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PubMed2003

Medial subtalar dislocation: importance of clinical diagnosis in distinguishing from other dislocations.

In an emergency situation, the clinical picture of ankle and subtalar dislocation may be similar. This may lead to the use of the improper technique of reduction, especially in a subtalar dislocation, resulting in the failure of reduction and further damage to the articular surfaces. A case of medial subtalar dislocation is presented, which was managed as an ankle dislocation and manipulated inappropriately, leading to a failure of reduction. The clinical signs of ankle and subtalar dislocation, including points of differentiation between the two are discussed, and the correct method of reduction of subtalar dislocation is described.

Adult↗
PubMed2006

Vertical axis patellar dislocation with ipsilateral femoral fracture: use of a closed percutaneous technique for reduction of the dislocation.

Intra-articular vertical axis dislocations are rare injuries, which mostly occur after blunt trauma. In this type of dislocation, the patella rotates along its vertical axis, bringing the articular surface to face medially or laterally. A 13-year-old boy sustained an intra-articular lateral patellar dislocation with a 90 degrees vertical axis medial rotation, which resulted in the articular surface facing laterally, the medial edge of the patella pointing posteriorly, and the lateral edge of the patella pointing anteriorly. As a result, the patella was wedged between the medial and lateral femoral condyles. He also sustained an ipsilateral closed distal femoral shaft fracture. Closed reduction of the dislocation was not successful. Subsequently an A-O reduction clamp was used percutaneously to reduce the patellar dislocation. The femoral fracture was then stabilized by internal fixation using a dynamic compression plate. Isolated vertical and horizontal dislocations have been previously described, but the presence of an ipsilateral femoral shaft fracture makes this a unique case. The percutaneous method used for reduction of the patella has not been previously described. A focused review of the literature, pathoanatomy, and methods of treatment of this condition are presented.

Adolescent↗
PubMed1991

Dislocation and fracture-dislocation of the hip.

Of 54 patients with posterior dislocations of the hip of type I and type II (Stewart and Milford 1954), 47 were followed for a mean period of 6.7 years (2 to 11). Of these, 23 had dislocation with minimal lesions of the acetabulum (type I) and 24 had an avulsed dorsocranial fragment (type II). All were reduced by closed methods within six hours. The subsequent treatment of type I dislocations was conservative. At the beginning of the period type II injuries were treated conservatively, but surgery was increasingly chosen for later cases. Type I dislocations had significantly better results (p < 0.05) than type II fracture-dislocations, regardless of the method of treatment. There were no essential differences between the results of surgical and conservative treatment in type II dislocations.

Adolescent↗
PubMed2001

Dislocation of the knee with lateral dislocation of the patella. A report of four cases.

In a group of 25 patients with traumatic dislocation of the knee, four, all of whom had similar ligament and medial soft-tissue injuries, also had associated lateral patellar dislocation. In all four reconstruction was delayed because of their other serious injuries. Having encountered the combination of knee dislocation and lateral patellar dislocation in 16% of our patients, we believe that it may be less rare than is commonly believed. We think that it is important to maintain a high index of suspicion of possible patellar dislocation when medial structures have been severely damaged. Early recognition and immobilisation in extension can prevent fixed lateral dislocation of the patella.

Adolescent↗
PubMed1979

[Spasm of the adductor muscles, pre-dislocation and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part I: The effect of open myotenotomy of the gracilis muscle and of the long and short adductor muscles in connection with total extrapelvine resection of the obturator nerve, on the hip joints and static function (author's transl)].

