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At least 775 records · Page 43Linked to original sources
PubMed2005

Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment.

OBJECTIVE: This report evaluates the subjective, clinical, and functional long-term results comparing surgical and conservative treatment in patients with a primary traumatic patellar dislocation. DESIGN AND SETTING: This retrospective clinical study focuses on patients with primary acute traumatic patellar dislocation. Patients with radiologic signs indicative of a predisposition for recurrent patellar instability were excluded from this study. PATIENTS: A total of 126 patients were examined a mean of 8.1 years after initial treatment of their primary patellar dislocation. INTERVENTIONS AND MAIN OUTCOME MEASUREMENTS: Patients were retrospectively divided into groups with conservative therapy (n = 63), diagnostic arthroscopy only (n = 20), immediate surgical reconstruction of the parapatellar ligament complex (n = 37), and refixation of osteochondral fragments (n = 6). Redislocation and resurgery rate, activity level, and subjective, clinical, and functional results were evaluated in these patients, and the outcomes in these groups were compared. RESULTS: In the long term, functional results (as expressed in the Lysholm score) were excellent or good in 85% of the patients, and good subjective results were reported by 71%, but follow-up revealed a recurrence rate of 26% in the total study population. The high activity level before the initial trauma could not be completely regained after treatment. There was no significant difference between the surgically and conservatively treated groups in the redislocation and reoperation rates, level of activity, or functional and subjective outcomes. CONCLUSIONS: Even with a focus on acute traumatic etiology and when factors predisposing to recurrent instability are largely excluded, the redislocation rate after treatment of acute patellar dislocation is still high, despite good clinical and subjective results. Conservative management seems to be the treatment of choice in patients with acute patellar dislocation, provided that the generally accepted indications for surgery, such as evidence of osteochondral fragments and major defects of the parapatellar ligament complex, are given due consideration.

Adolescent↗
PubMed2006

A case series of closed reduction for acute temporomandibular joint dislocation by a new approach.

OBJECTIVE: The management of acute temporomandibular joint dislocation relies on the traditional method, which involves intraoral manipulation of the mandible on both sides of the patient. Often, intravenous sedative or analgesic agents are needed to facilitate closed reduction. In this report, the authors introduce a new approach called the ipsilateral approach, in which extraoral or intraoral manipulation of the dislocated side is performed to accomplish closed reduction, without using sedatives or analgesics. Three methods, namely, extraoral, intraoral and combined, are described. METHODS: A prospective observational study was performed to investigate this ipsilateral approach. Six medical officers were recruited to attend to patients with acute temporomandibular joint dislocation. The following protocol was used: (1) Try the extraoral method in all patients first. (2) If it fails, use the intraoral method. (3) If both fail, attempt using a combined method. (4) If all fail, perform the traditional method as usual. RESULTS: A total of 24 episodes of temporomandibular joint dislocation were examined, out of which 13 were successfully reduced by the extraoral method. Of the remaining 11 episodes, 10 were successfully reduced by the intraoral method, the last case being reduced by the combined method. None of them requires sedation or analgesia. CONCLUSION: This ipsilateral approach, using extraoral and intraoral methods, is cost-effective, simple and convenient for the management of acute temporomandibular joint dislocation.

Emergency Service, Hospital↗
PubMed2004

The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study.

