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We report a case of tarsal dislocation with cuneonavicular dislocation associated with calcaneocuboidal dislocation. This dislocation is rare and severe because it causes disruption of both the medial and lateral columns of the foot. Early and prompt reduction of this rare injury was successful in this case and appears important.
Evaluation of a dislocated shoulder must classify the direction of dislocation and describe additional injuries as well as the recurrence rate. This is required in all types of dislocations by recording the case history in detail, and by examining the shoulder clinically as well as radiographically in two planes. Ultrasound and arthro-computer tomography are valid methods to demonstrate injuries of bony and ligamentous structures. They may therefore influence surgical treatment. In posterior dislocation of the shoulder quite often early diagnosis is missed. If this injury is suspected, careful clinical and radiographical evaluation is most important.
The authors have analysed the results of the treatment of 131 patients with dislocations and dislocation fractures of C 3-7. The stabilization of the injured segment by posterior surgical approach with a fixative draw was performed in 64 cases of dislocations of the cervical vertebrae when the compression of the spinal cord and its roots was eliminated by the setting of the dislocation. Anterior compression of the dural sac and disturbances in the supportability of the spinal column was an indication for anterior decompression and corporodesis in 67 cases.
The most common injuries of the carpus are lunate and perilunate dislocations. The authors describe a complex dislocation of the carpus associated with fractures of the scaphoid, lunate, and styloid process of the radius. The pathogenesis of this dislocation is believed to be extreme hyperextension and radial deviation of the wrist. This mechanism can cause posterior dislocation of the carpus with fracture of scaphoid and lunate.
27 patients (28 cases), were treated for perilunate dislocations in 20 and fracture-dislocations in 8. Capitate displacement was dorsal in 27 cases and palmar in 1 case, and in 16, the scaphoid was fractured. There was no substantial delay of treatment. In 8 patients treated with closed reduction, follow-up averaged 6 (1-15) years. 19 patients (20 cases) who underwent early open reduction with K-wire stabilization and ligamentous repair, had an average follow-up of 2 (0.5-7) years. The clinical outcome was evaluated using a scoring system based on pain, occupation, ROM and grip strength, while the radiographic outcome was assessed according to findings of carpal instability, nonunion of scaphoid, and/or arthrotic changes. In patients treated with closed reduction, results were fair in 3 and poor in 5, while patients treated with early open reduction had a better clinical score with 4 excellent, 9 good, 3 fair and 4 poor results. These findings suggest that perilunate fracture-dislocations are too unstable to be treated with closed reduction. In addition, a combined approach was found effective in the management of dorsal perilunate dislocations. Finally, open reduction presupposes reparation of the torn scapholunate ligament, to obtain normal carpal kinematics.
Reports on late results in perilunate dislocations and fracture dislocations are rare. In a series of 22 male patients with perilunate dislocation or fracture dislocation, treated operatively between 1976 and 1987, 15 patients (68%) were investigated 12 years (8 to 19 years, median/range) postoperatively. The average range of motion of the injured wrist was decreased by one third in comparison with the uninjured wrist and posttraumatic arthrosis was observed in all patients radiologically. Additional dynamic or static scapholunate dissociation was found in 53% (n = 8) of the patients. In contrast, only four patients suffered from pain and 87% (n = 13) of the patients reported no subjective decrease in wrist function in daily activities. Occupational change was never necessary.
Two cases of inferior obturator dislocation complicating treatment of congenital hip dislocation with closed reduction are described. Abduction and hyperflexion appear to be predisposing factors in development of this complication. Application of skin traction before any attempt is made at reduction will lengthen contracted soft tissues and may convert the inferior dislocation to a more manageable position. Open reduction was necessary in both patients, and the results were considered good.
We describe two patients with an Essex-Lopresti fracture dislocation in association with a dislocation of the elbow. This combination of injuries has not been previously reported. The Essex-Lopresti fracture is a rare injury, and the associated distal radioulnar dislocation is often missed. Meticulous radiographic evaluation of the wrist, including dynamic stress radiographs of the forearm, can lead to an earlier diagnosis and improved care of these patients.
102 primary shoulder dislocations have been evaluated. Some were retained in a Velpeau bandage reinforced with plaster immediately after reposition for three weeks, others were treated with a sling or tube gauze only. The frequency of recurrent dislocation in both groups was compared. It could be demonstrated that the results were equal for both groups. We conclude that fixation with Velpeau Sling and cast reinforcement does not significantly influence the occurrence of recurrent dislocations.
Transtriquetral perihamate ulnar axial dislocation associated with palmar lunate dislocation is a rare condition. We could find no other similar cases reported. The mechanism of injury was a combined anteroposterior crushing force that caused axial disruption of the carpus and the metacarpals and wrist hyperextension that caused the transtriquetral lunate dislocation. Our patient was treated with open reduction and internal fixation with good result.
