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PubMed1982

Subtalar dislocation of the foot.

We studied a series of seventeen cases of subtalar dislocation of the foot. There were on anterior, twelve medial, and four lateral dislocations. Of the seventeen dislocations, fourteen were closed and three, open. Two of the four lateral dislocations were open. Associated fractures involving the talocalcaneal or talonavicular joints were noted in eight feet, including three of the four with a lateral dislocation. In two feet these fractures were noted only on post-reduction polytomography. Associated fractures of the ankle mortise and of the metatarsals were present in seven feet. Associated fractures involving the subtalar or talonavicular joints, open dislocations, and associated injuries requiring immobilization of the foot for more than three weeks produced poor results due to pain and limitation of subtalar motion. Lateral dislocations were particularly prone to poor results, due to the frequency of open injuries and associated fractures. Cast immobilization for three weeks and early range-of-motion exercises of the subtalar joint are recommended for the best results.

Adolescent↗

PubMedDate not supplied

A comparative study of bilateral versus unilateral congenital dislocation of the hip.

The presentations, treatment requirements, results, and complications of 50 patients with bilateral congenital hip dislocation were evaluated and compared with a similar group of unilateral dislocations. Diagnosis was significantly delayed in the bilateral dislocations. The only consistent sign on initial clinical examination of the bilateral group was the symmetrical restriction of hip abduction. Treatment requirements were similar for the unilateral and bilateral dislocations, and in fact, the unilateral dislocations were more likely to undergo reconstructive procedure after successful closed reduction. Overall results, when based on age at diagnosis, were similar for the two groups. In both groups, females required less treatment and were more likely to have a good result. The complication of avascular necrosis was seen more frequently in the unilateral dislocation, while the bilateral dislocation had a higher incidence of inadequate reconstructive operations.

Child↗

PubMed1982

Chronic unreduced dislocations of the shoulder.

We evaluated the results of treatment in twenty-three patients with twenty-four shoulder dislocations that had gone unreduced for at least three weeks. Fourteen dislocations were posterior, eight were anterior, and one each was superior and inferior. Seventy-nine per cent of the posterior dislocations had not been recognized by the initial treating physician. Fourteen shoulders (58 per cent) were operated on. Of seven that were treated by open reduction with preservation of the humeral head, the results in two were graded as excellent; in three, as good; and in two, as fair. A Neer total shoulder-replacement prosthesis was used in one patient with an excellent result, and a Neer humeral-head prosthesis was used in two patients with a good and a fair result. In four patients, the humeral head was removed and a Jones procedure was performed, with one good and three fair results. There were no poor results after surgical treatment and it was not necessary to arthrodese any shoulder. We did not find it necessary to transfix the shoulder joint by screws or pins, or to use plaster spica casts to maintain stability of the shoulder following open reduction. Supporting the arm at the side in a position posterior to the coronal plane for a posterior dislocation, and anterior to the coronal plane for an anterior dislocation, proved to be comfortable and effective. There were no postoperative dislocations using this simple method. These results show that the over-all prognosis for surgical treatment of the chronic unreduced dislocation shoulder is more favorable than has previously been reported. A rating system based on 100 units was used to evaluate our final results, and is recommended as a standard system for future comparative studies.

Adult↗

PubMed1980

Classification and management of carpal dislocations.

A classification and plan of management for carpal dislocations are presented, based upon the following basic premises: perilunate and lunate dislocations are different stages of the same injury and are therefore managed identically; displacement may be either dorsal or volar; anatomic restoration of the 3 key elements (scaphoid, lunate, and capitate) is essential. Following initial closed reduction, rotary subluxation of the scaphoid and intercalary segment instability must be specifically looked for and corrected in the patient with perilunate or lunate dislocation without fracture of the scaphoid. In transcaphoid perilunate dislocation, anatomic reduction of the scaphoid fracture and maintenance of that reduction is necessary to prevent nonunion of the fracture and/or late dorsiflexion instability of the carpus. As with all ligamentous injuries, early diagnosis and treatment are essential. Failure to obtain or maintain anatomic position by closed methods is an indication for open reduction and internal fixation. Combined dorsal and volar approaches are recommended for perilunate and lunate dislocations. In some cases of transscaphoid perilunate dislocation, a limited Russe approach to stabilize the scaphoid fracture may be sufficient. Frequent concomitant injuries include median nerve damage, osteochondral fractures of the carpal bones, and fracture of the radial styloid. Isolated rotary subluxation of the scaphoid without perilunate dislocation is a more subtle injury which may require special radiographic views, and also demands early diagnosis and treatment.

