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PubMed2006

Traumatic noncontiguous double fracture-dislocation of the lumbosacral spine.

BACKGROUND CONTEXT: To our knowledge, the presence of noncontiguous fracture-dislocation of the lumbosacral spine occurring at two levels has not been reported. The etiology, evaluation, and treatment of the unusual injury is presented. PURPOSE: To notify spinal traumatologists about the possibility of this unusual injury. STUDY DESIGN: A case report of an unusual noncontiguous double fracture-dislocation of the lumbosacral spine. METHODS: A 26-year-old man was involved in a motor vehicle accident where his car fell over a bridge and plummeted approximately 300 feet before hitting the ground. The patient was transported to a major medical center where he was found to be conscious, and amazingly, his only major injury was fracture-dislocations of L2-L3 and L5-S1. His preoperative neurologic status showed a partial paraparesis to all motor groups of the lower extremities bilaterally. RESULTS: The patient underwent a posterior reduction, instrumentation, and fusion from L1 to S1 with autogenous bone graft and segmental pedicle screw instrumentation. One week postoperatively, he underwent an anterior spinal fusion of L5/S1. Postoperatively, his neurologic status improved allowing him to be ambulatory, with a normal lumbosacral alignment being well-maintained. CONCLUSIONS: Noncontiguous double fracture-dislocation of the lumbosacral spine is an unusual injury, which results from a very high-energy trauma. Prompt recognition of the injuries, reduction of the fracture-dislocations, and posterior stabilization is recommended for neural decompression, spinal alignment, and long-term stabilization.

Accidents, Traffic↗
PubMed1978

Radiological aspects of posterior dislocation of the hip.

Ninety-six cases of traumatic dislocation of the hip were admitted to one general hospital over a 10-year period. Eighty of these (83.3%) were posterior dislocations, usually with associated acetabular fractures (81.25%). The aetiology and various complications of posterior hip dislocation are described adn discussed, together with the radiographic management. Radiologists should take special care to exclude associated femoral and pelvic fractures both within and beyond the acetabulum. Fractures of the ipsilateral femur associated with posterior hip dislocation usually involve the femoral head and the radiological appearances and assessment of this injury is important. Ipsilateral femoral shaft fractures are less frequent, but it may be the hip dislocation which is then overlooked unless there is an awareness of the combined injury.

Acetabulum↗
PubMed1978

Arthrography of the shoulder in anterior dislocation: a study of African and Asian patients.

Arthrography of the shoulder was performed in 16 consecutive cases of primary anterior dislocation and in 11 cases of recurrent dislocation. All the primary dislocations were in African Negro patients and showed an unusually high incidence of capsular rupture rather than labral detachment. It is suggested that this is due to stronger soft tissue attachment to bone in Africans, resulting in fewer labral detachments and thus accounting for the low incidence of recurrent dislocation in the African populace. The series of recurrent dislocations, consisting of African and Asian patients, confirmed the low incidence in Africans but demonstrated labral detachment and humeral head defects common to both racial groups.

Adolescent↗
PubMed1998

Primary replacement of the humeral head in iatrogenically displaced fracture-dislocations of the shoulder: a report about six cases.

Dislocation of the shoulder is a common injury and may be associated with a variety of complications. We report six cases of primary replacement of the humeral head where closed reduction of a shoulder dislocation associated with an undisplaced fracture of the humeral neck led to displacement of the neck fracture. All dislocations examined were anterior with a displaced greater tubercle fracture. The patients had undergone closed reduction at other medical centres and were referred to us because of iatrogenically displaced fracture-dislocations of the shoulder. Three were women and three were men with a mean age of 52.8 years (range 38-72). Primary replacement of the humeral head was done in an average of 9.3 days (range 2-30 days) following the injury. The average follow-up period was 30.2 months (range 12-55 months). Postoperative pain, active range of motion and function were evaluated with the American Shoulder and Elbow Surgeons Criteria. The forward flexion averaged 124 degrees, active external rotation averaged 29 degrees and internal rotation (achieved movement) to the second lumbar vertebra. Because of the high risk of avascular necrosis and severe collapse of the humeral head, we conclude that the primary replacement of the humeral head is the superior treatment option in iatrogenically displaced fracture dislocations of the shoulder.

