[Ultrasonography for hip joint dislocation in neonates].
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This paper describes a new technique for prophylactic treatment of recurrent mandibular dislocation using injection of botulinum toxin A (BtA) into the lateral pterygoid muscles. BtA temporarily weakens muscles by blocking acetylcholine release, and thus operates through a principle different from established treatments such as joint sclerosant therapy, eminectomy or Dautry's procedure. The patient suffered recurrent mandibular dislocations caused by tardive dystonia. We injected 75 mu BtA percutaneously into each lateral pterygoid muscle under electromyographic guidance. No further dislocations occurred over the subsequent 10 months, and follow-up continues. There were no immediate or delayed side effects. More experience is required before this becomes an established treatment. BtA is usually given in outpatients, and is less invasive or destructive than previous options. It may not be suitable if dislocation is due to lax ligaments or weak muscles. Operators must be aware that other BtA preparations require a different dose.
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Congenital dislocation of the knee is a uncommon malformation. Frequently there is an association with other congenital deformities including congenital dislocation of the hip. The classification of Leveuf and Pais into three separate groups (Type A, Type B, Type C) is now widely accepted. Between October 1989 and April 1995 we evaluated ten children (five girls and five boys) with twelve dislocated knees. Clinical, radiographic and different ultrasonography examinations were carried out on both knees. The sonographic classification showed Type A in 3, Type B in 5 and Type C in 4 cases. The sonographic examination revealed the essential anatomic structures and their pathomorphology. The anterior and the posterior cruciate ligament could be demonstrated in the majority of the cases. Three dislocated knees showed an obliteration of the recessus suprapatellaris and fibrotic changes in the m. quadriceps. These cases required operative treatment. With conservative treatment we achieved a satisfactory result in eight children with nine disease knees. There was a good functional result with an average flexion of 106 degrees. Early conservative treatment recommend as the therapy of choice. Ultrasonography imaging offers the possibility of reliable differentiation into one of the three groups of the classification of Leveuf and Pais. Radiographic documentation during the therapy has become the exception. Ultrasonography imaging helped substantially in the decision making and the timing of operative treatment.
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A series of four consecutive complex dorsal metacarpophalangeal dislocations were treated using a dorsal approach with division of only the proximal portion of the extensor hood fibers. This is a relatively easy, safe and efficient exposure permitting optimal exposure of the volar plate and osteochondral fractures with minimal risk to neurovascular structures. This approach also allows early mobilization and may decrease scarring, adhesions, and subluxation of the extensor tendon.
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The method, algorithm and results of treatment for acromioclavicular dislocation with carbon fiber prosthesis in 12 male patients has been presented. Excellent results have been achieved in all cases.
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Several techniques have been used to treat chronic dislocation of the mandible. Most of these techniques represent attempts at reducing the mobility of the TMJ. The eminectomy procedure is an attempt at restoring normal joint function without reducing mobility of the joint. We have presented two cases of chronic dislocation of the mandible that were treated successfully by removal of the articular tubercle and the lateral portion of the temporal bone. Although surgery of the TMJ area may be hazardous if approached without caution, we feel that the complications associated with this procedure are minimized if adequate care is taken in flap design and tissue dissection. On the basis of the excellent results of the eminectomy procedures reported in the literature and of our own experience with this procedure, we feel that this is the preferred treatment for chronic dislocation of the mandible.
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