Ramzi Moucharafieh - Academia.edu (original) (raw)

Papers by Ramzi Moucharafieh

Curēus, Mar 21, 2024

Objectives: Carpal tunnel syndrome is a common condition seen in daily clinical practice. Multipl... more Objectives: Carpal tunnel syndrome is a common condition seen in daily clinical practice. Multiple minimally invasive techniques have emerged in the last decades for median nerve decompression. However, many research are needed to study the outcome on the patients and their safety profile. Methods: We will compare group A that includes patients operated on using the minimally invasive transverse incision (number of patients = n = 221, females 76.7% and males 22.8%) versus group B that includes patients operated on using the longitudinal incision (n = 194, female 70.1% and male 29.9%) in term of clinical satisfaction and safety. The mean age of group A is 58.1±5.1 and that of group B is 58.8±4.8. The male and female distribution in both groups and the mean age were both similar with no statistically significant difference for the age (p = 0.79) or the gender distribution (p = 0.1). Data collected prospectively at regular intervals in time (preoperatively and at one month, three months, and six months post-carpal tunnel release (CTR)) between January 2006 and December 2021 were reviewed retrospectively. Patients' clinical findings, grip strength measurement using a hand dynamometer, and postoperative satisfaction measured using the BCTQ (Boston Carpal Tunnel Syndrome Questionnaire) scoring system were recorded and analyzed for each technique. Results: A total of 415 patients were included in our study. All patients included had moderate to severe median nerve compression documented by nerve-conducted studies with positive Tinel's and Phalen's signs. Baseline demographics between group A (CTR through a longitudinal palmar mini-incision) and group B (CTR with a mini-transverse incision at the palmar crease) didn't show a statistically significant difference. Both groups showed improved grip strength and BCTQ scores at the post-operative follow-up. Conclusions: Median nerve decompression using both types of incisions has resulted in the same functional outcomes and patient satisfaction.

International Wound Journal

Paediatric complex wounds pose a challenge to the reconstructive surgeon due to the intricacy of ... more Paediatric complex wounds pose a challenge to the reconstructive surgeon due to the intricacy of reconstructive options required. Developments in microsurgery and microsurgical technique have brought free tissue transfer ever closer to the comfort zone of the reconstructive surgeon for reconstruction of paediatric traumatic complex wounds. We present our experience of microsurgical reconstruction in Lebanon for complex traumatic wounds in paediatric patients under the age of 10 years using the free anterolateral thigh (ALT) flap. The ALT flap has proven its value as a safe, adaptable, and aesthetically acceptable reconstructive option in paediatric complex trauma.

Case reports in orthopedics, 2012

Central acetabular fracture dislocation is usually caused by high-energy external trauma. However... more Central acetabular fracture dislocation is usually caused by high-energy external trauma. However, 26 cases that occurred as a result of a seizure attack appeared in the literature from 1970 to 2007, with the seizure attacks themselves caused by many different factors. In this setting, the central acetabular fracture not caused by direct trauma might initially remain unnoticed leading to a delayed diagnosis. In some cases, this may lead to death as a result of massive blood loss. We here present a case of bilateral central acetabular fracture dislocation as a result of a seizure attack.

$Research paper thumbnail of Case Report of Both Bone Forearm Refracture in an 8-year-old Girl$

Journal of Orthopaedic Case Reports

Introduction: Pediatric both bone forearm fracture is a common injury in children. A multitude of... more Introduction: Pediatric both bone forearm fracture is a common injury in children. A multitude of current treatments are available, with Titanium Elastic Intramedullary Nail system becoming very popular. The advantages of this treatment are many; however, refracture of these nails in situ is a reported uncommon complication, and there is a paucity in the literature on the appropriate management in these cases. Case Report: An 8-year-old girl suffered from a left both bone forearm fracture after a fall from height, for which she was treated with the use of Titanium Elastic Intramedullary Nail system. Despite callus formation and fracture healing on X-rays, the nails were not removed at the intended time of 6 months due to the economic status of the country and the viral outbreak of COVID-19. Therefore, after 11 months of fixation, the patient presented again after a fall from height with the left both bone forearm refracture with the Titanium Elastic Intramedullary Nail system in sit...

