Publications by authors named "Ali Hassan Chamseddine"

8 Publications

  • Page 1 of 1

Breakage of sliding hip screw after fixation of pertrochanteric hip fracture: A rare complication.

Int J Surg Case Rep 2021 Jul 22;85:106226. Epub 2021 Jul 22.

Division of Orthopedic Surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon.

Introduction: The authors report a rare case of lag screw breakage in a patient treated using locking DHS with home-made trochanteric stabilizing plate (TSP) for pertrochanteric hip fracture.

Case Presentation: A 67 year-old female was operated for pertrochanteric hip fracture with incompetent lateral wall using locking DHS with home-made TSP. At seven months postoperative, there was radiographic nonunion with breakage of the sliding lag screw. Patient was consequently scheduled for total hip replacement.

Discussion: Breakage of DHS lag screw has been attributed to multiple-cycle, low-stress fatigue failure associated with nonunion. Predisposing factors are: situation of the medial edge of the barrel at the level of the fracture site prohibiting fracture compression, and mechanical obstacle to the lag screw back sliding into the barrel. In our case, the use of handmade TSP interdicted lag screw back sliding and prevented fracture impaction which was already impaired by the location of the medial edge of the barrel at the fracture level. Additionally our fixation construct was very rigid because of the use of locking screws in the DHS side plate.

Conclusion: When DHS fixation is planned for unstable or potentially unstable trochanteric hip fracture the surgeon should be prepared by making available a TSP from the manufacturer in the operative room rather than improvising intra-operatively with handmade TSP; this augmentation device shouldn't interfere with lag screw back sliding. Furthermore the DHS barrel should ideally not impinge with the fracture site, and the use of locking screws in the DHS plate should be cautious.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijscr.2021.106226DOI Listing
July 2021

The instep flap for anterior ankle coverage with bone and hardware exposure.

Eur J Orthop Surg Traumatol 2021 Jun 12. Epub 2021 Jun 12.

Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25., Ghoubeiry, Beirut, Lebanon.

Purpose: The instep medial plantar flap is a well-known flap based on the medial plantar artery of the foot and usually used for coverage of soft tissue defects of the heel area. It has seldom been reported for coverage of anterior ankle area with exposure of the bone and metallic hardware after open reduction and internal fixation of distal tibial fractures. The primary purpose of this study is to evaluate the feasibility and viability of this flap as well as its reliability saving the internal fixation devices and efficiency protecting bone healing; the secondary purpose is to assess the condition of the flap and its cosmetic appearance, as well as occurrence of complications related to its harvesting.

Material And Methods: This is a retrospective review of medical records of patients operated from December 2015 to December 2020 with application of an instep flap for coverage of the anterior ankle area with exposure of the bone and metallic hardware secondary to open reduction and internal fixation of distal tibial fractures. All patients were reviewed for the purpose of this study; they were assessed for the viability and functional and sensory condition of the flap, signs of local infection, as well as for residual pain and sensory impairment of the toes; subjective cosmetic appearance of the flap was also judged.

Results: There were four patients with 32 years mean age and 35 months mean follow-up. The mean flap size was 7.75 cm × 5.75 cm. At final follow-up, all fractures were completely consolidated, and all flaps were living, stable, and sensitive. No distal sensation disturbance was noticed, and none of the patients had pain or annoyance caused by the flap or presented signs of infection. Only one patient expressed mild aesthetic complain.

Conclusion: The fascio-cutaneous instep medial plantar flap is a reliable solution to cover the anterior ankle area with exposure of the bone and metallic hardware after open reduction and internal fixation of distal tibial fractures, especially for defects measuring up to 9 cm × 6 cm. This flap is technically valid and reproducible; it offers good quality of soft tissue coverage with satisfactory cosmetic appearance and minimal morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00590-021-03055-4DOI Listing
June 2021

The adjunct use of lateral hinged external fixator in the treatment of traumatic destabilizing elbow injuries.

Int Orthop 2021 05 23;45(5):1299-1308. Epub 2021 Feb 23.

Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon.

Purpose: The purpose of this study is to evaluate the results of using a lateral hinged external fixator as an adjunct stabilizer in the treatment of a variety of acute destabilizing elbow injuries.

