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PubMed1999

Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations.

STUDY DESIGN: A prospective clinical study using magnetic resonance imaging of the cervical spine in a consecutive series of patients with cervical spine dislocations. OBJECTIVES: To determine the incidence of intervertebral disc herniations and injury to the spinal ligaments before and after awake closed traction reduction of cervical spine dislocations. SUMMARY OF BACKGROUND DATA: Prior series in which the prereduction imaging of disc herniations in the dislocated cervical spine are described have been anecdotal and have involved small numbers of patients. In addition, no uniform clinical criteria to define the presence of an intervertebral disc herniation in the dislocated cervical spine has been described. The incidence of disc herniations in the unreduced dislocated cervical spine is unknown. METHODS: Eleven consecutive patients with cervical spine dislocations who met the clinical criteria for an awake closed traction reduction had prereduction and postreduction magnetic resonance imaging. Using strict clinical criteria for the definition of an intervertebral disc herniation, the presence or absence of disc herniation, spinal ligament injury, and cord injury was determined. Neurologic status before, during, and after the closed reduction maneuver was documented. RESULTS: Disc herniations were identified in 2 of 11 patients before reduction. Awake closed traction reduction was successful in 9 of the 11 patients. Of the nine patients with a successful closed reduction, two had disc herniations before reduction, and five had disc herniations after reduction. No patient had neurologic worsening after attempted awake closed traction reduction. CONCLUSIONS: The process of closed traction reduction appears to increase the incidence of intervertebral disc herniations. The relation of these findings, however, to the neurologic safety of awake closed traction reduction remain unclear.

Adolescent↗
PubMed2004

Complete cervical intervertebral disc extrusion with spinal cord injury in the absence of facet dislocation: a case report.

STUDY DESIGN: Complete cervical disc complex extrusion, defined as the extrusion of both cartilaginous end-plates, the entire nucleus pulposus, and portions of the anulus fibrosus, is rare. A case of complete cervical disc complex extrusion with spinal cord injury in the absence of facet dislocation or subluxation in an obtunded patient is reported. OBJECTIVE: To report an unusual presentation of spinal cord injury and the occurrence of complete traumatic cervical disc complex extrusion in the absence of facet dislocation and normal plain radiographic findings. SUMMARY OF BACKGROUND DATA: Traumatic cervical disc herniation occurs in 54% to 80% of patients with facet dislocation. A report of complete extrusion of a cervical intervertebral disc complex (cartilaginous endplate, anulus, and nucleus pulposus) with spinal cord injury in the absence of dislocation has not been described, to the best of the authors' knowledge. METHODS: A clinical and radiographic review of such a case of complete traumatic cervical disc complex herniation in the absence of dislocation was performed. RESULTS: Plain radiographic imaging did not show any injury. A nondisplaced fracture of the left inferior facet joint was evident on computed tomography. The diagnosis of C4-C5 intervertebral disc extrusion was made only after magnetic resonance imaging. The vacuum effect of complete disc extrusion created a "white-out" appearance to the disc space on the sagittal T2 magnetic resonance image. The patient underwent anterior cervical discectomy and fusion with additional posterior cervical fusion. He subsequently regained functional strength against gravity in two of four limbs. He remains completely paraparetic in the left upper extremity and partially paraparetic in the left lower extremity. CONCLUSION: The case report highlights the occurrence of complete traumatic cervical disc extrusion in the absence of facet dislocation with normal plain radiographic findings and consequent spinal cord injury, which can accompany such an injury.

Accidents, Traffic↗
PubMed2001

Hairpin turn dislocations in two-dimensional smectic phases of long semiflexible polymers.

We elucidate hairpin turn dislocations in two-dimensional smectic phases of long semi-flexible polymers. We discuss hairpin shapes, sizes, and free energies. We find that hairpin dislocation core may be, under some circumstances, substantially bigger than the smectic period size. Such hairpin dislocations are accompanied by large voids that are stable equilibrium structures with sizes determined by a competition of the polymer bending elasticity and smectic bulk elasticity. The large size of hairpin voids is associated with a low hairpin energy, much smaller than anticipated before. The actual hairpin shape, size, and energy are all qualitatively sensitive to the detailed nature of smectics. We document this by considering hairpin dislocations in lyotropic smectics (systems stabilized by repulsion between polymers, with a positive osmotic pressure) and in thermotropic smectics (systems stable even at zero osmotic pressure, with a preferred distance between semiflexible molecules). We discuss in detail hairpin dislocations in lyotropic sterically stabilized Smectics as well as in DNA-cationic lipid complexes. We elucidate the extinction of hairpin dislocations by annihilations with polymer end points. In lyotropic smectics, rates of these processes are shown to be limited by sluggish reptation of semiflexible molecules, as well as by substantial energy barriers.

