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PubMed1995

Surgery in acute patellar dislocation--evaluation of the effect of injury mechanism and family occurrence on the outcome of treatment.

A retrospective study was made of 270 patients and 284 knees with acute patellar dislocation treated operatively. The mean follow up time was 4.1 years. Medical history revealed 21.1% of cases with previous dislocations and 15.6% of cases with family occurrence of patellar dislocation. The dislocation resulted from an athletic performance in 41.5% of cases. The sport events most often associated with patellar dislocation were soccer, gymnastics, and ice hockey. All cases were treated with reefing of medial capsule. Release of lateral patellar retinacula was performed in 243 cases. Two cases were treated primarily with the Elmslie-Roux-Trillat procedure. The subjective result of operative treatment was better and the redislocation rate was lower if the injury mechanism was traumatic rather than non-traumatic and if there was no history for family occurrence of patellar dislocation.

Acute Disease↗
PubMed2005

Scapular manipulation technique for reduction of traumatic anterior shoulder dislocations: experiences of an academic emergency department.

BACKGROUND: Shoulder dislocations account for almost 50% of all joint dislocations, which are most commonly anterior (90-98%) and occur due to trauma. This prospective study was conducted to report our experiences of using the scapular manipulation technique (SMT) to reduce traumatic anterior shoulder dislocations. METHODS: Between March 2002 and March 2003, SMT was applied to 41 patients who presented with traumatic anterior shoulder dislocation to the Gulhane Military Medical Academy, Department of Emergency Medicine, Ankara, Turkey, which is a level 1 trauma centre with an annual attendance of 85,000 patients. The technique was applied to patients in the prone position by a single operator. Where necessary, a procedural sedation/analgesia (PSA) protocol was followed. RESULTS: The study population consisted of 26 (63.4%) male patients aged between 17 and 76 years (SD 15.6). History of recurrent shoulder dislocations at the same site were taken from seven (17.1%) of the patients. Mean (SD) trauma to reduction time was approximately 61.5 (72) minutes (range 10-480). Five patients (12%) had a greater tuberosity fracture. SMT was attempted twice to only four (9.8%) patients by a standard PSA protocol. We experienced a success rate of 90.2% at the first attempt and 100% overall. None of the patients encountered any complication. CONCLUSIONS: We report the successful use of SMT in the prone position for the reduction of traumatic anterior shoulder dislocations, mainly without requirement of any sedatives or opiate analgesics. We believe that SMT may also be applied by inexperienced physicians, as it is simple, applicable, and easily understood. As no single method has a 100% success rate, SMT is a useful one to know.

Adolescent↗
PubMedDate not supplied

A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations.

BACKGROUND: Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations. HYPOTHESIS: Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute, traumatic shoulder dislocations in young athletes. Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program. Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients. The average follow-up was 36 months. RESULTS: Three patients were lost to follow-up. Twelve nonoperatively treated patients remained for follow-up. Nine of these (75%) developed recurrent instability. Six of the nine have required subsequent open Bankart repair for recurrent instability. Of the nine operatively treated patients available for follow-up, only one (11.1%) developed recurrent instability. CONCLUSIONS: Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional, nonoperative treatment.

Accidental Falls↗
PubMed2006

Quantitative assessment of glenohumeral translation after anterior shoulder dislocation and subsequent arthroscopic bankart repair.

