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At least 685 records · Page 38Linked to original sources
PubMed2005

Traumatic dislocation of the globe into the maxillary sinus associated with extraocular muscle injury.

BACKGROUND: The mechanism of complete dislocation of an intact globe into the maxillary sinus after an extensive blowout fracture has not been clearly documented. METHODS: A 68-year-old man sustained orbital wall fractures of the right orbit, resulting in dislocation of the globe into the maxillary sinus, associated with the transection of the medial and inferior rectus (MR and IR). We repaired the orbital wall fractures using Medpor barrier sheets, and repositioned the dislocated globe. And then, the distal section of the IR was sutured at its proximal end and the severed distal section of the MR was sutured at the fascial sheath and Tenon's capsule. RESULTS: After repositioning, the eyeball was intact without signs of perforation, but the patient's visual acuity was impaired, exhibiting a loss of light perception, coupled with a noted pallor of the optic disc. The patient's eye movement was severely restricted, but supraduction and abduction proved possible. CONCLUSIONS: This case demonstrates that the globe can be dislocated into the maxillary sinus following orbital wall fracture associated with extraocular muscle injury, and provides a clue into the mechanism underlying dislocation of the globe into the maxillary sinus.

Aged↗
PubMed2004

Therapeutic options and results following fixed atlantoaxial rotatory dislocations.

Atlantoaxial rotatory dislocation (AARD) represents a rare pathological condition of the upper cervical spine that is frequently misdiagnosed, leading to a delay in therapy. In a long-term assessment of clinical and radiological results, three different therapeutic options with regard to the length of the dislocation-therapy interval (DTI) were evaluated. Twenty-six patients were treated for AARD from December 1988 until April 2000. Proper diagnosis was established after an average interval of 15 months. Three different therapeutical protocols were followed in order to reduce the dislocation: (1) closed transoral reposition under general anesthesia; (2) temporary transoral fixation utilizing the Harms T-plate; (3) definitive transoral fusion. The eight patients treated by closed reduction had the best pain relief. The average visual analogue scale (VAS) score was 96.6 points, while the rotatory motion of the upper cervical spine, as assessed by dynamic MRI, was 25.3 degrees to each side. The length of the dislocation-therapy-interval (DTI) averaged 1.4 months. A mean VAS Score of 92.3 points was recorded in the ten patients treated with a temporary fixation of C1/C2. In this subgroup the DTI had an average length of 5.3 months. The mean rotation to each side was 13.9 degrees . In the eight patients who underwent definitive fusion the mean VAS score was 60.6 points, while the average length of the DTI was 40.5 months. In conclusion, the clinical outcome and the subjective well-being following AARD deteriorates with increasing length of the dislocation-therapy interval.

Adolescent↗
PubMed2005

Cranio-cervical stabilization of traumatic atlanto-occipital dislocation with minimal resultant neurological deficit.

Our purpose is to describe a case of atlanto-occipital dislocation and discuss treatment approaches to minimize subsequent neurological deficits. Traumatic atlanto-occipital dislocation, has traditionally been considered rare and lethal, due to resulting high levels of spinal cord injury. Outcomes are generally expected to be poor. However, recent case reports indicate that survival is increasing. Of patients who survive cranio-cervical dislocation, many endure resulting neurological deficits. We present a rare case of a 23-year-old male, who sustained an atlanto-occipital dislocation in a motor vehicle accident. The patient presented with a Glasgow Coma Scale (GCS) of 11T. Lateral C-spine x-ray and thin-section slices CT delineated a C1 ring fracture on the left side with approximately 1 cm anterior and superior subluxation of the occipital condyles of the cranium in reference to C1. The patient was completely awake, alert, and was following commands. The patient underwent a cranio-cervical stabilization from occiput to C3, using lateral mas screws (C1-C3) and transarticular screws (C2-C3). The Vertex (Medtronics) system used included longitudinal bars connected to the lateral mas plating system, which was subsequently used to place screws within the keel of the occipital bone. Motor strength and sensation remained intact following surgery. One-week post-operation, the patient was ambulating 140 feet, conversationally appropriate, and had a GCS of 15. This case illustrates the possibility for neurosurgical intervention of cranio-cervical dislocations to achieve optimal outcome and demonstrates that survival from this injury is not only conceivable, but recovery of function is also possible.

Adult↗
PubMed2004

Biomechanical analysis of the mechanism of elbow fracture-dislocations by compression force.

