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Abboud J, Moussa MK, Boushnak MO, Rahal MJH, Robial N. Belt and suspender technique for bipolar bone loss in shoulder instability. JSES Rev Rep Tech 2022; 2:354-359. [PMID: 37588879 PMCID: PMC10426609 DOI: 10.1016/j.xrrt.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Bipolar glenohumeral bone loss is a challenging condition to address in patients with recurrent anterior shoulder instability. In this category of patients, most isolated soft-tissue procedures such as remplissage or infraspinatus capsulotenodesis are associated with high risk of failure and instability recurrence. Even bony procedures such as Latarjet may fail to provide absolute stability, and instability may eventually recur. For a better understanding of the cause of failure in this particular type of patient, we may refer to the glenoid track concept which has been described as a useful tool for surgical planning. In fact, Latarjet procedure alone may leave a place for engagement of the Hill-Sachs defect on the anterior glenoid resulting in an off-track situation and secondary glenohumeral instability. In this technical note, we present the combination of arthroscopic remplissage and an open Latarjet procedure to treat patients with bipolar glenohumeral bone loss with good results at 31-month follow-up. Our aim is to propose these techniques as a possible rescue procedure for highly unstable shoulders combining engaged Hill-Sachs lesion and glenoid bone loss of more than 25%. We believe this technique would be a good option for patients who present other risk factors of recurrence such as past medical history of epilepsy, laxity, and psychiatric illnesses.
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Affiliation(s)
- Johnny Abboud
- University of Strasbourg, Faculty of Medicine, Strasbourg, France
- Department of Orthopedic Surgery and Traumatology, Hôpitaux Civils de Colmar, Colmar, France
| | - Mohamad K. Moussa
- Department of Orthopedic Surgery, Grand Hôpital de l’Est Francilien – Site de Meaux, Meaux, France
- Faculty of Medicine, University of Paris, Paris, France
| | - Mohammad O. Boushnak
- Université Libre de Bruxelles, Brussels, Belgium
- Department of Orthopedics and Traumatology, ULB Erasme University Hospital, Brussels, Belgium
| | - Mohammad Jawad H. Rahal
- University of Strasbourg, Faculty of Medicine, Strasbourg, France
- Department of Orthopedic Surgery and Traumatology, Hôpitaux Civils de Colmar, Colmar, France
| | - Nicolas Robial
- University of Strasbourg, Faculty of Medicine, Strasbourg, France
- Department of Orthopedic Surgery and Traumatology, Hôpitaux Civils de Colmar, Colmar, France
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Chamseddine AH, Asfour AH, Rahal MJH, Dib AA, Wardani HM, Boushnak MO. The adjunct use of lateral hinged external fixator in the treatment of traumatic destabilizing elbow injuries. Int Orthop 2021; 45:1299-1308. [PMID: 33624209 DOI: 10.1007/s00264-021-04985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/11/2021] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Ali Hassan Chamseddine
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon.
| | - Ali H Asfour
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon
| | - Mohammad Jawad H Rahal
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon
| | - Abbas A Dib
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon
| | - Hassan M Wardani
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon
| | - Mohammad O Boushnak
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon
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Chamseddine AH, El-Hajj OM, Haidar IM, Rahal MJH, Farhat HS, Hellani AA, Asfour AH, Zeyneddin MM. Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humeral shaft fractures. Int Orthop 2020; 45:253-263. [PMID: 33094402 DOI: 10.1007/s00264-020-04858-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Ali Hassan Chamseddine
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon.
| | - Oussama M El-Hajj
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Ibrahim M Haidar
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Mohammad Jawad H Rahal
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Hussein S Farhat
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Ali A Hellani
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Ali H Asfour
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Mariam M Zeyneddin
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
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Abstract
UNLABELLED This study evaluates the long-term results of rectus abdominis free-tissue transfer performed for lower extremity reconstruction. METHODS Over a period of 8 years 58 were available for long term follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. RESULTS At a mean follow-up of 18 years, there were no major complications in the soft tissue defect coverage group except for one patient who continued to have recurrent folliculitis over the weight bearing heel area, which was treated by repeated debridement. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. CONCLUSIONS The rectus abdominis free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis.
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Affiliation(s)
- Ramzi C Moucharafieh
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon; Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon.
| | - Alexandre H Nehme
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon
| | - Mohammad I Badra
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon
| | - Mohammad Jawad H Rahal
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center affiliated with Johns Hopkins International, Clemenceau Beirut, Lebanon
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