Vasilis Giannoudis

Leeds Teaching Hospitals NHS Trust

Introduction/purpose Carbon fibre plating (CFR-PEEK) became available to orthopaedic surgeons in 1998 as a competitor to the traditional metal implants. Despite this, the use of such implants has been limited globally. The aim of this study was therefore to explore the barriers to more widespread use of CFR-PEEK, specifically by examining orthopaed...

Mesenchymal stem cells are core to bone homeostasis and repair. They both provide the progenitor cells from which bone cells are formed and regulate the local cytokine environment to create a pro-osteogenic environment. Dysregulation of these cells is often seen in orthopaedic pathology and can be manipulated by the physician treating the patient....

Fixation failure in the proximal femur is an uncommon phenomenon, occurring most commonly as a result of biomechanical failure. This may be due to failure to achieve reduction or utilisation of an incorrect entry point, both of which can result in a varus deformity. Where this occurs, the proximal femur must be valgised and rigidly secured. If ther...

Failure of midshaft femoral fractures may have various aetiologies. Midshaft femur fractures can be challenging to treat if the surgeon cannot fully appreciate the implant used, patient factors and the plan they are aiming to achieve with the implant (absolute vs relative stabilisation). Adequate reduction and stable fixation are paramount when tre...

Metal work failure after fracture fixation is not common. However, when established it may be associated with pain, limb deformity, functional impairment and need for revision surgery. While the causes can be multifactorial including non-compliance, poor bone stock, non-optimum fixation, selection of wrong implant, metal fatigue and infection, its...

Failure of capitellum fixation is rare. The capitellum when fixed is susceptible to significant shear forces due to its anterior centre of rotation, particularly when loading the elbow in extension. Fixation should aim to best resist these forces, commonly attained through headless compression screws orthogonal to the fracture plane. Rehabilitation...

Although bone transport is a well-recognised technique to address segmental bone defects, optimal management of docking sites is not absolutely determined. Some surgeons routinely intervene in all cases, and others prefer to observe and intervene only if spontaneous union does not occur. Primary aim of the study was to compare rates of docking site...

Patients undergoing planned or unplanned orthopaedic procedures involving their upper or lower extremity can prevent them from safe and timely return to driving, where they commonly ask, ‘Doctor, when can I drive?’ Driving recommendations after such procedures are varied. The current evidence available is based on a heterogenous data set with varyi...

Introduction Infected tibial non-unions with associated bone loss can be challenging to manage. At present, the two main methods utilized in the management of these fractures include the Ilizarov technique of Distraction Osteogenesis (DO) using external fixator devices, or alternatively, the Induced Membrane Technique (IMT), devised by Masquelet. A...

Objective The objective of this study was to compare clinical outcomes of patients with trochanteric hip fractures treated with specific different cephalomedullary nail (CMN) designs. Methods A scoping review of the English literature was performed. Inclusion criteria were studies comparing perioperative and postoperative outcomes of trochanteric...

Purpose Obstetric outcomes in women following pelvic injuries requiring surgical fixation is not thoroughly known. We aimed to evaluate if radiographic measurements (RMs) can be used to provide information on delivery methods outcome after these injuries, and to evaluate if metal work removal is required prior to delivery. Method A retrospective s...

Introduction: ORTHOPOD: Day Case Trauma is a multicentre prospective service evaluation of day-case trauma surgery across four countries. It is an epidemiological assessment of injury burden, patient pathways , theatre capacity, time to surgery and cancellation. It is the first evaluation of day-case trauma processes and system performance at natio...

Reconstructive surgery of the clavicle using free vascularised fibula grafting (FVFG) is sometimes required for the management of severe bone loss or non-union. As the procedure is relatively rare, there is no universal agreement on the management and outcome. This systematic review aimed to first, identify the conditions for which FVFG has been ap...

The management of patients with multiple injuries remains challenging. Patients presenting with comorbidities, such as diabetes mellitus, may have additional unpredictable outcomes with increased mortality. Therefore, we aim to investigate the impact of major trauma centres in the UK on the outcomes of polytrauma patients with diabetes. The Trauma...

Management of severely injured patients remains a challenge, characterised by a number of advances in clinical practice over the last decades. This evolution refers to all different phases of patient treatment from prehospital to the long-term rehabilitation of the survivors. The spectrum of injuries and their severity is quite extensive, which di...

The ability to enhance fracture healing is paramount in modern orthopaedic trauma, particularly in the management of challenging cases including peri-prosthetic fractures, non-union and acute bone loss. Materials utilised in enhancing fracture healing should ideally be osteogenic, osteoinductive, osteoconductive, and facilitate vascular in-growth....

Purpose To systematically review the currently available existing evidence related to the presentation and management of simultaneous floating hip and knee injuries to identify injury characteristics, treatment strategies, and complications. Methods Data sources: Relevant articles were identified by searching Medline, PubMed, and Google Scholar da...

Avascular necrosis of the femoral head (AVNFH) is relatively infrequent, but if undiagnosed or untreated, it may result in significant functional disability, and due to severe ongoing pain, a total hip replacement (THR) may be necessitated. Most cases are associated with trauma, but a number of established risk factors exist. Diagnosis can be chall...

Background Appropriate preoperative skin cleansing is important to control surgical site infections. Both colored and colorless skin disinfectants are available, however certain types of skin preparation, such as octenidine-dihydrochloride with alcohol have a long residual antimicrobial effect but are available only in colorless form. We hypothesiz...

