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PubMed2000

A review of the treatment of hip dislocations associated with acetabular fractures.

Traumatic dislocation of the hip is an extremely severe injury. Although previously considered an uncommon lesion, it now is seen more often as a result of motor vehicle accidents. In most cases, dislocation of the hip is associated with fractures of the acetabulum, which ultimately can result in a higher incidence of complications than the complications observed in pure simple dislocations. Early recognition and prompt closed reduction of the dislocated hip constitute the cornerstone of proper treatment of this injury. Once the dislocation is reduced, definitive treatment of the acetabular fracture can be delayed to obtain a precise diagnostic evaluation. If surgical reconstruction of the acetabular fracture is indicated, it is done best in the first 10 days after the injury. A few patients in whom nonconcentric reduction, failed closed reduction, or impaired neurologic status occurs after reduction will require early open reduction and internal fixation of the fracture. Complications can be caused by the initial injury or by the treatment. Avascular necrosis of the femoral head, degenerative osteoarthritis, and heterotopic ossification are the main complications encountered in patients with unsatisfactory final results. Despite a perfect reduction of the hip dislocation and anatomic reduction of the acetabular fracture, a significant degenerative process of the hip is expected when the patient is assessed at long-term followup.

Acetabulum↗
PubMed1990

Acetabular depression fracture accompanying posterior fracture dislocation of the hip.

The acetabular depression fracture is defined as a rotated, impacted, osteocartilaginous fragment of the posteromedial acetabulum that occurs in conjunction with a posterior fracture dislocation of the hip. Displacement of this fracture fragment creates incongruity of the posterior acetabular articular surface and the potential for hip joint instability. A retrospective review of hip dislocations over a 3-year period disclosed 75 posterior fracture dislocations of the hip. A total of 71 hips had computerized tomography (CT) scanning after successful closed reduction of the dislocation. Of the 75 dislocations, 58 were treated with open reduction and internal fixation for reproducible posterior subluxation or redislocation upon clinical examination, non-concentric closed reduction, and/or unacceptable articular fracture displacement. The acetabular depression fracture was identified in 17 cases (23%). A total of 16 were found on preoperative CT scans, and one was discovered at the time of open reduction. Preoperatively, each of these injuries demonstrated posterior instability with hip flexion less than 90 degrees. Treatment consisted of disimpaction of the fragment with elevation to the level of the concentrically reduced femoral head. The fragment was stabilized with packed cancellous bone graft obtained from the greater trochanter. The separate posterior lip fragment was then reduced and internally stabilized to ensure reduction of the acetabular depression fragment. We conclude that this variant of the posterior fracture dislocation of the hip occurs in a significant percentage of these injuries. Preoperative recognition of this fracture may correlate with posterior hip instability, and its presence may be an indication for open reduction and internal fixation of the fracture. Long-term studies of this lesion are still needed.

Acetabulum↗
PubMedDate not supplied

Fracture of the radial head with associated elbow dislocation: results of treatment using a floating radial head prosthesis.

OBJECTIVES: To assess elbow function, complications, and problems of radial head fractures associated with elbow dislocation receiving surgical treatment with a floating prosthesis. DESIGN: Prospective clinical study. SETTING: University Hospital, Orthopaedic Department, Sart Tilman, Liège, Belgium. PATIENTS: Eleven consecutive adult patients were treated with a floating prosthesis for acute radial head fractures associated with elbow dislocation from January 1994 to September 1996. INTERVENTION: The floating radial head prosthesis (Tornier SA, Saint-Ismier, France) was used in all our patients. The implant is in two parts: a radial head made of high-density polyethylene enclosed in a cobalt-chrome cup, which articulates in a semiconstrained manner with the spherical end of a cemented intramedullary stem. The implants were inserted within the first week following the injury (range 2 to 7 days). Three cases also required internal fixation of the coronoid process of the ulna; in one case plate fixation of an olecranon fracture was also performed. MAIN OUTCOME MEASUREMENTS: Patients were assessed by physical examination, a functional rating index (Morrey et al.), and radiographs. The parameters evaluated were motion, stability, pain, and grip strength. Potential complications such as infection, prosthetic failure, or dislocation were investigated. RESULTS: The minimum follow-up time was two years (mean 32 months, range 24 to 56 months). Four patients were considered to have excellent results, four patients were considered to have good results, two patients had fair results, and one patient had a poor result. There were no cases of infection, prosthetic failure, or dislocation. No patient required prosthetic revision. CONCLUSION: The basic principle of maintaining anatomic and physiologic relationships applies when deciding on treatment for radial head fractures with associated elbow dislocation. The loss of lateral osseous support will render the elbow grossly unstable. We believe that a floating prosthesis may be indicated in Mason Type III radial head fractures associated with elbow dislocation, especially in the presence of associated destabilizing fractures. Well-controlled comparative randomized studies will be needed to delineate the optimal treatment for a given situation.

