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PubMedDate not supplied

Arthroscopic evaluation of acute initial anterior shoulder dislocations.

Arthroscopic evaluation of patients with an acute anterior shoulder dislocation was done to identify and classify the intraarticular lesions that might predict recurrent dislocations. Forty-five shoulders fit the following criteria for inclusion in our study: initial dislocation with no prior history of shoulder problems; confirmation of the dislocation radiographically or reduction by a physician; and arthroscopy within 10 days. The 42 men and 3 women had an average age of 21.2 years (range, 14 to 28 years). Mechanism of injury was a twisting of the arm into forced abduction and external rotation, a fall on the outstretched arm, or a direct blow to the shoulder. Based on this preliminary study of 45 shoulders, we present a classification of the lesions found in the acute shoulder dislocation. Group 1 (six shoulders) had capsular tears with no labral lesions: these shoulders were stable under anesthesia and had no or minimal hemarthrosis. Group 2 (11 shoulders) had capsular tears and partial labral detachments: these shoulders were mildly unstable and had mild to moderate hemarthrosis. Group 3 (28 shoulders) had capsular tears with labral detachments: these shoulders were grossly unstable and had large hemarthrosis. They had complete capsular/labral detachments. In the past, redislocation rates have been primarily related to age at the time of initial dislocation and, to a lesser degree, the period of immobilization. We have identified the intraarticular lesions in 45 patients with an initial anterior glenohumeral dislocation and classified these shoulders into three groups based on the lesions found. By doing so, we can develop a more accurate method of determining which shoulders are prone to recurrent dislocation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Biological factors predisposing to traumatic posterior dislocation of the hip. A selection process in the mechanism of injury.

The factors involved in the mechanism leading to traumatic posterior dislocation of the hip are examined. In 47 adult patients who had previously suffered such a dislocation, ultrasound scans were used to measure femoral anteversion on both the affected and the uninjured side. In 36 normal adult volunteers, used as controls, similar measurements were made. Femoral anteversion on both the injured and uninjured side was significantly reduced in the patients compared with the volunteers. These findings are discussed in the light of previous work which indicates that medial rotation is a factor in the mechanism of posterior dislocation of the hip. It is suggested that reduced anteversion acts like medial rotation to make the hip more susceptible to posterior dislocation, and that the less the anteversion the more likely is the injury to be a dislocation rather than a fracture-dislocation. It is concluded that patients who suffer such dislocated hips belong at one extreme of the normal population, having either reduced femoral anteversion or even retroversion, and that this anatomical feature selects towards hip dislocation rather than to injury of the femoral shaft, knee or tibia during the appropriate type of accident.

Adult↗
PubMed1989

Dislocation of the hip in cerebral palsy. Natural history and predictability.

To determine the natural history of dislocation of the hip in cerebral palsy, and to evolve methods to predict dislocation, the notes and radiographs of 462 patients with cerebral palsy were reviewed. Dislocation occurred in 10% of patients by progressive migration and subluxation of the proximal femur in the presence of acetabular dysplasia. Statistical analysis identified the radiographic features that helped to predict dislocation. Measurement of acetabular index, by a method that allows for rotation of the acetabulum, was the most powerful single predictor. Measurement of this index at two and four years of age could identify patients who would dislocate unless effective treatment was undertaken, those at risk of dislocation only if scoliosis developed, and those who would not dislocate. On the basis of this method of screening for dislocation, a logical system of surgical prophylaxis is proposed.

Adolescent↗
PubMed2005

Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component.

Malposition of the acetabular component is a risk factor for post-operative dislocation after total hip replacement (THR). We have investigated the influence of the orientation of the acetabular component on the probability of dislocation. Radiological anteversion and abduction of the component of 127 hips which dislocated post-operatively were measured by Einzel-Bild-Röentgen-Analysis and compared with those in a control group of 342 patients. In the control group, the mean value of anteversion was 15 degrees and of abduction 44 degrees. Patients with anterior dislocation after primary THR showed significant differences in the mean angle of anteversion (17 degrees), and abduction (48 degrees) as did patients with posterior dislocation (anteversion 11 degrees, abduction 42 degrees). After revision patients with posterior dislocation showed significant differences in anteversion (12 degrees) and abduction (40 degrees). Our results demonstrate the importance of accurate positioning of the acetabular component in order to reduce the frequency of subsequent dislocations. Radiological anteversion of 15 degrees and abduction of 45 degrees are the lowest at-risk values for dislocation.