This prospective study evaluated outcomes of closed reduction (CR) in non-displaced, non-dislocated condyle and subcondylar fractures (Class I) and open reduction and internal fixation (ORIF) of displaced (Class II) and dislocated (Class IV) fractures. Forty-five patients with 51 fractures (six (13%) with bilateral fractures), 11 (25%) CR and 34 (75%) ORIF, were enrolled in a 1-year follow up that 20 patients with 25 fractures completed. Condylar translation in Class I fractures recovered to 12mm for vertical opening, 9mm for protrusion, 8mm for mediotrusion; in Class II, respectively, 10, 7 and 9mm; and Class IV, respectively, 8, 7 and 7mm. Incisal movements recovered to 46, 8 and 9mm in Class I; 44, 7 and 9mm in Class II; and 43, 5 and 7mm in Class IV. Vertical and angular fragment reduction versus the non-fractured condyle was +0.3 to -1.9mm, +1.1 degrees to +1.8 degrees in Class I; -2.2 to -1.9mm, +0.6 degrees to -1.2 degrees in Class II; +2.9 to -1.1mm, +18.4 degrees to +6 degrees in Class IV. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. All complications subsided after 6 months; translation and incisal movements returned to within the normal range in proportion to the severity of displacement and dislocation. Vertical opening translation in Class IV fractures remained short-to-normal and was compensated by rotation. Unacceptable clinical function according to predefined standards was not found after 1 year. Angular reposition was better than vertical reduction. This study documents successful evidence-based treatment according to predefined criteria.
PURPOSE: To review the results of surgical reconstruction of posttraumatic elbow instability in the setting of either intact or repaired olecranon process using a protocol incorporating hinged elbow fixation. METHODS: Thirteen consecutive patients with ulnohumeral instability after a fracture-dislocation of the elbow, adequate articular surfaces, and adequate, stable alignment of the olecranon were treated with temporary hinged external fixation, preservation, or reconstruction of both the coronoid process and radiocapitellar contact and with repair or reconstruction of the lateral collateral ligament complex. There were 9 men and 4 women with an average age of 45 years. Seven patients had a terrible triad pattern injury and 6 had a posterior Monteggia pattern injury. All 13 patients had fracture of the radial head and 10 patients had fracture of the coronoid process. RESULTS: At an average follow-up period of 57 months stability was restored in every patient. The average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 and the average Mayo score was 84, with 6 excellent, 4 good, and 3 fair results. The average arc of ulnohumeral motion was 99 degrees. Six patients had radiographic signs of arthrosis including 5 of 6 patients with olecranon fracture-dislocations. CONCLUSIONS: A stable, functional elbow can be restored in most patients with persistent instability after fracture-dislocation of the elbow using a treatment protocol incorporating hinged external fixation.
The authors report a case of an irreducible dorsal dislocation of the first metatarsophalangeal joint, with concomitant Lisfranc dislocation and fractures of the second, third, and fourth metatarsals. This combination has been reported only once in the literature. This extremely rare combined injury results in a floating metatarsal. Open reduction of the metatarsophalangeal joint dislocation and fixation of Lisfranc joint and metatarsal fractures with Kirschner wires was performed. One year after surgery, the patient is active and the first metatarsophalangeal joint is asymptomatic, but there is mild pain in the Lisfranc joint.
The authors report a case of combined dorsal fracture-dislocations of all 4 fingers, palmar trapezo-metacarpal dislocation and metacarpophalangeal dislocation of the thumb following a motorbike accident. These exceptional lesions were treated as an emergency by reduction and pinning. With a follow-up of 13 years, the patient still worked as an electrician.
A new term called "femoral head anteposition" to describe the clinical appearance of a hip operated on because of CDH and suspected of anterior dislocation, has been introduced. CT scans of both the horizontal and sagittal planes of 22 hips suspected of iatrogenic anterior dislocation were made from 22 children. These had been operated on because of CDH by the open reduction method with derotation varus osteotomy of the femur and transiliac osteotomy by Dega. An evaluation of the CT scans combined with clinical examination allowed the differentiation of the homogeneous clinical appearance from the "anteposition". It was then possible to establish one or several coexisting reasons to the situation. These were: anterior dislocation of the hip, coxa magna after avascular necrosis, gluteal muscle fibrosis or periarticular ossifications.
Attention is brought to a unique case of an anterior dislocation of the proximal tibiofibular joint detected 1 month following closed reduction of a posterior knee dislocation. Open reduction and internal fixation were necessary to achieve a stable proximal tibiofibular joint. Additional attention should be paid to the proximal tibiofibular joint when evaluating acute or chronic knee dislocation.
In order to prevent permanent disability, a proper diagnosis of the fixed posterior fracture dislocation of the fibula with fracture dislocation of the ankle joint must be made. Full-length (knee to ankle) radiographs are necessary to make this diagnosis. Although a closed reduction has been described as successful, we feel that an open reduction is usually necessary. Freeing of the trapped fibula from behind the tibia results in a satisfactory reduction of this fracture dislocation. The reduction and fixation of the malleolar fragment is then simple, and an excellent result can be expected.
BACKGROUND: We report the outcomes of patients treated with a new arthroscopic treatment modality for knee dislocation after high-velocity trauma. METHODS: Twenty-three patients (12 men, 11 women; 25 knees) with traumatic knee dislocation were treated with this technique. Under arthroscopy with gravity inflow irrigation, the ruptured posterior cruciate ligament was reconstructed with a patellar bone-tendon-bone graft, and the anterior cruciate ligament was debrided subacutely. The collateral ligament, meniscus, and capsules were repaired through additional incisions. RESULTS: The average interval between injury and surgery was 11.1+/-5 days (range, 5 to 25 days). After a mean follow-up period of 27.2+/-7.86 months, the mean extension was 1+/-2 degrees and the average flexion was 129.6+/-4.91 degrees. The mean Lysholm score was 84. There were no major complications. CONCLUSION: Arthroscopic posterior cruciate ligament reconstruction seems to be an effective treatment for traumatic knee dislocation.