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PubMed2004

[Surgical treatment of type III acromioclavicular joint dislocations by a modified Bosworth technique].

BACKGROUND: We evaluated the results of surgical treatment of type III acromioclavicular joint dislocations by a modified Bosworth technique. METHODS: Thirty-four patients (9 females, 25 males; mean age 35 years; range 20 to 53 years) were treated with a modified Bosworth technique for type III acromioclavicular joint dislocations. Dislocations were caused by falls (n=18), traffic accidents (n=8), and during contact sports (n=8). Involvement was on the right side in 23 patients, and on the left side in 11 patients. The mean time to operation was two days (range 1 to 4 days). Functional evaluations were made with the use of the Constant scores. The mean follow-up was 35 months (range 12 to 57 months). RESULTS: The mean postoperative Constant score was 93 (range 46 to 96). No complications were seen during operation. The results were excellent in 24 patients (70.6%), good in seven patients (20.6%), and poor in three patients (8.8%). None of the patients had to change their jobs or give up any previous sports activities. Radiographically, the distal clavicle appeared normal in 32 patients, atrophied in one patient, and enlarged in another. Functional results were good in 12 patients (35.3%) in whom calcifications were detected in the coracoclavicular ligament. Dislocations recurred in three patients (8.8%). Two patients developed superficial infections. CONCLUSION: Surgical treatment of acromioclavicular joint dislocations by the modified Bosworth technique is a convenient option with regard to short- and long-term results.

Acromioclavicular Joint↗
PubMed1992

Posterior dislocation of total knee arthroplasty.

Posterior dislocation of the prosthesis after total knee arthroplasty is an infrequent but serious complication. Seven patients with this complication were treated from January 1985 until October 1989. Five of the seven dislocations occurred in primary total knee arthroplasties and two occurred after revision arthroplasty. Limb alignment before arthroplasty, when it could be determined, was valgus in all patients, averaging 25 degrees. In each case there was an identifiable problem with the knee extensor mechanism: five had patellar dislocations, one a patellar tendon rupture, and one a patellar fracture. In three of the posterior dislocations, there was also an imbalance of the flexion and extension gaps with excessive laxity of the ligaments in flexion. Treatment was individualized. In two patients, the knee was reduced closed and the patella subsequently tracked so that no reoperation was necessary. One ruptured patellar tendon could not be repaired in a 94-year-old patient with cardiac disease. A cylinder cast was applied with poor results. Operative intervention was required in four patients, one of whom required only a patellar realignment procedure. The three other patients required component revision procedures, however, in addition to patellar realignment procedures. In these three patients, laxity of the knee in flexion was so severe that posterior instability could not be corrected merely by patellar relocation. At a follow-up examination (average, 21 months postoperatively), all six patients who were treated as recommended had good results with no further dislocations, with the exception of the one patient with a patellar tendon rupture.

Aged↗
PubMed2004

Combined anterior and posterior shoulder dislocation as a manifestation of a brain tumour.

Seizures are sometimes the first manifestation of a brain tumour. They may give rise to shoulder fractures or fracture-dislocations. When bilateral, these lesions tend to be symmetrical. The patient reported here suffered from a previously undiagnosed brain tumour, the first manifestation of which were seizures, which provoked a bilateral shoulder dislocation in opposite directions. The posterior dislocation was recognized with a delay of 16 days. After an episode of seizures, shoulder dislocation can occur in either direction, and bilateral shoulder dislocations may not be symmetrical.

Accidental Falls↗
PubMed2004

Nerve injuries in anterior shoulder dislocations.

A retrospective study was conducted to determine the incidence of nerve injuries in anterior dislocations of the shoulder and to determine if a neurological examination is routinely performed in such cases. One hundred and fifteen shoulder dislocations in 100 patients (74 males, 26 females; mean age 35+/-18 years) were reviewed. Eighty-seven patients were examined for neurological injuries prior to reduction and 8 of these patients (9.2%) were found to have sustained neurological injuries. Following reduction, neurological examination was performed in 85 patients. Three patients who were not examined initially prior to reduction were subsequently found to have nerve injuries after reduction. Seven patients (7%) were not examined for neurological injury both before and after reduction of the dislocation. Eleven patients were found to have sustained nerve injuries in the final analysis. Axillary nerve injuries were the most common, occurring in 8 patients. In conclusion, nerve injuries are common in shoulder dislocations. The importance of performing and documenting the findings of neurological examination anterior shoulder dislocations needs to be reiterated.