Spasm and contraction of the adductor muscles involve, on the one hand, danger in respect of the development of a dislocation of the hip, and are a serious impediment to a walking ability on the other. Hence, surgery is often necessary. The article reports on the results of consequent weakening of the adductor muscles as a result of open myotenotomy in association with complete extrapelvine resection of the obturator nerve. 27 patients were subjected to surgery--in most cases bilaterally--at an age between 2 years and 5 months and 18 years, with a follow-up period of up to 15 years. The study does not include patients with spastic dislocation of the hip in whom this method was applied on the non-dislocated side and on the dislocated side in combination with iliopsoas tenotomy. This method makes it possible to achieve regression of existing defective positions of the hip joints. In a few cases, the valgus position of the neck of the femur was corrected to some extent. In two patients it was not possible to prevent the progress of a developing dislocation of the hip. These results show that, whereas the adductor muscles represent an essential factor for the occurrence of a spastic dislocation of the hip, other forces are most probably also involved. In the majority of cases, results were favourable in respect of the static function, although in some cases the success became evident after several years only, especially in mentally retarded patients and in apathetic individuals. Important for therapeutic success is the follow-up. The principles of its therapy are thoroughly discussed. Surgery is indicated only in special cases. Indications must be observed very strictly, since the risk of excessive weakening of the adductor muscles should not be underestimated.

Adolescent↗
PubMed1994

Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip.

We compared the 3-month dislocation rate for hip hemiarthroplasties inserted via the posterior and direct lateral routes. In all, 2906 primary hemiarthroplasties, performed between 1986 and 1992 in four hospitals on a training hospital rotation, were analysed. The posterior approach was used in 1656 (57%) and the lateral in 1250 (43%). The groups were otherwise comparable. The overall dislocation rate for the posterior approach was 9.0% (149/1656), whereas that for the direct lateral approach was 3.3% (41/2150). The difference is statistically highly significant. In addition, we analysed the dislocation rate for each approach in the three broad groups of surgical trainee. For senior registrars, there was no statistical difference in the dislocation rate. However, for registrars and senior house officers, there were statistically highly significant differences in the dislocation rate for posterior and direct lateral approaches (8.4% vs 3.3% and 14.2% vs 3.6%, respectively). We conclude that, because of the high mortality associated with dislocation of a hemiarthroplasty, the posterior approach for this operation should now be abandoned, especially by surgical trainees early in their careers.

Aged↗
PubMed1989

Streptococcal antigen-induced dislocation and dysplasia of the hip in newborn rats. Radiologic and histologic evaluation of a model of congenital dislocation of the hip.

Dislocation of the hip developed in 62% of newborn rats with streptococcal antigen-induced synovitis. Age at the time of the induction of synovitis is critical since dislocation is not observed in older rats. Synovitis with distention and laxity of the joint capsule is most likely responsible for the hip dislocation. Although congenital dislocation of the hip in children is not mediated by an inflammatory process, the current model of dislocation of the hip in rats is similar in being critically age-dependent, and associated with ligamentous laxity. Our model may be helpful in studying this important clinical entity.

Age Factors↗
PubMed1994

Concurrent perilunate dislocation in patients with elbow dislocation: case reports.

In three patients with elbow dislocations after falls on an outstretched upper extremity, concurrent perilunate dislocation was found. Closed reduction of the elbow dislocation achieved excellent functional results. Open reduction and internal fixation for perilunate dislocation provided anatomic reduction and satisfactory functional recovery in two patients. In the third, a delay in diagnosis of a perilunate dislocation necessitated proximal row carpectomy at 6 weeks.

Adult↗
PubMed1997

Floating metatarsal: concomitant Lisfranc fracture-dislocation and complex dislocation of the first metatarsophalangeal joint.

We describe a unique composite injury of the foot, with concomitant Lisfranc fracture-dislocation, and complex dislocation of the first metatarsophalangeal joint. When examining patients with Lisfranc joint injuries, one must keep in mind that the axial compression forces causing the injury may also damage the metatarsophalangeal joints, and direct attention to these structures. The reduction and stabilization of a "floating" first metatarsal should begin at the distal (metatarsophalangeal) end. The reduction of the distal dislocation will release tension on the plantar fascia, enabling the subsequent reduction of the proximal (Lisfranc) dislocation. A medial approach is convenient, affords easy access to the plantar and dorsal aspects of the joint, and repair of the medial joint structures when damaged. The use of screws for fixation of Lisfranc's fracture-dislocation, is well justified by the stability achieved.

Adult↗
PubMed1986

Dorsal dislocation of the radiocarpal joint with associated dorsal perilunar dislocation.