Biophysical Phenomena↗
PubMed2006

Diffusive atomistic dynamics of edge dislocations in two dimensions.

The fundamental dislocation processes of glide, climb, and annihilation are studied on diffusive time scales within the framework of a continuum field theory, the phase field crystal model. Glide and climb are examined for single edge dislocations subjected to shear and compressive strain, respectively, in a two-dimensional hexagonal lattice. It is shown that the natural features of these processes are reproduced without any explicit consideration of elasticity theory or ad hoc construction of microscopic Peierls potentials. Particular attention is paid to the Peierls barrier for dislocation glide or climb and the ensuing dynamic behavior as functions of strain rate, temperature, and dislocation density. It is shown that the dynamics are accurately described by simple viscous motion equations for an overdamped point mass, where the dislocation mobility is the only adjustable parameter. The critical distance for the annihilation of two edge dislocations as a function of separation angle is also presented.

Journal Article↗
PubMed2004

Determination of the three-dimensional structure of dislocations in silicon by synchrotron white X-ray topography combined with a topo-tomographic technique.

The determination of the three-dimensional dislocation structure, i.e. the configuration and nature of the dislocations, in silicon by synchrotron white X-ray topography combined with a topo-tomographic technique is demonstrated. A [001]-oriented CZ-Si crystal of diameter approximately 7 mm was fixed on a subsidiary goniometer with three rotation axes (omega, Rx, Ry) and x-y-z stages, keeping its growth axis parallel to the omega-axis. This goniometer was mounted on the swivel stage of the main diffractometer installed at the experimental hutch of beamline BL28B2 of SPring-8. After adjusting the (110) plane to be perpendicular to the incident white X-ray beam by observing transmission Laue patterns, the crystal was inclined by 4.3 degrees so that the 004 Laue spot could be formed by 60 keV X-rays. Laue topographs observed by rotating the omega-axis of the subsidiary goniometer were recorded using X-ray films and a cooled CCD camera. The direction of the dislocation lines, Burgers vectors and glide planes were determined by following the variation in features of the dislocation images in the 004 Laue spot and by examining the contrast of the dislocation images in the Laue spots concerning the [111] and [022] planes. It is concluded that white X-ray topography combined with the omega-rotation technique is useful for clarifying the three-dimensional dislocation structure.

Journal Article↗
PubMed1996

Dislocation of the third ventricle due to space-occupying stroke evaluated by transcranial duplex sonography.

Transcranial color-coded duplex sonography is a recently introduced method for visualizing (1) the blood flow velocity of the basal cerebral arteries and (2) the brain parenchyma as an acoustic impedance image. Dislocation of the third ventricle due to space-occupying stroke is an important clinical marker. This study evaluated the dislocation of the third ventricle from the brain midline by transcranial duplex sonography in 10 healthy volunteers. The mean dislocation was 0.2 +/- 0.3 mm. Eighteen stroke patients were investigated within 12 hours by both duplex sonography and computed tomography (CT) and the dislocation of the third ventricle was measured. Correlation between the two methods was high (r = 0.87, N = 27). Twelve stroke patients divided into three subgroups according to the extent of the space-occupying effects of the lesion were followed for 3 weeks. The increase and decrease of the dislocation of the third ventricle over the time were monitored. In conclusion, transcranial duplex sonography is a reliable tool to monitor dislocation of the third ventricle due to space-occupying stroke.

Adult↗
PubMed2002

Dislocation of the bearing of the Oxford lateral unicompartmental arthroplasty. A radiological assessment.

When the Oxford unicompartmental meniscal bearing arthroplasty is used in the lateral compartment of the knee, 10% of the bearings dislocate. A radiological review was carried out to establish if dislocation was related to surgical technique. The postoperative radiographs of 46 lateral unicompartmental arthroplasties were analysed. Five variables which related to the position and alignment of the components were measured. Dislocations occurred in six knees. Only one of the five variables, the proximal tibial varus angle, had a statistically significant relationship to dislocation. This variable quantifies the height of the lateral joint line. The mean proximal tibial varus angle for knees the bearings of which had dislocated was 9 degrees and for those which had not it was 5 degrees. In both groups it was greater than would be expected in the normal knee (3 degrees). Our study suggests that a high proximal tibial varus angle is associated with dislocation. The surgical technique should be modified to account for this, with care being taken to avoid damage to or overdistraction of the lateral soft tissues.