BACKGROUND: During the past decade, developments in arthroscopic technology have made arthroscopic repair of labral lesions feasible. However, results with the use of the transglenoid suture technique, or with the use of bioabsorbable tacks, have remained variable in the literature, and the recurrence rates are still inferior to those of open Bankart repair. HYPOTHESIS: Arthroscopic Bankart repair with suture anchors can re-create translational and rotational range of motion of the intact glenohumeral joint, and the number of preoperative dislocations has an influence on the result. STUDY DESIGN: Controlled laboratory study. MATERIALS: Twelve cadaveric shoulders were tested in a robot-assisted shoulder simulator. Anterior and posterior translation and external rotation were measured for intact, dislocated (shoulders were randomly selected to 1 of 3 groups, which were dislocated 1, 3, or 7 times), and repaired conditions at 0 degrees and 90 degrees of glenohumeral elevation. RESULTS: After shoulder dislocation, a significant increase was found in translation and rotation, confirming the creation of a traumatic shoulder instability model. Further testing of the specimen revealed that translational and rotational ranges of motion were reduced by arthroscopic Bankart repair at both testing positions. External rotation was decreased significantly at 0 degrees and 90 degrees of abduction. No significant differences were found between the 3 dislocation groups. CONCLUSION: The results demonstrate a sufficient biomechanical performance of arthroscopic Bankart repair using suture anchors in a traumatic anterior shoulder instability model. With the numbers available, no relationship was found between the number of dislocations and the postoperative result concerning translational or rotational motion. CLINICAL RELEVANCE: Glenohumeral translation and rotation after arthroscopic Bankart repair with use of suture anchors approached near normal values, confirming the clinical success of this technique.

Aged↗
PubMed2004

Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography.

BACKGROUND: We assessed acute phase multidetector computed tomography (MDCT) findings of Lisfranc fracture-dislocations in patients with multiple trauma referred to a Level I trauma center over a 29-month period. METHODS: Two hundred and eighty two patients (208 male and 74 female) between the ages of 13 and 89 (mean 42) years had, at the request of emergency room physicians, MDCT of the foot and ankle after acute injury. RESULTS: A total of 21 Lisfranc fracture-dislocations were found in 19 (7%) patients. Two main injury mechanisms were established: falling from high places in 10 injuries (48%) and traffic accidents in five (24%). Primary radiographs were available in 17 (81%) feet, and four (24%) had false negative radiographic results when compared to MDCT. In all Lisfranc fracture-dislocations MDCT showed the joint anatomy and the extent of dislocation better than primary radiographs, and in six (46%) of 13 true positive primary radiographs, MDCT revealed additional occult fractures in the Lisfranc joint. Multidetector CT revealed additional occult fractures in other parts of the foot and ankle in six (35%) of 17 feet. CONCLUSIONS: Standard radiography remains a primary diagnostic modality in acute foot and ankle trauma. Multidetector CT with high-quality multiplanar reconstruction (MPR) is recommended as a complementary examination in high-energy injury in patients with multiple trauma or in patients in whom radiographic images are equivocal. This may reveal Lisfranc fracture-dislocations, show the extent of the fracture-dislocation, and reveal occult fractures in other parts of the foot and ankle.

Acute Disease↗
PubMed1991

Ultrasonography in congenital dislocation of the hip. Simultaneous imaging of both hips from in front.

We describe a new technique for examining the infant hip using ultrasound. Both hips are imaged simultaneously via an anterior approach. The examination can be done with the hip either extended or flexed and abducted. The method has three advantages: 1) since both hips are imaged simultaneously, lines can be drawn to assist in determining the relationship between the femoral head and the pelvis; 2) proximal, anteroposterior and lateral displacement of the femoral head can all be demonstrated; 3) the method is applicable to the infant in a harness or a plaster cast to demonstrate maintenance of reduction of a dislocated hip. The usual direction of dislocation of the femoral head was anterior and lateral. Proximal migration was also observed in cases with more severe dislocation. In flexion, the dislocated head of the femur often moved posterior to the acetabulum. Of 1276 hips, in 638 infants aged from three weeks to one year, 49 showed congenital dislocation. The accuracy of our anterior method of sonography in diagnosing congenital dislocation of the hip compared well with the method of Graf and with radiography.

Female↗
PubMed1997

The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement.

