Chahine Assi

Lebanese American University Medical Center - Rizk Hospital · Orthopedics and Traumatology

Dual mobility cups (DMC) in total hip arthroplasty (THA) are becoming popular among orthopaedic surgeons. Substantial benefit of their use has been reported among high risk patients, particularly in reducing post-operative hip instability (dislocation). Many reports stated some concern when implanted in young and active people where complications s...

Introduction: Optimal positioning of the patellar component is crucial for the success of a total knee arthroplasty (TKA). Usually, the patellar component is placed empirically over the presumed centre of the patellar cut. Medialization of the prosthetic patella has been recommended; however, no evidence-based guidelines have been reported. Mater...

Introduction Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies w...

Background: The dual mobility cups (DMCs) were shown to reduce dislocation rate following total hip arthroplasty for any etiology, including femoral neck fractures. No reported studies evaluating DMC results for femoral neck fracture in a Middle Eastern population were found in the literature. Methods: This study aims to look for mortality rate,...

Introduction Dual-mobility cups (DMC) are currently used in patients having risk factors of instability. Most of the studies report the use of DMC in patients having a single high-risk variable. The aim of the study was to analyse a continuous series of patients treated with primary total hip arthroplasty (THA) and DMC with different high risk for...

Introduction Acute foot compartment syndrome (FCS) is a rare but potentially devastating complication that can occur following severe trauma of the limbs. In very are cases, such syndrome occurs following minor trauma. We present an exceptional case of acute FCS as a complication of an ankle sprain. Clinical findings A 32-year-old male patient pre...

Introduction and importance Chronic calcaneal osteomyelitis is a challenging condition associated with high relapse rates, requiring a multidisciplinary approach and various therapeutic options for effective management. We report a very rare case of a pyogenic osteomyelitis of the os calcis presented as a bone abscess. Case presentation A diabetic...

Background: Patients with diabetes mellitus (DM) are known to be predisposed to many complications in the lower extremities such as neuropathy, peripheral artery disease (PAD) and infection. Diabetic foot ulcers are complications of diabetes that can lead to lower extremity amputations, re-amputations and high mortality rates. Purpose: The aim of t...

Background: The treatment of severe diabetic toe infection complicated with osteomyelitis is often surgical. The decision on the level of amputation, when required, is difficult. Very few articles reported comparative outcomes between toe amputation and ray resection, and only in relation to the hallux. The aim of this preliminary report is to rec...

Basic inflammatory markers have been extensively studied to differentiate between non-infected and infected diabetic foot ulcers (DFU). Very rarely, basic hematological tests such as white cell count (WCC) and platelet counts were used as performance markers for DFU infection severity. The aim is to investigate these biomarkers in patients with DFU...

Background: Intra-capsular femoral neck fractures (FNF) are commonly encountered in trauma settings and are associated with high rates of morbidity and mortality. One of the most used methods of FNF treatment is the use of multiple cannulated screws. Many different screw constructs are reported in the literature, with no evidence of superiority of...

Introduction : On August 4, 2020, a massive explosion of a warehouse holding 2,700 metric tons of ammonium nitrate took place in the port of Beirut, Lebanon. This incident, which is considered as one of the largest industrial disasters lead to the death of at least 220 people and more than 6000 injuries. Hospitals near the blast were damaged signif...

Background The use of dual mobility cups (DMC) has been shown to reduce hip instability after revision surgery. For severe acetabular bone loss, reconstruction with a Kerboull cross-plate and bone allograft would contribute to restoring native hip position and bone stock. Only two papers reported on the combination of Kerboull cross-plate with bone...

Introduction Although iatrogenic injuries to the sural nerve (SN) are commonly encountered in calcaneal (Achilles) tendon (CaT) repair surgeries, the relationship between both structures have anatomical variations. A quantitative evidence synthesis has not been yet conducted. Our systematic review aims to better define the safe zone where the SN cr...

Background Five-year mortality and amputation frequencies after new-onset diabetic ulceration have been reported up to 55% and 74%, respectively. for patients with lower-extremity amputation. Following Charcot arthropathy, these frequencies were reported with wide variations. The aim of this meta-analysis is to provide a quantitative evaluation of...

Introduction: Anemia is significantly more prevalent in patients with diabetic foot complications. Severity of anemia has been shown to be associated with severity of DFD. The association between Hb level and DFU has rarely been investigated in surgical settings. Objective: This study compares Hb level in patients undergoing conservative surgica...

