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PubMed1976

Dislocations of the upper extremity in children.

Traumatic dislocations and subluxations of the upper extremity in children have been surveyed. The elbow joint is most commonly dislocated and is dislocated more frequently in children than in adults. Severe neurovascular injury may be associated with dislocation of this joint. The most common subluxation is that of the radial head, secondary to a "pulled elbow." Otherwise dislocations and subluxations of the upper extremity are uncommon in children, apparently because of the relative weakness of the epiphyseal plate. Most of these injuries are the result of predictable indirect forces. Principles of reduction and immobilization are based on the unique anatomic structure of the joint involved and the known anatomic disruption resulting from the trauma.

Acromioclavicular Joint↗
PubMed2004

Anatomical basis for functional treatment of dorsolateral dislocation of the proximal interphalangeal joint.

Dorsolateral dislocation of the proximal interphalangeal (PIP) joint is a common injury to the hand. Closed reduction of the dislocation anatomically realigns the avulsed ligaments; thus patients may be managed non-operatively. Standard treatment involves placement of a dorsal splint to prevent hyperextension and lateral stresses. This allows early active motion of the PIP joint while preventing a flexion contracture. In this fresh cadaver study, the PIP joint in 24 fingers was dorsolaterally dislocated. Four digits had to be excluded from the investigation due to a fracture dislocation with a bony fragment of >40% of the articular surface of the middle phalanx. After closed reduction, seven digits were further studied using the cryosection technique described by Kathrein et al. (1996, Clin. Anat. 9:227-231) to demonstrate the position of the avulsed palmar plate. In another 13 joints, the torn ligaments were examined by gross dissection. In 10 degrees of finger flexion, the avulsed palmar plate lay at its previous attachment to the base of the middle phalanx. The collateral ligament, ruptured at its attachment to the side of the head of the proximal phalanx, returned to its original position and was not interposed in the joint. The split between the collateral ligament and the accessory collateral ligament was also closed. Our data suggest that the ligamentous structures of the PIP joint, namely the palmar plate and collateral ligaments, typically return to their anatomic positions upon simple closed reduction of dorsolateral dislocations in fresh cadavers.

Aged↗
PubMed1990

[Dynamic stabilization of a total hip arthroplasty. Apropos of 100 total prostheses of which 52 dislocations].

This paper outlines the principal factors which stabilise a normal hip, and describes the modifications which occur following total joint replacement. Deficiencies in muscle function and mechanical restraints due to the prosthesis may be present. A biomechanical mathematical model has been devised which examines the variations in length of the middle gluteal muscle during movement, particularly in hip flexion, when there is the greatest risk of dislocation. This enables a critical evaluation of the muscle forces surrounding the hip, and allows identification of patients with a high risk of dislocation. These observations have been applied to a group of 100 patients, 52 of whom had experienced a dislocation and 48 with stable prostheses. Patients at high risk according to the statistical model tended to dislocate from one month after operation onwards, and are to be distinguished from those who dislocate early due to malposition of the prosthesis.

Biomechanical Phenomena↗
PubMed1981

Congenital hip dislocation and dysplasia in Southern Chinese.

In 1975 we carried out a survey in Hong Kong to locate Chinese children with congenital dislocation of the hip. Analysis of the available records between 1960 and 1975 gave an observed incidence which was at least 10 times less than found in Caucasians. The age and sex distribution, radiographic findings and the left-sided predominance were similar to Caucasians with congenital dislocation of the hip. However, unlike Caucasian children, the Chinese presented with dislocation and not dysplasia. The mothers of children with congenital dislocation of the hip were compared with a control group with normal children to assess their use of the "Hong Kong" position, in which the children are carried on the back of their mother with their hips in a position of wide abduction. Since only half of the children in either group were carried in this manner, other factors must be responsible for the low incidence of congenital dislocation of the hip in southern Chinese.

Adolescent↗
PubMed1986

Lesions in different types of anterior glenohumeral joint dislocation. An experimental study.

Three different kinds of anterior shoulder joint dislocation were studied in an experimental setup including 15 shoulder joint specimens. Lesion to the anterior-inferior part of the capsule was the most frequent finding in anterior dislocation. In anterior-superior dislocation lesions to the anterior-inferior part of the capsule and the posterior part of the cuff were equally prominent. Anterior-inferior dislocation was associated with lesions to all capsular structures including the glenohumeral ligament and both the anterior and posterior part of the cuff. From a clinical point of view, the study indicates that in some types of anterior dislocation a severe lesion of the posterior part of the capsule and cuff must also be considered.

