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PubMed1993

The mechanical cause of congenital dislocation of the hip joint. Dynamic ultrasound study of 5 cases.

5 hip joints with untreated congenital dislocation of the hip were examined for hip movement by ultrasound. With the hip joint flexed, the direction of the dislocated femoral head was posterior to the acetabulum. The dislocated femoral head displaced more posteriorly when the knee joint was extended, with the hip joint held in flexed position. As the dislocated hip was extended, on the other hand, the direction of the dislocated femoral head was anterior to the acetabulum. The dislocated femoral head displaced more anteriorly when the baby tried to bend the hip with the joint held in extended position. These findings indicate that a fetal posture with the hip flexed and the knee extended predisposes to the development of CDH by the action of hamstrings, and that an infant posture with the hip extended is likely to provoke femoral head dislocation by the action of the iliopsoas.

Biomechanical Phenomena↗
PubMed2000

Cervical facet dislocation: techniques for ventral reduction and stabilization.

OBJECT: To demonstrate the safety and utility of one surgical approach, the authors reviewed their experience with the ventral surgical approach for decompression, reduction, and stabilization in 10 patients with either unilateral or bilateral cervical facet dislocation. METHODS: Six patients presented with unilateral cervical facet dislocation and four patients with bilateral cervical facet dislocation. There were six male and four female patients who ranged in age from 17 to 72 years (average 37.1 years). The level of facet dislocation was C4-5 in one, C5-6 in four, and C6-7 in five patients. Three patients presented with a complete spinal cord injury (SCI), three patients with an incomplete SCI, three with radicular symptoms or myeloradiculopathy, and one patient was neurologically intact. All patients underwent plain radiography, magnetic resonance imaging, and computerized tomography evaluation of the cervical spine. All patients had sustained significant ligamentous injury with minimum or no bone disruption. All patients underwent ventral decompressive surgery, reduction of the dislocation, and stabilization of the cervical spine. Techniques for performing ventral reduction of unilateral or bilateral cervical facet dislocation are described. Decompression, reduction, and stabilization of the cervical spine via the ventral approach was accomplished in all but one patient. This patient underwent a ventral decompressive procedure and an attempt at ventral reduction and subsequent dorsal reduction and fusion in which a lateral mass screw plate fixation system was used; this was followed by ventral placement of instrumentation and fusion. There were no surgery-related complications. Postoperative neurological status was unchanged in four patients and improved in six patients. No patient experienced neurological deterioration after undergoing this surgical approach. CONCLUSIONS: The authors conclude that a ventral surgical decompression, reduction, and stabilization procedure provides a safe and effective alternative for the treatment of patients with unilateral or bilateral cervical facet dislocation without significant bone disruption.

Adolescent↗
PubMed1976

Congenital dislocation of the hip in the newborn. A correlation of clinical, roentgenogrhic and anatomical findings.

This study correlates roentgenography, arthrography, morbid anatomy and histology in four newborn infants with congenital dislocation of the hip. Three died shortly after birth. In two of these, manipulative reduction was impossible. Both demonstrated secondary adaptive changes at autopsy, indicating that the dislocation had been present for some time in utero. The first had a paralytic dislocation (meningomyelocele), and the second showed no pathologic findings other than the dislocated hip. The third infant had a dislocation that was reduced at birth. The child died of pneumonia on the 15th day. At autopsy, no secondary adaptive changes were found in the hip. The fourth infant, who had undergone open reduction because of a dislocation irreducible at birth, was retrospectively found to have an intrauterine dislocation when the maternal roentgenogram was reviewed. Significant secondary adaptive changes were noted at the time of operation.

Acetabulum↗
PubMed2001

[Dislocation of the humerus--diagnosis and the Arlt method of reduction].

Authors present 248 shoulder dislocations included recurrent dislocations in a 3-year period. All of dislocations were of anterior type except 3 posterior dislocations and 1 inferior or luxatio erecta. They describe and recommend method of reduction without local or general anesthesia according to Arlt, which was used in 234 cases with effectivity of 96.6%. Posterior dislocation can have a very subtle signs and is generally initially missed in more than 50% cases. Two X-ray views in posterior dislocation are necessary to confirm diagnosis. Authors used in addition to anteroposterior transthoracic view with no posterior dislocation missed.

Adolescent↗
PubMed1999

[Analysis and prevention of dislocation after total hip replacement].