Radiocarpal dislocations are uncommon injuries that occur even more rarely in association with intercarpal dislocations. All the reported examples of such intercarpal dislocations are volar. We here describe a patient with a unique dorsal radiocarpal dislocation with an additional dorsal perilunar dislocation. Radiographic identification of this injury has important implications for its successful treatment.

Adult↗
PubMed1979

[Spasm of the adductor muscles, pre-dislocations and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part II. The importance of the iliopsoas tendon, its tenotomy, of the coxa valga antetorta, and correction through osteotomy turning the hip into varus (author's transl)].

The following factors besides spasm and contraction of the adductor muscles contribute to the occurrence of dislocations of the hip in spastic paralysis: Spasm and contraction of the iliopsoas muscle and enhanced valgus position and antetorsion. The author holds the opinion that in case of malformation of the proximal end of the femur, it is not only the indirect action of the spastic musculature via the proximal femur-epiphyseal cartilage which is responsible for this phenomen in accordance with the law on functional adaption through longitudinal growth (Pauwels), but also the direct traction of the iliopsoas tendon. A clue in this direction is the often very pronounced elongation or enlargement of the trochanter minor. The author demonstrates the pathogenetic importance of iliopsoas contracture and malpositioning of the neck of the femur by means of analyses of the course in two patients. The following principles of treatment are postulated for spastic dislocation of the hip: Elimination of the pathogenetic factors through myotenotomy of the adductor muscles and complete resection of the obturator nerve, with observation of strict aftertreatment criteria, tenotomy of the iliopsoas, repositioning and osteotomy with turning into varus. Osteotomy without previous elimination of the pathogenetically acting muscular forces does not appear useful. Likewise, permanent re-positioning by means of muscle-relaxing operation cannot be sufficiently safe-guarded without additional osteotomy once the dislocation has taken place. In twelve patients with spastic dislocation of the hip, treated in accordance with these guidelines (two without osteotomy) aged 6 6/12 and 19 5/12 years, a roentgenologically good result was obtained in half of the cases, whereas the functional result was satisfactory not only with these patients but also with part of the other patients. If surgical treatment is instituted early enough, and if the experiences described here are taken into consideration, it is to be expected that the results will be even more satisfactory. The corset supporting the seated patient, developed by us, has been found very useful during the aftertreatment stage. A definite stand is taken against the therapeutic nihilism which leaves treatment of spastic dislocations to physiotherapy. It is also pointed out that indication for treatment is not represented only by the target of learning how to walk, but also by providing an overall improvement of the life situation of the patient, by either enabling him, or improving his ability, to sit or by "merely" improving the care of the perineum.

Adolescent↗
PubMed1996

Dislocation of the distal radioulnar joint associated with a transstyloid radiocarpal fracture dislocation. A case report and review of the literature.

Dislocations of the distal radio-ulnar joint (DRUJ) can be isolated or combined with fractures. Cases of DRUJ dislocations have been described with Galleazi fractures, open radius and ulna fractures and intraarticular fractures of the distal radius. We report a case of a volar DRUJ dislocation combined with a transstyloid radio-carpal dislocation. Because of severe instability of the wrist, open reduction of the radial styloid combined with an open reduction of the dislocated DRUJ is advised.

Adult↗
PubMed2006

[Operative treatment of complex lombosacral fracture dislocation: L5 chance fracture with trans S1-S2 dislocation].

Sacral fractures are uncommon injuries that are often diagnosed late, the transverse fracture dislocation of the sacrum at the S1-S2 level associated with a L5 Chance fracture has never been reported. The purpose of this report is to describe operative treatment of transverse fracture dislocation of the sacrum at the S1-S2 level associated with a L5 Chance fracture. A 17-year-old woman sustained multiple injuries in a road accident and presented with hypovolumic shock. Radiological assessment demonstrated transverse fracture dislocation of the sacrum at the S1-S2 level associated with a L5 Chance-fracture. Neurologic examination demonstrated L5 root deficit and perineal hypoesthesia. Operative treatment was undertaken. The procedure consisted of laminectomy of L5, S1, and S2 and osteosynthesis of L3-L4 - S3-S4 (in sacral alae). Attempts to reduce dislocation failed. Postoperative recovery was uneventful. One year after operative treatment the patient presented no neurologic deficit and had resumed normal activity. Follow-up radiological imaging demonstrated consolidation of fracture zones. Management for uncommon lumbrosacral junction injuries must take into account various parameters including hemodynamic condition, neurologic status, and stability of the spinal lesions. Decompression of neural impingement and stabilization of fractures by osteosynthesis appear to be a useful alternative that allows patients to stand again and begin rehabilitation quickly.