Indian Journal of Orthopaedics

Case reports in orthopedics, May 18, 2022

Traumatic injuries of the upper limb can result in variant fracture combination. This article dis... more Traumatic injuries of the upper limb can result in variant fracture combination. This article discusses a rare injury combination including ipsilateral proximal and distal humerus fractures alongside a distal radius fracture. The mechanism of the fall is unknown, but the patient being old with such a complex injury, one can only assume that osteoporosis played a major role. Open reduction and internal fixation was opted for the distal humerus and radius fractures, and percutaneous pinning was done for the proximal humerus fracture. Surgery is an option to each one of these injuries with different techniques available for managing such an association, with emphasis made on osteoporosis workup to help prevent such complex injuries.

Foot and Ankle Surgery, 2010

Corrigendum to: ''Long-term follow-up on microsurgical free-tissue transfer in foot and ankle rec... more Corrigendum to: ''Long-term follow-up on microsurgical free-tissue transfer in foot and ankle reconstruction'' [

Annals of Emergency Medicine, 1996

Articles Articles, All fields, Author, Advanced search. ... ruined much of the country's... more Articles Articles, All fields, Author, Advanced search. ... ruined much of the country's infrastructure, and caused many of the wealthy and educated to seek safer lives in the ... Thousands of people lost their homes or were forced to flee them; many came to the capital, Beirut, believing it ...

Pectoralis major tendon ruptures are uncommon injuries and most physicians have little experience... more Pectoralis major tendon ruptures are uncommon injuries and most physicians have little experience with the surgical treatment of this injury. The purpose of this article is to describe a new method of fixation of the ruptured tendon that facilitates the surgical procedure without altering the postoperative care, rehabilitation, and complication rate.

Copyright © 2012 Alexandre H. Nehme et al. This is an open access article distributed under the C... more Copyright © 2012 Alexandre H. Nehme et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Central acetabular fracture dislocation is usually caused by high-energy external trauma. However, 26 cases that occurred as a result of a seizure attack appeared in the literature from 1970 to 2007, with the seizure attacks themselves caused by many different factors. In this setting, the central acetabular fracture not caused by direct trauma might initially remain unnoticed leading to a delayed diagnosis. In some cases, this may lead to death as a result of massive blood loss. We here present a case of bilateral central acetabular fracture dislocation as a result of a seizure attack. 1.

Cureus, 2021

Osteoid osteoma of the distal phalanges in the hand is rare and difficult to diagnose. We report ... more Osteoid osteoma of the distal phalanges in the hand is rare and difficult to diagnose. We report a case of a 37-year-old Caucasian female patient who presented with a mass on the distal phalanx of the index finger. The patient was suffering from intermittent nocturnal pain for more than 18 months along with thickening, localized swelling, and clubbing of the distal phalanx of the right index finger. Radiographs revealed a lytic lesion of the distal phalanx of the right index finger with surrounding sclerosis. An MRI showed an intramedullary lesion with infiltration of the bone marrow, cortex, and surrounding tissue with focal sclerosis and elements of enhancements. A presumptive diagnosis of osteoid osteoma was made and surgical removal of the lesion by curettage and bone grafting was the treatment of choice. The curetted specimen was sent to pathology and the diagnosis of osteoid osteoma was confirmed. The patient was asymptomatic at six months postoperatively. Osteoid osteoma should be included in every differential diagnosis for patients presenting with atypical features of the distal phalanx of the hand.