Adolescent↗
PubMed2005

Traumatic anterior dislocation of the hip joint with posterior acetabular wall fracture.

The incidence of traumatic hip dislocation has increased in recent years as a result of high-energy trauma. Anterior hip dislocation forms less than 10-15% of all traumatic hip dislocations. Only a few case reports describe anterior dislocation along with acetabular fractures. The acetabular fracture involved the anterior wall or column in all such cases. We describe a rare case in which anterior superior dislocation of the hip was associated with a large fracture fragment of theposterior acetabular rim and adjacent wall.

Accidents, Traffic↗
PubMed2005

Anterior capsulolabral reconstruction for traumatic recurrent anterior shoulder dislocation.

The anterior capsulolabral reconstruction (ACLR) has been shown to yield satisfactory results predominantly in overhead athletes with atraumatic anterior shoulder instability. The purpose of this study was to assess the clinical results of patients who underwent ACLR for recurrent traumatic anterior shoulder dislocation. A retrospective review of 41 patients, mean age 29 (range: 16 to 55 years) who underwent ACLR for traumatic recurrent anterior shoulder dislocation was performed. All patients reported a traumatic anterior shoulder dislocation with subsequent recurrent instability. Seven patients had undergone previous shoulder stabilization surgery which had failed. The mean number of previous dislocations was 4.5 (range: 1 to 15). There were 31 males and 10 females, and the dominant arm was involved in 24 patients. In all cases, the capsulolabral complex was detached from the glenoid rim. The mean follow-up was 3.6 years (range: 15 to 80 months). All patients were evaluated by physical examination. The mean modified Rowe score was 93.6 (range: 65 to 100). There were 32 excellent, 5 good, 1 fair, and 2 poor results. Instability was eliminated in 38 patients (93%). Of 25 patients who engaged in recreational sports, all were able to return to their previous level of participation. One patient sustained a traumatic redislocation and underwent revision surgery. Two patients reported atraumatic recurrent subluxation with one requiring revision surgery due to persistent symptoms of instability. There was no loss of range of motion in comparison to preoperative values. Of the seven shoulders that had undergone previous surgery, all remain stable. These results indicate that a glenoid-sided capsulolabral reconstruction can restore shoulder stability in patients with recurrent traumatic anterior shoulder dislocation. Success rates comparable to those of other open anterior shoulder repair procedures can be achieved.

Adolescent↗
PubMedDate not supplied

[Subtalar dislocations with medial or lateral displacement (author's transl)].

The authors have observed 20 cases of subtalar dislocation, 16 with medial displacement and 4 with lateral displacement. The treatment given and the results are described. An experimental study has also been made which confirms that in medial dislocations the talo-navicular joint dislocates first whilst in lateral dislocations the talo-navicular joint dislocates last. The severity of assoicated lesions is emphasised. It is concluded that in severe displacement with complete extrusion of the talus, tibio-calcaneal arthrodesis gave better results than excision of the talus.

Adolescent↗
PubMed2005

10-year review of knee dislocations: is arteriography always necessary?

BACKGROUND: Historically, arteriography has been used routinely in patients with knee dislocations. Recently, selectivity based on physical examination (PE) has emerged. Critics cite limited clinical evidence. We sought to determine whether PE accurately confirms or excludes surgically significant vascular injuries associated with knee dislocations. METHODS: We conducted an institutional review board-approved retrospective review of patients admitted at a university-based Level I trauma center with knee dislocations from January 1, 1993, to December 31, 2002. Thirty-nine patients (28 male patients and 11 female patients; average age, 42.8 years) had 39 dislocations (27 left and 12 right, 26 posterior and 13 anterior). Most patients (n = 25) were involved in motor vehicle crashes. All patients underwent arteriography. RESULTS: Of the 20 normal arteriograms, all had normal PE. Of the 19 abnormal arteriograms, 8 had a normal PE and 11 were abnormal. Within this subgroup, none of the 8 with normal PE required surgery, whereas 7 of the 11 with abnormal PE required surgery. None of the nonoperative patients had vascular complications during the hospital stay. Sensitivity and specificity were 100% for PE on surgically significant vascular injury. CONCLUSION: Routine arteriography is unnecessary in patients with a normal PE after reduction of the knee dislocation.

Adult↗
PubMed2006

[Bilateral pure T11-T12 facet dislocation without neurologic residual deficit].