Adult↗
PubMed2001

Isolated dislocation of the second metacarpal at both ends.

A dislocation of the second metacarpal at both ends is reported herein for the first time. Six weeks after injuring her right hand in a fall while climbing stairs, a 34-year-old woman visited our clinic with pain, swelling, and deformity of her hand. The radiographs showed a volar dislocation of the head and a dorsal dislocation of the base of the second metacarpal. The probable mechanism of injury was the hyperextension at the metacarpophalangeal joint; this force dislocated the metacarpal head toward the volar plate. Force then further continued along the second metacarpal shaft in the hyperflexed wrist, thus dislocating the base dorsally. We performed an open reduction and K-wire fixation of the second metacarpophalangeal joint and an arthrodesis of the second carpometacarpal joint. At the six-month follow-up, the patient had restricted flexion (0 to 50 degrees) at the second metacarpophalangeal joint, but full range of motion at the interphalangeal joints. The grip strength on the right side was 70% of that measured in the uninvolved hand. Key Words: Dislocation, Second metacarpal.

Accidental Falls↗
PubMed1993

Complete dislocation of the knee without disruption of both cruciate ligaments.

Complete dislocation of the knee is recognized to be an extremely severe injury, representing one of the few true orthopedic emergencies. There is major trauma to the ligaments, capsule, and tendons, with a high incidence of associated damage to the popliteal artery and peroneal nerve. Resulting disability can be great, reflected by pain, stiffness, or instability of the knee; neurologic deficits in the foot and ankle; and even amputation if the vascular injury is not addressed promptly. Most accounts of knee dislocations in the literature have suggested that disruption of both cruciate ligaments is necessary for a complete dislocation to occur. This consensus is based on clinical observations and some laboratory investigations of ligament failure patterns. This report presents four cases of complete tibiofemoral knee dislocation without disruption of both cruciate ligaments. We also review the literature on knee dislocations with an emphasis on the biomechanics of soft tissue restraints about the knee and analyze how sufficient laxity can occur, with one cruciate ligament remaining intact, to allow for complete knee dislocation.

Adolescent↗
PubMed2001

Traumatic posterior dislocation of hip in children.

Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury.

Adolescent↗
PubMed1999

Bisegmental rotational fracture dislocation of the pediatric cervical spine. A case report.

STUDY DESIGN: A case of a bisegmental rotational fracture dislocation in the pediatric cervical spine is presented. OBJECTIVES: To highlight the problems in the diagnostics and surgical management of this rare type of injury. SUMMARY OF BACKGROUND DATA: Fractures of the cervical spine are relatively uncommon in childhood. To the authors' knowledge, this is the first reported case of a bisegmental rotational fracture dislocation in the pediatric cervical spine managed by a combined anteroposterior approach. METHODS: A 6-year-old girl was hit by a car as a pedestrian. In addition to an open fracture dislocation of the Lisfranc joint in the right foot, she sustained a bisegmental fracture dislocation at the lower cervical spine (C3-C5) with no neurologic deficit. The complete diagnosis of a locked rotational fracture dislocation could be established only by using computed tomography scans with three-dimensional reconstructions. The injury was managed with a combined anteroposterior open reduction and a bisegmental anterior fusion. RESULTS: Implant removal was performed after bony fusion 6 months after surgery. At follow-up assessment 2.5 years later, the girl had a good radiologic result and a full and pain-free functional recovery. CONCLUSIONS: Bisegmental rotational fracture dislocations in pediatric cervical spines are not easily diagnosed and may require three-dimensional computed tomography scan reconstructions for complete assessment. In such rare cases, a combined anteroposterior surgical procedure may be indicated, with a bisegmental anterior fusion providing a good functional result.

