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PubMed1989

[Recent peri-lunate dislocations of the wrist].

The authors analyse a series of 50 fresh dislocations of the carpal-lunate. 35 of these patients were reviewed clinically and radiologically: the radial peri-lunar dislocation is more often encountered than described in the literature. Lunate necrosis and collapse is rare and there is no relationship between secondary necrosis of the lunate and primary dislocation. The clinical results, with a mean time follow-up of 5 years and 6 months are good, but radiological abnormalities such as arthrosis and instability are seen without clinical complications. The authors present their management of dislocation of the carpal lunate but it seems that early diagnosis and treatment of these dislocations is essential for good results.

Carpal Bones↗
PubMed1989

[Structure of the correlations of genetic and environmental factors in congenital hip dislocation].

The aim of this paper was to determine the mechanisms of development or manifestations of the congenital dislocation of the hip by the method of multivariate analysis. The source of information were the family data about 300 children with congenital dislocation of the hip aged from 3 months to 15 years who had not been specially selected from those treated at the Centre and 300 children of the same age from unselected population. All the examinees were Georgians by nationality. Clinical methods of examination were employed. The results of the cluster analysis showed that the system of prognostic signs of the congenital dislocation of the hip consisted of 13 clusters in the experimental group (4 independent and 9 correlated) and of 13 clusters in the control group (5 independent and 8 correlated). The signs under investigation comprised the following groups of probable factors of the congenital dislocation of the hip: social-biological, geographical, obstetrical-gynecological, risk factors during the pregnancy, risk factors during the child birth on the mother's part, risk factors on the child's part, perinatal factors, postnatal factors, abnormalities of the child and its relatives. The obtained system of prognosis is well agreed with the biological mechanisms of the congenital dislocation of the hip. These data may be used for making perinatal and preclinical diagnosis, for raising the efficiency of medicogenetic consultations and for the initial orthopaedic prevention of the disease.

Adolescent↗
PubMed1989

Mehad: the Saudi tradition of infant wrapping as a possible aetiological factor in congenital dislocation of the hip.

A study was conducted to investigate the prevalence and the association between congenital dislocation of the hip and the Saudi tradition of infant wrapping with lower limbs in the extended adducted position (mehad). Fifty patients with an established diagnosis of congenital dislocation of the hip and, for comparison, a randomly selected group of 100 Saudi families with a total number of 414 children were included in this study. The results have shown that infant wrapping was very common, with no significant statistical difference in the prevalence between patients with an established diagnosis of congenital dislocation of the hip and the randomly selected group. The most commonly given reason for its use was to prevent limb deformities. Although on statistical grounds one cannot assume that infant wrapping as practised in Saudi Arabia is a cause of hip dislocation, the possibility exists that it may affect the future progress of a dislocated, subluxated or potentially dislocatable hip unfavourably. Accordingly, this practice should be actively discouraged.

Child, Preschool↗
PubMed1989

[Dislocations of the talus joints].

With the exception of fracture dislocations following fractures of the ankle joint and talus, dislocations in the talus are very infrequent injuries. They pose a lot of management problems: soft-tissue damage in open and closed dislocations, imperfect reduction caused by osteochondral fragments, recurrent instability, and aseptic necrosis of the talus, which is greatly feared. Anatomical and prognostic criteria are included in a classification of mono-, bi- and triarticular dislocations of the talus. Based on six of our own cases treated in the last 12 months, we report the mechanisms of injury, management, and early results. In accordance with the results in the literature in the last few years, reconstruction of ligament damage and joint debridement were carried out in four cases and the results described. One case of open total dislocation of the talus is presented, which was complicated by a fracture of the calcaneus without traumatic avascular necrosis.

Ankle Injuries↗
PubMed1989

Diagnosing dislocation of the hip in infancy.

In evaluating the diagnosis of dislocation of the hip in childhood by orthopedists in Oregon in 1985, we identified 36 dislocations in 32 patients, an incidence of 0.9 per 1,000 live births. In 12 patients, 12 dislocations (33%) were diagnosed after the neonatal period, 5 of which were diagnosed at walking age. Of the 12 children with a late diagnosis, 10 had normal hips when examined in the neonatal period. Neonatal screening will not detect all cases of congenitally dislocated hip. If dislocation of the hip in childhood is to be diagnosed in a timely manner, it is essential that children's hips be examined at the time of routine well-baby evaluations until a normal gait has been established.

Female↗
PubMed1989

[Tarsometatarsal fracture dislocations].

The late results of 16 tarsometatarsal fracture-dislocations are presented. The median period of observation was 9.5 years. Closed or operative reduction of the dislocations was performed and, in 11 cases, internal fixation with Kirschner wires was employed. Re-dislocation occurred only in the cases where the joint was not stabilized with Kirschner wire. The results were good in nine out of 12 cases with normal positions in the tarsometatarsal joints. None of the patients with persistent dislocation in the joint had good results. Exact closed reduction or operative reduction with internal fixation with Kirschner wire are recommended in the treatment of tarsometatarsal fracture-dislocations.

Adolescent↗
PubMed1989

Subtalar dislocations.

Subtalar dislocations are uncommon injuries. In an effort to obtain accurate information, eight recent major series (more than five patients) were summarized, including the experience at the authors' institution between 1975 and 1985 (12 patients). Medial dislocations predominated (79.5%), lateral injuries accounted for 17% of cases, and posterior (2.5%) and anterior (1%) dislocations were infrequent. Associated fractures with medial (55%) and lateral (72%) dislocations were common. Open injuries with lateral dislocations (25%) were more common, and avascular necrosis was uncommon (4%-5%). Males predominated (81%). It was evident that symptomatic subtalar instability occurred in younger patients treated with shorter periods of immobilization.