Introduction The pes anserinus consists of the sartorius, semitendinosus, and gracilis muscles. They coalesce together with the leg fascia to form the anserine plate. The semitendinosus and gracilis both form the deep layer of this plate and are clinically relevant for ligament reconstruction. The aim of the study is to report a detailed morphometr...

Purpose Many etiologies are known to lead to a tarsal tunnel syndrome (TTS). One rare cause is mass-occupying lesions, and particularly accessory or variant muscles (AVM). This study aimed to systematically collect published clinical cases of TTS caused by AVM. Methods An electronic literature search was conducted from inception to April 2021. The...

Venous leg ulcers (VLUs) are chronic and recalcitrant lower limb wounds that affect millions of patients annually, severely reducing their quality of life, and causing a significant burden on the health care system. Recently, Platelet rich plasma (PRP) has been used to improve healing of VLUs. This systematic review aimed at evaluating the effectiv...

Purpose Several risk factors for lower extremity amputation in diabetic patients have been identified; however, late presentation has been poorly investigated. Very few studies looked at the impact of such risk factor. As none has investigated the link between admission to amputation and late presentation in this population, we investigated such as...

Abstract Background In Lebanon, the role of the pharmacist remains underestimated in the medication reconciliation process, especially in surgical departments. This study aims to assess the impact of pharmacist-conducted medication reconciliation performed within 48 h of hospital admission to the orthopedic surgical department. Methods This was a p...

Though injuries to the distal tibiofibular (DTF) syndesmosis are commonly encountered in orthopedic and trauma settings, its anatomical structures have been poorly researched. The commonly overlooked DTF ligament injuries are known to cause chronic ankle pain, instability and post-traumatic osteoarthritis. Quantitative and morphological evidence sy...

Purpose The use of three-dimensional printing models in medical practice has been booming recently and its application to orthopedic surgery is gaining popularity. When treating fractures by open reduction and internal fixation, potential benefits have been associated with the use of 3D printing models. This review aims to quantitatively analyze th...

Purpose Though uncommon, Lisfranc complex joint injuries constitute a therapeutic challenge. Two surgical methods are commonly used to treat such injuries: open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The aim of this meta-analysis is to look for significant differences in the outcomes between these two techniques. Meth...

Background Limb preserving surgery for the treatment of diabetic foot complications (DFC) has been shown to yield excellent results and better outcomes when compared to non-surgical standard of care. The quality of the articles reporting the results of limb preserving surgery in treating DFC is quite low. The aim of this study was to evaluate the p...

Background The reverse sural fasciocutaneous flap (RSFCF) has been used with success to cover noncomplicated foot and ankle soft tissue defects. However, there are some controversies when it is used in patients having chronic diabetic foot ulcers. This aim of this meta-analysis was to evaluate the efficacy of RSFCF in covering diabetic foot and ank...

Several studies have been conducted to investigate the relation between 25-hydroxyvitamin D [25(OH)D] level and diabetic neuropathy (DN). However, there is still no clear conclusion due to differences in study design and cut-off values used in the published work, in addition to the absence of a comprehensive meta-analysis on the topic. The present...

Purpose The palmaris longus (PL) tendon present a high degree of variations; the commonest is its absence which could reach more than 40% in some populations. The PL tendon is highly relevant in hand reconstructive surgery; however, MRI variations of PL tendon have been exceptionally reported. To this, this study investigated PL tendon variations u...

The standard medical care (SC) of non-infected diabetic foot ulcers (DFUs) has been reported to yield varying rates of wound healing with high recurrence rate in non-infected wounds. Conservative surgery has been advanced as an alternative to SC in treating resistant non-complicated and complicated DFUs. Studies reporting resection arthroplasty (RA...

Background Osteomyelitis of the diabetic foot is a very challenging condition and amputation is often indicated. In some cases where the infection is localized and the surrounding soft tissue is mildly involved, an internal pedal amputation (IPA) based on resection and limited excision of the infected bone have been suggested as a viable option. Th...

Anemia was found to be prevalent in patients with diabetes mellitus. Higher rates of anemia were reported in patients having diabetic foot ulcers (DFU). With the presence of an altered microcirculation, the potential negative effects of anemia might impede ulcer healing leading to higher rates of amputation and mortality. Medline, Embase, Scopus, C...

