ABSTRACT Lipofibromatous hamartoma is a rare tumor-like overgrowth of fibroadipose tissue surroun... more ABSTRACT Lipofibromatous hamartoma is a rare tumor-like overgrowth of fibroadipose tissue surrounding the nerves. Most commonly, it involves the median nerve. The tumor is usually present at birth and grows very slowly. The expected age of clinical presentation is the third or fourth decades of life. The case reported here had a rapid overgrowth and presented at the age of eight. Our case is the first reported case of lipofibromatous hamartoma of the median nerve in the pediatric age group.
Antibiotic cement-coated intramedullary nails (ACCINs) are increasing in popularity as a viable s... more Antibiotic cement-coated intramedullary nails (ACCINs) are increasing in popularity as a viable solution for the treatment of fracture-related infections (FRIs), infected long bone nonunions, and arthrodeses without an external fixator. ACCINs effectively manage to fulfill three of the basic principles for eradicating osteomyelitis: dead space management, antibiotic delivery, and bone stability. We performed a retrospective review of 111 patients who were treated with ACCINs between January 2014 and December 2020. In our series, 87.4% (n = 97) of patients achieved healed and uninfected bone or stable arthrodesis at a mean follow-up of 29.2 months (range, 6–93 months). Additionally, 69.1% (n = 67) of healed patients were resolved after only one procedure, and the remainder (30.9%, n = 30) healed after one or more additional procedures. The mean number of additional procedures was 2.1 (range, 1–6 additional procedures). The overall limb salvage rate was 93.7% (n = 104). The majority o...
Local antibiotic delivery using different carriers plays an important role in both infection prop... more Local antibiotic delivery using different carriers plays an important role in both infection prophylaxis and treatment. Besides dead space management, these carriers have the advantage of providing a high concentration of local antibiotics with a lower risk of systemic toxicity. Few studies have reported on systemic toxicity associated with antibiotic-impregnated carriers. The present study investigates the systemic tobramycin concentration at 24, 48 and 72 h postoperatively after using tobramycin-loaded polymethyl methacrylate (PMMA) and calcium sulfate (CS) as local antibiotic carriers. Additionally, this work assesses the renal function postoperatively for indications of acute kidney injury (AKI). Fifty-two patients were treated in 58 procedures with tobramycin and vancomycin-loaded PMMA, CS, or both. All systemic tobramycin levels were <2 mcg/mL at 72 h, and the resulting rate of AKI was 12% (7/58). In conclusion, local tobramycin antibiotic delivery using PMMA, CS, or both r...
Introduction Talus fractures are not uncommon and one of the serious fractures in the foot and an... more Introduction Talus fractures are not uncommon and one of the serious fractures in the foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. They have been reported to be associated with calcaneum as well as talus fractures. Aim To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation. Methods We retrospectively reviewed 93 consecutive talus fractures in the period between 1/1/2011 to 1/11/2018. Inclusion criteria were: The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and three view ankle plain radiographs. Two independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification, if any. Any dispute was resolved by the senior author.Patient records...
European Journal of Orthopaedic Surgery & Traumatology
PurposeStable or unstable pelvic ring fractures are sometimes associated with L5 transverse proce... more PurposeStable or unstable pelvic ring fractures are sometimes associated with L5 transverse process (TP) fractures. This review aimed to determine the effect of L5 TP fractures on pelvic ring fracture stability.MethodsWe searched electronic databases (including MEDLINE, Google Scholar, and SCOPUS) and performed hand searching of English orthopedics journals and conference abstracts until May 2017. We pooled data from five studies, with a total of 278 patients.ResultsOf 28 studies, five were included (four studies involved adult patients, one pediatric population). Of the 278 pelvic fractures (average age 37.33 years; male 132 and female 92), 99 (35.6%) were stable and 179 (64.4%) were unstable (fracture B and C, according to the Tile classification). Sixty-seven (24.1%) were cases with L5 TP, and 211 (75.9%) were cases without L5 TP fracture. The typical causes of injury were road traffic accident (59.2%), fall from height (23.6%), and crush injuries and injuries by heavy objects (17.2%). The pooled odds ratio (OR) of L5 TP between the stable and unstable groups calculated with random effect analysis was 0.418 (0.083–2.108; p = 0.291); after excluding the study on a pediatric population, the pooled OR was 0.349 (0.056–2.159; p = 0.258).ConclusionsL5 TP fractures may indicate high-energy trauma; however, no relationship between L5 TP fractures and pelvic ring fracture stability exists.Level of evidencePrognostic Level IV.
Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examine... more Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP’s recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors’ (n = 63) vs. nurses/physiotherapists’ (n = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments’ pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children’s pain, child...
Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient ... more Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient mobilization requires a functioning knee extensor apparatus. The purpose of this retrospective study was to report our technique of sartorius muscle transfer for restoration of extension mechanism function and the outcomes of five patients. Patients with ruptured knee extensor mechanism secondary to trauma or knee arthroplasty-related issues were studied retrospectively. In all patients, sartorius muscle was transferred to restore the quadriceps tension deficit. Increase in the knee active range of motion, increase in the extensor mechanism power by one grade on Medical Research Council scale, and improvement in the extension lag were observed in all patients. The sartorius muscle transfer can be a reliable option to restore the knee extensor mechanism in chronic quadriceps tendon injuries. Our initial results are promising and showed improvement of the extensor mechanism muscle power, i...