BACKGROUND: The risk of arterial injury with knee dislocation is well known. The most effective method for rapidly and accurately diagnosing arterial injury in this setting remains a topic of debate. Both physical examination and arteriography have been advocated, although each of these methods has its critics. The authors propose that the ankle-brachial index (ABI) can accurately predict whether patients with knee dislocations have sustained vascular injury. METHODS: A prospective study enrolled 38 patients with knee dislocation to evaluate for potential arterial injury using clinical pulse examination and ABI. Patients with an ABI lower than 0.90 underwent arteriography. Those with an ABI of 0.90 or higher were immobilized and admitted for serial examination and delayed arterial duplex evaluation. RESULTS: Of the 38 patients, 11 (29%) had an ABI lower than 0.90. All 11 had arterial injury requiring surgical treatment. The remaining 27 patients had an ABI of 0.90 or higher. None had vascular injury detectable by serial clinical examination or duplex ultrasonography. The sensitivity, specificity, and positive predictive value of an ABI lower than 0.90 were 100%. The negative predictive value of an ABI that reached 0.90 or higher was 100%. CONCLUSIONS: The ABI is a rapid, reliable, noninvasive tool for diagnosing vascular injury associated with knee dislocation. Routine arteriography for all patients with knee dislocation is not supported.

Adolescent↗
PubMed1981

Congenital dislocation of the radial head: spectrum and natural history.

A retrospective review of 24 patients with congenital radial head dislocation and three patients with congenital elbow dysplasias was performed. Eight patients had only congenital radial head dislocations and no other anomalies. In these eight patients, a noted limitation of elbow and forearm motion was greatest in those with anterior dislocations. Limitation of wrist motion also was noted in all affected extremities. Unilateral congenital radial head dislocation as well as progressive subluxation to dislocation were documented. There was no increased loss of motion as growth occurred. Significant pain was noted only in adults. Radial head excision after age 15 relieved pain and improved cosmesis but failed to significantly affect motion. Excision performed prior to this age showed regrowth of the proximal radius. A finding of increased ulnar length in relation to the radius in wrist roentgenograms of affected extremities was a significant diagnostic sign.

Abnormalities, Multiple↗
PubMed1983

Congenital dislocation of the hip: a biomechanical study in autopsy specimens.

The role of mechanical factors in neonatal hip instability was studied in four experimental series of autopsy specimens. The induced hip deformation and dislocation were examined by serial cryosectioning and cryodissection. Loading of the hips at 45 degrees of flexion with moderate forces for 3 h resulted in deformation and dislocation similar to those found at autopsy in congenital dislocation of the hip. There was no macroscopic damage to the joints. Loading at 135 degrees of flexion--to simulate a breech position--also resulted in dislocation, but the cartilage deformation was less pronounced than after loading at 45 degrees of flexion. When the same hip was loaded first at 135 degrees of flexion for 3 h and then at 45 degrees of flexion for another 3 h, the findings were similar to those following loading at 45 degrees of flexion alone. Thus a redeformation of the hip had taken place during the second step of the experiment. After unloading of the deformed and dislocated hips, marked joint laxity was observed, and examination 3 h after unloading showed incomplete recovery of the deformation.

Acetabulum↗
PubMedDate not supplied

Unilateral posterior dislocation of the radial head in identical twins.

Congenital dislocation of the radial head, particularly bilateral, is seen in association with many syndromes affecting the musculoskeletal system. The consensus in the literature suggests that all isolated unilateral dislocations are posttraumatic in origin. Recent reports, therefore, recommend that unilateral dislocation be treated by open reduction, despite the benign natural history of the anomaly. We report on identical twins with isolated unilateral posterior dislocation in whom there is little doubt about the presence of the dislocation at birth.

Child↗
PubMedDate not supplied

Techniques for reduction of anteroinferior shoulder dislocation.

Dislocation of the shoulder joint is common. The shoulder is affected in up to 60% of all major joint dislocations, one study citing an incidence of 1.7% in the general population. The most common form is anteroinferior dislocation. A variety of techniques to reduce shoulder dislocation has been described. The key to successful relocation is a thorough understanding of the anatomy of both the enlocated and the dislocated shoulder joint.

Adult↗
PubMed2001

An easy method to reduce anterior shoulder dislocation: the Spaso technique.