Aged↗
PubMed1982

Recurrent and non-recurrent dislocation following total hip arthroplasty.

The rate of post-operative dislocation after primary total hip arthroplasty in 1739 cases was 3.3 per cent; 0.9 per cent being classified as recurrent dislocations. Malposition of the socket, limb shortening or any other single technical factors could not be demonstrated to be responsible for post-operative dislocation of the hip. A previous osteotomy predisposed for dislocation, but in no case was this dislocation classified as recurrent. Cases with a previous cervical-femoral fracture were significantly more commonly dislocated compared with coxarthrosis cases. This fact probably could be explained by a high rate of alcoholism in men and old age in women.

Aged↗
PubMed1975

Cryoextraction of dislocated lenses.

Twenty-two dislocated lenses were removed using cryoextraction. They occurred in a consecutive series of 1,800 planned intracapsulars. Included in the complete series were 16 dislocated lenses in 3 groups: Marfan's syndrome, homocystinuria and congenital types of dislocations. None of these were removed since the patient's vision was adequate in each case. These patients are still under observation. In one case, we used the Hagler-Calhoun double pronged needle. We think this procedure is entirely too traumatic. In 21 cases, the dislocated lenses were removed intracapsularly. In one instance, the lens nucleus had been dislocated in an earlier operation, and there was advanced secondary glaucoma. The lens was removed with cryosurgery, resulting in a useful eye with no pain. Cryoextraction of dislocated lenses is the least traumatic surgical approach and is the method of choice.

Aged↗
PubMed2002

Bilateral traumatic testicular dislocation--a case report.

Traumatic testicular dislocation is a rare complication of blunt scrotal trauma. It is usually related to straddle injuries from motorcycle accidents and is commonly accompanied by scrotal hematoma and pelvic fracture. Bilateral dislocation of the testes is relatively rare. We report a rare case of bilateral testicular dislocation after a motorcycle accident. Abdominal computed tomography (CT) and color Doppler ultrasonography are helpful in locating the dislocated testicle and detecting its blood flow. Closed reduction of a superficial testicular dislocation may be attempted first. After appropriate physical examination and image study, emergent surgical reduction should be considered because of the high incidence of failure of closed reduction. We recommend that emergency physicians should be aware of potential testicular injury among trauma cases. Early reduction and early urological consultation are also recommended because of histological changes seen in dislocated testis.

Accidents, Traffic↗
PubMed2003

[The cause and management of intraocular lens dislocation into anterior vitreous cavity].

OBJECTIVE: To study the causes and management of the intraocular lens (IOL) dislocation into anterior vitreous cavity. METHODS: The author retrospectively analyzed the causes of the IOL dislocation treated in the past 10 years. Twenty-eight dislocated IOLs were replaced after anterior vitrectomy. RESULTS: The causes of the IOL dislocation were: (1) IOL vertically sank down into the vitreous cavity through the broken inferior zonules. (2) The superior haptics were not placed in the ciliary sulcus and overturned down into vitreous cavity because of the vitreous prolapse closing the ciliary sulcus. (3) Inferior haptics were put behind the posterior capsule and into the vitreous cavity. After follow-up for 6 months to 10 years, the postoperative best-corrected visual acuities (BCVAs) of 28 patients were 20/100 to 20/20. No complications happened. CONCLUSIONS: The IOL dislocation into anterior vitreous cavity was related to the rupture of the posterior capsule, break down of the lens zonules, prolapse of the vitreous, improper position of implanted IOL and iris complication. The simplest and most effective method for management of IOL dislocation into anterior vitreous cavity is to directly remove the IOL from vitreous cavity after anterior vitrectomy and re-fixate it in the ciliary sulcus.

Adult↗
PubMed1992

[Risk of dislocation and cataract formation in 240 IOGEL lenses. 4 years experiences].