OBJECTIVE: To analyse and prevent postoperative dislocation after total hip replacement (THR). METHODS: Of 850 cases operated on by THR 15 (1.7%) had postoperative dislocation. Eleven were revision cases while the other 4 were operated on their primary procedures. RESULTS: Postoperative dislocation after THR were found in 15 cases. Eleven cases had posterior dislocation by posterolateral approach after revision of THR. Anterior dislocation occurred in 2 cases who received lateral approach. Another two cases of dislocation were related to the design of prosthesis. Separation of polyethylene liner and metal shell in acetabular prosthesis was noted in the two cases. All the cases but 1 were reduced operatively. The cases with malpositioned prosthesis were revised operatively. Augmentation procedure was carried out to increase the strength of abductor. In one case, relocation of the great trochantor increased the strength of abductor. No redislocation was observed during follow-up. CONCLUSIONS: Postoperative dislocation after THR are due to malpositioning of prosthesis, unbalanced bilateral soft tissues, especially the loosening of abductor. Evaluating carefully the development of the pelvis and the deviation of normal bone markers is important in addition to accurate insertion and installment of the prosthesis intraoperatively. Complete clearance of osteophytes and bone cements around the acetabulumis reqaired apart from the repairment of adjacent soft tissues. Double check of hip stability should be carried out before the closure of incision.

Aged↗
PubMed2002

Patellar dislocation in army conscripts.

Between 1990 and 1996, 119 Finnish male conscripts underwent operative treatment for patellar dislocation. There were 68 conscripts (58%) with primary and 51 conscripts (42%) with recurrent patellar dislocation. Sixty-five (55%) dislocations occurred during military service, 40 (34%) occurred during sports activities, and 14 (11%) occurred during leisure time. The most common cause of injury was military training at battle exercises (n = 30). The typical injury mechanism was knee valgus rotation on fixed foot and tibia (97 conscripts, 82%). Surgical procedures performed were open in 75 conscripts (63%) and arthroscopically assisted in 44 conscripts (37%). Twenty-three (19%) redislocations occurred during follow-up (mean, 6 years; range, 3-9 years). The subjective outcome of treatment was excellent in 23 (19%), good in 42 (35%), moderate in 44 (37%), and poor in 10 (9%) conscripts. The most common residual complaint was patellofemoral pain (25 conscripts, 21%). Only 42 (35%) conscripts were able to finish their military service normally; fitness classification was decreased in 16 conscripts (13%), and 61 (52%) were temporarily exempted from military service (class E). The results of operative treatment did not differ significantly in conscripts with primary and recurrent dislocation, except for the time of first recurrence, which was significantly longer in conscripts with primary than with recurrent dislocation (27 versus 9 months). Patellar dislocation is the most common form of severe knee injury among conscripts and significantly hampers military service. Operative treatment yields only satisfactory results. Preventive measurements should be considered. A suggested algorithm for the treatment and classification of acute and recurrent patellar dislocation among military conscripts is presented.

Acute Disease↗
PubMed2003

[Dislocation of total hip prostheses; risk factors and treatment].

Primary hip prostheses dislocate in 0.4 to 8.7% of the cases. Revision hip prostheses dislocate in 5 to 20% of the cases. High age, female sex, co-morbidity and alcoholism increase the risk of dislocation. The surgical approach of the hip and the experience of the surgeon are important factors in the operation technique. The anterior approach causes the least dislocations, but a disadvantage of this approach is that patients are more likely to walk with a limp afterwards. The selected implant also influences the dislocation risk. The smaller the head, the narrower the neck must be. Furthermore, the femur must not come to be too close to the pelvis. If necessary, a cup can be used with a raised anterior edge. Treatment of a primary dislocation is usually conservative and is based on providing the patient with guidelines. An abduction brace can be prescribed if a patient is not able or willing to comply with these rules. If dislocation is a recurring problem, revision of the prosthesis is often the only solution.

Age Factors↗
PubMed2004

Knee dislocations: an evaluation of surgical and conservative treatment.