Carpal Bones↗

PubMed1980

Dislocation in total hip arthroplasties.

In a series of 1,443 total hip arthroplasties performed between 1970 and 1975, dislocation was the most frequent complication and its incidence was found to be increasing. Dislocatin was frequently associated with component malposition that the surgeon was not aware of at the time of surgery and was relatively frequent among less experienced surgeons. It was especially frequent if the patient had had previous hip surgery and was related to the difficulty of the surgery rather than the primary hip disease. Increasing incidence was associated with change in operative technique and less stringent patient selection. Dislocation was 2 1/2 times more frequent if trochanteric osteotomy was not performed. The tip of the greater trochanter was moved significantly closer to the center of the prosthetic head in the patients who dislocated. Traction for up to three weeks did not lower the incidence of subsequent dislocation compared with mobilization of the patients as soon as tolerated after dislocation. Surgery was effective in preventing further dislocations in patients with recurrent dislocation and component malposition. The use of an articulated prosthesis is not recommended.

Anthropometry↗

PubMed1994

Isolated traumatic dislocation of the hip. Long-term results in 50 patients.

From 1974 to 1989, we treated 50 patients with a simple dislocation of the hip: 38 were posterior dislocations and 12 were anterior. All dislocations primarily treated at our hospital were reduced by closed methods within three hours (mean 85 minutes (10 to 180)) and 43 were reviewed after an average follow-up of 8 years (2 to 17). It is widely held that isolated hip dislocation reduced within six hours gives an excellent outcome, but we found a significant number of complications. There were radiological signs of partial avascular necrosis in two, mild osteoarthritis in seven, and moderate degeneration in two. Heterotopic ossification was seen in four patients, but 29 of 33 MRI examinations were normal. Objective evaluation according to the Thompson and Epstein (1951) criteria showed fair and poor results in 3 of 12 anterior dislocations, but in 16 of 30 posterior dislocations. In six of the seven patients with no other severe injury, the hip had an excellent or good result; in only three of the eight patients with severe multiple injuries was this the case. The important factors in the long-term prognosis appear to be the direction of the dislocation and the overall severity of injuries.

Adolescent↗

PubMed1996

Closed reduction of a rare type III dislocation of the first metatarsophalangeal joint.

OBJECTIVE: To discuss a rare Type III dislocation of the first metatarsophalangeal (MP) joint, without fracture, that used a closed reduction technique for correction. CLINICAL FEATURES: A 43-yr-old man suffered from an acute severe dislocation of his great toe as the result of acute forceful motion applied to the toe as his foot was depressed onto a brake pedal to avoid a motor vehicle accident. Physical examination and X-rays revealed the dislocation, muscle spasm, edema and severely restricted range of motion. INTERVENTION AND OUTCOME: The dislocation was corrected using a closed reduction technique, in this case a chiropractic manipulation. Fourteen months after reduction, the joint was intact, muscle strength was graded +5 normal, ranges of motion were within normal limits and no crepitation was noted. X-rays revealed normal intact joint congruency. The patient experienced full weight bearing, range of motion and function of the joint. CONCLUSION: Although a Type III dislocation of the great toe has only once been cited briefly in the literature, this classification carries a recommended surgical treatment protocol for correction. No literature describes a closed reduction of a Type III dislocation as described in this case report. It is apparent that a closed reduction technique using a chiropractic manipulation may be considered a valid alternative correction technique for Type III dislocations of the great toe.

Adult↗

PubMed1996

[Carpometacarpal dislocations of the long fingers. Apropos of 26 cases with review of 20 cases].

PURPOSE OF THE STUDY: A retrospective study reports the evolution of patients treated for dislocation of one or several of the four medial carpometacarpal joints. MATERIALS AND METHODS: In five of twenty-six patients, the dislocations were undiagnosed in emergency. Twenty-five dislocations were dorsal. A patient presented a divergent dislocation of the four medial metacarpals proximal ends. The mean age was 25-30 years. Twenty-six patients were treated: ten by closed reduction and sixteen by open reduction. Stabilization by oblique K-wire pining was used in twenty-four cases. Twenty patients were followed for an average of fourty-one months. Six patients were lost for follow-up. Two patients had an an ulnar nerve injury. In eighteen cases, dislocation was associated with avulsion fracture of the involved bone. Eleven fractures of the distal carpal row was reported. RESULTS: The results were assessed by the range of wrist and fingers motion, grip strength, pain and deformity. Three patients had a limited range of wrist motion, five patients had a limited range of fingers motion. Six patients had a loss of fourth and fifth carpometacarpal joint motion. Eight patients had an excellent grip strength. Four patients were pain free and fourteen had climatic pain, or after strenuous use of the hand. Eleven had no deformity or limited prominence and three a disabling deformity. Results were rated good in thirteen cases, fair in three and poor in four. DISCUSSION: Dislocation or fracture-dislocation of the carpometacarpal joints are uncommon injuries. The diagnosis can be easily missed. The authors recommend closed or open reduction but constant fixation by pins and immobilization in a plaster cast. In this study, the majority of results was good when no serious injuries were associated and when reductions were stabilized with k-wires. One out of four poor results had been treated by closed reduction without k-wires, the three others were due to associated injuries.