Acetabulum↗
PubMed2004

[Method for the evaluation of factors influencing the dislocation stability of total hip endoprotheses].

Dislocation of the artificial joint is a serious complication of total hip replacement. Various factors with an influence on dislocation stability were determined clinically. Our goal was to develop a method for evaluating experimentally the parameters implant design, position and the load situation for their influence on joint stability. With the newly developed testing device the range of motion to impingement and to dislocation can be determined at different implant positions. In addition, the rotational moments on subluxation, i.e. the "levering out" of the femoral head, can be determined. By way of example several hip implants were examined during movements associated with dislocation, e.g. (internal-)rotation in 90 degrees flexion and 0 degrees adduction as well as with (external-)rotation in combination with 10 degrees extension and 15 degrees adduction. Irrespective of implant design and position, the following movement phases can be differentiated: undisturbed motion, impingement, subluxation and, finally, complete dislocation of the head. On the basis of the range of motion of the specific phases, the moments occurring and the direction of dislocation, different implant systems can be compared. In this study the influence of the head diameter on the dislocation stability of the hip endoprosthesis is shown. With the aid of the model presented herein, a data set showing the most favourable and/or most dislocation stable implant position can be acquired for different combinations of the implant components. Additionally, useful information for implant design can be deduced and applied to new developments and/or modifications of existing implant components.

Arthroplasty, Replacement, Hip↗
PubMed1996

The teardrop in congenital dislocation of the hip diagnosed late. A quantitative study.

We retrospectively reviewed the radiographs of the pelvis and hips of forty-five patients who had unilateral congenital dislocation of the hip treated with closed reduction and application of a cast without subsequent operations. The radiographs were made at the time of the initial diagnosis, two years after the reduction, when the child was ten years old, and at skeletal maturity. The width, shape, and type of the teardrop; the thickness of the acetabular floor; the acetabular index; the center-edge angle; the articulotrochanteric distance; and the Severin class at maturity were measured in the dislocated and contralateral, normal hips. At the time of the initial diagnosis, a well defined teardrop was seen in thirty-six (80 per cent) of the normal hips and in seven (16 per cent) of the dislocated hips. There was no difference in the width of the teardrop in the seven dislocated hips compared with that in the normal hips, although the v-shaped and crossed types of teardrops were more frequent in the dislocated hips. The v shape was not observed in the normal hips but was seen in sixteen dislocated hips two years after the reduction and in twelve dislocated hips when the children were ten years old. The superior and inferior widths of the teardrop of the dislocated hips were significantly greater than those of the normal hips (p < 0.001 and p < 0.05, respectively) when the children were ten years old. The hips with residual acetabular dysplasia had a v-shaped teardrop, widening of the superior width of the teardrop, and thickening of the acetabular floor. These hips, which were usually Severin class IV at the time of skeletal maturity, had a poor prognosis in adult life.

Acetabulum↗
PubMed1996

Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study.