Bone Plates↗
PubMed2003

Prenatal sonographic diagnosis of the congenital dislocated spine: a case report.

STUDY DESIGN: A case of congenital dislocated spine diagnosed by prenatal sonography is reported. OBJECTIVES: To report the first documented case of prenatal diagnosis, to point out the characteristic features of prenatal sonography of congenital dislocation of the spine, and to show the results of a careful management of birth in cases of congenital dislocated spine. SUMMARY OF BACKGROUND DATA: The congenital dislocated spine consists of an anterior defect in formation of the vertebrae with a displaced vertebra and angulation of the neural canal. Instability and the consequent possibility of neurologic damage are the major features of this rare entity. Early intervention is essential to prevent an irreparable neurologic deficit. METHODS: Pre- and postnatal imaging was reviewed. Early postnatal treatment is described. RESULTS: Prenatal diagnosis of the congenital dislocated spine can be detected with sonography and confirmed by radiography and magnetic resonance imaging. CONCLUSIONS: Prenatal diagnosis of the congenital dislocated spine is of the utmost importance for parental counseling and obstetrical management.

Female↗
PubMed2004

Traumatic patellar dislocation in children and adolescents: treatment update and literature review.

PURPOSE OF REVIEW: Traumatic patellar dislocation in children and adolescents is a complex problem resulting from a range of anatomic and mechanical conditions. A careful review of the literature demonstrates certain risk factors that predispose children to recurrent dislocation. With this understanding, these conditions can be managed more aggressively in the hope of an improved outcome. Additionally, a vast number of surgical procedures to correct patellar instability have been described, and recent cadaveric studies are now guiding surgical interventions. RECENT FINDINGS: Risk factors for recurrent dislocation may include various skeletal abnormalities, increased quadriceps angle, generalized ligamentous laxity, and family history. Recent anatomic and biomechanical studies have demonstrated that the medial patellofemoral ligament and the vastus medialis obliquus are the primary restraints to lateral translation and ultimately dislocation of the patella. Management should therefore be directed both at correcting anatomic abnormalities when indicated and at reconstruction of medial restraints to patellar tracking. SUMMARY: The recommendation for management of a traumatic patellar dislocation in a skeletally immature patient is initially conservative, emphasizing early motion and quadriceps strengthening. However, in patients for whom conservative management has failed or who are at particularly high risk for dislocation and require surgical intervention, repair or reconstruction of the medial patellofemoral ligament is the treatment of choice. Recent works have included investigation of less invasive techniques in children.

Adolescent↗
PubMed2004

Prevention and treatment of dislocation after total hip replacement using large diameter balls.

The purpose of this study was to review safety and efficacy of total hip arthroplasty using large-diameter femoral heads in treatment and prevention of dislocation. One hundred forty hips in 135 patients were replaced using femoral heads at least 36 mm in diameter. The average age of the patients was 61.6 years. The patients were grouped into three categories depending on their diagnoses: recurrent dislocations from previous total hip replacements (Group 1; 29 hips); revision surgeries not including revisions for dislocations (Group 2; 54 hips); and primary surgeries (Group 3; 57 hips). The average followup was 5.5 years (range, 1-17 years). A total of 16 hips were revised: six for instability, four for fracture or disassociation of a conventional polyethylene liner, three for aseptic loosening of the socket, and three for sepsis. One hip from Group 1 dislocated at 12.5 years postoperatively, was treated with closed reduction, and since has been nonrecurring. UCLA hip scores all improved significantly. The prevalence of dislocation varied among the three groups, with 13.7% for Group 1, 1.8% for Group 2, and 3.5% for Group 3. The failure in the six cases that required revision for instability was attributable to poor socket orientation. All the hips became stable after revision without the use of a constrained acetabular liner. Large-diameter femoral heads provide additional stability not only for patients with recurrent dislocations, but also for patients having revision. The new, more wear-resistant bearings now enable the surgeon to extend the use of big femoral heads to primary total hip arthroplasty. Metal-on-metal seems to be the material of choice for a bone-conserving reconstruction with large femoral heads.