BACKGROUND: We evaluated the results of surgical or non-operative treatment of knee dislocations and the effect of associated soft tissue injuries on the planning of treatment. METHODS: The study included 12 patients (10 males, 2 females; mean age 34 years; range 17 to 75 years). Knee dislocations were caused by low-energy injuries in five patients, and by high-energy injuries in seven patients. All the knees were dislocated posteriorly. Three dislocations were open. Three patients had popliteal artery injuries and three patients had peroneal nerve injuries. Dislocations affecting the anterior and/or posterior cruciate ligaments were treated surgically (n=6), whereas the medial collateral ligament and lateral ligament injuries were treated non-operatively (n=6). The Lysholm scores and the range of motion of the knees were compared between surgically and conservatively treated groups. The mean follow-up period was 46 months (range 26 to 82 months). RESULTS: The mean range of motion of the knees (116 degrees versus 72 degrees ; p<0.01) and the mean Lysholm scores (84.6 versus 74; p<0.01) differed significantly between patients undergoing surgical and non-operative treatment. Chronic laxity occurred in two knees (one with surgical, one with conservative treatment). Arthrofibrosis developed in four patients (one with surgical, three with conservative treatment). There were no deep infections. Superficial infections occurred in two open dislocations. CONCLUSION: Knee dislocations should be regarded as significant limb-threatening injuries. Evaluation and immediate treatment of vascular insufficiency is of primary importance. Then, treatment depending on the presence and severity of ligamentous injuries is essential to provide a stable and functional extremity.

Adolescent↗
PubMed2004

[Dislocation after total hip arthroplasty].

From 1997 to 2002 in the Department of Traumatology there had been performed 488 total hip replacements: 334 in men and 454 in women at the age between 20 and 84 (average 63.6). The procedures were performed by 12 surgeons and postero-lateral approach was used. Dislocation was found in 22 patients (4.51%): 14 women and 8 men. Majority of dislocation occurred during first 8 weeks after an operation and 68% of them happened during first 6 weeks. The surgical treatment was necessary in 10 cases (45% of all dislocation): 3 patients had only a surgical reposition and 7 patients had a revision arthroplasty. There was found that most cases of dislocation took place at the age above 81 years. Dislocation occurred 5 times more frequently in patients operated on for a femoral neck fractures then for coxarthrosis. The prosthesis TT1 most often dislocated possibly due to its shape (low Head Neck Ratio). Based on our own experience we find dislocation is a multifactorial complication and precise description of causes is usually very difficult.

Adult↗
PubMed2005

Sports-related shoulder dislocations: a state-hospital experience.

This retrospective study was conducted in a state hospital set-up and aimed at identifying the incidence of sports-related shoulder dislocations and their characteristics and the sports events involved. All patients with shoulder dislocation related to sporting activities admitted to the hospital from January 1999 to December 2002 were included in the study. There were 18 sports-related shoulder dislocations out of 106 all shoulder dislocations admitted during this 4-year period. The average age of the patients was 25.4 years. All but two were male. All were anterior dislocations. Recurrent dislocation constitutes 78% of the cases with an average of 3 times re-dislocation. Rugby and badminton were the major contributors to the injuries followed by volleyball, soccer and swimming. Conservative treatment was successfully instituted for 88% of the patients and 12% opted for surgical intervention.

Adult↗
PubMed1990

[Experimental study on the etiology of pathogenesis of acetabular dysplasia in congenital dislocation of the hip].

In order to investigate the etiology of pathogenesis of congenital hip dislocation and acetabular dysplasia, experiments using fetuses of pregnant rabbits were conducted. The following findings were obtained. (1) Dislocation occurred in approximately 40% of total animals used. The earliest dislocation was seen 2 days after birth. (2) The hip dislocation could be relatively and easily generated by exogenous factors during the perinatal period, even without such primary cause, as hip joint dysplasia. The acetabular dysplasia could be generated secondarily to dislocation. (3) There was a difference in the cause of acetabular dysplasia between areas of the acetabulum with and without load. (4) The acetabular depth growth in the dislocated hip was more seriously impaired than the longitudinal and transverse diameters of the acetabular entrance. These results have indicated that endochondral ossification of the epiphyseal cartilage of the acetabulum in the dislocated hip was more markedly impaired than that of Y epiphyseal cartilage.

Acetabulum↗
PubMed1989

[Dislocations of the carpometacarpal joint of the thumb--results of follow-up].