The senior one of us performed 438 primary and 181 revision total hip arthroplasties with use of so-called modern prostheses between July 1983 and January 1994. Fifty-three patients, who had had forty-seven primary procedures and twelve revisions, either died or were lost to follow-up less than two years after the operation and were excluded from the study. The results for the remaining 446 patients (391 primary procedures and 169 revisions) were analyzed to determine the influence of patient-related and operative factors and the position of the acetabular component on the rate of dislocation. Dislocation occurred after thirty-two (6 per cent) of the 560 total hip arthroplasties: seventeen (4 per cent) of the 391 primary procedures and fifteen (9 per cent) of the 169 revisions (p = 0.046). There was no relationship between the variables of age, gender, obesity, or preoperative diagnosis and dislocation after either primary or revision arthroplasty. Seven (23 per cent) of the thirty arthroplasties in the patients who had a history of excessive intake of alcoholic beverages (more than 2.1 liters [seventy-two ounces] of beer or more than 0.2 liter [six ounces] of other alcoholic beverages a day) were followed by a dislocation compared with twenty-five (5 per cent) of the 530 arthroplasties in the patients who did not have such a history. This difference was significant for the patients who had had a revision arthroplasty (p = 0.00005), but with the numbers available we could not detect a difference for those who had had a primary arthroplasty (p = 0.264). Radiographic analysis was performed for thirty-two hips that had dislocated and thirty-two that had not (seventeen primary procedures and fifteen revisions in each group), matched exactly according to the type of prosthesis and the operative approach (but not age). We detected no association between either the version or the abduction angle of the acetabular component (within the range of 39 to 56 degrees for the primary prostheses and 38 to 57 degrees for the revision prostheses) and the risk of dislocation. Thirty of the thirty-two hips in each group had an abduction angle of the acetabular component that was in the so-called safe range of 30 to 50 degrees.

Acetabulum↗
PubMed2001

Position of immobilization after dislocation of the glenohumeral joint. A study with use of magnetic resonance imaging.

BACKGROUND: Glenohumeral dislocations often recur, probably because a Bankart lesion does not heal sufficiently during the period of immobilization. Using magnetic resonance imaging, we assessed the position of the Bankart lesion, with the arm in internal and external rotation, in shoulders that had had a dislocation. METHODS: Coaptation of a Bankart lesion was examined with use of magnetic resonance imaging, with the arm held at the side of the trunk and positioned first in internal rotation (mean, 29 degrees) and then in external rotation (mean, 35 degrees), in nineteen shoulders. Six shoulders (six patients) had had an initial anterior dislocation, and thirteen shoulders (twelve patients) had had recurrent anterior dislocation. Fast-spin-echo T2-weighted axial images were made when the dislocation had occurred less than two weeks earlier, and spin-echo T1-weighted axial images after intra-articular injection of gadolinium-diethylenetriamine pentaacetic acid were made when the dislocation had occurred more than two weeks earlier. Separation and displacement of the anteroinferior portion of the labrum from the glenoid rim were measured on the axial images, and coaptation of the anterior part of the capsule to the glenoid neck was assessed by measurement of the detached area, opening angle, and detached length. RESULTS: Separation and displacement of the labrum were both significantly less (p = 0.0047 and p = 0.0017, respectively) when the arm was in external rotation than when it was in internal rotation. The detached area and the opening angle of the anteroinferior portion of the capsule were both significantly smaller (p = 0.0003 and p < 0.0001, respectively), and the detached length was significantly shorter (p < 0.0001) with the arm in external rotation. CONCLUSION: Immobilization of the arm in external rotation better approximates the Bankart lesion to the glenoid neck than does the conventional position of internal rotation.

Adolescent↗
PubMed2004

Surgical management of knee dislocations.