Tibial plateau fractures range from simple to complex. Most complex injury types are managed surgically but for some, a decision is made to treat without surgery. We present a case that was managed non-operatively but due to failure of bone union, later required surgical intervention. We discuss the choice of management and potential risk factors i...

Introduction Carbon fibre-reinforced polyetheretherketone (CFR-PEEK) plates represent an exciting development within trauma and orthopaedic surgery, offering advantages including radiolucency, material properties similar to bone, and lack of localised tissue reaction. As more call for trials examining their use, there is no data available as to the...

By definition, anteroposterior (AP) compression type 1 (APC-1) injury is a type of pelvic ring injury, which is widely acknowledged as ‘stable’. Unstable forms of this injury are very rare and present a challenge for diagnosis and clinical management. Detailed herein is a man in his early 30s, referred to our institution with a 2-year history of pu...

Purpose High clinical success rates have been reported with the Masquelet technique in the treatment of traumatic bone loss. An increasing number of studies suggest that various factors can influence the properties of induced membranes. Goal of this systematic review is to answer the following questions: (1) which are the ideal spacer properties (m...

The Reamer-Irrigator-Aspirator (RIA-2) system has been established as a safe and reliable device to harvest large amounts of autograft. Nevertheless, hardware complications may occur. Breakage of the reamer head from the drive shaft with intramedullary retention of small metal debris has never been dealt with. The authors provide a technical trick...

Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature. In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes. Tre...

- 20-year-old male road-traffic accident - Sustained right acetabulum fracture, left proximal femur fracture, right patella fracture and pulmonary contusions - Had fixation within 4 days of his left proximal femur fracture and his right acetabulum: -Following fixation of his left femur fracture, developed symptoms of complete left sciatic nerve pal...

Purpose To consolidate the evidence from the available literature and undertake a meta-analysis to provide a reference for physicians to make evidence-based recommendations to their patients regarding the return to driving after hip or knee arthroscopic procedures. Methods A systematic review was conducted using Preferred Reporting Items for Syste...

Background: There is limited evidence available on return to driving for patients undergoing knee arthroplasty (KA). Primarily, surgeons have used brake reaction time as a surrogate measure of safe return to driving. The purpose of this study was to review existing literature and provide guidance on the recovery of braking performance following kn...

Background On the 11th March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Multiple new guidelines were proposed and existing models of social, domestic and hospital care altered. Most healthcare systems were largely unprepared for this, and the pandemic has tested their adaptability. This study aimed to assess the...

A 35-year-old woman attended the emergency department after sustaining a reverse oblique proximal femur fracture, which was amenable to intramedullary nailing. Her presentation was complicated by a background of severe generalised recessive dystrophic epidermolysis bullosa, with extensive blistering of most of her skin, including the area over the...

Nonunion remains a major complication of the management of long bone fractures. The primary aim of the present study was to investigate whether raised levels of C-reactive protein (CRP) and white blood cell count (WBC), in the absence of clinical signs, are correlated with positive intraoperative tissue cultures in presumptive aseptic long-bone non...

Background/Objective Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons’ recommendations range between 4–8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact. However, it is important to ensure pat...

The gold standard of safe-guarding the quality of published science is peer review. However, this long-standing system has not evolved in today's digital world, where there has been an explosion in the number of publications and surgical journals. A journal's quality depends not only on the quality of papers submitted but is reflected upon the qual...

Aim: This UK based multi-centre study reports clinical characteristics, early outcomes and predictors of mortality in 34 consecutive COVID-19-positive hip fractures so that the lessons learnt could be utilised in other parts of World who are at a different phase of the pandemic. Methods: This study analysed patient admitted with hip fractures wi...

Posterior wall (PW) fractures represent one of the most common fractures of the acetabulum. Posterior column (PC) fractures are rarer, but the incidence of simultaneous presence of both PW and PC fracture is slightly higher. Both PW and PC acetabulum fractures are sustained following high-energy trauma. Routine initial radiographic workup includes...

Introduction: The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach1,2. Indications & contraindications: Step 1 preoperative planning: Review the patient's general condition and imaging studies, plan the sequence of reduction and fixation, and make sure th...

Introduction: The ilioinguinal approach is the standard approach for the open reduction and internal fixation of the majority of displaced, anteriorly based acetabular fractures as it offers wide access to the acetabulum, is extensile, and has been associated with enhanced recovery. Indications & contraindications: Step 1 preoperative planning:...

Background/purpose: It has been suggested that hospital admission during weekends poses a risk for adverse outcomes and increased patient mortality, the so-called 'weekend effect'. We undertook an evaluation of the impact of weekend admissions to the management of polytraumatised patients, in a Level I Major Trauma Centre (MTC) in the UK. Materia...

Hip fractures in the elderly population have become a ‘disease’ with increasing incidence. Most of the geriatric patients are affected by a number of comorbidities. Coagulopathies continue to be a special point of interest for the orthopaedic trauma surgeon, with the management of this high-risk group of patients a hot topic of debate among the ort...

Despite the remarkable advances achieved within the boundaries of the new discipline of Pelvic surgery, pelvic ring disruptions remain challenging and complex problems in orthopaedics. The long-term complications related to reconstruction techniques of these injuries have motivated researchers and surgeons to explore various alternative treatment m...