This report deals with twenty-nine dislocations of the carpometacarpal joint of the thumb--twenty-five closed and four compound dislocations, three of which were part of complex injuries of the hand--treated during the period 1957 to 1983. The closed dislocations comprised eighteen dorsal, three dorsal-ulnar, two dorsal-radial, one palmar, and one palmar-ulnar. The compound dislocations comprised one radial (isolated), one palmar-radial, one dorsal-radial, and one palmar-ulnar; the last three occurring together with complex injuries. Eleven patients were followed up after an average period of about eleven years. Closed dislocations including those with minor tears of ligaments and/or the joint capsule do not require operative treatment. Reduction and immobilization for four weeks in a plaster splint with inclusion of the thumb were sufficient; recurrence of the dislocations did not occur. The compound dislocations required temporary transarticular Kirschner wire fixation as the ligament and the capsule were completely torn.

Adolescent↗
PubMed1989

A study of glenohumeral orientation in patients with anterior recurrent shoulder dislocations using computerized axial tomography.

Thirty-six patients with recurrent anterior shoulder dislocations and 11 normal patients who had no history of shoulder problems were evaluated by a G.E. 8800 fourth generation computerized axial tomographer to quantitate humeral head retrotorsion and glenoid tilt. The study objective was to determine if osseous orientation was a major etiologic factor in patients with recurrent anterior shoulder dislocations. The normal position of the humeral head as determined by CT scan is 30 degrees retroversion with respect to its distal articular axis. In dislocations this value changes to a more anteverted position of 24 degrees retroversion. Glenoid tilt could not be given a single value since it changes from retroversion superiorly toward more anteversion inferiorly. This change in glenoid tilt was greater in the dislocators with inferior sections measuring 2 degrees anteversion in the dislocators and 1 degree retroversion in the uninvolved shoulder and in the normal population. The change in humeral retroversion and glenoid tilt in the recurrent dislocators was statistically significant when compared with the uninvolved shoulder and to the normal population. Thus, the glenoid humeral orientation appears to be a significant predisposing factor to recurrent anterior shoulder dislocations.

Adult↗
PubMed1988

[Treatment of unreduced anterior shoulder dislocation].

We evaluated the results of treatment in six patients with unreduced chronic anterior dislocations of the shoulder. In three patients the dislocations had not been recognized by the initial treating physician. In the remaining three patients the dislocations initially had been diagnosed but reduction had failed and the dislocations had remained unreduced. In one of the six shoulders the dislocation was left unreduced. The dislocation existed for 3.5 years and there was absence of disabling functional impairment, pain or neurovascular disturbance. In five of six shoulders the function was severely impaired. One of five shoulders with an anterior dislocation of three weeks duration could be reduced by closed manipulation. Four shoulders underwent open reduction. In all patients the humeral head could be preserved. Associated osseous lesions of the glenoid or the humeral head (Hill-Sachs lesions, fractures) were treated by rotation osteotomies according to Weber and the Eden-Lange-Hybinette procedure. Preoperatively all shoulders were graded as poor. Postoperatively the results in one was graded as excellent, in three as good and in one (algodystrophy of the left arm) as fair.

Adolescent↗
PubMed1986

[Fractures and dislocation fractures of the wrist joint].

Most carpal fractures are based on the same injury mechanism. In most cases the injury is caused by a fall on the dorsiflexed hand, which is raised as a protective measure, and less frequently by a fall on the clenched fist. The latter leads to passive palmar flexion, pronation and radial inclination of the hand; in the former, the hand is passively superextended by the impact, supinated, and brought into ulnar inclination. The instability caused by injury to various articular structures has four developmental stages. The bones or syndesmoses that are involved depend on the stage and quantitative relationship between the three above-mentioned moments of force. If the lateral ligament of the wrist is slack, scaphoid fractures occur; in the last stage of superextension, fractures of the capitate bone occur. With increasing ulnar inclination, perilunar dislocations or fracture-dislocations and triquetrum fractures occur in the third stage and dislocations of the semilunar bone in the fourth stage. In addition, compression and avulsion of the 1st, 4th or 5th metacarpal bones cause fractures of the trapezium and the hamate bone. To avoid unpleasant late sequels, scaphoid fractures with diastasis due to soft tissue interposition or non-reducible dislocated scaphoid fractures must be treated surgically. Vertical oblique fractures and scaphoid fractures with small proximal fragments are relatively good indications for operation. Perilunar instability and dislocations, particularly De Quervain's fracture-dislocations, must be treated operatively because reduction of the scaphoid bone requires a different approach than correcting alignment in the carpus and because soft tissue interpositions are always present, even though they may not be evident in the X-ray pictures. Fracture-dislocations in the distal carpal row also require operation, preferably percutaneous internal fixation using K-wire and fluoroscopy. Immobilization is accomplished by a below-elbow cast with a dorsal plaster splint up to the interdigital webs and from the palmar to the proximal crease. The thumb is only embedded in trapezium fractures; fractures requiring fist or above-elbow casts are indications for operation.