BACKGROUND: The evaluation and management of knee dislocations remain variable and controversial. The purpose of this study was to describe our method of surgical treatment of knee dislocations with use of a standardized protocol and to report the clinical results. METHODS: Forty-seven consecutive patients presented with an occult (reduced) or grossly dislocated knee. Fourteen of these patients were not included in this series because of confounding variables: four had an open knee dislocation, five had vascular injury requiring repair, three were treated with external fixation, and two had associated injury. The remaining thirty-three patients underwent surgical treatment for the knee dislocation with our standard approach. Anatomical repair and/or replacement was performed with fresh-frozen allograft tissue. Thirty-one of the thirty-three patients returned for subjective and objective evaluation with use of four different knee rating scales at a minimum of twenty-four months after the operation. RESULTS: Nineteen of the thirty-one patients were treated acutely (less than three weeks after the injury) and twelve, chronically. The mean Lysholm score was 91 points for the acutely reconstructed knees and 80 points for the chronically reconstructed knees. The Knee Outcome Survey Activities of Daily Living scores averaged 91 points for the acutely reconstructed knees and 84 points for the chronically reconstructed knees. The Knee Outcome Survey Sports Activity scores averaged 89 points for the acutely reconstructed knees and 69 points for the chronically reconstructed knees. According to the Meyers ratings, twenty-three patients had an excellent or good score and eight had a fair or poor score. Sixteen of the nineteen acutely reconstructed knees and seven of the twelve chronically reconstructed knees were given an excellent or a good Meyers score. The average loss of extension was 1 degrees, and the average loss of flexion was 12 degrees. There was no difference in the range of motion between the acutely and chronically treated patients. Four acutely reconstructed knees required manipulation because of loss of flexion. Laxity tests demonstrated consistently improved stability in all patients, with more predictable results in the acutely treated patients. CONCLUSIONS: Surgical treatment of the knee dislocations in our series provided satisfactory subjective and objective outcomes at two to six years postoperatively. The patients who were treated acutely had higher subjective scores and better objective restoration of knee stability than did patients treated three weeks or more after the injury. Nearly all patients were able to perform daily activities with few problems. However, the ability of patients to return to high-demand sports and strenuous manual labor was less predictable.

Adolescent↗
PubMed2005

Surgical management of knee dislocations. Surgical technique.

BACKGROUND: The evaluation and management of knee dislocations remain variable and controversial. The purpose of this study was to describe our method of surgical treatment of knee dislocations with use of a standardized protocol and to report the clinical results. METHODS: Forty-seven consecutive patients presented with an occult (reduced) or grossly dislocated knee. Fourteen of these patients were not included in this series because of confounding variables: four had an open knee dislocation, five had vascular injury requiring repair, three were treated with external fixation, and two had associated injury. The remaining thirty-three patients underwent surgical treatment for the knee dislocation with our standard approach. Anatomical repair and/or replacement was performed with fresh-frozen allograft tissue. Thirty-one of the thirty-three patients returned for subjective and objective evaluation with use of four different knee-rating scales at a minimum of twenty-four months after the operation. RESULTS: Nineteen of the thirty-one patients were treated acutely (less than three weeks after the injury) and twelve, chronically. The mean Lysholm score was 91 points for the acutely reconstructed knees and 80 points for the chronically reconstructed knees. The Knee Outcome Survey Activities of Daily Living scores averaged 91 points for the acutely reconstructed knees and 84 points for the chronically reconstructed knees. The Knee Outcome Survey Sports Activity scores averaged 89 points for the acutely reconstructed knees and 69 points for the chronically reconstructed knees. According to the Meyers ratings, twenty-three patients had an excellent or good score and eight had a fair or poor score. Sixteen of the nineteen acutely reconstructed knees and seven of the twelve chronically reconstructed knees were given an excellent or good Meyers score. The average loss of extension was 1 degrees , and the average loss of flexion was 12 degrees . There was no difference in the range of motion between the acutely and chronically treated patients. Four acutely reconstructed knees required manipulation because of loss of flexion. Laxity tests demonstrated consistently improved stability in all patients, with more predictable results in the acutely treated patients. CONCLUSIONS: Surgical treatment of the knee dislocations in our series provided satisfactory subjective and objective outcomes at two to six years postoperatively. The patients who were treated acutely had higher subjective scores and better objective restoration of knee stability than did patients treated three weeks or more after the injury. Nearly all patients were able to perform daily activities with few problems. However, the ability of patients to return to high-demand sports and strenuous manual labor was less predictable.

Acute Disease↗
PubMed2006

Hospital cost of dislocation after primary total hip arthroplasty.