ABSTRACT Lipofibromatous hamartoma is a rare tumor-like overgrowth of fibroadipose tissue surroun... more ABSTRACT Lipofibromatous hamartoma is a rare tumor-like overgrowth of fibroadipose tissue surrounding the nerves. Most commonly, it involves the median nerve. The tumor is usually present at birth and grows very slowly. The expected age of clinical presentation is the third or fourth decades of life. The case reported here had a rapid overgrowth and presented at the age of eight. Our case is the first reported case of lipofibromatous hamartoma of the median nerve in the pediatric age group.
Antibiotic cement-coated intramedullary nails (ACCINs) are increasing in popularity as a viable s... more Antibiotic cement-coated intramedullary nails (ACCINs) are increasing in popularity as a viable solution for the treatment of fracture-related infections (FRIs), infected long bone nonunions, and arthrodeses without an external fixator. ACCINs effectively manage to fulfill three of the basic principles for eradicating osteomyelitis: dead space management, antibiotic delivery, and bone stability. We performed a retrospective review of 111 patients who were treated with ACCINs between January 2014 and December 2020. In our series, 87.4% (n = 97) of patients achieved healed and uninfected bone or stable arthrodesis at a mean follow-up of 29.2 months (range, 6–93 months). Additionally, 69.1% (n = 67) of healed patients were resolved after only one procedure, and the remainder (30.9%, n = 30) healed after one or more additional procedures. The mean number of additional procedures was 2.1 (range, 1–6 additional procedures). The overall limb salvage rate was 93.7% (n = 104). The majority o...
Local antibiotic delivery using different carriers plays an important role in both infection prop... more Local antibiotic delivery using different carriers plays an important role in both infection prophylaxis and treatment. Besides dead space management, these carriers have the advantage of providing a high concentration of local antibiotics with a lower risk of systemic toxicity. Few studies have reported on systemic toxicity associated with antibiotic-impregnated carriers. The present study investigates the systemic tobramycin concentration at 24, 48 and 72 h postoperatively after using tobramycin-loaded polymethyl methacrylate (PMMA) and calcium sulfate (CS) as local antibiotic carriers. Additionally, this work assesses the renal function postoperatively for indications of acute kidney injury (AKI). Fifty-two patients were treated in 58 procedures with tobramycin and vancomycin-loaded PMMA, CS, or both. All systemic tobramycin levels were <2 mcg/mL at 72 h, and the resulting rate of AKI was 12% (7/58). In conclusion, local tobramycin antibiotic delivery using PMMA, CS, or both r...
Introduction Talus fractures are not uncommon and one of the serious fractures in the foot and an... more Introduction Talus fractures are not uncommon and one of the serious fractures in the foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. They have been reported to be associated with calcaneum as well as talus fractures. Aim To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation. Methods We retrospectively reviewed 93 consecutive talus fractures in the period between 1/1/2011 to 1/11/2018. Inclusion criteria were: The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and three view ankle plain radiographs. Two independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification, if any. Any dispute was resolved by the senior author.Patient records...
European Journal of Orthopaedic Surgery & Traumatology
PurposeStable or unstable pelvic ring fractures are sometimes associated with L5 transverse proce... more PurposeStable or unstable pelvic ring fractures are sometimes associated with L5 transverse process (TP) fractures. This review aimed to determine the effect of L5 TP fractures on pelvic ring fracture stability.MethodsWe searched electronic databases (including MEDLINE, Google Scholar, and SCOPUS) and performed hand searching of English orthopedics journals and conference abstracts until May 2017. We pooled data from five studies, with a total of 278 patients.ResultsOf 28 studies, five were included (four studies involved adult patients, one pediatric population). Of the 278 pelvic fractures (average age 37.33 years; male 132 and female 92), 99 (35.6%) were stable and 179 (64.4%) were unstable (fracture B and C, according to the Tile classification). Sixty-seven (24.1%) were cases with L5 TP, and 211 (75.9%) were cases without L5 TP fracture. The typical causes of injury were road traffic accident (59.2%), fall from height (23.6%), and crush injuries and injuries by heavy objects (17.2%). The pooled odds ratio (OR) of L5 TP between the stable and unstable groups calculated with random effect analysis was 0.418 (0.083–2.108; p = 0.291); after excluding the study on a pediatric population, the pooled OR was 0.349 (0.056–2.159; p = 0.258).ConclusionsL5 TP fractures may indicate high-energy trauma; however, no relationship between L5 TP fractures and pelvic ring fracture stability exists.Level of evidencePrognostic Level IV.
Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examine... more Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP’s recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors’ (n = 63) vs. nurses/physiotherapists’ (n = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments’ pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children’s pain, child...
Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient ... more Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient mobilization requires a functioning knee extensor apparatus. The purpose of this retrospective study was to report our technique of sartorius muscle transfer for restoration of extension mechanism function and the outcomes of five patients. Patients with ruptured knee extensor mechanism secondary to trauma or knee arthroplasty-related issues were studied retrospectively. In all patients, sartorius muscle was transferred to restore the quadriceps tension deficit. Increase in the knee active range of motion, increase in the extensor mechanism power by one grade on Medical Research Council scale, and improvement in the extension lag were observed in all patients. The sartorius muscle transfer can be a reliable option to restore the knee extensor mechanism in chronic quadriceps tendon injuries. Our initial results are promising and showed improvement of the extensor mechanism muscle power, i...
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Papers by Ahmed Elhessy