Adult↗
PubMed1999

Acute elbow dislocations: simple and complex.

The elbow is the second most common joint dislocated in adults. Up to 20% of dislocations are associated with fractures. Treatment principles are reduction of the joint, stabilization of associated fractures, and early motion. Ligament repairs or reconstruction and hinged external fixators are necessary in some cases to restore stability for early motion. In general, simple dislocations have a better prognosis than complex dislocations (fracture-dislocations).

Acute Disease↗
PubMed1993

Reduction of anterior shoulder dislocations by scapular manipulation.

STUDY OBJECTIVES: This study examined the success rate, time required, technical ease, and reported patient discomfort for the use of scapular manipulation in the reduction of anterior shoulder dislocation. This study included a new variation of this technique using the seated position. DESIGN: Prospective case series over a 19-month period. SETTING: The emergency departments of a university and a community hospital. TYPE OF PARTICIPANTS: Patients with anterior shoulder dislocations. INTERVENTIONS: Emergency medicine resident and attending physicians were instructed in the technique of scapular manipulation in a classroom setting and requested to use this method initially for the reduction of anterior shoulder dislocations. Premedication was at the physician's discretion. MEASUREMENTS AND MAIN RESULTS: There were 54 patients with 61 dislocations. Scapular manipulation was attempted by 19 residents and 12 attending physicians. The overall success rate of scapular manipulation was 79%, whereas that of physicians experienced with the technique was 86%. Of the successful reductions, 65% were performed in less than one minute, and physicians rated the technique as very easy or easy to perform in 74% of these cases. No premedication was used in 64% of the attempts at scapular manipulation, and these patients reported pain ratings similar to those of the premedicated groups. No complications were noted in this study. CONCLUSION: Scapular manipulation generally is a simple, rapid, and reliable technique for the reduction of anterior shoulder dislocation.

Adolescent↗
PubMed1996

Clinically significant abnormalities in postreduction radiographs after anterior shoulder dislocation.

STUDY OBJECTIVE: To determine the incidence of clinically significant fractures or other abnormalities seen on postreduction shoulder radiographs which were not seen on postreduction should radiographs which were not seen on the prereduction films obtained for anterior shoulder dislocations. METHODS: Retrospective chart review of 131 patients who presented with a total of 175 anterior shoulder dislocations to the emergency department of an urban, university-affiliated, Level 1 Trauma Center with an emergency medicine residency program. All patients had complete medical records, radiographs before and after reduction, and no fractures reported on the prereduction films. RESULTS: There were three avulsion fractures (1.7%; 95% confidence interval [CI], 0% to 4.5%) detected on postreduction radiographs. In all three cases, a radiologist who was blinded to the original interpretations and the purpose of the study also noted the fractures on the prereduction films, although these fractures were not detected on the original interpretations. There were 14 new Hill-Sachs deformities (8%; 95% CI, 4% to 12%). In one case (.6%; 95% CI, 0% to 2.8%), the postreduction radiograph demonstrated a persistent dislocation, which was subsequently reduced in the ED. This was the only postreduction finding that altered acute management. CONCLUSION: Postreduction radiographs rarely reveal any clinically significant abnormality after an anterior shoulder dislocation has been reduced. Emergency physicians and orthopedic surgeons should question whether the time and expense of obtaining routine postreduction films in the ED for anterior shoulder dislocations is justified. A prospective study is needed to validate our findings.

Adult↗
PubMed1999

Finite element analysis of a novel design approach to resisting total hip dislocation.