BACKGROUND: The treatment of dislocation following primary total hip arthroplasty usually requires the use of expensive hospital resources and sometimes requires revision surgery. The hospital costs associated with treating this complication have not been previously analyzed, to our knowledge. The purpose of this study was to assess the financial impact of treating dislocations at our institution. METHODS: Between 1997 and 2001, 3671 patients underwent a total of 4054 consecutive primary total hip arthroplasties at our institution. The patients were prospectively followed at regular intervals, and their follow-up data were recorded in an institutional total joint registry. Ninety-nine hips (2.4%) in ninety-nine patients dislocated. The costs to our institution to treat these dislocations were evaluated by determining the cost of each treatment episode required to reestablish hip stability and were expressed as the percent increase in cost compared with that of an uncomplicated primary total hip replacement. RESULTS: Of the ninety-nine hips that dislocated, sixty-two (63%) remained stable after one or more closed reductions and thirty-seven (37%) ultimately required revision surgery. The hospital cost of each closed reduction episode represented 19% of the hospital cost of an uncomplicated total hip replacement. When revision surgery was eventually needed, the average hospital costs of one or more closed reductions and the subsequent revisions represented 148% of the hospital cost of an uncomplicated primary total hip replacement. CONCLUSIONS: Dislocation after primary hip replacement continues to be a prevalent and costly complication that diminishes the cost-effectiveness of an otherwise very successful surgical procedure.

Adult↗
PubMedDate not supplied

Anterior shoulder dislocations in sports.

Anterior shoulder dislocations, primary and recurrent, are among the most disabling injuries to the shoulder that can plague the athlete. The diagnosis is easily made by the following: the physical appearance of the shoulder; loss of capability by the athlete to internally and externally rotate the shoulder with the elbow at his side; by evaluating the mechanism of injury; and x-rays. Anterior shoulder dislocations should be reduced as soon as possible after diagnosis, to minimise the stretching effect on the neurovascular structures while the humeral head is dislocated. The reduction is not done to allow the athlete to return immediately to sport. Use of a simple traction method in the first 10 to 15 minutes following the injury will result in a successful reduction in the vast majority of dislocations. Reduction of the humeral head can be confirmed by the athlete regaining the capability to internally and externally rotate his shoulder with his elbow at his side. Following reduction, the athlete should begin a treatment regimen which includes a restrengthening programme emphasising the muscles of internal rotation and adduction plus rigid restrictions of activities until the goals of the rehabilitation programme are satisfied. The author's experience with this treatment regimen with athletes at the United States Naval Academy, has shown a decrease of the recurrence rate of primary anterior shoulder dislocations to 25% versus the 80% recurrence rate we have become familiar with from studies done which did not stress specific rehabilitation programmes. The athlete should also be instructed in a self-performed traction method for reduction should a redislocation occur, to minimise the stretching effect on the neurovascular structures and allow relief from discomfort. Surgery for primary and recurrent anterior dislocations should only be considered when the athlete fails to achieve the desired goals after participating in a specific, progressive, adequate rehabilitation programme.

Adolescent↗
PubMed1985

Dislocation of the temporomandibular joint meniscus: contrast arthrography vs. computed tomography.

A prospective study to determine the accuracy of computed tomography (CT) for the diagnosis of dislocation of the temporomandibular joint (TMJ) meniscus was made by performing both CT and contrast arthrography on 18 joints suspected of meniscus dislocation. Arthrography rather than surgery was chosen as the quality standard for comparing CT findings, as not all patients undergoing the studies underwent surgery. The CT protocol included scanning with both closed- and open-mouth series, 1.5-mm-thick slices, soft-tissue and bone-detail settings, and coronal and sagittal reformations. Arthrography was done with linear tomography, after both lower and upper compartmental injections under fluoroscopic control. The results of each test were reported independently by the radiologist who obtained either all of the arthrograms or all of the CT scans. For dislocation of the meniscus, there was excellent agreement between the two methods. Nine menisci were dislocated according to both arthrography and CT. One meniscus was thought to be dislocated by CT, but this was not confirmed with arthrography. CT seems to be nearly as accurate as arthrography for showing meniscus dislocation, is performed with lower x-ray exposure, and is noninvasive. Arthrography discloses more detailed information about the joint meniscus, such as perforation and maceration, and should continue to be used when this kind of information is clinically important.

Adult↗
PubMed1995

Patient characteristics in dislocations after primary total hip arthroplasty. 60 patients compared with a control group.

To determine patient-related risk factors for dislocation after a primary Charnley hip arthroplasty, we compared 60 patients with at least one dislocation to a randomly selected group of 118 patients with no dislocation. Apart from an increased mortality rate among the patients with a dislocated prosthesis, we could not relate dislocations to any somatic and psychiatric disorder or to the use of any particular group of pharmaceuticals. However, suspicion of alcohol abuse was commoner among men in the dislocated group.

