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PubMed1997

[Hip dislocation without bone injuries].

Dislocation of the hip is rare and so we regard every hip dislocation as an emergency until it has been reduced. From 1977 to 1996 a total of 82 patients with hip dislocation were treated at the Traumatic Surgery Clinic, University of Vienna, Austria. The average age at injury was 29 years. Some 77 patients had unilateral dislocation of the hip, but only in 5 cases was bilateral dislocation found. Iliac dislocation was most common (54 patients). Our treatment consisted in reduction within 6 h of the injury under general anaesthesia (Böhler) and 14 days bedrest. Then the patients were mobilized with full weight bearing, depending on the pain. Of the patients 29 had no clinical infirmities, 8 patients reported temporarily occurring pain and in 6 patients we found a limited range of movement in the hip joint with occasional pain. In all, 43 patients were followed up after 1/2 to 19 years. Radiological signs were seen in 17 patients and avascular necrosis of the femoral head in 1. So after careful evaluation of the patients and the kind of treatment, we recommend the following: 1. Immediate, gentle reduction of the hip joint; 2. Bedrest for 14 days; 3. Early mobilization with full weight bearing.

Adolescent↗

PubMed1997

MRI of cervical facet dislocation.

The MRI examinations of eight patients with cervical vertebral dislocation demonstrated by conventional radiography were reviewed. All patients had axial and sagittal T1- and T2-weighted imaging on a 1.5-T Unit. This revealed unilateral partial facet dislocation (in two patients), bilateral partial facet dislocation (in two), unilateral complete dislocation (in two) and bilateral complete facet dislocation (in two). In six patients there was cord contusion, three had focal disc protrusions and four unilateral absence of normal flow void in one of the cervical vertebral arteries. In all cases, the dislocated facets were shown well on the far-lateral sagittal images.

Adolescent↗

PubMed2000

Arthrographic examination of the pseudocapsule of the hip after posterior dislocation of total hip arthroplasty.

We examined the pseudocapsule in ten patients with posterior dislocation after total hip arthroplasty (THA) using arthrography to investigate the relationship between dislocation and the state of the pseudocapsule. The pattern of contrast medium pooling demonstrated on tangential views was evaluated. In five patients with early dislocation arthrography showed leakage indicating lack of pseudocapsule whereas there was no leakage in five patients with late dislocation. Repeat arthrography revealed healing of the pseudocapsule could progress by 6-8 weeks after dislocation. These findings suggest that the difference in the pseudocapsule between those who dislocate early and late may explain different clinical outcomes in the two groups.

Arthrography↗

PubMed2006

Dislocation of the shoulder joint with ipsilateral humeral shaft fracture: two case reports.

INTRODUCTION: A combination of the shaft fracture of the humerus with shoulder dislocation is a rarely documented injury. Moreover, few reports describe a long-term outcome after a follow-up period over 10 years. The present article is the first report of long-term clinical results obtained with this combined injury. MATERIALS AND METHODS: We present two cases of the dislocation of the shoulder joint with ipsilateral humeral shaft fracture. One is an anterior dislocation and the other is posterior. The anterior dislocation was closely reduced on the date of injury, but the posterior dislocation required open reduction 6 weeks after the injury because it was missed at the initial diagnosis and identified 4 weeks after the injury. In the latter case, shoulder pain and limitation of the motion persisting after the first surgery had to be treated by anterior acromioplasty and arthrolysis of the shoulder. In both cases, the humeral fracture was fixed by retrograde intramedullary nailing using a Küntscher nail and successful bone union was achieved. RESULTS: At over 10-year follow-up examination, both patients had no limitation in activities of daily living and no restrictions to their normal occupation. The radiographs of the shoulder joint demonstrated good clinical results, with no degenerative change or osteonecrosis. CONCLUSION: We have experienced two cases of dislocation of the shoulder joint with ipsilateral humeral shaft fracture and reported long-term results over 10 years. Good clinical results were demonstrated in both cases.

Accidents, Traffic↗

PubMed2002

Longer immobilization extends the "symptom-free" period following primary shoulder dislocation in young rugby players.