Objective The diabetic foot disease is one of the most serious complications of diabetes causing high rates of amputations, premature deaths and healthcare cost. While standard non-surgical care is the mainstay of treatment of diabetic foot ulcers (DFU), many reports demonstrated that conservative surgery particularly in the forefoot, compared bett...

PurposeThere are few papers investigating the morphometry of hip muscles and reporting either a single muscle or a group of synergistic muscles. With the development of hip joint simulation, hip arthroplasty implants, and gait analysis, a set of biometric data covering all the muscles that act on the hip joint is needed.Methods Using a rigorous dis...

Introduction: Total hip replacement provides mostly fair functional and clinical results. Many factors play an essential role in hip stability and long-term outcomes. Surgical positioning remains fundamental for obtaining accurate implant fit and prevent hip dislocation or impingement. Different categories of robotic assistance have been establish...

An amazing number of surgical techniques have been reported to treat hallux valgus (HV) deformity. The most two popular are the Chevron and the Scarf osteotomies. Both claim to generate good correction of the deformity. The aim of this meta-analysis is to look for significant outcome differences between both treatments and their variants. A compreh...

Introduction: Dual-mobility cups (DMC) are gaining popularity mainly for their reduced rate of dislocation following total hip arthroplasty (THA). Currently, indication for DMC use extends beyond patients with high risk of dislocation or revision THA cases. Many authors reported DMC outcomes in primary THA for all aetiologies. However, some report...

Abstract Significance: Diabetic foot ulcers (DFUs) are associated with high morbidity, mortality, and health costs. Standard care (SC) associated with nonsurgical offloading is the mainstay treatment for DFUs, but it has high recurrence and infection rates. Metatarsal head resection (MHR) has been proposed as an effective surgical offloading techn...

Significance: Diabetic foot ulcers (DFUs) are associated with high morbidity, mortality, and health costs. Standard care (SC) associated with nonsurgical offloading is the mainstay treatment for DFUs, but it has high recurrence and infection rates. Metatarsal head resection (MHR) has been proposed as an effective surgical offloading technique for...

Background Infected diabetic foot ulcers (DFU) complicated with calcaneal osteomyelitis are a real challenge for limb preservation. Very few alternatives to amputation are available, mainly the resection of a part or the totality of the calcaneal bone. Calcanectomies were advanced as limb-sparing procedures in patients with heel osteomyelitis. Howe...

Objectives Foot complications in patients with diabetes or peripheral artery disease (PAD) are serious events in the life of the patients leading to amputations and mortality. No evidence synthesis has been reported on mortality rates following minor lower extremity amputation (LEA); thus, a quantitative evidence synthesis was needed. Methods A sy...

Insufficiency fractures are a common complication of bisphosphonate use and have recently been reported in association with Roux-en-Y Gastric Bypass Surgery (RYGB). This study reports a case of a 62-year-old female, 6 years status post Mini Gastric Bypass – One Anastomosis Gastric Bypass (MGB-OAGB), presenting to our institution with bilateral groi...

Background Diabetic and ischemic foot ulcers are difficult to heal, and the mastering of numerous treatment methods is imperative to achieve healing. One of these methods is the fillet toe flap used to cover specific diabetic wounds of the forefoot associated with toe osteomyelitis. Instead of amputating the infected toe, phalanges are removed whil...

Introduction: Post-operative misalignment of the lower limb mechanical axis following total knee arthroplasty (TKA) is thought to be associated with clinical failure. In a balanced knee, a neutral global mechanical axis following the use of intra-medullary (IM) guidance does not necessarily imply a horizontal TKA joint line. Using femoral and tibi...

Valgus slipped capital femoral epiphysis (SCFE) is a rare entity which leads to a proximolateral displacement of the hip epiphysis. The literature on valgus SCFE consists of case reports or case series. Since no evidence synthesis has been conducted, a systematic review on all published cases of valgus SCFE was conducted. The search strategy locate...

The treatment of diabetic foot ulcers (DFUs) is usually based on local debridement, topical agents, and nonsurgical off-loading. When compared with nonsurgical methods, a number of articles reported better results with surgery. The aim of this meta-analysis was to collate quantitative evidence on the outcomes of surgery versus nonsurgical treatment...

» Diabetic foot ulcers cause higher rates of amputation and mortality; amputations yield even higher mortality rates than diabetic foot ulcers. Conservative excisional surgical procedures could be a suitable alternative to amputations, with comparable results with respect to wound-healing and infection control. Also, toe-sparing conservative surgic...