Adult↗
PubMed1985

Subtalar dislocations: a prognosticating classification.

A review of the literature and analysis of eight cases of subtalar dislocations was undertaken to correlate our experience with others and to determine a classification for prognostication. Our findings corresponded with those found by others. A 75% incidence of associated injuries was present in our series and these represented a continuum of varying degrees of complication. A new system was devised whereby increasing severity of associated injuries correlated with increasing rate of complications, including loss of motion, arthritis, pain and avascular necrosis. Dislocations were classified according to: no associated injuries, those with soft tissue injuries, extra-articular fractures, intra-articular fractures and those prone to development of avascular necrosis, ie, open dislocations and fractures of the body of the talus. It was found that associated fractures increased the immobilization period as well as the incidence of complications. Intra-articular fractures have demonstrated increased rates of arthroses in the subtalar joint. Avascular necrosis, an infrequent but devastating complication, is primarily associated with open dislocations and dislocations with concomitant fractures of the body of the talus. Our series had two open subtalar dislocations, neither of which developed avascular necrosis.

Adolescent↗
PubMed1992

Lateral subtalar dislocation. A literature review and unusual case report.

An unusual case of suspected lateral subtalar joint dislocation was reported. A review of the literature found that medial dislocations were reported four times more frequently than lateral dislocations. Half of the cases of subtalar dislocation reviewed here described associated fractures, the incidence of which was higher in lateral dislocations. In both types of dislocations examined, almost half were reduced nonoperatively. In most cases, long-term results of repair of these injuries were considered favorable.

Adult↗
PubMed2000

Unilateral mandible fracture with bilateral TMJ dislocation.

Temporomandibular joint (TMJ) dislocation occurs when the condylar head slips forward causing the posterior articulating surface of the condyle to advance ahead of the articular eminence, possibly becoming entrapped. Following dislocation, the ligaments around the joint often stretch, causing severe muscle spasms and joint pain. There is no standard evaluation and treatment method for acute TMJ dislocation, but the most effective course is immediate reduction. This paper presents a 42-year-old woman who sustained a unilateral mandible fracture with bilateral TMJ dislocation in an automobile crash. Although the fracture was apparent on plane film and panorex, the dislocation was not found until six weeks later, when the jaw was unwired. At that time, the dislocation was suspected because of decreased range of motion, but was not verified until an MRI was performed. The result was long-term therapy, eventual bilateral TMJ surgery, and chronic TMJ pain for the patient.

Accidents, Traffic↗
PubMed2000

[Results of treatment of traumatic elbow dislocation in children].

Between 1987 and 1997 the authors treated 49 children with traumatic dislocation of the elbow joint. The study presents the results of treatment of 26 children, mean age of 10.7 years (ranging from 5.5 to 14.5 years) at the time of trauma. The mean follow-up time was 4.3 years (ranging from 1 to 10.5 years). In one case an anterior dislocation was observed, while in the remaining cases posterior dislocation was diagnosed. Twenty-five children were treated with closed reduction of the dislocation, followed by immobilization in a plaster cast. One case with a chronic dislocation was treated surgically. Concurrent injuries were observed in 18 (69.2) children. The most common concurrent trauma was a fracture of the medial epicondyle (44% of cases with additional trauma). The following additional fractures were also noted: fracture of the lateral epicondyle, fractures of the forearm, of the neck of the radius, of the olecranon, epiphyseolysis of the distal epiphysis of the radius with a concomitant fracture of the medial epicondyle. In 19 cases very good result was achieved. In 7 cases sequels of the dislocation were noted. These were: in 3 cases flexion contractures (5 degrees, 10 degrees, 15 degrees) of the elbow joint, in two cases periarticular ossification (in 1 case this entity was treated surgically with very good result), in 1 case an asymptomatic non-union of the medial epicondyle with a 30 degrees flexion contracture in the elbow joint, and in 1 case (treated surgically) a 90 degrees flexion contracture with a movement range up to 105 degrees with degenerative changes visible on X-ray in the joint was noted.

Adolescent↗