Adolescent↗
PubMed2005

Dislocation of primary THA done through a posterolateral approach in the elderly.

UNLABELLED: We assess the rate of dislocation of total hip arthroplasty (THA) through a posterolateral approach in elderly patients and determine if this complication can be minimized. We retrospectively reviewed 150 THAs done between 1992 and 2002, through a posterolateral approach in patients 80 years and older. A hybrid THA was done in 46% of patients and both components were cemented in 54% of patients. A 28-mm head was used in 83% of the patients and a 32-mm head was used in 17% of patients. An elevated liner, with the elevation placed posteriorly, was used in 38% of hybrid cases. Starting in mid-1998, the posterior capsule was preserved and repaired at the time of wound closure (n = 77, 51%). Dislocation occurred in eight hips (five recurrent) at an average time to dislocation of 26.9 months (range, 1-79 months). No dislocations occurred when using a 32-mm head or a 28-mm head with a lipped liner in association with repair of the posterior capsule. Statistical regression analysis indicated that capsular repair was the single most important predictive factor for dislocation. When using the posterolateral approach for THA in patients older than 80 years, we suggest using a 32-mm head in combination with posterior capsular repair to reduce the incidence of dislocation. LEVEL OF EVIDENCE: Therapeutic study, Level III-1 (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Aged, 80 and over↗
PubMed2005

Atlanto-occipital dislocation with traumatic pseudomeningocele formation and post-traumatic syringomyelia.

STUDY DESIGN: A case report of traumatic atlanto-occipital dislocation complicated by the development of anterior and posterolateral pseudomeningoceles and the late development of syringohydromyelia is presented. OBJECTIVE: To describe a unique post-traumatic and postsurgical course following atlanto-occipital dislocation. SUMMARY OF BACKGROUND DATA: Syringomyelia is a significant potential long-term complication in patients recovering from traumatic atlanto-occipital dislocation. Cord enlargement and increased T2 signal can be a marker of abnormal cerebrospinal fluid flow dynamics. This "presyrinx state" can be seen before clinical evidence of neurologic compromise. Pseudomeningocele formation after atlanto-occipital dislocation is rare, with only 3 reported cases. To our knowledge, all reported cases describe retropharyngeal pseudomeningoceles, and posterolateral pseudomeningocele as seen in this case has not previously been described. METHODS: A single case is reported with an emphasis on the imaging findings related to the patient's subsequent neurologic deterioration. RESULTS: Following a pedestrian-motor vehicle collision, the patient received initial evaluation and treatment at a local foreign medical facility, where his cervical spine was cleared. Several days following stabilizing treatment and surgery, the patient was transferred to a foreign-based United States military medical facility and ultimately to our institution, where magnetic resonance imaging demonstrated occipitocervical dissociation. The patient was taken to the operating room for surgical stabilization. Four months after his index operation, the patient underwent halo removal. Follow-up magnetic resonance imaging revealed thickening of the cervical spinal cord in conjunction with diffuse high cord T2 signal and a small low cervical segment of syringomyelia. The patient was observed with follow-up magnetic resonance imaging obtained after 1 month. At this time, the low cervical syrinx had enlarged slightly, a small thoracic syrinx was observed, and cine imaging of cerebrospinal fluid flow demonstrated obstruction at the level of the foramen magnum. The patient was taken to the operating room fordecompression of the foramen magnum and posterior fossa and duraplasty. One month later, the patient's clinical condition began to deteriorate, and repeat imaging showed continued enlargement of the patient's syrinx and hydrocephalus. He was admitted for an urgent shunt procedure but unfortunately sustained cardiorespiratory arrest while on the ward awaiting surgery. CONCLUSIONS: Atlanto-occipital dislocation is rarely survivable, and delayed diagnosis can negatively affect long-term clinical outcome. This case illustrates how, despite early signs of improvement, post-traumatic syringomyelia may occur months or even years after spinal trauma and should always be considered in patients who experience late neurologic deterioration after atlanto-occipital dislocation.