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 2021

Background: Although the association between femoroacetabular impingement (FAI) syndrome and hip ... more Background: Although the association between femoroacetabular impingement (FAI) syndrome and hip osteoarthritis (OA) is well established, not all hips exhibiting cam or pincer morphologies (i.e. imaging findings of FAI syndrome) are symptomatic or arthritic. It is difficult to detect which subgroup will wear out, or how does the arthritic process start radiographically. Therefore, we measured in a retrospective study based on computed tomography (CT) analysis, the joint space width (JSW) according to a standard protocol and we investigated its variation according to the presence of a cam and/or pincer morphology. We hypothesized that the radiological presence of a cam and/or pincer hip morphologies, even in asymptomatic subjects, would affect JSW. Methods: Two hundred pelvic CT scans performed for non-orthopedic etiologies in asymptomatic patients were analyzed using a 3D software. After excluding patients with hip OA or previous hip surgery, 194 pelvic CT scans (388 hips) were retained. We measured for each hip the presence of FAI syndrome imaging findings (cam and pincer morphologies) using the classical parameters of coxometry. In addition, we performed a measurement of articular joint space width according to a standard protocol. We then calculated the mean thickness of 3 defined regions along the femoroacetabular joint: anteriorsuperior, posterior-inferior, and posterior-superior. Lastly, we compared the JSW across 4 groups: hips with (1) no cam or pincer, (2) pincer, (3) cam, and (4) cam and pincer morphologies using a multivariate analysis. Additionally, a topographic heatmap of JSW was plotted allowing quantitative representation of JSW along the joint. Results: Increased JSW with peak difference of 0.9 mm (25.7%) was found in hips with cam and pincer morphologies when compared to normal ones (p ¼ 0.002) and to hips with pincer or cam morphologies only. Conclusion: Positive variations in JSW were associated to the presence of cam and pincer morphologies. This significant increase in JSW could be one of the earliest measurable changes preceding later classical alterations.

Injury, 2020

Injury of the brachial plexus and peripheral nerve often result in significant upper extremity dy... more Injury of the brachial plexus and peripheral nerve often result in significant upper extremity dysfunction and disability. Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries. These transfers require an intimate knowledge of nerve topography, a technically demanding Intraneural dissection and require extensive physical therapy for retraining. In this review, we present a summary of the most widely accepted nerve transfers in the upper extremity described in the current literature.

Injury, 2019

This study evaluates the long-term results of rectus abdominis free-tissue transfer performed for... more 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.

Case Reports in Orthopedics, 2019

Cystic lymphangiomas are benign tumors originating mainly in the head and neck of the pediatric p... more Cystic lymphangiomas are benign tumors originating mainly in the head and neck of the pediatric population. The authors report a rare case of cystic lymphangioma in the right elbow of an 8-month-old baby treated successfully by complete surgical resection.

HIP International, 2010

A 79 year old woman with bilateral hip replacements presented with severe left thigh swelling, an... more A 79 year old woman with bilateral hip replacements presented with severe left thigh swelling, and life threatening hypovolemic shock. After adequate resuscitation, an angio CT scan of her pelvis showed a false aneurysm of the external iliac artery in proximity to a loose pegged cemented cup. A pelvic X-ray 6 years prior to presentation had revealed a medialized high riding pegged cemented cup with a loose cemented stem. Vascular reconstruction followed by revision of the left THA was necessary.

Case reports in orthopedics, 2017

We present the case of a 13-year-old boy who sustained a locked central fracture dislocation of t... more We present the case of a 13-year-old boy who sustained a locked central fracture dislocation of the right acetabulum following a bicycle fall. Immediate external reduction maneuvers under general anesthesia were unsuccessful due to intrapelvic entrapment of the femoral head. Open reduction internal fixation was achieved 48 hours later. After an initial satisfactory postoperative course, the patient ended up developing severe hip osteoarthritis 16 months after the procedure. The rarity of this injury in children is discussed, with its possible implications on joint congruity and potential growth injury.

Case Reports in Orthopedics, 2017

The purpose of this study is to report a rare case of acetabular osteochondroma with a unique cli... more The purpose of this study is to report a rare case of acetabular osteochondroma with a unique clinical presentation occurring in an adult with normally developed hips. The distinctive size and location of the lesion required an open approach with surgical dislocation of the hip for complete resection.

The Journal of Foot and Ankle Surgery, 2016

Case Reports in Orthopedics, 2012

Intra-articular osteoid osteoma is uncommon accounting for approximately 12% of all osteoid osteo... more Intra-articular osteoid osteoma is uncommon accounting for approximately 12% of all osteoid osteomas. It presents diagnostic and therapeutic challenges since several traumatic or degenerative pathologies of the joint can be simulated with delay in the diagnosis. We report the clinical, radiographic, and histopathological findings in 2 cases of intra-articular osteoid osteoma of the femoral neck and of the acetabulum. Technical aspects of arthroscopic excision and results of surgery are discussed. Arthroscopy allowed complete excision of the osteoid osteomas, with a short postoperative rehabilitation and excellent functional results.