Bilateral pure facets dislocation in the thoracic spine is rare, but when it does occur in almost every instance produces a severe spinal cord lesion. It is thought to be caused by a flexion distraction mechanisms in most of the cases. A case is presented of a male suffered a polytrauma with important thoracic, abdominal, and esqueletic injuries in a car accident. The patient was in a hospital during two weeks, and one month after the trauma a bilateral pure dislocation of T11-T12 facets was diagnosed. Diagnosis was made with radiographs and CT with sagittal reconstruction. After an open reduction and fixation, recovery was complete within the first postoperative week. Facet dislocation in the thoracic spine is associated in many cases with thoracic and abdominal injuries that worsen the clinical picture, and thus it may contribute to misdiagnosis of the facet dislocation, specially in the cases with no neurological symptoms, adding a risk of secondary spinal cord damage. High-resolution CT with sagittal reconstruction provides an adequate and rapid demonstration of the luxation and associated thoraco-abdominal damages. Facet dislocation are unstable injuries that require open reduction and fixation. Recovery of patients with incomplete lesions is frequent, however, recovery from complete lesions did not occur.

Humans↗
PubMed2005

[Rare dislocations of feet joints--the results of treatment and rehabilitation].

The authors present rare dislocations of feet joints including subtalar dislocations of the foot, total dislocations of the talus, dislocations of the talocalcaneal joint and dislocations of the talo-crural and tarsometatarsal joint. They make objective and subjective assessment of remote results of their non-operational treatment. They also pay attention to dangers and remote after-efects of shown feet injuries.

Female↗
PubMed2006

[Traumatic dislocation of the hip in a 3-year-old boy with a painful knee].

A 3-year-old boy had pain on the medial side of his left knee after his father fell on him. When the pain still persisted 4 days later, further diagnostics revealed dislocation of the hip. The pain disappeared and function was restored after closed reposition under fluoroscopic control followed by immobilisation with a plaster cast. Traumatic dislocation of the hip in childhood is a relatively rare injury, but may have far-reaching consequences. As the sensitivity to pain in children differs from that in adults, an examiner must be on the alert for a traumatic dislocation of the hip whenever a child presents with a fitting history and dysfunction ofthe leg, regardless of the localisation of the pain. Pain in the knee is often reported in case of hip disorders. Avascular necrosis of the caput femoris is a well-known and dreaded complication of traumatic dislocation of the hip in children. The risk of complications is certainly increased sharply if the hip luxation goes unnoticed and reposition takes place after more than 6 hours. Closed reposition as rapidly as possible or alternatively open reposition of the dislocated hip under general anaesthesia is the indicated treatment.

Child, Preschool↗
PubMedDate not supplied

Reduction of acute anterior shoulder dislocations: comparing intraarticular lignocaine with intravenous anesthesia.

Anterior shoulder dislocation is the most common dislocation in the body. Various methods of anesthesia are available for reduction. The objective of this study was to compare the application of intra-articular anesthesia with intravenous anesthesia for reduction of acute anterior shoulder dislocation. This study was conducted at Kathmandu Medical College Teaching Hospital (KMCTH) and Kathmandu Hospital and comprised of patients coming with anterior dislocation of shoulder from July 2001 to June 2005. Forty-five patients aged 17-55 years with no associated fractures of adjoining bones were included in the study. In twenty-three patients, reduction was done using intra-articular anesthesia and in 22 patients intravenous anesthesia was given. In five patients (three in intra-articular group and two in intravenous group) the reduction technique had to be changed to the Hippocratic method. In these three patients intravenous anesthesia had to be given after intra-articular anesthesia failed to relieve pain and spasm. In the intravenous group two patients had to be admitted overnight while in the intra-articular group none had to be admitted to the hospital. However, in the intra-articular group the average time taken from injection to reduction was significantly longer (<.001). The use of intra-articular lignocaine for reduction of shoulder dislocation is safe and effective especially when patients present early. In patients presenting late (more than 5 hours) intravenous anesthesia should be primarily considered as the method for shoulder reduction.

Acute Disease↗
PubMed2006

[Evaluation of pediatric patients with traumatic hip dislocation].