The purpose of this study was to evaluate the effect of longer immobilization following primary shoulder dislocation in young rugby players for the prevention of recurrence. We sent a questionnaire regarding shoulder dislocation to all senior high school and college rugby teams in the southwest region of Japan. We received replies from 5476 players in 196 teams (i.e., answers were received from 76% of the teams). Based on the answers from the 79 rugby players who had undergone shoulder dislocations and who were eligible for the study, we divided them into two groups; group I: immobilization for 0-3 weeks at the time of the initial dislocation (n = 61), and group II: immobilization for 4-7 weeks (n = 18). We compared the time-course from primary dislocation to recurrence between the two groups, using the Kaplan-Meier method. The age range at the time of the primary dislocation was 14-23 years (average, 16.7 years). The probability of recurrence in groups I and II, respectively, was 78% and 44% after 1 year; and 85% and 69% after 2 years. The median period from return to rugby to recurrence was 4 months in group I and 14 months in group II. The symptom-free period was extended when immobilization was carried out for 4 weeks or more, in comparison with the symptom-free period in those who had immobilization for 3 weeks or less.

Adolescent↗

PubMed1994

Acute dislocation of the carpometacarpal joint of the thumb: an anatomic and cadaver study.

An anatomic study was undertaken to provide an understanding of the ligamentous disruption that occurs during acute dislocation of the thumb carpometacarpal joint. Thirty-eight cadaver thumbs were dissected free of soft tissue, with the ligaments preserved. The dorsoradial, posterior oblique, anterior oblique, and intermetacarpal ligaments were identified in all specimens. A dorsal dislocating force was applied to the base of the thumb metacarpal to recreate the mechanism of clinical dislocation. Serial sectioning of the ligaments was performed with the metacarpal in neutral, flexion, and extension. The primary restraint to dorsal dislocation was found to be the dorsoradial ligament, with the anterior oblique ligament allowing dislocation by subperiosteal stripping from the base of the first metacarpal. After reduction, the joint was most stable in pronation and extension, which tightened the anterior oblique ligament. We conclude that the dorsoradial ligament is the primary restraining force with respect to acute dorsal dislocation of the thumb carpometacarpal joint.

Acute Disease↗

PubMed1993

Dislocation following primary posterior-stabilized total knee arthroplasty.

From 1981 through 1991, 3,032 primary total knee arthroplasties were performed using the Insall-Burstein Posterior Stabilized Condylar Prosthesis (IB-I, IB-II, and IB-II modified) (Zimmer, Warsaw, IN). Fifteen posterior dislocations occurred: 4 with the IB-I system occurring 2 or more years after surgery, 10 with the IB-II system (8 occurring 6 months after surgery and 2 occurring 2-3 years after surgery), and 1 with the IB-II modified system occurring 9 months after surgery. Statistically significant differences for the rate of dislocation between both the IB-I and IB-II modified arthroplasties versus the IB-II arthroplasties were found (P < .001). In an attempt to identify a cause for these dislocations, the authors retrospectively assessed the 15 dislocated cases with respect to sex, age, weight, height, preoperative and postoperative Hospital for Special Surgery scores, preoperative and postoperative alignment, preoperative versus postoperative reconstruction dimensions, patellar thickness and height, and postoperative flexion and compared the results with those patients who did not experience dislocation. Possible etiologies and mechanisms of dislocation were sought. There were no significant differences between the control and study groups for any variable assessed, with the exception of postoperative flexion, which averaged 118 degrees for the study group and 105 degrees for the control group (P < .001). Conservative management was successful in 11 cases. In September 1988 the IB-II system was introduced; modification of the tibial insert was made in January 1990.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2004

Influence of component positions on dislocation: computed tomographic evaluations in a consecutive series of total hip arthroplasty.

Component positions in a consecutive series of total hip arthroplasty through a posterolateral approach without capsular and external rotator repair, using the same prosthesis type, head size, and liner, were evaluated using computed tomography, and correlation with occurrence of postoperative dislocation was assessed. The 9 hips with posterior dislocation had significantly lower cup anteversion than the 181 hips without dislocation. Seven (78%) of the 9 hips with posterior dislocation had cup anteversion <20 degrees, irrespective of stem anteversion. These findings suggest that among variables of component positions, cup anteversion is one of the important factors for risk of dislocation, and that intentionally placing the cup at low anteversion to compensate for high femoral neck anteversion may predisposes the hip to postoperative dislocation.