OBJECTIVE: A new design concept has been developed to reduce the propensity for dislocation in total hip patients. The ability of this design to increase the stability of the hip joint is studied. DESIGN: The new design involves a convex-curved acetabular lip, extending from the hemispherical articulating surface to the outer edge of the cup. The femoral component has a matching, reverse curve. BACKGROUND: Dislocation is a continuing problem in total hip arthroplasty, a complication experienced by 2-11% of patients with primary surgeries, and much higher percentage of patients in revision series. Confounding factors and sources of variability in the clinical domain make it difficult to identify specific parameter influences. METHODS: A three-dimensional nonlinear finite element model has been developed for the purpose of studying the dislocation event. We report the first use of this finite element model to analyze the potential for improving hip stability by a new total hip component design concept. RESULTS: The results show that this new design achieves 28% more resisting moment build-up during dislocation, and has a higher range of motion from impingement to onset of subluxation. The new curved lip design also develops 50% less polyethylene von Mises stress in the impingement zone. CONCLUSIONS: This design has excellent potential for increasing the inherent stability of the total hip joint. RELEVANCE: Recurrent dislocation is the second leading cause of total hip failure next to late loosening. This study shows the potential of a new total hip design to increase the stability of the artificial hip joint.

Arthroplasty, Replacement, Hip↗
PubMed2001

Fracture dislocations of the elbow in athletes.

Elbow dislocations can result in extensive injury to the supporting structures of the elbow joint. Principles of treatment include prompt reduction of the dislocation and treatment of associated fractures. The goal is to restore joint stability and to allow for early mobility. Most simple dislocations are stable after closed reduction with early mobility that can lead to anatomic and functional restoration. When stability is compromised, as with many complex dislocations, further stabilization with ligament repair, reconstruction, and fracture fixation also can lead to satisfactory results. The prognosis following complex dislocations is more guarded in the athlete, and depends on anatomic restoration and initiation of early motion.

Athletic Injuries↗
PubMed1983

The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint.

The diagnosis of an isolated subluxation or dislocation of the distal radioulnar joint (DRUJ) may be extremely difficult to make from the standard radiographic examination. Radiographs and computerized tomographic (CT) scans of cadaver wrists were used to evaluate subluxation and dislocation of the DRUJ. Both subluxation and and dislocation could be accurately diagnosed from a true lateral radiographic projection of the wrist with the forearm in neutral rotation. Minimal supination or pronation of the forearm led to inaccurate diagnosis. A single CT scan through the DRUJ was diagnostic for subluxation and dislocation in all positions of forearm rotation. Wrist pain, plaster immobilization, or suboptimal wrist positioning may make it impossible to obtain a perfect lateral view of the wrist, thereby precluding the radiographic diagnosis of DRUJ subluxation and dislocation. In this instance, a single CT scan through the DRUJ is recommended.

Humans↗
PubMed2003

Acute complications associated with shoulder dislocation at an academic Emergency Department.

Shoulder dislocation is the most frequent dislocation treated in the Emergency Department (ED). Orthopedic literature cites up to a 55% incidence of fracture, vascular or neurologic injury associated with this injury, but these studies suffer from referral bias. No large ED series has been reported. This retrospective chart review was conducted in an academic ED for patients with shoulder dislocation presenting July 1, 1995-June 30, 2000. There were 263 charts identified; 73 were miscoded and 5 were lost, leaving 190 for analysis. Mean age was 34.3 years. Fifty-five patients had at least one fracture (29%), 48 of which (76%) were of the Hill-Sachs type. Despite presence of a fracture, all shoulders underwent successful ED reduction. Sensory nerve deficits were found in 24 (12.6%), which persisted after reduction in 25% of these patients. No vascular injuries were identified. The finding of fracture in 33% of patients with shoulder dislocation is in the range of rates reported in the orthopedic literature (15-55%). The finding that, despite the presence of a fracture, all underwent successful closed reduction is important, as one-third of these patients will have this condition. Neurologic deficits in 12% is significantly lower than the 21-65% reported in the orthopedic literature. Although complications associated with shoulder dislocation were relatively common, they did not significantly affect ED management.

Academic Medical Centers↗
PubMedDate not supplied

Metacarpophalangeal joint dislocation: indications for open surgical reduction.

