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Posterior dislocation of the hip while playing basketball.
Injuries in basketball are usually to the ankles and knees. Dislocation of the hip is usually associated with severe trauma--for example, road traffic accidents. A case is reported here in which a 22 year old club basketball player slipped on landing from a jump shot, forcing him into a side splits position from which he sustained a posterior dislocation of the hip resulting in a sciatic nerve palsy.
Palsy of the common peroneal nerve after traumatic dislocation of the knee.
Injury to the common peroneal nerve was present in 14 of 55 patients (25%) with dislocation of the knee. All underwent ligament reconstruction. The most common presenting direction of the dislocation was anterior or anteromedial with associated disruption of both cruciate ligaments and the posterolateral structures of the knee. Palsy of the common peroneal nerve was present in 14 of 34 (41%) of these patients. Complete rupture of the nerve was seen in four patients and a lesion in continuity in ten. Three patients with lesions in continuity, but with less than 7 cm of the nerve involved, had complete recovery within six to 18 months. In the remaining seven with more extensive lesions, two regained no motor function, and one had only MRC grade-2 function. Four patients regained some weak dorsiflexion or eversion (MRC grade 3 or 4). Some sensory recovery occurred in all seven of these patients, but was incomplete. In summary, complete recovery occurred in three (21%) and partial recovery of useful motor function in four (29%). In the other seven (50%) no useful motor or sensory function returned.
Krogius tenoplasty for recurrent dislocation of the patella. Failure associated with joint laxity.
Thirty-three patients treated with a Krogius tenoplasty for recurrent dislocation of the patella have been followed for an average of 3 years; the knees were classified according to Rünow. In 14 of 34 operated knees dislocations had recurred. Most of the recurrences were found in patients with generalized joint laxity, whereas only one of nine knees with only a high Insall index had redislocated. Patients with generalized joint laxity should not be treated with the Krogius tenoplasty as the sole procedure.
Congenital dislocation of the knee: a description of four cases in rural Kenya.
Four infants with congenital dislocation of the knee seen in rural Kenya are described. All presented in the first 5 days after birth. Three were treated with a posterior plaster slab, renewed at 2 weekly intervals for 6 weeks. One infant was treated by passive exercises, taught to the mother. At the last follow-up at 6 weeks, all the infants had almost normal knee flexion and hyperextension of the joint was no longer possible. The need for early treatment, which can be quite simple and is highly effective, is emphasized.
OPEN FRACTURE DISLOCATION OF THE KNEE.
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Traumatic dislocation of the knee joint.
The results in thirty-three of fifty-three traumatic dislocations of the knee followed for more than one year confirmed our conclusion, made in 1971, that early repair of all torn ligaments gives the best results, and that the vascular status following this injury must be observed carefully since vascular repair or thrombectomy within eight hours of injury gives the best chance of preventing gangrene of the leg. The twenty associated fractures in these thirty-three patients were treated successfully with conventional methods, except for three displaced fractures of the medial tibial plateau in which closed reduction failed and internal fixation was required.
[Congenital dislocation of the knee].
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Congenital dislocation of the knee. A report of 5 cases.
Reports on 3 infants who suffered from congenital dislocation of the knee and 2 with genu recurvatum deformity are presented. The theory that abnormal intra-uterine fetal position may cause these deformities has gained support over previous concepts, as demonstrated by the baby born by caesarean section.
Complete dislocation of the knee.
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Irreducible dislocations of the knee joint.
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[Traumatic posterolateral rotatory dislocation of the knee].
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Screening for extermity arterial injury with the arterial pressure index.