Adolescent↗
PubMed1985

[A radiological study of the hip in cerebral palsy in relation to pathogenesis of dislocations].

In recent years it has been reported that dislocation of the hip in cerebral palsy (CP) occurs most frequently in the non-ambulatory patient. This study compares the radiographic anatomy of the hip in CP with normal values and suggests the cause of dislocation. The cases of CP were divided into three groups according to ambulation and dislocation: group 1 consisted of 111 hips in a total of 64 ambulatory children, group 2, 116 hips in 72 non-ambulatory children, and group 3, 37 hips including 13 dislocated hips and 24 subluxated hips in 32 children. Of these 37 hips, patients with a dislocated hip and 3 subluxated hips were ambulatory but the beginning of their independent walking was as late as 5 years of age or even later. The following results were obtained. Femoral antetorsion was markedly increased in CP, and the difference was statistically very significant for all groups 1, 2 and 3 (p less than 0.001, and p less than 0.01 between groups 1 and 2). In CP groups there was no regression with age. Significant increases in femoral inclination were found in CP groups (p less than 0.001). There was, however, no significant differences among groups 1, 2 and 3, and so the degree to which these were the cause for dislocation was less than that of femoral antetorsion. Significant shortness of the femoral neck was noted between groups 1 and 3 (p less than 0.01), with significant regression with age in all CP groups. The mean value of the acetabular index in group 3 was 34.5 +/- 5.9, which was significantly higher than in group 1, and group 2 (p less than 0.001). In groups 2 and 3 there was no regression with age. Thus dislocation and subluxation of the hip in CP can be caused by the increase of antetorsion of the femur and acetabular dysplasia and depend on the ability of walking.

Acetabulum↗
PubMed1985

Late dislocations in patients with Charnley total hip arthroplasty.

I analyzed the cases of thirty-two patients in whom a Charnley total hip arthroplasty had dislocated for the first time between five and ten years postoperatively. I evaluated the possible factors that caused the late dislocations. Most of the factors were similar to those that were also present in a control group of patients who had had an arthroplasty that had not dislocated and in a group in which dislocation had occurred at variable times postoperatively. Two significant factors did emerge. First, the patients with late dislocation had a greater range of motion, especially in flexion, than those in the two control groups. Second, the acetabular component showed radiographic evidence of loosening in more of the patients in the group with late dislocation than in either of the control groups. I postulated, but did not prove, that stretching of the pseudocapsule of the hip over time and extremes of motion may lessen soft-tissue constraints and allow for late dislocation.

Adult↗
PubMed1985

Posterior fracture dislocation of the hip with fractures of the femoral head.

In general, all traumatic dislocations of the hip must be treated as surgical emergencies. Multiple attempts at closed reduction are contraindicated, particularly in Type V dislocations. Every effort must be made to recognize the dislocation, particularly in patients with other severe lower extremity trauma. Reduction within 24 hours gives better results than late reductions. Roentgenograms of the pelvis must include both hips after closed or open procedures as a check for a concentric reduction of the hip. Any abnormality, or failure to reduce the avulsed head fragment, demands an immediate hip arthrotomy. The good results, after primary open reduction, although under 50%, were better than closed or closed followed by open reduction. Our approach is to discard the avulsed head fragment. No conclusions can be made regarding screw fixation of the avulsed fragment because there was an insufficient follow-up period in this procedure. Long-term follow-up examination is necessary in Type V fracture dislocations because one can anticipate that arthritic changes will develop in more than 50% of patients. Anterior approaches to excise head fragments in Type V dislocations are contraindicated. Early intervention is indicated in all dislocations with sciatic or peroneal nerve paralysis. Because most dislocations in this series were due to automobile accidents, the routine use of seat belts could have prevented many of these injuries.

Acetabulum↗