In complex dislocations of the metacarpophalangeal joint, the volar plate is separated from the proximal phalanx and the metacarpal head is entrapped within surrounding tissue structures. These complex dislocations must be managed by open surgical reduction to reduce the dislocation and realign the volar plate. A 58-year-old male presented to the emergency department with a complex dislocation of the metacarpophalangeal joint of the left little finger, which was successfully treated by open reduction in the operating room. The indications for open reduction of metacarpophalangeal joint dislocations are reviewed.

Collateral Ligaments↗
PubMedDate not supplied

Use of a hinged external knee fixator after surgery for knee dislocation.

PURPOSE: This study documents short-term clinical outcomes in patients with knee dislocations after blunt trauma and evaluates the compass knee hinge (CKH) external fixator for their treatment. TYPE OF STUDY: Nonrandomized prospective functional outcome study. METHODS: Forty patients with 43 knee dislocations were evaluated. Twelve knees underwent ligament reconstruction followed by placement of a CKH; this was group A. Group B included 27 knees that underwent the same treatment and rehabilitation protocol except that an external brace was used rather than a CKH. RESULTS: Thirty-six patients with 39 knee dislocations underwent follow-up ranging from 14 to 41 months (mean, 24). Four patients with 4 knee dislocations were lost to follow-up (1 group A, 3 group B). Group A underwent 27 knee ligament procedures with 2 (7%) failures based on clinical examination. Group B underwent 102 ligament procedures with 30 (29%) failures (P <.05). Anterior cruciate ligament (ACL) reconstruction revealed that 7 group A patients experienced 1 (14%) failure and 25 Group B patients experienced 7 (28%) failures. Posterior cruciate ligament (PCL) reconstruction in 7 group A patients included no failures, and 20 PCL reconstructions in group B included 1 failure. Reconstruction of the posterolateral corner (PLC) yielded no failures in 2 group A patients and 5 (25%) of 20 in group B. Repair of 8 PLCs in group A yielded 1 (12.5%) failure and 26 PLC repairs in group B had 14 (54%; P =.05). SF-36 data revealed low mean values with no significant differences between groups with current enrollment. CONCLUSIONS: Knee dislocation after blunt trauma requires aggressive surgical treatment and physical therapy. In the short-term evaluation, the CKH allows aggressive physical therapy without placing repaired or reconstructed ligaments under high stresses that can result in failure.

Accidents, Traffic↗
PubMed1993

Arthroscopic view of an irreducible knee dislocation.

Irreducible knee dislocation is a rare effection of the knee joint; only 23 cases have been reported in the literature. This is a case report of a 35-year-old man who injured his left knee in a motorcycle accident. Dislocation was documented on radiograph. His neurovascular status was intact. Attempts under sedation and anesthesia and even arthroscopy failed to reduce the dislocation. Eventually, the patient had open reduction of the dislocation. An arthroscopy view of the dislocation showed that the medial femoral condyle was buttonholed through the anteromedial capsule and retinaculum. Arthroscopy was an excellent tool for partial lateral meniscectomy and planning the open surgical procedure.

Accidents, Traffic↗
PubMed1986

Arthroscopic repair of the medial retinaculum and capsule in acute patellar dislocations.

Treatment for acute dislocations of the patella is highly controversial among many knee surgeons. This study proposes an arthroscopic technique for the surgical repair of the retinacular-capsular defects caused from acute patellar dislocation. The clinical material used involved 30 cases with no previous history of patellar instability and with history of documented lateral dislocation accompanied by an acute hemarthrosis. All individuals in this study were treated with arthroscopic medial capsular-retinacular repair and lateral retinacular release. The follow-up on these patients, ranging from 1 to 7 years postoperatively, revealed that the results of treatment were gratifying in all instances with the exception of one traumatic redislocation. It appears that the arthroscopic procedure used in this study was successful in stabilization of the acute dislocation of the patella, and that it is a beneficial addition to present surgical treatment for the acute dislocation of the patella. This technique provides early accurate diagnosis and, thus, early accurate restoration of normal anatomy. This technique is by no means the only way, but it is one way to obtain satisfactory results in the treatment of this most difficult problem.