OBJECTIVES: We evaluated pediatric patients who were treated for traumatic dislocation of the hip. METHODS: Traumatic dislocation of the hip was detected in five children (all boys; mean age 9 years; range 7 to 13 years) between 1991 and 2005. Dislocations occurred in the right hip in four cases, and in the left hip in one, all of which had posterior localization. Etiology was fall during play in two children, and fall from height or car crash in three. One patient had posterior wall avulsion fracture of the acetabulum. Early radiologic follow-ups included conventional radiographs and computed tomography. Functional results were assessed with the Harris hip scoring system. Four patients had a sufficient follow-up period with a mean of 44 months (range 19 to 64 months). RESULTS: All the patients were treated with closed reduction under general anesthesia after a mean of 6.4 hours (range 2 to 16 hours) following trauma. Functional results were excellent in all the patients, with a mean Harris hip score of 92 (range 84 to 96). Based on early postoperative radiologic control with computed tomography, no surgical intervention was considered for posterior wall avulsion fracture of the acetabulum in one patient. At 40-month follow-up, he had no complaints, had a full range of motion and a hip score of 92. While no complications were observed in patients undergoing early reduction, one patient whose dislocation was reduced 16 hours after trauma developed avascular necrosis of the femur head 18 months after treatment, at which time his hip score was 84. CONCLUSION: Early reduction is of particular importance for the follow-up course of traumatic hip dislocations in childhood.

Adolescent↗
PubMed1991

[Articular disk dislocation in the human TMJ].

A three-dimensional model of articular disk dislocations has been developed. Histological examination of 35 temporomandibular joints in near sagittal section reveals sometimes extreme anterior displacement in about 50% and slight posterior displacement of the disk in 6% of the specimens. In the frontal plane medial dislocation prevails in more than 70% of the 32 specimens evaluated, whereas there is only one lateral dislocation. Within the predominantly medio-anterior direction of dislocation there are, however, variations. Excentric forces relative to the center of gravity of the disk always result in dislocations accompanied by rotation in the anterior or posterior part. Where the resulting forces apply on the center of gravity there is a translation in a medio-anterior direction.

Aged↗
PubMed1990

[Posterior shoulder dislocation. An often overlooked injury].

Posterior dislocation of the shoulder is rare. Only 2% of dislocated shoulders are displaced posteriorly, and these are chiefly of the subacromial type. Over 60% of the cases are not diagnosed initially because the arm is held in the normal position of adduction and internal rotation. The most consistent findings on physical examination are: the fixed internal rotation of the arm and the characteristic movement of the scapula with abduction of the upper extremity. It is essential that appropriate radiographs are obtained to correctly diagnose the dislocation. While the routine anteroposterior shoulder film is often enough to diagnose various anterior dislocations, it is not sufficient to diagnose the subacromial type of posterior dislocation. We recommend an anteroposterior view and an axillary lateral or tangential scapula view.

Adult↗
PubMed1990

Lateral ankle dislocation without fracture.

Ankle fracture dislocations are a common entity in orthopaedic practice and their treatment is well documented. Dislocations of other joints are usually treated by closed reduction with a brief period of immobilization. This ankle dislocation without fracture is a rare injury which was treated similarly to other joint dislocations. An intact bony construct of an ankle following dislocation allows for subsequent joint stability when soft tissues have healed.

Adult↗
PubMed1990

[Rare, bilateral posterior shoulder dislocation. A case report].

Posterior shoulder dislocation is a very rare injury, accounting for only 1-2% of all shoulder dislocations. It is very often misdiagnosed because its clinical symptoms are not characteristic and the X-ray pictures are often misinterpreted. In many cases this means delayed treatment and impaired shoulder function. The most common cause of posterior shoulder dislocation is an epileptic seizure. In approximately 50% of all cases a ventral impression fracture of the humeral head is diagnosed. This is known as the "reverse Hill-Sachs lesion". About 10% of all posterior shoulder dislocations are associated with fracture of the lesser tuberosity of the humerus. In this paper a case of bilateral posterior shoulder dislocation with bilateral fracture of the lesser tuberosity of the humerus is described. The luxations were caused by an epileptic seizure following chronic alcohol abuse. Following early commencement of an exercise programme excellent results were obtained, and no redislocations occurred.

Combined Modality Therapy↗
PubMed1990

Teratologic dislocation of the hip: review of a series of 17 cases.

Teratologic dislocation of the hip is defined as a congenital dislocation which is irreducible by gentle manipulation at birth. It is often associated with other congenital defects, the most common of which is arthrogryposis. In a series of 25 teratologic dislocations, we studied 17 dislocations that were treated and followed up for an average of 4 years and 6 months (minimum 1 year, maximum 10 years). Clinical and radiological results confirm that the treatment--mainly surgical--can give these children, even arthrogrypotic ones, a congruent and functional hip. This treatment may be recommended for bilateral as well as for unilateral teratologic hip dislocation.

Abnormalities, Multiple↗