Adolescent↗
PubMed1984

Dorsal dislocation of the fourth and fifth carpometacarpal joints and simultaneous dislocation of the metacarpophalangeal joint of the small finger: a case report.

A patient with dorsal dislocation of the fourth and fifth carpometacarpal (CMC) joints and dislocation of the metacarpophalangeal (MP) joint of the small finger was managed successfully by open reduction and transarticular fixation of the CMC joint dislocation and closed reduction of the MP joint dislocation. This rare combination of injuries has not been reported previously.

Adult↗
PubMed2001

Concurrent dorsal dislocations and fracture-dislocations of the index, long, ring, and small (second to fifth) carpometacarpal joints.

OBJECTIVE: To review the outcome of patients with concurrent dorsal dislocations and fracture-dislocations of the second, third, fourth, and fifth carpometacarpal (CMC) joints treated with open reduction and internal fixation (ORIF). DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS: Between 1991 and 1997, twelve multiply injured patients with the described CMC injury complex (one open injury) were treated with ORIF (eleven patients) or percutaneous wire fixation (one patient) by the same surgeon. INTERVENTION: Treatment consisted of ORIF with Kirschner wires followed by splints and immediate metacarpophalangeal and interphalangeal joint range of motion exercises. MAIN OUTCOME MEASUREMENTS: Grip strength, wrist and finger range of motion, pain, need for additional surgery, and return to work. RESULTS: Of the ten patients available for follow-up (mean, three years), all had been treated with ORIF (eight within forty-eight hours of injury and two had treatment delayed for four weeks because of delayed diagnosis and management of more serious injuries). Three patients had additional surgery (planned secondary second and third CMC arthrodeses). Grip strength of the operated hand in the five patients with JAMAR testing was 50 percent (n = 3), 75 percent (n = 1), and 90 percent (n = 1) of that in their contralateral hands. Five patients were pain-free, and five reported occasional, activity-related pain. The five patients who worked before the injury returned to their previous occupations (one with slightly modified duties). CONCLUSION: This is the largest series of patients with this CMC injury complex and the first report of open CMC dorsal dislocations and fracture-dislocations. Although early ORIF is suggested, delay of up to four weeks did not adversely affect results.

Adult↗
PubMed2006

The two-step maneuver for closed reduction of inferior glenohumeral dislocation (luxatio erecta to anterior dislocation to reduction).

The 2-step closed reduction maneuver was developed to aid in the rarely encountered inferior shoulder dislocation. The maneuver converts the humeral head from an inferior dislocation to an anterior dislocation and then reduces the humeral head into the glenoid. The operator places one hand on the shaft of the humerus and the other hand on the medial condyle. The hand on the shaft initiates an anteriorly directed force rotating the humeral head from an inferior to an anterior position. Once this is accomplished, the humerus is adducted against the body. The humerus is then external rotated reducing the humeral head into the glenoid. Two cases of inferior shoulder dislocation were closed reduced by using the described technique with minimal analgesia and without a change in the postreduction neurovascular status.

Humans↗
PubMed1999

Anterior dislocation of the elbow in a child with congenital posterior dislocation of the radial head. A case report.

A 9-year-old boy presented with anterior dislocation of the left elbow associated with a long-standing posterior dislocation of the radial head. Lack of full extension of the elbow joint was reported since birth. The dislocated elbow was reduced. No treatment was undertaken for the dislocated radial head. Radiographic evidence of dysplasia of the contralateral radial head provided a significant diagnostic criterion of a congenital malformation.

Child↗