Objective Videos of surgical procedures are viewed by some as potential training resources for surgeons and residents. However, there is little evidence on the effectiveness of surgical videos on learning and understanding complex three-dimensional surgical procedures. Lower extremity amputation is a complex surgery, and many residents and surgeons...

Objectives Antegrade intramedullary nailing (AIMN) using 2k-wires seems to be superior to other modalities in treating displaced fractures of the fifth metacarpal neck (FFMN). Few reports demonstrated similar results retrospective with a single k-wire. The aim of the study is to describe our single k-wire technique and evaluate the related results....

The palmaris longus muscle, and its tendon, is one of the most variable muscles in humans. Though it has been extensively researched in the adult population, its variations and development in the fetal period were rarely investigated. The aim of this meta-analysis is to conduct an evidence synthesis on PL variations and the prevalence of its agenes...

Articles reporting surgically treated DFUs are searched for and the data collected in a systematic approach. Through this process, a more accurate way to evaluate these procedures could be offered and implications for clinical practice and future research could be proposed. Our personal experience was in line with the good surgical outcomes reporte...

Background & aims: Vitamin D deficiency is known to be prevalent in patients with diabetes and in particular in those having symptoms of diabetic peripheral neuropathy (DN). Thus, it is worthy to investigate whether a supplementation of vitamin D would improve pain among those having diabetes and DN. Methods: A systematic literature search was p...

Conservative treatment is the basis for diabetic foot ulcer (DFU) management, whereas surgical treatment is usually reserved for patients with failed, recurrent, or nonresponsive infected wounds. However, many reports demonstrated good to excellent results following surgery. Evidence synthesis on surgical offloading techniques and clear guidelines...

Study design: Prospective study. Purpose: The goal of this study was to evaluate the impact of anterior lumbar interbody fusion (ALIF) on L5-S1 level for restitution of distal segmental lordosis and to investigate its consequences on spino-pelvic parameters and the global sagittal balance. Overview of literature: Lumbar surgery must be adapted...

We present a familial case of valgus slipped capital femoral epiphysis (SCFE). Charts of members of the same family having the condition were retrieved. Clinical and radiological examinations were conducted after 10 years of the initial presentation and treatment. Two siblings, brother and sister, were initially diagnosed with valgus SCFE and treat...

Although they occur frequently, diabetic toe ulcers (DTUs) are poorly investigated. Long-term antibiotics or toe amputation are the usual indications for complicated DTU treatment. Some authors reported good to excellent results following conservative surgery (CS) for recalcitrant or infected wounds; yet no systematic review has been published. Sev...

Background: The tendon of the plantaris muscle (PM) is highly relevant in surgical practice. It is used as a graft for tendon/ligament repair or reconstruction in hand surgery whenever palmaris longus (PL) is lacking. Its occurrence in humans is reported to be high. Methods: A meta-analysis based on cadaveric studies was conducted to quantitatively...

Purpose: Ankle Charcot neuroarthropathy presents a great challenge for treatment. While conservative treatments yield poor results, arthrodesis is considered the treatment of choice for unstable Charcot ankles. There are two methods used for ankle fusion: retrograde intramedullary nail (IMN) and external fixator (EF). Literature reports inconclusi...

Background/objective: Pseudoaneurysms (PA) are rare complications following ankle arthroscopy (AA). Delay in diagnosis is reported to be frequent and could lead to serious complications. Evidence synthesis on the clinical context of such complication lacks in the literature. Methods: A systematic review is conducted to locate all relevant papers...

Diabetic lower limb ulcers are a serious complication to diabetes that could lead to amputation and death. Split-thickness skin graft (STSG) has been proposed by some authors to treat noninfected diabetic wounds, mainly those found in the leg and on the dorsum of the foot. No quantitative evidence synthesis over this technique has been reported in...

Diabetic foot ulcers (DFUs) are usually treated with conservative management based on debridement, topical agents, and nonsurgical off-loading; however, the recurrence rate following such standard care is reported to be high. In the case of recalcitrant or recurrent ulcers, a surgical off-loading technique such as the metatarsal osteotomy (MO) is i...

Introduction. Soft tissue defects in the distal leg and foot are challenging conditions for reconstruction. The widely used reverse sural fascio-cutaneous flap (RSFCF) has been reported with large variation in complication frequency. Some authors reported higher complications in the diabetic population when compared with trauma patients. We compare...