Methods: A retrospective review was performed on the medical records of patients in whom a lateral monolateral elbow hinged external fixator was applied by the senior author. The indication to apply the fixator corresponded to a variety of acute injury patterns ranging from simple elbow trauma or dislocation to complex fracture-dislocation, and the decision was based on either the presence of recurrent or persistent instability in any direction and/or to secure a vulnerable or weak bony fixation or soft tissue repair as intra-operatively judged by the surgeon. The fixator was inserted in the same setting after the repair of the associated ligamentous and/or bony structures. Patients operated after one month of the trauma and those presented with open elbow injury or associated humeral or ulnar shaft fracture were excluded. Rehabilitation was immediately started and the fixator removed at six to eight weeks with elbow testing and gentle manipulation under general anaesthesia, and resuming of rehabilitation after removal. Clinical assessment was performed for all patients according to the Mayo Elbow Performance Score (MEPS) with evaluation of range of motion at regular intervals till the end of the post-operative first year, then at final follow-up for the purpose of the study with radiographic assessment for evaluation of elbow reduction and concentricity.

Results: There were 13 patients with a mean age of 42 years. Two patients had instability secondary to LCL rupture; one patient had redislocation because of associated coronoid process fracture; one patient had radial head fracture with rupture of both collateral ligaments; five patients had terrible triad injury with variable association of collateral ligaments lesions; and four patients had posterior Monteggia fracture-dislocation. The mean MEPS was 90 at a mean follow-up of seven years with six excellent, six good, and one fair result. All patients had a concentrically reduced and stable elbow as assessed clinically and radiologically with a mean functional arc of motion of 132° for extension-flexion and 178° for pronation-supination.

Conclusion: The hinged elbow external fixator represents a valuable adjunct in the therapeutic arsenal for the treatment of unstable elbows after bony and soft tissue repair. It provides satisfactory results in terms of stability and function and should be available in the operating room when a surgeon treats a complex elbow dislocation or fracture-dislocation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-021-04985-8DOI Listing
May 2021

Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humeral shaft fractures.

Int Orthop 2021 01 23;45(1):253-263. Epub 2020 Oct 23.

Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon.

Purpose: The objective of this study was to evaluate the feasibility and safety of a minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure for proximal humeral shaft fractures using lateral minimal proximal and distal approaches and lateral bridge plating with primary radial nerve control, and to assess its clinical and radiographic outcomes.

Methods: A retrospective review was done for the medical records of adult patients admitted for fracture of the proximal humeral shaft without associated injury to the ipsilateral upper limb and who consented to undergo a novel MIPPO technique herein reported. Patients were reviewed at regular follow-up periods and assessed at a final follow-up for evaluation of Constant, normalized Constant, and QuickDASH scores.

Results: There were 21 adult patients with mean age of 56 years. Three patients were lost from early follow-up; one of them had post-operative radial nerve paralysis. Eighteen patients were reviewed for the purpose of this study at a mean of 20 months of final follow-up; among them, one patient developed post-operative radial nerve paralysis with complete recovery after three months. Bone healing was achieved without any malalignment in 17 patients at a mean of 15 weeks, and one patient developed nonunion. At final assessment (mean, 20 months), the mean values of Constant, normalized Constant, and QuickDASH scores were 84 (range, 59 to 100), 95 (range, 73 to 100), and 5 (range, 0 to 18.2) respectively.

Conclusion: Compared to pre-reported methods of MIPPO, this technique of lateral proximal and distal mini-approaches with lateral bridge plating after primary control of the radial nerve seems safe and feasible for proximal humeral shaft fractures. It gives good clinical and radiographic results with excellent restoration of upper limb function, very low incidence of post-operative radial nerve injury, and high rate of bone union in good alignment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-020-04858-6DOI Listing
January 2021

FARES method for reduction without medication of first episode of traumatic anterior shoulder dislocation.

Int Orthop 2019 05 29;43(5):1165-1170. Epub 2018 Aug 29.

Division of Orthopaedics and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.

Purpose: The aim of this study is to demonstrate the efficiency of (FARES) method for reduction of first-episode anterior shoulder dislocation, as well as its safety, reliability, and quick easy reproducibility by inexperienced physicians without any use of medications.

Methods: This was a prospective study of 28 patients with first episode of anterior shoulder dislocation that underwent closed reduction using FARES method by junior orthopaedic residents without use of any analgesic, muscle relaxant, or anesthesia. Only two attempts of reduction were allowed for each patient. The time needed for reduction was recorded, and the patients were asked to grade their pain according to a visual analog scale from 0 to 10.

Results: Reduction was achieved after one attempt in 21 patients (75%) and after two attempts in three additional patients (total 85.7%). The mean time needed for reduction was 62.66 seconds, and the mean visual analog scale for pain evaluation was 5.29.