Two hundred and forty-five patients who had had 247 primary anterior dislocations of the shoulder were followed for ten years in a multicenter study at twenty-seven Swedish hospitals. The ages of the patients at the time of the dislocation ranged from twelve to forty years. The patients were assigned to one of three treatment groups: immobilization with the arm tied with a bandage to the torso for three to four weeks after reduction of the dislocation; use of a sling, which was discontinued after the patient was comfortable; or immobilization for various durations. At the ten-year follow-up evaluation, no additional dislocation had occurred in 129 shoulders (52 per cent). Recurrent dislocation necessitating operative treatment had developed in fifty-eight shoulders (23 per cent): thirty-four (34 per cent) of the ninety-nine shoulders in patients who were twelve to twenty-two years old, sixteen (28 per cent) of the fifty-seven shoulders in patients who were twenty-three to twenty-nine years old, and eight (9 per cent) of the ninety-one shoulders in patients who were thirty to forty years old. Twenty-four (22 per cent) of the shoulders that had had at least two recurrences during the first two or five years seemed to have stabilized spontaneously without operative intervention at ten years. Dislocation of the contralateral shoulder occurred in association with sixteen (16 per cent) of the ninety-nine shoulders in patients who were twelve to twenty-two years old, twelve (21 per cent) of the fifty-seven shoulders in patients who were twenty-three to twenty-nine years old, and only three (3 per cent) of the ninety-one shoulders in patients who were thirty to forty years old. The type and duration of the initial treatment had no effect on the rate of recurrence. Radiographs, made for 185 shoulders at the time of the primary dislocation, demonstrated an evident Hermodsson (Hill-Sachs) lesion in ninety-nine shoulders (54 per cent); this finding was associated with a significantly worse prognosis with regard to recurrence than was no evident lesion (p < 0.04). Radiographs made for 208 shoulders at the ten-year follow-up examination were evaluated for post-dislocation arthropathy. Twenty-three shoulders (11 per cent) had mild arthropathy and eighteen (9 per cent) had moderate or severe arthropathy. Some of the shoulders that had arthropathy had had no recurrence.

Adolescent↗
PubMed2001

Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases.

BACKGROUND: The radiographic characteristics and treatment of radiocarpal dislocation are not well defined. There have been only two reported series of more than eight patients. Thus, there are many questions concerning treatment and functional results. METHODS: Two groups of patients were defined. Group 1 included all patients with pure radiocarpal dislocation and patients with only a fracture of the tip of the radial styloid process. Group 2 included patients with radiocarpal dislocation and an associated fracture of the radial styloid process that involved more than one-third of the width of the scaphoid fossa. A retrospective review and a clinical evaluation were performed. RESULTS: From 1975 to 1998, we observed twenty-seven cases of radiocarpal dislocation. Four were displaced volarly, and twenty-three were displaced dorsally. Fourteen patients presented with associated lesions. Four patients were treated with closed reduction and immobilization in a plaster cast; five, with percutaneous Kirschner wire fixation and cast immobilization; and two, with an external fixator. Eleven patients had open reduction with Kirschner wire fixation and cast immobilization. The seven patients in Group 1 had a highly unstable injury, and four of the seven patients presented with ulnar translation of the carpus. At the time of follow-up, at an average of 26.8 months, pronation averaged 76 degrees; supination, 66 degrees; wrist flexion, 54 degrees; wrist extension, 54 degrees; radial inclination, 15 degrees; and ulnar inclination, 18 degrees. The average grip strength was 27 kg. Group 2 included twenty patients. Only thirteen, with dorsal dislocation, were evaluated at the time of follow-up, which averaged fifty-one months. At that time, six reported no pain; four, slight pain; and two, moderate pain. Pronation averaged 63 degrees; supination, 76 degrees; wrist flexion, 51 degrees; wrist extension, 56 degrees; radial inclination, 21 degrees; and ulnar inclination, 39 degrees. Grip strength averaged 38 kg. Seven patients had complications. CONCLUSIONS: On the basis of our experience and a review of the literature, we believe that patients with pure radiocarpal dislocation or with radiocarpal dislocation with a fracture of the tip of the radial styloid process should be treated with reattachment of the ligaments through a volar approach. In patients with radiocarpal dislocation and a fracture of the radial styloid process that involves more than one-third of the width of the scaphoid fossa, the ligaments are still attached to the radial fragment. We believe that in this group of patients, exact articular reduction should be performed through a dorsal approach. Additional studies are needed to support these hypotheses.

Adolescent↗
PubMed2005

Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty.