Introduction. Soft tissue defects in the distal leg and foot are challenging conditions for reconstruction. The widely used reverse sural fascio-cutaneous flap (RSFCF) has been reported with large variation in complication frequency. Some authors reported higher complications in the diabetic population when compared with trauma patients. We compare...

Recurrent dislocation, being a major reason for revision total hip arthroplasty (THA), was found to decrease significantly using dual mobility cup (DMC) compared to standard cups (SC), and that in both primary and revision THA. These acetabular implants have gained popularity in recent years in different countries besides the country of original co...

Background: Contradictory results have been reported in the literature over the beneficial effect of the lateral soft tissue release (LSTR) when associated to an osteotomy for the treatment of hallux valgus (HV). Materials and methods: Six comparative studies totalizing 425 patients (549 feet) were computed and comparing two groups: one group of...

Acetabular reconstruction aims at filling bony defects and positioning the acetabular component in its anatomical place. To this, the use of Kerboull plate would give an automatic optimal positioning while reconstructing the acetabular cavity. We developed a technique, the cross technique, that approaches acetabular reconstruction in a systematic w...

Neurovascular and tendon structures are considered at risk when performing ankle arthroscopy. Injury rate and distance from portals to such structures varied in the literature. The aim of this meta-analysis is to evaluate the injury risk of these structures in terms of proximity and injury prevalence. Thirteen studies including 184 cadaveric ankle...

Introduction: Osteonecrosis of the femoral head (ONFH) remains a therapeutic challenge for patients undergoing total hip arthroplasty (THA). The majority of these patients are young with high functional demand, and show an increased risk of dislocation following surgery than patients with osteoarthritis. The use of double mobility cup (DMC) has be...

Correction notice to: Early results of total hip arthroplasty using dual-mobility cup in patients with osteonecrosis of the femoral head SICOT-J 2018, 4, 4, https://doi.org/10.1051/sicotj/2018001 Chahine Assi1, Nadim Kheir1, Camille Samaha1,2, Pascal Kouyoumdjian3, and Kaissar Yammine1,4,* 1 Department of Orthopedic Surgery, Lebanese American Unive...

The patella remains one of the main sources of post-operative complication following total knee arthroplasty surgery. Optimal positioning of the patellar component is still a controversy with no clear-cut guidelines. Instead of choosing an empirical position, we described a novel surgical technique to better locate the patellar button based on the...

Purpose: Achilles injuries are very common, mainly among young athletes. When indicated, the surgical treatment aims for strong repairs that can resist distraction and consequently ruptures. The majority of the published clinical meta-analyses reported comparisons between broad treatment modalities such as conservative treatment, open, and minimal...

Aim of the study:: Methods based on the positive linear relationship existing between stature and long bones are most commonly used to estimate living stature in forensic anthropology. The length of the sternum and its parts has been advanced as a plausible alternative to estimate stature when such long bones are missing or damaged. Material and...

Background: Soft tissue defects in the foot and ankle region are challenging conditions particularly in diabetic patients. We evaluated the reliability of the sural flap in treating such defects among a diabetic population. Material and Methods : This is a continuous retrospective series of 14 patients with type 2 diabetes treated with an ipsilater...

La dysplasie épiphysaire hémimélique (DEH) est une pathologie rare touchant l’enfant et le jeune adolescent. Elle correspond à des excroissances épiphysaires multiples unilatérales (1 à 4) et dans la majorité des cas localisées sur un seul hémicorps. Les auteurs rapportent leur expérience de neuf cas de DEH ayant bénéficié d’une résection précoce e...

Dysplasia epiphysealis hemimelica (DEH) is a rare developmental bone disorder with hemimelic involvement of one or more epiphysis. We report on nine new cases and discuss the clinical manifestations, the value of MRI, and the results of complete and early surgical resection of these lesions. In this retrospective study, nine patients with a diagnos...

Precise biometric data of calcaneus, cuboid bones and calcaneocuboid joint are not alluded to in textbooks of anatomy. This study focussed on the biometry of 50 calcanei, 30 cuboid dry bones, and anatomical specimens of 21 transverse tarsal joints. Measurement of the length, width, angular orientation, contact surface and radius of curvature, rolli...

The aim of proximal femoral osteotomies (PFO) in children is to restore normal anatomy and optimal joint congruency to prevent medium and long-terms degenerative deterioration of the hip. They play an important role in the treatment of neurological subluxations or dislocations of the hip. Advances in modern imaging and surgical techniques have impr...