Humans↗
PubMed1986

Traumatic posterior dislocation of the hip--prognostic factors influencing the incidence of avascular necrosis of the femoral head.

To elucidate the factors important for development of avascular necrosis of the femoral head following traumatic posterior dislocation of the hip, 98 adult patients with 100 hip dislocations were reviewed after a minimum follow-up of 5 years. Avascular necrosis of the femoral head was found in only 4.8% of the hips reduced within 6 h, but in 52.9% of the hips reduced more than 6 h after the injury. Dislocations were classified according to Stewart and Milford [11]; a significantly higher incidence of avascular necrosis was found in grade-III and -IV dislocations than in grade-I and -II dislocations. We could not demonstrate any benefit from skeletal traction or non-weight bearing. The age of the patients was of no importance.

Adolescent↗
PubMed1986

Anatomical variations of the semilunar notch in elbow dislocations.

The anatomical relations of the semilunar notch of the ulna were studied in radiographs, taken in a strict lateral view, from 100 patients with elbow dislocations. The results were compared with those from a control group of 150 patients without dislocation or other radiographic pathology. We found that the coronoid process and an angle (a) formed between the axis of the ulna and a line going through the tip of the coronoid process and the tip of the olecranon were significantly smaller than those in the control group (P = 0.02). The central angle of the semilunar notch was significantly larger in the dislocation group than in the control group (P = 0.009). The smaller angle (a) and larger central angle in the dislocation group are a result of a lower coronoid process, but they are also due to the prominent tip of the olecranon. The results suggest that the dislocation mechanism is partly a hyperextension, with the tip of the olecranon as the pivot point.

Disease Susceptibility↗
PubMed1988

[Sternoclavicular dislocations. Observations on the treatment and result of 49 cases].

Over a period of 19 years, 49 dislocations of the sternoclavicular joint were treated. Two were epiphyseal separations. The dislocation was an isolated injury in only 41% of the patients. There were associated injuries to the scapula in 55% and to the thorax in 37%. Forty dislocations were anterior, 8 retrosternal and one merely unstable. Seventeen were treated by operation, 15 by closed reduction and 17 were left untreated. We have been able to review 55% of these patients with an average follow up of 6.7 years; 15 were between 2 and 6 years after injury, and 12 between 6 and 16 years. The end result was achieved by 3 months; 42% of patients had an excellent result, 58% were satisfied and 25% disappointed with the final outcome. Operative treatment gave 66% of excellent results, whereas immobilisation, particularly with unreduced dislocations, accounted for most of those judged unsatisfactory. Closed treatment should be undertaken initially, but if reduction is not achieved an operation should be carried out. If old unreduced dislocations are unsatisfactory they should be stabilised by myoplasty, or by excision of the inner end of the clavicle if the articular surface is damaged.

Adolescent↗
PubMed1986

[Posterior shoulder dislocation].

Posterior dislocations of the shoulder can be caused by various mechanisms, the most common one, being epileptic seizures. Therefore many patients or their relatives hesitate to admit, how the injury has actually occurred. Spängler et al. published in 1975 several reasons why the diagnosis of "posterior subluxation of the humeral head" is often missed. Usually very typical errors in the evaluation of the clinical findings lead to misinterpretation of the radiograms. In spite of the fact that long-term results of untreated posterior subluxations can be surprisingly good, reduction must be achieved as soon as possible. Deep impression-fracture of the humeral head are the cause of recurrent dislocations. Various methods have been described to treat this condition by filling the defect with subscapularis tendon or cancellous bone. Avulsion-fractures of the posterior rim of the glenoid can successfully be refixed with small screws. In case of dislocation fractures through the anatomical neck, prosthetic replacement of the head leeds to satisfying results. So-called habitually dislocations are more common in boys and do usually not require surgery, as the inclination to dislocate becomes less frequent in later years. Only in adults operation may be indicated. Posterior apposition of a bone graft can be recommended.

Adult↗
PubMed2000

[Comparative study of sagittal and coronal MRI of histological disk and temporomandibular joint specimen for examining an identity of anterior disk dislocation and anterior capsular connective tissue].