Following planned extracapsular cataract extractions we implanted 240 IOGEL lenses into the capsular bag and noticed 5 dislocations into the vitreous cavity, 2 after an Nd-YAG capsulotomy, 4 postoperatively and 1 after surgical repositioning. Postoperatively, one lens was subluxated into the anterior chamber. Thirty-three patients required a 4- to 5-mm Nd-YAG capsulotomy because of a fibrotic or regenerative secondary cataract. Two lenses dislocated 2 and 6 weeks after the YAG capsulotomy into the vitreous cavity; the capsulotomy was performed 5 and 6 months, respectively, after the implantation. In 4 patients the IOGEL lens dislocated 3 times within the first 3 days and once within the first 3 months after implantation. Primary stable placement in the bag could be achieved, however. One patient required repositioning of the lens because of decentration 3 months after implantation. The lens dislocated on the following day. Late dislocation of the flexible and soft IOGEL lens can be due to the fact that the lenses do not adhere to the capsular sheets. Furthermore, postoperative capsular shrinkage enlarging a posterior capsular opening leads to lens dislocation. Eight patients underwent a secondary anterior chamber lens implantation. In three patients the IOGEL lens was explanted, in two of them without and in one of them with serious complications. The other five patients still have their IOGEL lens deep in the vitreous without complications. We suggest that if a YAG capsulotomy is necessary, it should not be performed before the 6th postoperative month. It should also not exceed 4 mm in diameter and no IOGEL lens should be implanted if a capsular rupture occurs intraoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cataract Extraction↗
PubMed2004

Acromioclavicular Dislocation: Conservative or Surgical Therapy.

REFERENCE: Phillips AM, Smart C, Groom AFG. Acromioclavicular dislocation: conservative or surgical therapy. Clin Orthop. 1998;353:10-17. CLINICAL QUESTION: Among patients with acromioclavicular (AC) dislocation, does surgical intervention produce better outcomes than conservative therapy? DATA SOURCES: Studies were identified by a MEDLINE search (1966-1997) and a manual search of the reference lists of each relevant study identified. The medical subject heading of acromioclavicular dislocation was used as the primary search term. STUDY SELECTION: The search was limited to English-language journals listed in Index Medicus. Studies were included if they described severely displaced dislocations of the AC joint, mostly characterized as grade III injuries (Allman or Rockwood classification) or if there was at least 1-cm displacement of the clavicle. If more than 1 study included the same group or subgroups of patients, the study with the best assessed methods was used. Studies were divided into 4 classifications: group 1, randomized trials of surgery versus conservative therapy; group 2, nonrandomized trials of surgery versus conservative therapy; group 3, surgical trials only; and group 4, conservative trials only. DATA EXTRACTION: Data-extraction and study quality-assessment procedures were not explained in detail. The primary outcome measures were overall outcome, return to work, return to premorbid activities, complications, and radiographic features. Secondary measures were pain, range of motion, and strength. RevMan software (version 1.05; Cochrane Centre, Oxford, UK) was used for statistical analysis. MAIN RESULTS: Specific search criteria identified 600 articles for review, of which 24 met inclusion and exclusion criteria: 2 in group 2, 3 in group 3, 14 in group 4, and 5 in group 4. A total of 1172 patients were represented (surgical treatment = 833, mean = 43.7 months' follow-up; conservative treatment = 339, mean = 60.4 months' follow-up). Both surgically and conservatively treated patients reported similar overall satisfactory outcome (88% surgical versus 87% conservative). Patients with surgical treatment reported longer time to return to work and premorbid activities. Among patients treated surgically, 59% had additional surgery, 6% had wound breakdown, 20% had fixation failure, and 3% reported residual deformity. Only 1% of conservatively treated patients reported wound problems, 6% had additional surgery, and 37% reported residual deformity. In only 1 study did the authors report the incidence of posttraumatic arthritis: 25% among surgically treated and 43% among conservatively treated patients. Analysis of secondary outcomes suggests that both groups had little or no pain (93% surgical, 96% conservative) but more conservatively treated patients had normal to near-normal range of motion (95% versus 86%) and normal strength (92% versus 87%). Conservative treatment of AC dislocations is 21% more likely to result in a satisfactory outcome than surgical treatment (odds ratio = 0.79, 95% confidence interval = 0.36, 1.71). The need for additional surgery is 7.4 times more likely and infection is 3.2 times more likely with surgical management. CONCLUSIONS: These data suggest that the current evidence does not support surgical treatment of grade III AC dislocations with respect to overall patient satisfaction as well as clinical outcomes such as pain, range of motion, and strength.

Journal Article↗
PubMed2006

[Dislocation of an indwelling catheter from digestive organs in arterial infusion chemotherapy].