Adolescent↗

PubMed1978

Arytenoid dislocation.

The reported incidence of arytenoid cartilage dislocation is low. This may be due to the wide range and orientation of motion allowed by the cricoarytenoid articulation and the laxity of its joint capsule. In two previously reported instances of arytenoid dislocation, the authors have suggested that endotracheal intubation is generally not sufficient to cause dislocation of an arytenoid cartilage, but that, in their cases, a predisposing factor had set the occasion for dislocation. In this communication, three cases of arytenoid cartilage dislocation, which each followed a single instance of endotracheal intubation are presented. In all three cases, painful swallowing was the main presenting symptom. Clinical features that differentiate arytenoid cartilage dislocation from vocal cord paresis are summarized. Early reduction of the dislocation, while the patient is under local anesthesia, is recommended, and the techniques are described in detail.

Adult↗

PubMed2006

Atom probe tomography characterization of solute segregation to dislocations.

The extent and level of solute segregation to individual dislocations may be quantified by atom probe tomography. The technique is best applied to materials with high dislocation densities, such as cold worked, mechanically alloyed, or neutron-irradiated materials. Dislocations may be observed in field ion images by a change of the normal concentric atom terraces at crystallographic poles to spirals. Solute segregation is evident in field ion images by brightly imaging atoms near the core of the dislocation. Dislocations are evident in atom maps in the three-dimensional atom probe by linear regions of enhanced solute concentration. The maximum separation envelope and tracer methods may be used to quantify the levels of solute at the dislocation at the subnanometer scale. Examples of interstitial and substitutional element segregation in a mechanically alloyed, oxide dispersion strengthened ferrite steel and phosphorus segregation to dislocations in neutron-irradiated pressure vessel steels are presented.

Electron Probe Microanalysis↗

PubMed2004

[Treatment of dislocated 3- and 4-part fractures of the proximal humerus with an angle-stabilizing fixation plate].

In the presented prospective study 35 consecutive patients with displaced 3- and 4-part fractures of the proximal humerus, including fracture dislocations, were treated with a fixator plate comprising angular stability between May 2001 and December 2002. After 18.5 (8-29) months 31 (89%) fractures were available for follow-up. Good and very good results were obtained in 64%. A poor result was documented in 23%. 64% of the patients had no or mild pain, 71% were able to abduct the arm over 90 degrees . Fracture classification according to Neer and AO had no influence on the outcome, with a mean Constant Score of 76 points. Partial avascular necrosis (AVN) of the humeral head was seen in 16% of all cases representing 4% of the fractures without dislocation and 80% of the fracture dislocations. Fracture dislocation (p=0.02) and AVN (p=0.005) had a negative effect on the Constant Score, with AVN being a predictor for a high level of pain (p=0.04). Secondary dislocation of the greater tuberosity was seen in two patients, loosening of screws in one patient and a fracture below the plate in another one. Secondary dislocation or loss of reduction of the head was not recorded. Angle stable plate fixation with tension band wiring of the tuberosities is an effective and safe option to treat this difficult fractures, also in elderly patients with osteoporotic bone. Because 40% of the 4-part fractures with fracture dislocation yielded a satisfactory or better result, the plate fixator with angular stability may be an alternative to prosthetic replacement in selected cases.

Adult↗

PubMed2004

Scleral fixation of dislocated posterior chamber intraocular lenses: Temporary haptic externalization through a clear corneal incision.