PROBLEM: Anterior dislocation of the articular disk of the temporomandibular joint (TMJ) found by MRI tomography often presents a problem. It may persist in MRI despite improvement of articular symptoms and even be found in healthy persons free of any symptoms. Can this be explained by the similarity in structure of the anterior connective tissue of the disk and capsule and their pathological changes? Is a second coronal plane required for MRI investigation? MATERIAL AND METHODS: The preauricular regions of 72 patients of the TMJ clinic were examined by oblique-sagittal and oblique-coronal MRI. A Siemens-Vision MRI was used. It was also possible to prepare 10 articular disks of the TMJ with anterior capsular tissue as well as 20 complete TMJs of adults from autopsy material. Sagittal, transversal, and horizontal serial sections were examined histologically. RESULTS: In 49 of the 72 cases examined, an anterior dislocation without reduction found in the sagittal MRI was not confirmed in the oblique-coronal MRI. In the sagittal MRI it was possible to differentiate three, in the coronal MRI six typical forms of magnetic resonance signals, which are represented in figures. They are compared with anatomical and histological connective tissue findings adjacent to the TMJ. The structural similarity of the disk and anterior capsular tissue of the TMJ is demonstrated. The close connection of the disk and connective tissue surrounding the TMJ makes differentiation of MRI findings difficult especially following regressive and adaptive reactions. CONCLUSIONS: In MRI, anterior capsular tissue is able to simulate dislocation of the disk. Pathological tissue reactions may alter the MRI signal and lead to the wrong diagnosis of dislocation of the disk. Diagnosis of an anterior disk dislocation cannot be established solely on the basis of oblique-sagittal MRI findings.

Adult↗
PubMed2000

Natural history of unreduced congenital dislocation of the hip in adults.

The natural history of 33 patients with 43 unreduced congenital dislocations of the hip was reviewed. The average age at the first consultation was 50 years. Four were men and 29 were women. Ten patients had bilateral and 23 unilateral complete dislocation. Average follow-up lasted 9.2 years. At the final follow-up 23 hips and 18 knees were painful. Lumbago was observed in 6 of 15 patients under the age of 50 and in 14 of 18 patients over the age of 50 at the final follow-up. The average Harris hip scores at the first and final consultations were 69 and 70, respectively. The average dislocation index was increased in the standing more than in the lying position. In unilaterally dislocated hips the average femorotibial angles in the ipsilateral and contralateral knees to the dislocated hip were 172 and 179 deg, respectively. Lumbar degenerative scoliosis of more than 5 deg was observed in 16 patients.

Female↗
PubMed2003

[Intraarticular pathology of atraumatic shoulder dislocations. An arthroscopic study].

AIM OF THE STUDY: According to the literature, atraumatic shoulder dislocations occur without or only minor trauma,self-reduction and no or little pain. Little is known about intraarticular pathology in this entity. It was the purpose of our study to evaluate such findings. METHODS: During a 2-year period,226 patients had surgery for shoulder dislocation.28 patients met the criteria for atraumatic dislocation as above (group A). Patients with bony pathology or recurrent microtrauma were excluded. All had been treated with a rehabilitation program without success.28 consecutive patients with surgery after posttraumatic dislocation served as a control group (group B). At the beginning of the surgery,arthroscopy was performed in all patients and the intraarticular findings were recorded. For the capsulo-labral pathology,we determined 3 types: type I had capsular elongation or scarring and included so called "non-Bankart-lesions"; type II had classic "Bankart"-lesions and type III more complex capsulo-labral lesions like e.g. "ALSPA"-lesions. RESULTS: The mean age in group A was 27.6 y and 26.2 y in group B.12 patients in group A and 5 in group B were female. The average no.of dislocations was 10 (1-30) or 9 (1-28), respectively. In group A we saw type I lesions in 11 patients (39.3%), type II lesions in 9 (32.1%) and type III lesions in 8 (28.6%) patients. In group B we found type I lesions in 8 (28.6%), type II lesions in 4 (14.3%) and type III lesions in 16 (57.1%) patients.Hill-Sachs lesions were found in 22 (78.6%) and 23 (82.1%) of the patients, respectively.Also, we saw chondral glenoid damage, cuff lesions and SLAP-lesions in both groups. CONCLUSION: The above mentioned criteria for atraumatic shoulder dislocation do not exclude intraarticular pathology comparable to posttraumatic cases, at least for patients, who do not respond to a conservative treatment. Besides the etiology, the given pathology must be considered for therapy.

Adult↗
PubMed2006

[Bipolar dislocation injury of the forearm].

Bipolar dislocation injury of the forearm is rarely documented. It is a combined forearm injury with trauma on the elbow side and on the side of the wrist joint. We describe two different cases of this complex dislocation. The first patient suffered from a Monteggia-like dislocation fracture with transscaphoid dislocation of the wrist. The second person had an acute longitudinal radioulnar membrane dissociation after elbow dislocation with an additional scapholunate tendon rupture. The difficult management of these injuries is illustrated by these cases.