OBJECTIVE: To introduce the Spaso technique for reducing anterior shoulder dislocation by reporting the success rate of the Spaso technique performed by junior emergency medicine residents. DESIGN: Retrospective case series. SETTING: Urban accident and emergency department. PARTICIPANTS: Patients with anterior shoulder dislocations. INTERVENTIONS: The Spaso technique was applied by the emergency medicine residents to reduce anterior shoulder dislocation. RESULTS: The emergency medicine residents applied the Spaso technique to reduce 16 cases of anterior dislocated shoulder during the study period. The Spaso technique was successful in 14 of 16 cases. The overall success rate was 87.5% (95% CI 60.4, 97.8%). No complications were noted. CONCLUSION: A new method has been introduced for reduction of anterior shoulder dislocation by reporting the experience of junior residents. The Spaso technique is simple, effective and able to be performed by single operator. Although the sample size was small, the result of the study could provide background information for planning a properly designed randomised controlled trial to evaluate the Spaso technique.

Adult↗
PubMed2005

Recurrent elbow dislocation--an uncommon presentation.

A 58 year old female attended our A&E department following a fall in the garden with swelling and bruising of the right arm and the elbow. Anteroposterior and lateral radiographs were interpreted as showing a normal elbow joint. A diagnosis of soft tissue injury to the elbow was made and the patient was discharged with advice. She returned 2 days later, did not have an x ray, and again given advice. Three weeks later she was referred back to A&E by the general practitioner with persistent swelling of the elbow. Further radiographs showed a posterolateral dislocation of the elbow. The elbow was reduced under sedation but was subsequently dislocated at follow up, and was treated by external fixator and transolecranon pin. The fixator was removed at 4 weeks and the elbow was then stable. This case highlights that recurrent elbow dislocations due to significant ligament injuries can present in joint and subsequently dislocate. A high index of suspicion is necessary and appropriate referral to the specialist must be made to avoid the morbidity associated with recurrent dislocation. It also emphasises the need to always assess the patient on his or her own merits despite previously normal investigations.

Elbow Joint↗
PubMed2006

Proximal tibiofibular dislocation.

Proximal tibiofibular joint dislocation is an uncommon injury, which may be easily missed on plain radiography. If recognised, it can be treated in the emergency department, avoiding surgery and long term problems. The case is presented of a 22 year old male rugby player who was tackled from the left hand side while turning to the left. He heard a "pop" from his knee as he fell to the ground. Clinical examination revealed a prominence in the area of the fibular head. There was no evidence of peroneal nerve injury. Plain x rays confirmed a clinical suspicion for anterior dislocation of the proximal tibiofibular joint. Proximal tibiofibular joint dislocation typically occurs when the knee is slightly flexed and the foot is rotated and plantar flexed. Antero lateral dislocation is the most common pattern. Diagnosis is largely clinical, but the findings may be subtle. Plain films may not show any abnormality and computed tomography is the investigation of choice if there is clinical suspicion for the injury. The dislocation should be reduced in the emergency department, but controversy exists whether early mobilisation or casting is the most appropriate course of action.

Adult↗
PubMed1976

Radiologic classification of posterior dislocations of the hip: refinements and pitfalls.

Seventeen traumatic hip dislocations seen during a 15-month period were evaluated. In 10 of the 14 cases of posterior hip dislocation, the final Thompson-Epstein classification differed from the initial radiographic classification. Dislocations of the hip often result in radiographically obscure femoral head and acetabular damage. High quality radiographs with oblique and coned-down views are of substantial aid in evaluating the dislocated hip. After closed reduction of a dislocated hip, further views and tomography are helpful but diagnostic pitfalls exist. A persistently widened hip joint, even with negative plain films and tomography, indicates possible intra-osteochondral debris or incompletely reduced femoral head fragments.

Adolescent↗
PubMed1993

Prior lateral patellar dislocation: MR imaging findings.