Adult↗

PubMed2006

Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators.

PURPOSE: The purpose of this study was to assess the relation between generalized joint laxity and patellar hypermobility in unilateral recurrent patellar dislocators. TYPE OF STUDY: Case series. METHODS: A total of 82 patients (23 male and 59 female patients) with unilateral recurrent patellar dislocation were studied compared with an age- and sex-matched control group. The modified Carter and Wilkinson criteria for generalized joint laxity and lateral patellar hypermobility test were examined. RESULTS: Generalized joint laxity (score of 4 or 5) was present in 20 patients (24%) with recurrent patellar dislocation in 8 subjects (10%) of the control group. The mean total score was 2.5 (SD, 1.4) in the recurrent patellar dislocators and 1.7 (SD, 1.3) in the control group. The incidence of generalized joint laxity (P = .013) and the mean total score (P = .00004) were statistically significant between the two groups. A hypermobile patella was present in 42 patients (51%) and in 5 subjects (6%) of the control group. There was a large statistically significant difference between the two groups (P < .00001). CONCLUSIONS: Although a hypermobile patella and generalized joint laxity were significant between the recurrent patellar dislocators and the control group, a hypermobile patella was more significant than generalized joint laxity as the predisposing factors of patellar dislocation. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Adolescent↗

PubMed2005

Arytenoid cartilage dislocation: a 20-year experience.

SUMMARY: Arytenoid cartilage dislocation is an infrequently diagnosed cause of vocal fold immobility. Seventy-four cases have been reported in the literature to date. Intubation is the most common origin, followed by external laryngeal trauma. Decreased volume and breathiness are the most common presenting symptoms. We report on 63 patients with arytenoid cartilage dislocation treated by the senior author (RTS) since 1983. Significantly more posterior than anterior dislocations were represented. Although reestablishing joint mobility is difficult, endoscopic reduction should be considered to align the heights of the vocal processes. This process may result in significant voice improvement even long after the dislocation. Strobovideolaryngoscopy, laryngeal electromyography, and laryngeal computed tomography (CT) imaging are helpful in the evaluation of patients with vocal fold immobility to help distinguish arytenoid cartilage dislocation from vocal fold paralysis. Familiarity with signs and symptoms of arytenoid cartilage dislocation and current treatment techniques improves the chances for optimal therapeutic results.

Adolescent↗

PubMed1992

A classification of acute acromioclavicular dislocation: a clinical, radiological and anatomical study.

Forty-eight patients with acute acromioclavicular dislocation were assessed clinically and radiologically before random allocation to non-operative management (28) or open reduction and coracoclavicular screw fixation (20) and followed for a minimum of 4 years. In 6 patients, late salvage surgery was required, the results of which were inferior to early operative intervention. Early surgery also gave better results than non-operative treatment in severe disruptions which could be identified in the acute stage. Three types of acromioclavicular dislocation which have predictable clinical outcomes could be distinguished on radiographs. When treated non-operatively, type A dislocations (19 per cent) may develop painful subluxation, type B (68 per cent) remain dislocated but retain sufficient muscle attachment to avoid fatigue on activity, and type C (12 per cent) leave a weak and unsightly shoulder. In type C dislocations, the clavicle is displaced 2 cm or more from the acromion on plain anteroposterior radiographs and the attached origin of the anterior deltoid is avulsed. Type C dislocations may benefit from early operative reconstruction.

Acromioclavicular Joint↗

PubMed2001

Dislocation after total hip arthroplasty: a single surgeon's experience.

The purpose of this article is to evaluate the dislocations that occurred in a single surgeon practice over a 26 year period. After extensive research, the authors concluded that dislocation continues to occur long after the initial arthroplasty procedure. Patients should be aware that more than a quarter of dislocations occur 2 years following surgery. Use of modular 22 millimeter components were associated with the highest dislocation rate. These components should be used very cautiously. Constrained liners have helped decrease the dislocation rate following revision for dislocation.

Aged↗

PubMed1986

Screening for congenital dislocation of the hip, scoliosis, and other abnormalities affecting the musculoskeletal system.

