to distal radioulnar joint (DRUJ) instability were documented. Results Eleven DOBs were reported out of the 28 specimens, suggesting a prevalence of 39.3%. The mean thickness was 0.88 mm (range: 0.6-1.3 mm), the mean width was 5.22 mm (range: 2.2-8.4 mm), and the mean length was 25.68 mm (range: 22.7-29.2 mm). Proximally, the mean distance from the bundle's ulnar insertion to the tip of the styloid process of the ulna was 51.02 mm (range: 45.5-55.6 mm) while distally, the mean distance from the bundle's insertion to the radius to the tip of the styloid process of the radius was 34.5 mm (range: 31.3-37.7 mm). After a follow-up of at least six months, improvement was evident in all measured areas in the three patients who underwent surgery. Additionally, they reported satisfaction and accomplishment of their preoperative goals. Conclusions Discrepancies in measurements in some anatomic features between studies are probably due to variations in specimen types, measurement methods, and sites. Efforts must continue to be made on a more extensive scale and in a more standardized manner for more factual results and conclusions. "Reconstructionrecreation" or "original construction-creation" procedures yield promising results in a fast, simple, and less invasive manner than traditional methods of DRUJ stabilization.
Journal of Long-term Effects of Medical Implants, 2019
The distal oblique bundle has been recognized as a distinct structure of the distal interosseous ... more The distal oblique bundle has been recognized as a distinct structure of the distal interosseous membrane of the forearm since 2009, when Noda et al. named it. Our minireview will attempt to summarize knowledge gathered and provide guidelines toward possible questions that arise when reading studies about this topic. It is our strong belief that the distal oblique bundle is worth investigating in full, since it seems to have an important role as a stabilizer of the distal radioulnar joint. Due to the efforts of a small number of surgeons and authors, the groundwork for understanding its purpose has been laid, but more research needs to be done.
Orthopaedic Proceedings, Feb 1, 2004
Aim : We investigated the combination of closed reduction, percutaneous osteosynthesis with screw... more Aim : We investigated the combination of closed reduction, percutaneous osteosynthesis with screws and external fixation in the treatment of high-energy fractures of the tibial condyles with severe soft-tissue lesions. Method : We studied 35 fractures (11 open) of the tibial condyles. Twenty-eight were Schatzker type VI, 5 type V and 2 type I. The fracture was reduced under fluoroscopic control and the articular surface was fixed with cannulated lag screws. In 23 patients (group A) a unilateral external fixation was applied with the proximal pins placed in the tibial condyles. In 12 patients (group B) an external fixation crossing the knee was used for 6 weeks followed by a knee brace. The follow-up period was 8–45 months Results: All fractures united in a mean time of 15 weeks except for two in group A that needed conversion to internal fixation. Ten knees developed pintract infection. All knees had range of motion of at least 1000 except for one in group B that developed osteoarththritis. A collapse of the articular surface of more than 5mm and malalignment of more than 60 were observed in 7 and 5 patients in group A and B respectively. Conclusions: Limited internal and external fixation are a satisfactory technique for selected fractures of the tibial plateau, particularly with poor soft-tissue envelope. Crossing the knee with the external fixator does not necessarily lead to significant stiffness.
Cureus, Jan 25, 2019
The distal oblique bundle of the forearm is a structure that has been under vigorous investigatio... more The distal oblique bundle of the forearm is a structure that has been under vigorous investigation for the past decade. It is part of the distal interosseous membrane (DIOM) and seems to have an important stabilizing effect in the distal radioulnar joint. In this essay, we have tried to summarize the anatomical characteristics of the structure. We have also compared and contrasted this to our own experience with eight freshly frozen forearms. It is our strong belief that the distal oblique bundle (DOB) may play a keystone role in future stabilization techniques of the distal radioulnar joint, and its anatomy characteristics need to be fully investigated.
Wrist malalignment, in cases of malunited fractures of the distal radius, is not always a consequ... more Wrist malalignment, in cases of malunited fractures of the distal radius, is not always a consequence of adaptation of the wrist to new conditions, but an expression of non-diagnosed ligamentous injuries. The aim of our study is to examine if the wrist malalignment is correctable with radius osteotomy. Twenty nine patients (17 female, 12 male) of mean age 51 years, with symptomatic malunited fracture of the distal radius with dorsal angulation, of duration 3 months -47 years, were examined. Twenty seven patients underwent corrective radius osteotomy (open dorsally in 26 cases and closed palmarly in 1 case). Fixation material (plate and screws) was placed on the dorsal side in 23 cases and on the volar side in 4 cases. In all patients measurements on the lateral X-ray view, concerning the reversal of the normal palmar tilt of the radius, the radiolunate and lunocapitate angles, were performed before and after surgery. Based on those measurements patients were divided in two groups: a...