PURPOSE: To illustrate the constellation of magnetic resonance (MR) findings that suggest prior patellar dislocation. MATERIALS AND METHODS: A computer search of all MR examinations of the knee with a coded diagnosis of patellar dislocation performed between February 1988 and October 1990 disclosed 22 cases (11 male and 11 female patients, aged 1-70 years). RESULTS: Eighteen cases (82%) demonstrated hemarthrosis, medical retinacular disruption, and contusion of the lateral femoral condyle. In 11 cases, the patella was displaced from the trochlear sulcus, but in no patient was there complete dislocation at the time of imaging. Axial short-inversion-time inversion-recovery (STIR) images demonstrated subtle subchondral and cancellous signal intensity abnormalities that were often poorly appreciated on T2-weighted images. In 11 cases, patellar dislocation was not suspected before MR imaging. CONCLUSION: Hemarthrosis, medial patellar and lateral femoral contusion, and retinacular disruption suggest prior lateral patellar dislocation. Because of its sensitivity to subtle intraosseous signal abnormality, axial STIR imaging is a valuable adjunct in the evaluation of the acutely injured knee.

Contusions↗
PubMed1984

Arthrography of the dislocated elbow joint.

Arthrography has been suggested as a useful tool for diagnosing ligament ruptures. In 14 consecutive patients with non-fractured elbow dislocations arthrography was performed after reduction of the dislocation. One or two days following arthrography all elbows were examined under general anesthesia with regard to stability and half of them were randomized for surgery with exploration and suture of both the ulnar and the radial collateral ligaments. Arthrography, even if performed within 24 hours after the injury, was found to be unreliable in diagnosing ligament injuries after elbow dislocation. Leakage of the contrast medium was more or less limited to the site of the major injury, which in the dorsal and dorso-radial dislocation was a rupture of the volar aspect of the capsule and the ulnar side of the joint in the radial dislocation.

Adolescent↗
PubMed2005

Mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocation: a medium-term follow-up.

BACKGROUND: Although recurrent patellar dislocations are not uncommon, their pathophysiology and treatment are controversial. HYPOTHESIS: Stabilization of recurrent patellar dislocations can be successfully managed with a mini-open approach. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty-two patients (23 knees) underwent a mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocations with an average follow-up of 4.4 years (range, 1.4-14 years). The average age at the first dislocation was 15 years (range, 5-26 years), and the average age at surgery was 23 years (range, 12-65 years). RESULTS: There was 1 postoperative dislocation (4%) and 1 recurrent subluxation (4%). The average Kujala knee score was 88.2 +/- 13.5, with overall good scores in each category. The lowest scores involved squatting (5.7), abnormal painful kneecap movements (subluxations) (7.1), and jumping (7.9). Overall, there was a statistically significant improvement in the Tegner score from 3.7 +/- 1.8 before surgery to 6.9 +/- 2.0 after surgery (P < .001). Six knees (26%) were rated subjectively as excellent, 15 (65%) as good, 2 (9%) as fair, and 0 (0%) as poor. All 22 patients (100%) stated that the procedure was worthwhile. Radiographically, there was a statistically significant improvement in the congruence angle (normal, -8.0 degrees +/- 6.0 degrees) from 15.7 degrees +/- 12.6 degrees (range, 0.0 degrees to +44.0 degrees) before surgery to -11.5 degrees +/- 8.7 degrees (range, -20.0 degrees to +10.0 degrees) after surgery (P < .001) and in the lateral patellofemoral angle (normal, >0 degrees) from -0.2 degrees +/- 6.4 degrees (range, -10 degrees to +8 degrees) before surgery to 7.9 degrees +/- 2.6 degrees (range, 0.0 degrees to +11.0 degrees) after surgery (P < .001). CONCLUSION: Our mini-open technique provides anatomical restoration with limited morbidity and cosmetically appealing results. Furthermore, our redislocation rates compare favorably with traditional, more extensile open approaches.

Adolescent↗
PubMedDate not supplied

The Magnuson-Stack procedure for treatment of recurrent glenohumeral dislocations.