The three main conditions affecting the musculoskeletal system currently being screened for are spina bifida cystica, congenital dislocation of the hip, and scoliosis. The techniques of screening are different for each: amniotic fluid analysis for spina bifida cystica, a manual physical examination for congenital dislocation of the hip, and a visual examination for scoliosis. Properly time amniotic fluid analysis for alpha-fetoprotein is both a sensitive and specific test for neural tube defects. However, because of the low incidence of spina bifida cystica, this examination is justified only in high-risk pregnancies. Maternal serum screening has not achieved widespread acceptance because of its lack of sensitivity and the low and apparently falling incidence of the deformity. The neonatal manual examination for congenital dislocation of the hip is now well established and widely practiced. Almost all agree that the incidence of persistent congenital dislocation of the hip has been lowered as a result. However, the examination lacks both sensitivity and specificity because of intrinsic difficulties with the examination and the occurrence of late onset subluxation and dislocation. It is becoming apparent that congenital dislocation of the hip is a dynamic problem in the peri- and early neonatal period. Repeated careful evaluation of the hips during infancy is necessary to make the diagnosis as early as possible. To further enhance early detection, it may be necessary to consider obtaining an anteroposterior pelvis radiograph at age 4 to 6 months in babies at high risk. The visual evaluation for scoliosis is a very sensitive test but lacks specificity. Efforts are now being made to quantify visual screening techniques and thus decrease the numbers of false-positive examinations.

Adolescent↗

PubMed2004

[Progressive intra-acetabular dislocation of bipolar hip prostheses: four cases].

Certain complications, such as acetabular erosion or cup dissociation, are specific to bipolar prostheses. Progressive intra-acetabular dislocation has not been reported to date. We report 4 cases. Four elderly women developed progressive intra-acetabular dislocation after implantation of a bipolar prosthesis for femoral neck fractures. The metal-backed cup verticalized progressively and the ball gradually dislocated into the acetabulum, eroding it. Revision was undertaken with a hemispheric bone ingrowth cup and partial grafting. Follow-up was then uneventful. This phenomenon is different from the acute intra-acetabular dislocation that may occur after rupture of the anti-dissociation mechanism (polyethylene ring) incorporated in the design of new implant models, or after dissociation between the ball and the cup during closed reduction of a dislocation, the cup catching on the acetabular rim. It is not due to a variation in the neck-head angles (we observed varus, valgus, and neutral angles) nor to a problem between the modular head and the neck (at the morse cone taper). For us, the cause of this progressive intra-acetabular dislocation is poor cup design associated with a weak retention system. If the centers of the inner and outer spheres are superimposed, the cup has a natural tendency to drop into varus because of its weight. This becomes even worse if the center of the outer sphere is medial to the ball center. The cup should be designed so that the center of the outer sphere (bipolar cup) lies lateral to the center of the inner sphere (ball) creating a valgus torque for the cup. Designing a bipolar cup is not as a simple matter as it may seem. We emphasize the importance of the position of the rotation centers.

Acetabulum↗

PubMed2004

[Irreducible knee dislocation by medial capsulo-ligament incarceration].

PURPOSE OF THE STUDY: Irreducible dislocation of the knee is exceptional. Incarceration of the capsulo-ligamentary elements in the inter-condylar notch is a particular causal mechanism. We report four new cases and review the literature to describe the diagnostic and therapeutic approach. MATERIAL AND METHODS: Between January 2001 and January 2002, four patients underwent surgery after trauma (wind surf, ski accidents) producing an irreducible knee dislocation. Mean patient age was 53 years and mean follow-up was 16 months. The IKDC classification was used to assess outcome. RESULTS: Physical examination revealed characteristic signs: a groove facing the medial joint line with signs of cutaneous suffering just above and a fold line behind the medial condyle. Orthopedic reduction failed. Surgery was performed in all cases and revealed incarceration of the entire capsulo-ligamentary structure in the intercondylar notch with the medial condyle in an extra-articular position. After surgical reduction, healing was achieved in all cases without cutaneous necrosis. The mean subjective IKDC score was 53.9. DISCUSSION: Orthopedic reduction is impossible in about 4% of all cases of knee dislocation. Clinical signs are characteristic when the medial capsulo-ligamentary structures are incarcerated in the intercondylar notch; the anatomic injury is almost always the same. Vasculonervous complications are exceptional but an emergency arteriography should be obtained to rule out an infra-clinical intimal lesion. Cutaneous necrosis is a specific complication of irreducible dislocation. Early and complete reduction is required to prevent necrosis. Arthroscopic management raises the risk of compartment syndrome since peripheral lesions are not healed. Satisfactory functional recovery requires associated repair of the cruciate ligaments. CONCLUSION: This type of irreducible dislocation of the knee is a specific clinical entity. It usually results from postero-lateral rotation but may exceptionally occur after lateral dislocation. A groove associated with a fold line indicates the need for rapid surgical reduction to avoid the risk of cutaneous necrosis.