Fracture-dislocations of the coronoid and olecranon were produced experimentally, and their onset mechanisms were analyzed to clarify the effects of compression force on the coronoid and olecranon. The study used two-dimensional finite element method (2D-FEM) simulations and static loading experiments. The latter applied axial force distally to 40 cadaveric elbows. Posterior fracture-dislocations occurred between 15 degrees of extension and 30 degrees of flexion, anterior or posterior fracture-dislocations at 60 degrees, and only anterior fracture-dislocations at 90 degrees. Injuries were mainly to anterior or posterior support structures. The 2D-FEM simulations showed that the stress concentration areas moved from the coronoid process to the olecranon as position changed from extension to flexion. The very high frequency of concurrent fracture-dislocations of radial head or neck in the current study indicated that the radial head may also function as a stabilizer in the anterior support system.

Aged↗
PubMed1999

Treatment of traumatic atlanto-occipital dislocation in chronic phase.

We report the case of 27-year-old woman who presented with mild neurological deficits with significant anterior dislocation of the atlanto-occipital junction in a chronic phase after initial conservative treatment in another hospital. The importance of early diagnosis and treatment for atlanto-occipital dislocation is emphasized. The dislocation could not be reduced sufficiently either by halo ring cervical traction or surgical procedure 5 months after the accident. Therefore, transoral odontoidectomy for decompression of the medulla, together with the posterior occipitocervical fusion with a titanium loop brace was performed. The patient's symptoms disappeared completely within a few months after the operation. Magnetic resonance imaging findings suggesting soft tissue damage is the key to an early diagnosis and subsequent stabilization of traumatic atlanto-occipital dislocation in the early phase. Transoral decompressive odontoidectomy combined with posterior fusion may be considered for the treatment of irreducible atlanto-occipital dislocation in a chronic phase.

Adult↗
PubMed1982

Traumatic anterior dislocation of the hip in childhood.

One hundred and eleven traumatic anterior dislocations of the hip in children were collected from the literature and statistically evaluated together with 4 cases treated at our institute. The incidence of open dislocations, associated lesions (avulsion of the greater trochanter, damage to the femoral vessels, and fracture on the shaft of the ipsilateral femur), and irreducible recent dislocations was noteworthy, demanding special methods of primary management. In 41 patients, with follow-up averaging 5 years, the incidence of complications, especially avascular necrosis, was also high. Anterior dislocation of the hip in this age group is to be considered a serious injury. Concerning the final state of the hip-joint, factors giving a poor prognosis appear to be severe injury, open dislocation, associated fractures near the joint, delayed reduction, and, possibly, open procedures.

Adolescent↗
PubMed1976

External pterygoid myotomy for recurrent mandibular dislocation. Review of the literature and report of a case.

Dislocation of the temporomandibular joint is a condition that requires immediate attention. Several conservative methods are effective in the treatment of the acute episode, but surgical treatment is indicated for chronic dislocation. Many, sometimes conflicting, procedures have been proposed for the surgical treatment of chronic dislocation. Comprehensive review and analysis of the literature reveals that this confusion is generated by a poor understanding of the etiology of chronic dislocation. External pterygoid myotomy is recommended as the surgical treatment of choice since it eliminates the forces responsible for pulling the mandible into the dislocated position. A case is presented to demonstrate the effectiveness of this procedure.

Cartilage, Articular↗
PubMed1992

Clinical symptoms of open lock position of the condyle. Relation to anterior dislocation of the temporomandibular joint.

Nine cases of open lock position of the condyle of the temporomandibular joint (TMJ) are reported. In two patients recurrent dislocation of the TMJ was diagnosed clinically, and four had previous episodes of anterior dislocation. An arthrotomographic examination revealed that the condyles of the affected TMJs were located anterior to the anterior bands of the disks at an open-mouth position. An arthrographic fluoroscopic examination showed that the anterior bands mechanically obstructed the anteriorly displaced condyles from posterior movement into the articular fossae to various degrees at open-mouth position. One cause of anterior dislocation of the TMJ is thought to be fixation of the condyle in the open lock position resulting from a disturbance of a neuromuscular mechanism. In the two patients with dislocation, occlusal treatment eliminated muscular symptoms and the dislocations completely disappeared.

Adult↗
PubMed1990

Traumatic and spontaneous dislocation of extensor tendon of the long finger.

Extensor tendon dislocation is an unusual problem in patients unaffected by rheumatoid arthritis. Sixteen cases of ulnar dislocation of the long extensor tendon of the long finger are reported. Five of these cases were classified as traumatic dislocation and 11 as spontaneous dislocation. All cases were treated by surgery. Differences in anatomic and clinical features between traumatic and spontaneous dislocation of the long extensor tendon are described.

Adult↗
PubMed2003

Sciatic nerve injuries associated with traumatic posterior hip dislocations.