The Magnuson-Stack procedure was developed in 1943 as a treatment for recurrent anterior dislocation of the glenohumeral joint. Since that time, very little literature has been published on this procedure. The purpose of our study is to evaluate its efficacy in preventing further dislocations and, also, introduce the Cybex Isokinetic Dynamometer as a quantitative tool in scientifically evaluating total shoulder function. At the Bryn Mawr (Pennsylvania) Hospital from 1971 to 1978, 43 patients underwent a Magnuson-Stack procedure. Twenty-nine returned detailed questionnaires; 26 of these patients returned for clinical and roentgenographic examination by one of the authors, and 18 had their shoulder motion and power quantitatively compared to their contralateral normal arms with the Cybex Isokinetic Dynamometer. Eighty-five percent of shoulders did not dislocate postoperatively; 90% considered their results satisfactory. By gross physical examination, no shoulder atrophy was noted. Strength seemed to equal the uninjured shoulder. Range of motion showed a 10 degrees loss of external rotation as measured with a hand-held goniometer. However, by testing range of motion with the Cybex system, a 25 degrees lack of external rotation was noted. Force values measured at 60 degrees of arc/sec and 180 degrees of arc/sec showed an 18 and 10% deficit, respectively, in external rotation. The authors believe that the Magnuson-Stack procedure has a place in the treatment of recurrent anterior dislocations of the shoulder. Also, the Cybex II isolated joint testing system provides an accurate reproducible method of comparing the postoperative results of all patients treated for dislocation of the shoulder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Missed and associated injuries after subtalar dislocation: the role of CT.

Subtalar joint dislocation (STJD) is an uncommon injury, but carries with it a potential for significant functional disability. We hypothesized that a significant number of injuries associated with subtalar joint dislocation may be unrecognized by plain radiographic examination. Therefore, we reviewed the records of all STJDs over a three-year period, identifying nine cases. The majority of injuries occurred in men (78%) with a mean age of 29 years. Overall, the mean age at injury was 32 years. The right lower extremity was most frequently injured (87.5%). Plain films initially diagnosed a STJ dislocation in all patients. A CT scan was performed in all cases. In 100% of patients, CT identified additional injuries missed on initial plain radiographs. In 44% of patient, new information gathered by CT dictated a change in treatment. Based on our findings, we conclude that CT is an invaluable tool to assess for associated injuries in STJ dislocation, and should be performed in all cases of STJ dislocation.

Adult↗
PubMed1995

Subtalar joint dislocations.

Dislocations of the subtalar joint are rare injuries. The anatomy, pathophysiology, treatment, and prognosis of subtalar joint dislocations have been well described in the literature. The purpose of this paper is to review the current literature on subtalar joint dislocations, as well as outline those aspects of the anatomy, pathomechanics, and treatment pertinent to care of the patient with subtalar joint dislocation. In addition, complications and obstacles to reduction are described. Subtalar joint dislocations, although not common, have increased in frequency over the last decade. Generally, they can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer some disability with subtalar joint stiffness the primary complaint. Associated intra-articular fractures increase the risk of posttraumatic arthrosis.

Biomechanical Phenomena↗
PubMed1998

Plantar lateral dislocation of the medial cuneiform: a case report.

This case report describes an isolated plantar lateral dislocation of the medial cuneiform. We were able to find only one other similar case reported in the literature. That case had a delayed diagnosis of 5 months and with an associated an avulsion fracture of the second metatarsal base. Dines et al. reported an isolated dorsomedial dislocation at the medial cuneonavicular joint. An irreducible dorsomedial dislocation with the anterior tibialis tendon being trapped between the medial cuneiform and the navicular has been reported. A distal and lateral dislocation of the medial cuneiform was reported in association with displacement of the second to fourth metatarsal and medial fractures of the navicular and cuneiform. The current report differs from previous cases. There was not an associated fracture; the direction of the dislocation was unique and could be reduced closed.

Adult↗