Accidents, Traffic↗
PubMed2006

Traumatic atlanto-occipital dislocation with atlantoaxial subluxation.

STUDY DESIGN: This is a case report of a patient who survived traumatic atlanto-occipital dislocation with atlantoaxial subluxation. OBJECTIVE: To describe the useful points of 3-dimensional computerized tomography (CT) and magnetic resonance imaging (MRI) for an evaluation of atlanto-occipital dislocation. SUMMARY OF BACKGROUND DATA: Atlanto-occipital dislocation is a severe ligamentous injury that usually results in either a fatal outcome or severe neurologic deficit. To our knowledge, no patient who has survived atlanto-occipital dislocation with atlantoaxial subluxation has yet been reported. METHODS: Three-dimensional CT was performed to confirm the diagnosis of atlanto-occipital dislocation and precisely evaluate the magnitude of displacement. MRI clearly showed a disruption of the ligamentous structures, which play a role as the primary stabilizers of the cranium on the cervical spine. RESULTS: As soon as the patient's general condition improved, the posterior spinal fusion with internal fixation was performed to maintain the stability of cervical spine. A significant degree of motor function was regained within 2 years after injury. CONCLUSIONS: In this case, the diagnosis was accurately confirmed, and the cervical spine was evaluated in detail using both 3-dimensional CT and MRI as a reliable examination for atlanto-occipital dislocation.

Adult↗
PubMed2007

A safe and effective way for reduction of temporomandibular joint dislocation.

Anterior dislocation of the temporomandibular joint (TMJ) is a common problem which demands immediate reduction to relieve the discomfort. The most popular technique is to put the operator's thumbs over the molar teeth of the patient and push the dislocated jaw downward and backward. This maneuver takes a lot of effort and usually needs sedation. Failure to reduction is not uncommon. Furthermore, the physician has to take the risk of being bitten and disease transmission. A novel method for reduction of the dislocated TMJ via extraoral route is presented, based on the observation that once the mandible is dislocated anteriorly, the coronoid process and anterior border of the ramus can be palpated easily over the cheek. By applying steady pressure over this prominent part, the anteriorly dislocated mandible can be reduced easily. From May 2000 to July 2005, there were 7 anterior mandible dislocations treated successfully by this method in Chang Gung Memorial Hospital. None of the patients need any adjuvant medication for sedation or relaxation. This technique is simple and effective, and the physicians are spared from the risk of bite trauma and unexpected disease transmission.

Adolescent↗
PubMedDate not supplied

Hip dislocation in spastic cerebral palsy: long-term consequences.

We evaluated 38 noninstitutionalized patients with spastic quadriplegic cerebral palsy with 51 dislocated hips. Nine hips had been reduced. The mean follow-up was 18 years, with an average age of 26 years. At follow-up, four were ambulatory with aids. Patients who could walk had normal intelligence and a level pelvis. In patients with 18 unreduced unilateral hip dislocations, pelvic obliquity and scoliosis were present in 12. In seven patients with reduced unilateral hip dislocations, similar findings were present in only two patients. Half of the dislocated hips were painful. Based on these findings, we recommend reduction of unilateral dislocations. Bilateral dislocations may benefit from reduction if treatment is undertaken before significant adaptive deformity of the femoral head occurs.

Adult↗
PubMedDate not supplied

Late developmental dislocation of the hip after initial normal evaluation: a report of five cases.