This study was undertaken to test the hypothesis that patients transferred between hospitals with a dislocated hip have a greater incidence of sciatic nerve injury than patients who have their hip reduced at the first facility. One hundred six dislocated hips were included in this 12-year retrospective study. Sixty-nine hips were relocated at the first hospital and 36 patients were transferred with the hip still dislocated to LDS Hospital. There was a higher incidence of major sciatic nerve injury (complete sciatic or peroneal motor deficit) in patients transferred with the hip still dislocated (P =.0453). Time to relocation was significantly longer in patients with major motor nerve injury (P =.016). The presence of an associated fracture had no influence on sciatic nerve injury rates. The length of time a hip remains dislocated influences the incidence and severity of major sciatic nerve injury.

Adolescent↗
PubMed2005

Femoral neuropathy due to patellar dislocation in a theatrical and jazz dancer: a case report.

This case report describes a teenage female, high-level modern dancer who suffered multiple left patellar dislocations. Her history is atypical in that after her fifth dislocation, her recovery was hindered secondary to persistent weakness and atrophy of her quadriceps out of proportion to disuse alone. Electrodiagnostic studies and magnetic resonance imaging showed evidence of a subacute femoral neuropathy correlating chronologically with her most recent patellar dislocation. This case suggests that further diagnostic study may be warranted in patients with persistent quadriceps weakness or atrophy after a patellar dislocation, because this may suggest the presence of a femoral neuropathy. This is important because the strength training goals and precautions differ in disuse atrophy and a neuropathy. We believe this is the first reported case of a femoral neuropathy associated with the mechanism of a patellar dislocation.

Adolescent↗
PubMed2003

The role of arthroscopy in chronic anterior shoulder dislocation: technique and early results.

Dislocation that lasts longer than 3 weeks is called chronic or unreduced shoulder dislocation. Treatment alternatives can be closed reduction, open reduction, resection arthroplasty, prosthesis, arthrodesis, and no therapy. The English-language literature includes no evidence on arthroscopic reduction for the treatment of unreduced shoulder dislocation. The goal of our study was to present our technique and period results on the arthroscopic reduction we performed in 2 cases 4 and 5 weeks after anterior shoulder dislocation. Reduction could not be achieved by closed reduction under anesthesia. With arthroscopic visualization, adhesions within the joint were released with blunt dissection. Repeat reduction attempts were unsuccessful in these 2 cases. Labroligamentous lesions of the inferior glenohumeral ligament were repaired using 3 absorbable tacks. On the second day after the surgery, isometric exercises were started. The results were evaluated using a 100-unit test recommended by Rowe and Zarins (80 units in case 1; 85 units in case 2). Reduction of chronic unreduced shoulder dislocations using arthroscopy is an alternative technique for selected patients. It also allows repair and treatment of the intra-articular pathology in the joint and makes early postoperative rehabilitation possible.

Adult↗
PubMed2006

Simulated capsulolabral lesion in cadavers: dislocation does not result from a bankart lesion only.

PURPOSE: Although an anteroinferior capsulolabral detachment (typical Bankart lesion) has been evaluated in other experimental studies, it has not yet been tested with an apprehension test in an intact shoulder model. METHODS: Adjacent combinations of 4 zones of the capsuloligamentous complex were sequentially detached from the glenoid neck in 50 cadaveric shoulders. Stability was tested before and after each resection step: inferior stability with a sulcus test and anterior stability with an anterior drawer test and with a load-and-shift test in the apprehension position. RESULTS: A metastable anteroinferior dislocation occurred in 18 specimens after section of 3 zones and in 14 only after section of 4 zones. A locked dislocation occurred after section of all 4 zones in 33 specimens and in the other 17 shoulders only after the posterior capsule was also cut. CONCLUSIONS: The humeral head cannot dislocate anteroinferiorly when there only is a Bankart lesion. In our study superior and posterior extension was necessary before the tensioning mechanism in external rotation and abduction failed enough for dislocation to occur. CLINICAL RELEVANCE: Because the Bankart lesion is most likely not the only lesion present in patients with recurrent dislocation, a careful search for other lesions needs to be done when one is attempting surgical treatment. These lesions would need to be treated as well if one wants to avoid the risk of residual instability.

Aged↗
PubMed2006

Interprosthetic dislocations of the Charnley/Hastings hemiarthroplasty--report of 11 cases in 350 consecutive patients.

We report 11 cases of interprosthetic dislocation of the Charnley/Hastings hemiarthroplasty in a retrospective study of 350 consecutive patients treated for an acute femoral neck fracture. We found a total of 14 dislocations (4.0%), 11 were interprosthetic. The median age of the 350 patients was 79 (36-99) years and the median age of the 11 patients with an interprosthetic dislocation was 85 years (82-94). The median time from surgery to radiologically acknowledged dislocation was 18 (4-64) days. These interprosthetic dislocations may be caused by either an assembly mistake perioperatively, by maximum angulation and impingement between the components, or by trauma.