PURPOSE: To report the results of managing dislocated posterior chamber intraocular lenses (PC IOLs) by externalizing the haptics through a clear corneal incision. SETTING: The Retina Center at Pali Momi, Aiea, Hawaii, USA. METHODS: This retrospective consecutive series comprised cases in which a dislocated PC IOL was managed with pars plana vitrectomy. With this method, the dislocated PC IOL is retrieved and stabilized in the anterior chamber. The haptic is externalized through a clear corneal incision for suture knot placement and then reinserted. A scleral fixation suture is placed 1.25 mm posterior to the limbus under a scleral flap. RESULTS: The study included 14 eyes of 14 patients with a minimum follow-up of 6 months (median 15.4 months). There were 2 subluxated PC IOLs, 11 posteriorly dislocated PC IOLs, and 1 in-the-bag IOL dislocation. Postoperative vision and/or visual symptoms were stable or improved in 86% of eyes. Two eyes had worse vision caused by conditions not related to surgery including chronic cystoid macular edema from latanoprost use and optic atrophy. All IOLs were well fixated and stable, although 1 eye with asymmetric haptics had a slightly tilted IOL. CONCLUSIONS: Dislocated PC IOL management by externalizing the haptic through a clear corneal incision stabilized the IOL in the anterior chamber, minimized intraocular operative manipulations, and allowed easier placement of the opposite haptic over residual capsule, if available. Stable fixation was achieved without dislocation or IOL-related complications recurring.

Aged↗

PubMed2006

Volar dislocation of the extensor carpi ulnaris tendon on magnetic resonance imaging is associated with extensor digitorum communis tendon rupture in rheumatoid wrists.

PURPOSE: Extensor tendon rupture in rheumatoid wrists is a common problem and causes immediate dysfunction of the digits. The best treatment for tendon rupture may be prophylactic management, although the factors associated with tendon rupture must first be identified. The purpose of this study was to evaluate structures around rheumatoid wrists using magnetic resonance imaging with forearm rotation and to identify factors associated with extensor tendon rupture as indications for prophylactic surgery. METHODS: The subjects were 34 patients (40 wrists) with active rheumatoid arthritis. The extensor digitorum communis (EDC) tendons were ruptured in 15 wrists. Magnetic resonance imaging of the wrists was performed in maximally pronated and supinated positions of the forearm. Axial images of the distal radioulnar joints (DRUJs) were selected to evaluate DRUJ synovitis, dorsal tenosynovitis, volar dislocation of the extensor carpi ulnaris (ECU) tendon, sigmoid notch angle, and the radioulnar ratio (RUR) (ie, the degree of DRUJ subluxation). RESULTS: No significant correlations were found between EDC tendon rupture and DRUJ synovitis, dorsal tenosynovitis, or RUR in pronation. Extensor digitorum communis tendon rupture correlated significantly with volar ECU tendon dislocation, sigmoid notch angle, and RUR in supination. Radioulnar ratio correlated significantly with volar ECU tendon dislocation only in supination and not in pronation. Thus, DRUJ subluxation was advanced even in the supinated wrist with volar ECU tendon dislocation. As a factor associated with EDC tendon rupture, volar ECU tendon dislocation had 87% sensitivity and 76% specificity. CONCLUSIONS: Volar ECU tendon dislocation is associated with increased RUR in supination and EDC tendon rupture. Volar ECU tendon dislocation can thus be considered a factor associated with EDC tendon rupture, and its presence may indicate the need for prophylactic surgical intervention in a subset of rheumatoid arthritis patients.

Adolescent↗

PubMed2006

Dislocation of posterior-stabilized mobile-bearing knee prosthesis. A case report.

Spin-out of mobile-bearing knees is a significant early complication of mobile-bearing total knee arthroplasty. Dislocation of the cam-post mechanism of fixed-bearing posterior-stabilized knees occurs more rarely. We have observed an unusual case of dislocation of posterior-stabilized rotating-platform total knee arthroplasty, which has both a cam-post mechanism and rotating platform. A 65-year-old man with knee osteoarthritis and cervical spondylotic myelopathy underwent total knee arthroplasty using a mobile-bearing prosthesis. The dislocation, which occurred 4 days postoperatively, could not be reduced by closed manipulation. However, spontaneous reduction occurred 6 days after the dislocation, which did not recur. A gap mismatch or trapezoidal-shaped gaps may lead to dislocation or spin-out of the bearing insert. This case illustrates that dislocation of a posterior-stabilized mobile-bearing total knee arthroplasty can occur, and both quadriceps deficiency and ligament laxity may contribute to the risk of dislocation.

Aged↗

PubMed2004

Testicular dislocation: an uncommon and easily overlooked complication of blunt abdominal trauma.