Apergis Emmanuel MD, PhD Director of Orthopaedic Department. Red Cross Hospital-Athens e-mail: ap... more Apergis Emmanuel MD, PhD Director of Orthopaedic Department. Red Cross Hospital-Athens e-mail: [email protected] Radiocarpal fracture-dislocations are the most debatable of carpal dislocations. The term radiocarpal fracture-dislocations has been used incorrectly for many previously reported cases. Thus, many questions arise concerning their incidence, terminology and classification. In this review, an attempt is made to determine the criteria based on which an injury can be classified as radiocarpal fracture-dislocation. Additionally, the surgical treatment of radiocarpal fracture-dislocations with combined access, allows for a relatively accurate description of osteoligamentous injuries, both on the palmar and on the dorsal side of the wrist. Four types of injuries in the dorsal and two types of injuries in the palmar dislocations are portrayed. Furthermore, a new classification is proposed based on five parameters: those of chronicity, pathoanatomy, direction, associated injuries ...
Fracture of the volar rim of the distal radius could be an isolated fracture or part of a complex... more Fracture of the volar rim of the distal radius could be an isolated fracture or part of a complex type of fracture. Frequently it is displaced and rotated because of the attachment of the volar radio-carpal ligaments. Fixation of this fragment is mandatory to preserve integrity of radio-carpal and distal radio-ulnar joints. Given the difficulty of manipulation of this osteochondral fragment we studied the efficiency of a wire-loop as a method of fixation of this fragment. Eleven patients were examined (8 male, 3 female) mean age 42,6 years (21–72 years) who had various type of fractures of the distal radius but had in common the presence of an osteochondral fracture of the volar radial rim in the ulnar side (7 patients), in the radial side (3 patients) or on both sides (1 patient). Distal radius fracture was type B3.1 (1 patient), B3.3 (4 patients), C3.1 (3 patients), C1.3 (1 patient) and radiocarpal fracture-dislocation in 2 cases. All patients were treated operatively. Eight of th...
Scaphoid fractures generally progress to a certain type of carpal instability, i.e. DISI, if the ... more Scaphoid fractures generally progress to a certain type of carpal instability, i.e. DISI, if the fracture was not appropriately treated and turned to nonunion. Usually such instability produces incongruity between carpal bones followed by synovitis, becomes painful within a few years, and often requires surgical treatment in due course. However, it is also true that some types of scaphoid fractures are less symptomatic and often left untreated. Long after fracture around more than ten years, fracture nonunion becomes symptomatic and radiographic examination reveals massive osteophytes formation around the scaphoid. Moreover, despite the long duration after injury, we often encounter cases without severe DISI deformity. Recent 3-dimenssional analysis of scaphoid nonunion has revealed that carpal instability following scaphoid nonunion is closely related to whether the fracture line passes distal or proximal to the scaphoid apex. The scaphoid apex, which is the most dorsal and ulnar nonarticulating part of the scaphoid1, where the dorsal scapholunate interosseous ligament and the proximal fi ber of the dorsal intercarpal ligament attach. In their article, there were two clear patterns of the interfragmentary motions of the scaphoid based on the fracture location. In the unstable (mobile) type scaphoid nonunion, the fracture was located distal to the scaphoid apex, and the distal scaphoid was unstable relative to the proximal scaphoid. In the stable type scaphoid nonunion, the fracture was located proximal to the scaphoid apex, and the interfragmentary motion was considerably less than with the distal type. Through several researches investigating scaphoid nonunions 3-dimensionally 1, 3-5, I have noticed that for ordinary clinician, judgments of fracture locations using 2-dimensional and conventional x-rays were often inaccurate when compared to judgments using 3-dimensional CT images. For example, fi gure 1 shows two pulse: committee reports Figure 1: Oblique view X-ray and 3-D images of two patients with A) type 1 B1 and B) B2 scaphoid nonunion. Despite relationships between fracture line and the scaphoid apex are completely diff erent, fracture lines on teh scaphoid body on the x-ray look similar.
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Papers by Emmanuel Apergis