Elbow Joint↗
PubMed1997

Unilateral medial dislocation of the temporomandibular joint.

We present our experience of the rare condition of unilateral medial dislocation of the temporomandibular joint (TMJ) in 11 patients with head trauma who had received a direct lateral blow on the chin. The diagnosis was made by direct coronal CT of the TMJ performed from 6 h to 7 days following the injury. In 6 patients, subcondylar fracture of the ipsilateral mandibular ramus was also demonstrated. A second CT performed 11-16 months following the first one demonstrated pseudoarthrosis of the fractured ramus in these 6 patients. The second CT was identical to the first in the remaining 5 patients with pure dislocation of the condyle. All patients suffered from severe disability of the TMJ. The maximal vertical distance between the upper and lower incisors in patients with uncomplicated dislocation ranged between 8 and 12 mm. In cases with complicated medial condylar dislocation with fracture and pseudoarthrosis of the mandibular ramus, this distance ranged between 16 and 25 mm, probably because of additional movement in the area of the pseudoarthrosis. The maximal vertical distance between the incisors was compared with a control group of 20 normal adults who had values from 40 to 52 mm. Medial unilateral dislocation of the TMJ can appear in two forms: uncomplicated or complicated, with pseudoarthrosis of the ipsilateral mandibular ramus.

Adult↗
PubMed2002

Fracture dislocations of Lisfranc's joint treated with closed reduction and percutaneous fixation.

We reviewed 42 patients (mean age 37.7+/-14.2 years) with closed fracture dislocations of Lisfranc's joint treated with percutaneous screw fixation. Mean follow-up was 58.4+/-17.3 months. The aim was to compare dislocations in which a perfect anatomical reduction had been reached with dislocations in which reduction was only near anatomical. The mean American Orthopaedic Foot and Ankle Society score for all patients was 81.0+/-13.5. There were no significant differences in outcome scores between patients with perfect anatomical reduction and patients with near anatomical reduction. However, patients with combined fracture dislocations obtained statistically better scores than patients with pure dislocations.

Adolescent↗
PubMed2006

Severe damage of the femoral head after dislocation and difficult reduction maneuvers after total hip arthroplasty.

INTRODUCTION: Aseptic loosening associated with osteolysis and release of wear particles is the main reason for revision of total hip arthroplasty (THA). Damage of femoral heads is well known to increase the wear rate at the articulating surface. Instability and dislocation are serious complications and are the second most frequent reason for revision surgery after THA. In the present work the possible damaging of the femoral head as a result of difficult reduction maneuvers of dislocated THA should be investigated. PATIENTS AND METHODS: In three cases of total hip dislocation an open reduction was performed after dislocation of primary THA. Thereby one metal and two ceramic femoral heads were retrieved. Each head was analyzed macroscopically and by scanning electron microscopy (SEM) subsequently. RESULTS: In the first case the SEM analysis revealed severe titanium deposits on the retrieved ceramic head in the case of repeated unsuccessful closed reduction maneuvers. In the second case the retrieved ceramic head showed multiple scratches and a spalling of the surface structure. In the third case the retrieved metal head presented a roughened surface and severe scratches at the articulating area. DISCUSSION: Difficult reduction maneuvers following total hip dislocation can lead to severe damaging of the femoral head associated with an increase of the surface roughness. While repeated reduction maneuvers can lead to metallic deposits and spalling of the surface of ceramic heads, severe scratches can occur at metal heads. The damaging of the femoral head at the articulating surface can lead to increased wear and subsequent aseptic implant loosening. Therefore, open joint reduction has to be considered in cases of difficult or unsuccessful closed reduction maneuvers to prevent severe femoral head damage which may cause an increased release of wear particles.

Aged↗
PubMed1998

Complete dorsal dislocation of the metacarpophalangeal joint of the thumb.

In the pathology of simple complete dislocation involving the metacarpophalangeal joint of the thumb, whether or not the palmar plate is interposed within the joint is controversial. Nine cases of complete dorsal dislocation of the joint were reviewed, and cadaver dissection was performed to study the pathology of this injury. Eight of the nine patients were seen within 4 days of injury and treated successfully by closed manipulation. One patient treated 7 days after the injury required open reduction. We were able to reproduce the pathological anatomy of the dislocation, wedging of the palmar plate in the joint of the cadaver. In this cadaver and in all clinical cases, radiographs showed a complete dislocation with an increased distance between the palmar edge of the base of the proximal phalanx and the metacarpal head, indicating an interposition of the palmar plate. Our study suggests that in simple complete dislocations of this joint, the palmar plate is interposed between the displaced bones.

Adolescent↗