An indwelling catheter was dislocated into the duodenum during the course of hepatic arterial infusion for multiple metastases of colon cancer to the liver. A possible cause of extravascular dislocation includes an exposure to highly concentrated anticancer due to defective positioning of the catheter side hole and bending of the catheter. A dislocation of the hepatic arterial infusion catheter into the digestive tract is a serious complication and accounts for 10% of all dislocations. Although countermeasures consisting of monitoring progress, laparotic catheter extraction and endoscopic catheter extraction, a monitoring process is selected in nearly all cases. Even though hepatic arterial infusion has established as being effective against liver tumors, there is a possibility of encountering more of these cases in the future along with an increase in the number of cases and a prolongation of treatment that improves prognoses. In the case, a catheter extravascular dislocation has occurred in addition to complications stemming from the dislocation itself. There was also a risk of exacerbation of prognosis resulting from being forced to discontinue the treatment. It is therefore necessary to pay close attention to positioning of the catheter side hole and its immobilization.

Catheters, Indwelling↗
PubMedDate not supplied

[The diagnosis of the dislocation and microdislocation of an endocardiac electrode based on x-ray and electrocardiographic study data].

The X-ray films and ECG records were analysed in 11 cases of dislocation and 20 cases microdislocation of the endocardial lead in patients with monopolar ventricular pacing. In 3 patients lead was dislocated into the right ventricle cavity, in 2 patients--in the another heart cavity, in 6 cases lead dislocation was negligible. In 20 cases of microdislocation the fluctuation all intracardiac parts of the endocardial lead not only his distal end was revealed. Therefore it is better to call this complication of heart pacing "the endocardial lead instability". The X-ray picture of the negligible lead dislocation was identical to microdislocation: a thickening unclear contour of the distal lead end. The ECG picture in cases of dislocation was different from microdislocation: the lack of pacing contrary to pacing preserved in cases of microdislocation. All patients with dislocation and microdislocation had high amplitude spike of pacemaker impulses.

Adult↗
PubMed1996

Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses.

BACKGROUND AND OBJECTIVE: Retinal detachment is a complication of dislocated crystalline and intraocular lenses. The purpose of this study was to compare the frequency and management of coexisting or subsequent retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses (PC IOLs). PATIENTS AND METHODS: A retrospective, consecutive series of patients undergoing vitrectomy for dislocated PC IOLs (99 eyes) or removal of retained lens material (80 eyes) were studied. RESULTS: Eyes with retinal detachment and retained lens fragments (2 cases) or dislocated PC IOLs (2 cases), or retinal detachment following vitrectomy for removal of retained lens fragments (2 cases) or repair of dislocated IOL (1 cases) were identified. The prevalence of coexisting or postoperative retinal detachment and retained lens fragments (5% total) was slightly higher than the prevalence of coexisting or postoperative retinal detachment and dislocated PC IOLs (3% total). The retina was reattached in all cases using the standard scleral buckling and vitrectomy techniques. CONCLUSION: The rate of retinal detachment associated with retained lens material is decreased compared with previous reports. This may possibly be a results of increasing attention to minimizing surgical trauma by the cataract surgeon at the time of lens fragment loss and by the vitrectomy surgeon during primary repair.

Aged↗
PubMed2005

Re-dislocation following open reduction for developmental dysplasia of the hip.

We have reviewed 17 patients (18 hips) who required repeat open reduction for recurrent or persistent dislocation after a previous attempt at open reduction for developmental dysplasia of the hip (DDH). The mean follow-up was 5.5 (3-15) years. At the review, five patients were limping and had limited hip motion but no pain. Six hips were classified as Severin class III or more, and avascular necrosis was evident in 11. We suggest that technical failure is usually the cause for re-dislocation in unilateral cases, as we discovered at repeat open reduction in five of six patients with unilateral dislocation. The biological behaviour of bilateral dislocations may in some way be different since in nine of 11 patients with bilateral dislocations, no obvious cause could be attributed. The outcome is usually poor.

Child, Preschool↗
PubMed2006

Simultaneous ipsilateral posterior knee and hip dislocations: case report, including a technique for closed reduction of the hip.

In isolation, dislocations of the hip and knee require emergent reduction to minimize the risks of serious complications, including vascular and neurologic injury, osteonecrosis of the femoral head, and loss of motion and function. With simultaneous dislocation of the ipsilateral hip and knee, as in the situation of hip dislocation with concomitant femoral shaft fracture, reduction of the hip may prove difficult because of the inability to control the femoral segment. In this setting, general anesthesia is commonly required. We present the case of a patient who sustained an ipsilateral hip and knee dislocation who underwent closed reduction of the knee in the emergency department but required general anesthesia and the insertion of Schanz pins in the femur to reduce the hip dislocation.

Accidents, Traffic↗