BACKGROUND: It has been postulated that use of a larger femoral head could reduce the risk of dislocation after total hip arthroplasty, but only limited clinical data have been presented as proof of this hypothesis. METHODS: From 1969 to 1999, 21,047 primary total hip arthroplasties with varying femoral head sizes were performed at one institution. Patients routinely were followed at defined intervals and were specifically queried about dislocation. The operative approach was anterolateral in 9155 arthroplasties, posterolateral in 3646, and transtrochanteric in 8246. The femoral head diameter was 22 mm in 8691 of the procedures, 28 mm in 8797, and 32 mm in 3559. RESULTS: One or more dislocations occurred in 868 of the 21,047 hips. The cumulative risk of first-time dislocation was 2.2% at one year, 3.0% at five years, 3.8% at ten years, and 6.0% at twenty years. The cumulative ten-year rate of dislocation was 3.1% following anterolateral approaches, 3.4% following transtrochanteric approaches, and 6.9% following posterolateral approaches. The cumulative ten-year rate of dislocation was 3.8% for 22-mm-diameter femoral heads, 3.0% for 28-mm heads, and 2.4% for 32-mm heads in hips treated with an anterolateral approach; 3.5% for 22-mm heads, 3.5% for 28-mm heads, and 2.8% for 32-mm heads in hips treated with a transtrochanteric approach; and 12.1% for 22-mm heads, 6.9% for 28-mm heads, and 3.8% for 32-mm heads in hips treated with a posterolateral approach. Multivariate analysis showed the relative risk of dislocation to be 1.7 for 22-mm compared with 32-mm heads and 1.3 for 28-mm compared with 32-mm heads. CONCLUSIONS: In total hip arthroplasty, a larger femoral head diameter was associated with a lower long-term cumulative risk of dislocation. The femoral head diameter had an effect in association with all operative approaches, but the effect was greatest in association with the posterolateral approach.

Aged↗
PubMed2006

Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients.

BACKGROUND: The prevalence and risk factors for recurrent instability and functional impairment following a primary glenohumeral dislocation remain poorly defined in younger patients. We performed a prospective cohort study to evaluate these outcomes. We also aimed to produce guidelines for the design of future clinical trials, assessing the efficacy of interventions designed to improve the outcome after a primary dislocation. METHODS: We performed a prospective cohort study of 252 patients ranging from fifteen to thirty-five years old who sustained an anterior glenohumeral dislocation and were treated with sling immobilization, followed by a physical therapy program. Patients received regular clinical follow-up to assess whether recurrent instability had developed. Functional assessments were made and were compared for two subgroups: those who had not had instability develop and those who had received operative stabilization to treat recurrent instability. RESULTS: On survival analysis, instability developed in 55.7% of the shoulders within the first two years after the primary dislocation and increased to 66.8% by the fifth year. The younger male patients were most at risk of instability, and 86.7% of all of the patients known to have recurrent instability had this complication develop within the first two years. A small but measurable degree of functional impairment was present at two years after the initial dislocation in most patients. Sample-size calculations revealed that a relatively small number of patients with a primary dislocation would be required in future clinical trials examining the effects of interventions designed to reduce the prevalence of recurrent instability and improve the functional outcome. CONCLUSIONS: Recurrent instability and deficits of shoulder function are common after primary nonoperative treatment of an anterior shoulder dislocation. There is substantial variation in the risk of instability, with younger males having the highest risk and females having a much lower risk. Future clinical trials to evaluate primary interventions should evaluate the prevalence of recurrent instability and functional deficits, with use of an assessment tool specifically for shoulder instability, during the first two years after the initial dislocation.

Adolescent↗
PubMed1983

Systematic approach to identifying fourth and fifth carpometacarpal joint dislocations.

Dislocations of the carpometacarpal (CMC) joints are rare injuries which often have subtle radiographic findings that may be overlooked. A systematic approach for evaluation of the carpometacarpal joints is developed from analyzing the radiographic findings in 17 cases of CMC dislocations at the fourth and fifth CMC joints. Principles of parallelism, symmetry, overlapping articular surfaces, indistinct cortical rim, and parallel M lines are used in this evaluation. Ten patients had combined fourth and fifth CMC joint dislocations and seven had solitary dislocations at the fifth CMC joint. Most of these CMC dislocations are dorsal (71%). In combined fourth and fifth CMC joint dislocations, loss of parallelism and symmetry is observed at the fourth CMC joint with overlap identified primarily at the fifth CMC joint. Fracture of the fourth metacarpal base is often an associated injury. In solitary fifth CMC dislocations, slight ulnar offset of the fifth metacarpal on the hamate is the most consistent finding in association with loss of parallelism, symmetry, and overlap. Fracture of the radial margin of the fifth metacarpal base is often observed with solitary fifth CMC joint dislocations. A systematic approach and establishing the diagnosis from standard radiographic views is emphasized.