Certain extremity injuries presenting to the ED or Trauma Unit warrant increased suspicion for underlying arterial trauma. Such injuries include knee dislocations, displaced medial tibial plateau fractures and other displaced bicondylar fractures around the knee, open or segmental distal femoral shaft fractures, floating joints, gunshot wounds in proximity to neurovascular structures, or mangled extremities. Once the diagnosis of arterial trauma is made, a multi-disciplinary approach is warranted. The diagnostic strategies for vascular injury have undergone an evolution over the past 2 decades. One and a half percent to 4.6% of patients hospitalized with blunt extremity trauma have associated vascular compromise [Bunt TJ, Malone JM, Moody M, et al. Am J Surg 1990;160(2):226-8; Reid JD, Weigelt JA, Thal ER, et al. Arch Surg 1988;123(8):942-6; Applebaum R, Yellin AE, Weaver FA, et al. Am J Surg 1990;160(2):221-4; discussion 224-5; Dennis JW, Frykberg ER, Veldenz HC, et al. J Trauma 1998;44(2):243-52; discussion 242-3]. An efficient and effective evidence-based approach to diagnosing vascular injury is necessary, as the difficulty in diagnosis, the multiplicity of diagnostic strategies, the limited time frame in which to initiate appropriate treatment, the limb threatening complications of a missed diagnosis, and the increased awareness of health care expenditures make this entity an intimidating diagnostic challenge [Johansen K, Lynch K, Paun M, et al. J Trauma 1991;31(4):515-9; discussion 519-22; Lynch K, Johansen K. Ann Surg 1991;214(6):737-41; Walker ML, Poindexter Jr JM, Stovall I. Surg Gynecol Obstet 1990;170(2):97-105; Kendall RW, Taylor DC, Salvian AJ, et al. J Trauma 1993;35(6):875-8]. The purpose of this article is to present an evidence-based algorithm for patients who present with either arterial injury or a high-risk of arterial injury. A diagnostic algorithm will be presented, and the rationale for diagnostic interventions will be discussed in the context of current medical literature.
[Traumatic dislocation of the knee treated by early surgical repair (author's transl)].
The authors have treated twelve traumatic dislocations of the knee. Three were treated conservatively with one satisfactory result. Nine were treated by early surgical repair with seven satisfactory results. The technique of ligamentous repair is described. The authors emphasise the frequency and severity of associated vessel and nerve damage. They found acute lesions of the popliteal artery in five cases, three of which had to be operated upon immediately with arterial suture or graft. In one case, ischaemia appeared four days after dislocation and the thrombosed artery was repaired by a venous graft. In one case a lesion of the lateral popliteal nerve which did not recover was treated by palliative surgery. In one case, secondary skin necrosis was treated by skin flap transplantation using micro-surgical technique with a satisfactory result. It is concluded that ligamentous and vascular repairs should be undertaken at the same procedure after arteriography.
The treatment of congenital dislocation of the knee with the Pavlik harness.
We have used the Pavlik harness in the treatment of congenital dislocation of the knee in six knees in five patients, with satisfactory results. We believe that the muscles in the thigh which cross both the hip and knee joints, the rectus femoris and hamstrings, play an important role in the spontaneous reduction of the joint. Full correction is not always obtained, our results are comparable with those described by other authors. We consider that the advantages of using the harness are that a spontaneous correction can be obtained, maximal correction can be obtained after three months of treatment and the method is safer than others used.
Dislocation of the knee.
The results of treatment for vascular and ligamentous injuries in 17 patients who suffered complete dislocation of the knee were reviewed. Eight patients had 23 associated injuries. All nine patients who had injuries of the popliteal artery had arterial reconstruction with saphenous vein bypass grafts, which were successful in eight (89%). Intraoperative arteriography after vascular repair showed a narrowed anastomosis requiring revision in two (22%) of the nine patients and distal thrombi requiring removal in five (55%) patients. Delay in arterial repair was responsible for the one failure. Eleven patients had satisfactory results after early open ligament repair. The results were less favorable in the patients not treated with early ligament repair.
[On irreducible dislocation of the knee].
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Current status of a hinge prosthesis (GUEPAR).
Although a great many GUEPAR hinge knee prostheses have been successful, the early complications have been numerous. Also, long-term follow up studies have been hampered owing to the patients' advanced age. Many of the patients died of causes unrelated to their knee. The use of this prosthesis is limited to very old patients or individuals with grossly dislocated knees. Previous problems such as patellar pain have been resolved. Because the femoral and tibial stems have been reinforced, they are much stronger and cement is no longer necessary for fixation. The part that articulates with the patella has been changed so that it is now more shallow and better adapted to the shape of the patella.