Adult↗
PubMed2004

Anterior shoulder dislocations: beyond traction-countertraction.

The shoulder is the most commonly dislocated large joint presenting to American Emergency Departments (ED). Anterior dislocations account for the great majority of these dislocations. Most anterior shoulder dislocations can be reduced in the ED using a variety of reduction techniques. The traction-countertraction technique is quite familiar to most Emergency Physicians, however, many other effective methods of reduction have been described. No method has proven 100% successful, and occasionally multiple attempts using different techniques are required to effect reduction. This article reviews some of the other techniques used to reduce anterior shoulder dislocations, variations reported on these techniques, and their success rates, advantages, and disadvantages.

Emergency Medical Services↗
PubMed2006

Selective radiography in 100 patients with suspected shoulder dislocation.

We sought to prospectively validate an algorithm for selective radiography in the Emergency Department (ED) management of patients with suspected shoulder dislocation. Physicians ordered pre- and post-reduction radiographs based on an algorithm incorporating the mechanism of injury, previous dislocations, and the physician's clinical certainty of joint position. Follow-up consisted of telephone calls and chart review. Of 100 patients, 94 had shoulder dislocation, and 59% were recurrent. Thirty percent had both pre- and post-reduction radiographs, 45% had pre- or post-reduction only, and 25% had no shoulder films, yielding an overall 46% reduction in X-ray utilization. Mean ED times were significantly shorter for patients managed without radiographs. On telephone follow-up (76%) and chart review (100%), we found no missed fractures or persistent dislocations. Use of a clinical decision rule for selective radiography reduced the number of radiographs and time spent in the ED, while missing no fractures or dislocations.

Adult↗
PubMed2005

Second-look arthroscopy of cartilage changes of the patellofemoral joint, especially the patella, following acute and recurrent patellar dislocation.

OBJECTIVE: The purpose of this study was to clarify some pathogenesis of the cartilage changes of the patellofemoral joint in patellar dislocation knees. METHODS: A first arthroscopy was performed in a total of 60 knees, including 30 knees of acute patellar dislocation (APD) and 30 knees of recurrent patellar dislocation (RPD). At the time of the first arthroscopy, 58 knees sustained open medial patellofemoral ligament repair/reconstruction, and 2 knees had only arthroscopy examination. In APD knees, the second-look arthroscopy was performed 16.7 months after the first arthroscopy, and in RPD knees, 25.2 months after the first arthroscopy. RESULTS: In most APD knees, cracking primarily on the central dome of the patella did not have a remarkable change but in several knees that had a high number of cracking or interlaced cracking, cracking became worse with fibrillation. Osteochondral defect site primarily on the medial facet showed fibrillation and/or ulceration (erosion). In most RPD knees, fissuring primarily on the central dome did not have a remarkable change, and fibrillation and/or erosion mainly on the medial facet also did not have a remarkable change. However, in four knees with the continuation of patellar dislocation, the patellar cartilage changes had definitely worsened. On the other hand, in the first and second-look arthroscopy, most APD and RPD knees had no remarkable cartilage lesions or cartilage changes of the femoro-trochlear aspect. CONCLUSIONS: One of the pathogenesis of fissuring in RPD knees seems to be cracking occurring at the time of APD. Two of the pathogenesis of fibrillation may result from the reparative reaction of the cartilage in osteochondral defect site and the cartilage change due to a high degree of cracking damage mainly on the central dome in APD injury. The continuation of patellar dislocation definitely makes the patellar cartilage lesions worse.

Acute Disease↗
PubMedDate not supplied

The association of subacromial dimples with recurrent posterior dislocation of the shoulder.

Posterior positional dislocation is a form of atraumatic posterior recurrent dislocation commonly presenting in late teenage years. It has been an observation of ours that patients with posterior positional dislocation may have a small skin dimple, or tether, over the posteromedial deltoid of both shoulders. Fourteen consecutive patients with an established diagnosis of recurrent posterior positional dislocation were taken from our diagnostic database and reviewed along with 14 age- and sex-matched controls. For each patient and control, a diagnostic battery of clinical signs of instability was recorded and a photograph taken of the posterior aspect of the shoulder. The posterior dimple sign was associated with posterior instability with a sensitivity of 67% and a specificity of 92%. The clinical association of a posterior skin dimple and posterior recurrent positional dislocation has not been recognized before. This feature is discussed and the literature is reviewed.

Adolescent↗