Adult↗

PubMed2004

[Capsular shift for voluntary dislocation of the shoulder: results in children].

PURPOSE OF THE STUDY: Chronic shoulder instability is uncommon in patients with an immature skeleton. Some of these pediatric patients can produce their dislocation voluntarily raising the question of the traumatic or constitutional nature of the condition as well as its direction and tolerance. We report our experience with 29 patients. MATERIAL AND METHOD: Over a period of 28 years, 29 children aged 5 to 15 years were treated for voluntary shoulder dislocation. The dislocation was painful and poorly tolerated in 19, affecting daily life and sports activities. Posterior dislocation was observed in 15 patients and anterior dislocation in 4, but the direction was not always easy to establish, particularly in children with ligament laxity; multiple directions were not uncommon. Rehabilitation for at least eight months did not relieve pain in 11 patients who had a sensation of a blocked, unreliable shoulder which could not be controlled voluntarily. Posterior capsulorrhaphy was performed in 8 patients and anterior capsulorrhaphy in 3. RESULTS: Mean follow-up was 8 years. At last follow-up, all shoulders were stable and shoulder motion was normal with no loss of function. More than half of the children had resumed sports activities. Capsulorrhaphy was proposed when the pre-operative explorations did not reveal any bone or rim anomaly. The only preoperative finding in the operated patients was increased capsule volume, particularly in the inferior portion. Intraoperatively, ulceration of the humeral cartilage was found in two patients. Anatomic reconstruction of the capsuloligamentary structures enabled recovery of passive stability and active stability of the scapulohumeral joint, preventing further voluntary dislocation.

Adolescent↗

PubMed2000

High-velocity knee dislocation with vascular injury. Treatment principles.

A high-velocity knee dislocation is a true orthopedic emergency. A high index of suspicion is necessary to identify reduced knee dislocations in multiple trauma patients. Coexisting injuries are common in patients with high-velocity knee dislocations. After an initial assessment, the knee joint should be reduced immediately and splinted. Popliteal artery injury is common in high-velocity dislocations. Arteriograms can be helpful but should not delay operative treatment of obvious arterial injuries. Early restoration of flow to the ischemic limb will avoid amputation in most patients. The orthopedic surgeon must consider a variety of approaches when treating a patient with this type of injury. A spanning external fixator is a useful method for temporary immobilization in knee dislocation patients who have open dislocations, arterial repairs, or closed head injuries. Early surgery to improve the functional stability of the knee must be balanced against the risk of major surgery in patients with severe lower extremity and systemic injuries. The long-term risk of knee stiffness versus instability must be considered. Selective, subacute, aggressive collateral ligament repair and bicruciate reconstruction with allografts offer the best chance for optimal outcome.

Angiography↗

PubMed1999

Complications of shoulder dislocation.

Dislocations of the shoulder are the most common joint dislocations seen in the emergency department, and complications of shoulder dislocations are more frequent than is generally believed. It is vital that emergency physicians have current knowledge of complications associated with shoulder dislocations because of their important role in recognition and prevention. Delayed recognition of complications can have an impact on the long-term outcome of patients. Prompt recognition and follow-up are essential. Most references address reduction methods rather than recognition of specific complications. Emergency physicians have few opportunities to update their knowledge of complications of shoulder dislocations. This article briefly reviews mechanisms of shoulder dislocation and discusses complications in light of the mechanisms of injury.

Biomechanical Phenomena↗