Conclusion: FARES method is a fast, reliable, and safe method for reduction of a first episode of anterior shoulder dislocation and can be easily performed by inexperienced physicians and junior residents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-018-4131-4DOI Listing
May 2019

KAPANDJI TECHNIQUE AS AMINIMALLY INVASIVE PROCEDURE FOR SELECTED PATIENTS WITH TWO- AND THREE-PART FRACTURES OF THE PROXIMAL HUMERUS.

J Med Liban 2016 Jul-Sep;64(3):168-74

Current algorithms for decision making in proximal humerus fractures consider the fracture pattern along with the patient characteristics and surgeon’s experience. Minimally invasive techniques for reduction and internal fixation of many types of these fractures have recently been widely promoted, especially with the use of the newly developed locking plate systems. Intramedullary flexible nailing is one of the oldest techniques using minimally invasive reduction and fixation of proximal humerus fractures. Kapandji technique uses the “Deltoid V” landmark as entry point for intramedullary insertion of the flexible nails into the humeral head. The authors report their experience with this procedure in twenty-six, relatively young patients with good bone quality, presenting with displaced 2- or 3-part extra-articular fracture of the proximal humerus, treated with percutaneous reduction and intramedullary flexible nailing as described by Kapandji. Nineteen medical records were available for this retrospective review, with 9 to 12 months follow-up. There were 15 excellent and 1 good results when patients were assessed for pain, function and range of motion of the shoulder. The authors submit that Kapandji technique is a valuable procedure for management of extra-articular displaced 2- and 3- part proximal humerus fractures in young patients with good bone quality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12816/0031527DOI Listing
September 2017

GUIDING PRINCIPLES AND PEARLS IN A STEPWISE SURGICAL TECHNIQUE OF REVISION TOTAL KNEE ARTHROPLASTY.

J Med Liban 2016 Jul-Sep;64(3):126-33

The authors aim at reviewing the guiding principles in revision total knee arthroplasty according to a stepwise procedure. Strict preoperative planning is of paramount importance for this surgery. Thorough clinical history and physical exam, the assessment of limb deformity and knee range of motion as well as knee stability in flexion, extension and mid-flexion are crucial. Blood exam, standardized radiographic views, and CT scan are powerful tools for etiologic diagnosis of total knee arthroplasty failure. Templating is unique and mandatory to provide the surgeon with the critical data concerning the valgus position of the femoral component, the AP size of the femoral component, and the optimal position of the joint line; these three parameters are determinant for the final clinical outcome. A stepwise surgical technique with close adherence to the guiding principles of revision knee arthroplasty should be adopted from skin incision to closure. Femoral and tibia components with modular stem are ideally set at their optimal position as predetermined by templating. Any residual implant-bone gap is filled with metallic augment or bone graft. Finally, repositioning of the patella on a symmetrical bone cut presents a great value for a successful procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12816/0031520DOI Listing
September 2017

Transfracture medial transposition of the radial nerve associated with plate fixation of the humerus.

Int Orthop 2017 07 19;41(7):1463-1470. Epub 2017 Jan 19.

Division of Orthopaedic surgery, American University of Beirut Medical Centre, Beirut, Lebanon.

Purpose: The aim of this study was to illustrate safety, feasibility and advantages of transfracture medial transposition of the radial nerve during the lateral approach and lateral plating of humeral fractures located in the mid and distal shaft.

Methods: This was a retrospective review and analysis of medical records and radiographs of 19 patients who underwent a transfracture medial transposition of the radial nerve. Fifteen patients were treated for fresh fracture and four for nonunion. All patients were followed up clinically and radiographically for a minimum of 12 months.

Results: Pre-operative radial nerve paralysis was present in four patients in the fresh fractures group; post-operative paralysis occurred in two. All patients completely recovered a few months after the index procedure. Except for two, all patients achieved bone healing. One patient from the fresh-fracture group developed nonunion, and one from the nonunion group experienced persistent nonunion; both underwent successful revision surgeries. In addition, four patients with a fresh fracture underwent revision surgery for hardware removal. All but two patients showed no restricted elbow or shoulder joint motion compared with the opposite side.

Conclusion: Transfracture transposition of the radial nerve during open reduction and internal fixation of humeral shaft fractures is a safe, harmless and feasible procedure when applied for fractures of the middle and distal humeral shaft; it removes the nerve from the surgical field during fracture manipulation and fixation, with a gain in length of the nerve by transforming its course from spiral to straight. Following radial nerve transposition across the fracture, a repeat surgical approach to the humerus for hardware removal or treatment of nonunion transforms the procedure into a simple one; the skin incision is carried straight down to the bone without the need to identify or dissect the nerve that was previously transposed to the medial compartment of the arm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-016-3397-7DOI Listing
July 2017
-->