STUDY OBJECTIVE: We report testicular dislocation as an unusual complication of blunt abdominal trauma. METHODS: The computer data bank of Chang Gung Memorial Hospital was searched for the period from 1987 to 2002, and 1,967 male patients with blunt abdominal trauma were admitted to the emergency department. Among these patients, records of 9 patients associated with testicular dislocation were collected. A retrospective review of the clinical records, abdominal computed tomography (CT) results, and subsequent scrotal sonograms was jointly performed by 2 radiologists, an emergency physician, and a trauma surgeon. RESULTS: Of these 9 patients (age range 6 to 53 years; mean 23 years), 7 patients were in motorcycle crashes, 1 patient had explosive injury, and 1 patient had seat belt injury. Associated testicular dislocation was initially missed in all patients. CT for evaluating blunt abdominal trauma revealed liver lacerations in 2 patients and pancreatic fracture, pancreatitis, bowel perforation, pubic bone fracture, and contralateral inguinal hernia in 1 each. Typical CT findings of testicular dislocation (empty scrotum and displaced testis) were retrospectively seen in 7 patients, but prompt CT diagnosis of testicular dislocation was achieved only in 3 patients, who were subsequently treated with closed manual reduction, obviating surgery. In the remaining 2 patients, CT examination did not include the scrotum and testicular dislocation, which was diagnosed by subsequent sonography. Delayed diagnosis occurred in 6 patients (duration 3 to 60 days; mean 19 days). Five of the patients underwent orchiopexy, and 1 underwent orchiectomy. CONCLUSION: In blunt abdominal trauma patients, associated testicular dislocation is easily overlooked. A complete physical examination in the trauma patient, including palpation of both testes, is strongly recommended.

Abdominal Injuries↗

PubMed1998

Delayed intraocular lens dislocation after neodymium:YAG capsulotomy.

A poly(methyl methacrylate)(PMMA) intraocular lens (IOL) dislocated into the vitreous cavity in 2 patients after a neodymium:YAG (Nd:YAG) laser posterior capsulotomy. In Case 1, the capsulotomy was performed 19 months after extracapsular cataract extraction (ECCE) and sulcus fixation of an IOL. Six months later the IOL dislocated posteriorly. In Case 2, ECCE with intracapsular IOL implantation was followed 4 years later by an Nd:YAG capsulotomy; 6 months later the IOL dislocated into the vitreous cavity within the intact capsular bag. Different mechanisms were responsible for the dislocation: in case 1, radial tearing of the large capsular defect with IOL loosening and dislocation into the vitreous cavity; in Case 2, zonulysis and IOL dislocation within the intact capsular bag. A neodymium:YAG capsulotomy may cause delayed IOL dislocation into the vitreous cavity.

Aged↗

PubMed2002

Protein unfolding is not a prerequisite for endoplasmic reticulum-to-cytosol dislocation.

We examined the effects of protein folding on endoplasmic reticulum (ER)-to-cytosol transport (dislocation) by exploiting the well-characterized dihydrofolate reductase (DHFR) domain. DHFR retains the capacity to bind folate analogues in the lumen of microsomes and in the ER of intact cells, upon which it acquires a conformation resistant to proteinase K digestion. Here we show that a Class I major histocompatibility complex heavy chain fused to DHFR is still recognized by the human cytomegalovirus-encoded glycoproteins US2 and US11, resulting in dislocation of the fusion protein from the ER in vitro and in vivo. A folded state of the DHFR domain does not impair dislocation of Class I MHC heavy chains in vitro or in living cells. In fact, a slight acceleration of the dislocation of DHFR heavy chain fusion was observed in vitro in the presence of a folate analogue. These results suggest that one or more of the channels used for dislocation can accommodate polypeptides that contain a tightly folded domain of considerable size. Our data raise the possibility that the Sec61 channel can be modified to accommodate a folded DHFR domain for dislocation, but not for translocation into the ER, or that a channel altogether distinct from Sec61 is used for dislocation.

Cytosol↗

PubMed2000

Dislocation propagation in GaN films formed by epitaxial lateral overgrowth

We have investigated by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) the relationship between surface morphological evolution and dislocation propagation in GaN films formed by epitaxial lateral overgrowth (ELO) in hydride vapour phase epitaxy. The SEM observations revealed that step and terrace structures were formed on (0001) surfaces of the films both in the earlier and the later stages of growth, suggesting the occurrence of step-flow growth during ELO. Bending dislocations with laterally propagated segments were frequently observed in the ELO films and their morphology led to a reduction in threading dislocation density in the film surface regions. Systematic TEM observations were performed to reveal the detailed structure of the bending dislocations. Comparison between the SEM and the TEM results showed that the lateral propagation of the dislocation was closely related to the appearance of the [1101) facets. A mechanism for dislocation propagation is discussed that explains the observed dislocation structure and surface step morphology.

Journal Article↗