Adult↗
PubMed1995

Traumatic anterior dislocation of the hip: spectrum of plain film and CT findings.

Traumatic anterior dislocation of the hip represents 11% of all hip dislocations and is classified into superior and inferior types [1]. Whereas inferior anterior hip dislocation is easily recognized on an anteroposterior radiograph of the pelvis, the radiographic appearance of superior anterior hip dislocation is less straightforward, often leading to an initial misdiagnosis of posterior hip dislocation. Misdiagnosis of the direction (anterior versus posterior) of a hip dislocation can result in failed closed reduction or an improper surgical approach to open reduction. In addition, recognition of associated impaction fractures is important, as patients with this finding have a greater tendency to develop traumatic arthritis [2, 3]. This pictorial essay, which is based on our experience with 20 cases of anterior hip dislocation, including five of the rare superior type, illustrates the spectrum of radiographic findings and distinguishing features associated with anterior hip dislocation.

Adult↗
PubMed1984

Functional treatment of congenital dislocation of the hip.

A prerequisite for the development of congenital dislocation of the hip is ligamentous laxity of the hip-joint, which is demonstrable shortly after birth when the hip can be easily dislocated and reduced. This situation is described as dislocatable hip. Ligamentous laxity naturally tends to disappear, and 90% of all dislocatable hips in fact stabilize spontaneously. No dislocation develops unless an exogenous factor is involved. In infants born in breech presentation the hyperextension of the knees with the resulting increased tension in the hamstrings plays a role. During or shortly after birth, the deflexion of the hip-joint causes an increased tension in the relatively shortened iliopsoas muscle, as a result of which the hip can be dislocated in postero-superior direction. By the time the infant is two months old secondary changes (more specifically restricted abduction) become more pronounced. It may therefore be stated that contracture of the iliopsoas muscle is one of the causes, and restricted abduction a consequence of congenital dislocation of the hip. The degree of dislocation is determined by a balance between the degree of ligamentous laxity and the influence of exogenous factors. When the infant starts to stand and walk, its body weight also begins to function as a deforming exogenous factor. When dislocatable hips are not treated immediately after birth, the frequency of congenital dislocation of the hip at the age of three months amounts to 1-2 per 1000 neonates. The male:female ratio is 1:4. The secondary changes in the osseous structures of the hip-joint should always be studied three-dimensionally. Apart from conventional antero-posterior pelvic roentgenograms, CT-scans can enhance spatial insight. The secondary changes manifest themselves in an enlarged neck-shaft angle, increased femoral anteversion, an increased inclination of the acetabulum and possibly also in diminished acetabular anteversion. In view of the high radiation load involved, examination by CT-scan is not yet a routine procedure in congenital hip dislocation. Radiological examination is usually confined to an antero-posterior pelvic roentgenogram on which the acetabular angle, the neck-shaft angle and the CE-angle can be measured. These are all values projected in a frontal plane. To determine the real values the degree of acetabular and femoral torsion has to be known. With the aid of the CT-scan the torsion of the acetabulum and of the femoral neck as well as their summation - the instability index - can be measured without difficulty.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1999

[Habitual mandibular dislocation in two patients with Parkinson's disease].