Arthroscopy↗
PubMed1998

Arthroscopic stabilization of the shoulder for acute primary dislocations using a transglenoid suture technique.

Many studies report the results of arthroscopic stabilization for recurrent shoulder instability, with widely variable recurrence rates; however, there are very few reports of the use of these techniques in acute first-time dislocations. We report the clinical outcomes of 17 patients who had arthroscopic stabilization using a transglenoid suture technique for acute primary dislocation. The surgery took place between March 1992 and March 1994 and, to date, there has been one recurrent dislocation (6%) and no recurrent subluxation. There were no major complications, although a number of patients found the knot tied over the infraspinatus fascia to be uncomfortable until it resorbed. All patients examined had normal power and range of motion, and a clinically stable shoulder. All 16 patients without recurrence were satisfied with their result. Nine patients returned to sports at the same or higher level, including such vigorous contact sports as Australian Rules football and rugby. Three patients did not return to the same level of sporting activity because of lack of confidence in the shoulder or a fear of dislocation despite no clinical evidence of instability. Five patients reported a lack of confidence in the shoulder without clinical evidence of instability. We suggest that arthroscopic stabilization with transglenoid sutures or a suture anchor technique is a reasonable option for the athlete with an acute primary shoulder dislocation who wishes to return to sports.

Adult↗
PubMed2003

Relationship between length of stay and dislocation rate after total hip arthroplasty.

The purpose of this study was to determine if decreased postoperative inpatient time (length of stay; LOS) after total hip arthroplasty (THA) was correlated with an increase in the dislocation rate after discharge. Reduced access to physical therapy, nursing reinforcement of dislocation precautions, and medical supervision could lead to a higher rate of adverse behaviors (such as inappropriate flexion and rotation) and accidents that might have otherwise been avoided in the initial 3 -months after surgery. We examined records from 850 patients (2 surgeons) who underwent primary THA from 1993 to 1998. LOS had progressively decreased over the 4 years since implementation of a clinical pathway (CP) in late 1993. The average LOS in 1992 was 6.6 days and was lowest in 1998 at 3.9 days. The dislocation rate before the CP was 0.5%. The dislocation rate increased significantly to 3.9% after implementation of the CP (P =.015). Use of the CP offers numerous advantages but is associated with a higher dislocation rate.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Magnetic resonance imaging evaluation of capsulolabral tears after traumatic primary anterior shoulder dislocation. A prospective comparison with arthroscopy of 25 cases.

The purpose of our study was to evaluate the use of static magnetic resonance imaging (MRI) as a preoperative diagnostic tool in young patients with a traumatic primary anterior shoulder dislocation. Twenty-five patients who had acute primary traumatic anterior shoulder dislocation were examined with MRI and arthroscopy. The patients (18 male and 7 female) were between 16 and 39 years old (mean age, 27 years). They had no previous shoulder dislocations. The dislocations were confirmed radiographically. Examination with MRI and arthroscopy was performed within 10 days after the trauma. The MRI evaluation was performed before the arthroscopic examination, and the images were interpreted by an experienced magnetic resonance radiologist. No information from the MRI examination was available to the orthopedic surgeons before arthroscopy. The standard of reference for comparison was arthroscopy. Subacute MRI evaluation identified 15 labral tears, 12 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff lesion, and 1 partial rupture of the biceps tendon. Arthroscopic examination revealed 22 labral tears, 15 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff tear, 1 partial rupture of the biceps tendon, and 1 osseous Bankart lesion. Anterior capsulolabral tears and Hill-Sachs lesions appeared with a high incidence after acute anterior primary shoulder dislocation. Conventional MRI was only moderately reliable in the preoperative evaluation of labral tears and Hill-Sachs lesions, and it failed to give an accurate, differentiated preoperative diagnosis of the capsulolabral lesions.

Adolescent↗