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathologies ranging from hip instability to frank dislocation. The current understanding is that cases of late diagnosis were missed during the newborn period. However, there is some evidence that a number of hip subluxations or dislocations may have been clinically stable in the neonatal period, but dislocate late. We present 5 cases of otherwise healthy children with normal physical examinations and hip radiographs in the first 3 months of life who later developed hip dislocations. Four of the 5 cases required surgical open reduction. In light of these cases and others in the literature, normal neonatal screening for DDH does not assure that continued normal development of the hip joint will happen. Our study confirms the existence of another entity in the wide spectrum of DDH: the late hip dislocation. Therefore, hip evaluations should be continued beyond the neonatal period until the child begins to walk. Parents should be informed that hip dislocation can occur in a late form, and they should be encouraged to take their children for repeated evaluations even if the neonatal screening is normal.

Age Factors↗
PubMed2006

Chondrocyte apoptosis in response to dislocation of the hip in the rat model.

BACKGROUND: Joint dislocation is a traumatic event that can lead to osteoarthritis. The purpose of this paper is to study cartilage changes following prolonged joint dislocation for 1, 2 or 8 h. METHODS: Sprague-Dawley rats (n = 27) were used in this study. Surgical dislocation of the hip under anaesthesia was carried out on the animals. The joints remained dislocated for 1, 2 or 8 h. The joints were subsequently harvested and terminal deoxnucleotidyl transferase-mediated dUTP nick-end labelling testing was carried out to show chondrocyte apoptosis in the femoral head and acetabulum. Using this test, the apoptotic index, which is the proportion of apoptotic chondrocytes to total number of chondrocytes, was calculated. A comparison of apoptotic indices was made among the three groups. RESULTS: The mean apoptotic indices for the femoral head for the 1-, 2- and 8-h groups were 0.065 +/- 0.025, 0.162 +/- 0.031 and 0.201 +/- 0.030, respectively. There was a significant difference (P < 0.05) in the mean apoptotic indices between each of the three groups. For the acetabulum, the mean apoptotic indices were 0.046 +/- 0.012, 0.051 +/- 0.023 and 0.057 +/- 0.031 for the 1-, 2- and 8-h groups, respectively. There was no significant difference (P > 0.05) between each of the three groups. CONCLUSIONS: Dislocation of a joint causes chondrocyte apoptosis. There is a progressive increase in the apoptotic index with prolonged dislocation of the rat hip.

Acetabulum↗
PubMed2006

Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation.

BACKGROUND: Bankart lesions and Hill-Sachs lesions are commonly associated with anterior shoulder dislocations. The presence of Bankart lesion indicates the need for surgical repair. Magnetic resonance imaging (MRI) has been shown to be sensitive in detecting these two lesions. The aim of this study is to investigate the correlation between Bankart lesions and Hill-Sachs lesions on MRI for patients with traumatic anterior shoulder dislocations. METHODS: Between 2003 and 2005, 61 patients from Alfred and Sandringham Hospitals had an MRI as part of the investigation for traumatic anterior shoulder dislocations. The MRI scans were reviewed and subsequently confirmed by a radiologist to show the presence or absence of Bankart and Hill-Sachs lesions. The data were then analysed by a statistician. RESULTS: Although patients with one of these lesions were more than two-and-a-half times as likely to have the other, small study numbers precluded this result from achieving statistical significance. (odds ratio, 2.67 (0.83-8.61), P = 0.10). Younger age was a strong predictor of a recurrence of shoulder dislocation (odds ratio, 0.93 (0.89-0.98), P = 0.005). The presence of Bankart or Hill-Sachs lesions on MRI for the primary shoulder dislocation group was similar to the recurrent group (73% vs. 72% for Bankart lesion and 67% vs. 70% for Hill-Sachs lesion). CONCLUSION: There is a strong correlation between both lesions. This apparent trend can be useful in predicting the presence of a Bankart lesion when a Hill-Sachs lesion is identified on a plain radiograph. This study suggests the consideration of surgical repair after identification of a Hill-Sachs lesion on plain radiographs, especially for younger patients where the rate of re-dislocation is high.

Adolescent↗