There have been few case reports of mandibular dislocation in Parkinson's disease (PD) so far. We experienced habitual mandibular dislocation in two PD patients. They were a 74-year-old woman and a 56-year-old man, who were both graded V by Hoehn and Yahr's staging and had a 13- and 14-year history of PD, respectively. Remarkable retroflexion and rigidity of the neck was observed in both patients. Anterior dislocation of the jaw occurred without any special cause. Once the jaw was dislocated, it required unexpected power to reduce the dislocation against the rigidity. In a case of postencephalitic parkinsonism, continuous parkinsonian tremors of the mandible over a long period was indicated as a cause of the recurrent dislocation seen in the patient. No mandibular tremor, however, was observed in the present cases. The common feature of our two patients was retroflexion of the neck, which was assumed to make the suprahyoid muscles stretched and the mouth opened widely, causing the recurrent mandibular dislocation. Since the recurrence was prevented by chin cap, early chin cap therapy for the mandibular dislocation in parkinsonian patients is recommended.

Aged↗
PubMed2000

Posterolateral dislocation of the elbow joint. Relationship to medial instability.

BACKGROUND: Dislocation of the elbow joint is the second most common dislocation in the upper extremity, dislocation of the shoulder being the most common. It has been reported that uncomplicated dislocation of the elbow joint may be associated with a decreased range of motion, degenerative changes in the elbow joint, ectopic calcification, or neurological deficits. As the medial collateral ligament complex can be completely disrupted during dislocation, we evaluated the association between the long-term results of treatment of simple posterolateral dislocation of the elbow and the presence of persistent medial or valgus elbow instability. METHODS: Fifty patients who had a mean age of thirty-three years (range, eighteen to fifty-eight years) had closed reduction of a posterolateral dislocation of the elbow without associated fractures. The extremity was immobilized in an above-the-elbow plaster cast for three weeks. After a mean duration of follow-up of nine years (range, six to thirteen years), forty-one patients were evaluated with an interview, a physical examination, and radiographs made while a valgus load was applied to the elbow. RESULTS: The average score according to the system of The Hospital for Special Surgery was 91 points (range, 49 to 100 points), and thirty-one patients described their elbow function as good or excellent. Twenty-four patients had evidence of medial instability on radiographs made while a valgus load was applied to the elbow. Twenty-one patients had signs of degeneration of the joint, and twenty-five patients had ectopic ossification. Magnetic resonance imaging combined with arthrography was performed for the first twenty patients; eight had evidence of rupture of the medial collateral ligament, seven had generalized degenerative changes of the cartilage, and four had a chondral defect of the capitellum. (The study could not be completed for the remaining patient.) Medial instability on radiographs was correlated with signs of degeneration (p = 0.001), ectopic ossification (p = 0.01), a worse score according to the system of The Hospital for Special Surgery (p = 0.002), and persistent pain (p = 0.04). CONCLUSIONS: Posterolateral dislocation of the elbow joint can lead to persistent valgus instability that is associated with a worse overall clinical and radiographic result.

Adult↗
PubMed2002

Dislocation after revision total hip arthroplasty : an analysis of risk factors and treatment options.

BACKGROUND: Dislocation is a leading and underemphasized cause of failure in revision total hip arthroplasty. Although this fact is generally well recognized, we are aware of no detailed assessments of this problem to date. Our purpose therefore was to evaluate the risk factors leading to instability after revision as well as the expected outcome of various treatment strategies. METHODS: Data were obtained from 1548 revision arthroplasties in 1405 patients who were followed for a minimum of two years (range, 2.0 to 16.4 years; mean, 8.1 years) or until dislocation occurred. Revisions specifically performed because of instability were excluded from the analysis. Risk factors were recorded along with treatment strategies and their success. The statistical relevance of both sets of variables was calculated. RESULTS: A dislocation occurred after 115 (7.4%) of 1548 revision hip arthroplasties. The use of an elevated rim liner was associated with significant decreases (p < 0.05) in dislocation following revision of femoral and acetabular components. The presence of trochanteric nonunion was a significant risk factor for subsequent dislocation (p < 0.001). Revisions with 32-mm and 28-mm-diameter femoral heads were both more stable than was revision with a 22-mm-diameter head (p < 0.05 for each). Surgery was the initial treatment for twelve of the 115 dislocations. Six of the twelve hips had no further instability. Of the 103 postoperative dislocations initially managed nonoperatively, only thirty-six did not redislocate. Thirty-eight of the sixty-seven hips that had an additional dislocation after closed treatment had repeat surgery for treatment of the instability. Only eleven of the thirty-eight hips were stable at one year after surgery. Overall, at the time of the final assessment, sixty-five (57%) of the 115 hips were stable, forty-one (36%) remained unstable, and the status of nine (8%) was unknown. CONCLUSIONS: The risk factors for instability after a total hip revision are not the same as those after a primary procedure. The extent of the soft-tissue dissection is probably the most important variable since head size and trochanteric nonunion are related to "soft-tissue tension." Modular acetabular components with an elevated rim help to stabilize a hip undergoing a revision procedure.

Age Distribution↗
PubMed2004

The incidence of fractures and dislocations referred for orthopaedic services in a capitated population.

BACKGROUND: The purpose of this study was to determine the annual incidence rates of non-work-related traumatic fractures and dislocations (excluding head and facial injuries) referred for orthopaedic services in a large population enrolled under a capitated insurance contract. METHODS: The number of fractures and dislocations that were referred for orthopaedic services were recorded prospectively from among an average of 135,333 persons per year who were enrolled under a capitated insurance contract during the three-year study period. These data were used to determine the gender-specific and age-specific incidence rates of fractures and dislocations referred for orthopaedic services. RESULTS: A total of 3440 fractures and 422 dislocations were referred for orthopaedic services during the three-year study period. The incidence rate of fractures referred for orthopaedic services was 8.47 per 1000 member-years, with a significantly (p < 0.0001) higher rate among males. Members between the ages of ten and fourteen years had the highest rate of fractures referred for orthopaedic services (21.52 per 1000 member-years). The lifetime risk of a traumatic fracture referred for orthopaedic services to the age of sixty-five years was one in two for both males and females. The incidence rate of dislocations referred for orthopaedic services was 1.04 per 1000 member-years, which did not differ significantly (p = 0.75) between genders. Members between the ages of fifteen and nineteen years had the highest rate of dislocations referred for orthopaedic services (2.75 per 1000 member-years). The lifetime risk of a traumatic dislocation referred for orthopaedic services to the age of sixty-five years was one in sixteen for both male and female members. CONCLUSIONS: Young males had the highest rate of traumatic fractures referred for orthopaedic services. Adolescents of both genders had high rates of traumatic dislocations referred for orthopaedic services. The lifetime risk of a non-work-related fracture referred for orthopaedic services to the age of sixty-five years is approximately equal to that of coronary artery disease.

Adolescent↗
PubMed2004

[The selection of the surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury].

OBJECTIVE: To investigate how to select an appropriate surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury. METHODS: The clinical data of 54 patients of lower cervical spine fracture and dislocation were retrospectively analyzed. There were 29 cases with vertebral body compressive fracture and dislocation, 7 cases with vertebral body bursting fracture and dislocation, 3 cases with unilateral facet dislocation, 15 cases with bilateral facet dislocation. All cases were associated with spinal cord injury. According to American Spinal Injury Association (ASIA) grades, 21 cases were in A grade, 5 cases in B grade, 22 cases in C grade and 6 cases in D grade. All patients had surgical reduction, decompression, stabilization and fusion, 43 cases in anterior approach and 11 cases in posterior approach. RESULTS: All patients were followed up in 12 to 36 months, the mean follow-up time was 18 months. There were no great vessels, trachea, esophagus or spinal cord iatrogenic injury. There were no pull-out and breakage of screws or plates. Fusion was achieved in all patients at an average of 12 weeks postoperatively. There were no pseudarthrosis or bone nonunion. Of all the patients, 96.3% were acquired completely reduction and the normal intervertebral height and lordosis were maintained. Patients with complete spinal cord had no neurologic recovery, but they felt relief from upper limb pain or numb. Incomplete spinal cord lesions improved on average 1-2 Frankel grade after surgery. CONCLUSIONS: For lower cervical spine fracture and dislocation, an ideal anatomy reduction can be obtained with either anterior or posterior approach surgery. It is important to select a suitable surgical approach according to different types of cervical fracture and dislocation.

Adolescent↗