Adolescent↗
PubMed1988

Proximal interphalangeal joint dislocations without fractures.

Injuries to the proximal interphalangeal joint are extremely common. An understanding of the complex anatomy of this joint is essential for diagnosis and treatment of proximal interphalangeal joint sprains and dislocations. Lateral injuries are among the commonest injuries in the hand. These are often stable after reduction, requiring only closed treatment. Occasionally, however, the collateral ligament can be trapped in the joint and require open reduction. Dorsal dislocations represent the most common dislocation in the hand. These, too, are usually stable after reduction and can be treated by closed methods. On occasion, however, these dislocations will be open or irreducible by closed means, requiring surgical intervention and repair of damaged structures. Complex rotary dislocations are exactly that: complex. An exact understanding of the damaged structures and causes of irreducibility frequently makes this an injury often requiring open reduction and selective repair of damaged soft tissue structures. Fortunately, prompt diagnosis, reduction, and institution of appropriate treatment can usually afford the patient good function after these injuries. It must be noted that stiffness is more common than instability, and active range-of-motion exercises instituted at the proper time are essential. These joints will often remain permanently thicker after injury in spite of optimal care, and tenderness and soreness with use may persist for 6 to 12 months.

Adolescent↗
PubMed1988

Traumatic volar dislocation of the second, third and fourth carpometacarpal joints: mechanism and manipulation.

Traumatic volar dislocation of the second, third and fourth carpometacarpal joints without associated fracture is extremely rare. A single case, treated successfully by manipulative reduction supplemented with splint immobilization and isometric and isotonic muscle exercise is reported, with restoration of complete anatomical alignment revealed by postmanipulative radiographs. The radiology of carpometacarpal joint dislocation is discussed. The conservative traction-dorsiflexion manipulative reduction for multiple volar carpometacarpal joint dislocations is described and recommended before using open reduction. Based on the case, it is postulated that the mechanism of a carpometacarpal joint dislocation is due to a sudden violent force acting almost perpendicularly to the metacarpal head or heads; the reactive forces create the opposite directed forces as a lever type of strain on the involved carpometacarpal joint and produce the dislocation.

Carpal Bones↗
PubMed1987

Perilunate dislocations of the carpus. A long-term review.

The long-term results of 19 perilunate dislocations of the carpus (including 9 transscapho-perilunate dislocations) were: good, 7 cases; fair, 8; poor, 4. The 9 transscapho-perilunate dislocations gave worse results than simple dislocations, with pseudarthrosis in 5 cases. Arthrosis was found in more than half the cases, more frequently in transscapho-perilunate dislocations and in cases associated with a fracture of the radial styloid. Radiographic signs of instability were observed in 8 wrists. The unstable wrists had a high incidence of arthrosis and showed decidedly worse clinical results compared to stable wrists (good, 1; fair, 4; poor, 3, as compared to good, 6 and fair 4). In all the unstable wrists we therefore believe that the results may be improved if the radiographic signs of instability are specifically looked for immediately after reduction so that abnormal anatomical relationships in the carpus can be corrected early.

Adolescent↗
PubMed1987

Coxarthrosis following traumatic posterior dislocation of the hip.

One hundred and twenty-seven hips in 125 adults were treated for traumatic posterior dislocation during a period of two decades. Ninety-eight patients (100 hips) were available for follow-up examination at a minimum of five years (average, fourteen years) after injury. By both clinical and radiographic criteria eighty hips (80 per cent) had an excellent or good result. Forty-two per cent of the hips that were reduced more than six hours after the dislocation had an excellent or good result and 88 per cent of those that were reduced within six hours after dislocation had an excellent or good result. Thirty-one per cent of the hips with a Grade-III dislocation had an excellent or good result, as compared with 90 per cent of those with a Grade-I dislocation. Twenty-two per cent of the hips with an excellent or good result had avascular necrosis of the femoral head. We found the time-interval between injury and reduction, the severity of the initial injury, and the development of avascular necrosis of the femoral head to be the most important factors with regard to the long-term prognosis. Avascular necrosis occurred most frequently in hips that underwent reduction after a delay of more than six hours.

Adolescent↗
PubMed1986

Missed or developmental dislocation of the hip.

In 15 documented cases, subluxation or dislocation of the hip was discovered months or years after previous multiple normal physical examinations. The examiners were unique in that six were professors specializing in childrens' orthopedics, four were board-certified orthopedists, and five were pediatricians. An increased acetabular index, subluxation, and early dislocation may not always be detected on physical examination. Delayed diagnosis of dislocation is not evidence that an inadequate physical examination was performed. An increased acetabular index may allow the femoral head to move laterally out of the acetabulum and become a delayed dislocation. The delayed subluxed or dislocated hip constitutes an entity not necessarily related to the neonatal subluxable or dislocatable hip.

Child, Preschool↗
PubMed1985

Patellar dislocation following total knee replacement.

The reported incidence of patellar problems after total knee replacement has ranged from 5 to 30 per cent. Patellar dislocation is infrequent but can cause disabling symptoms. Between January 1974 and May 1982, eleven patients (twelve knees) with symptomatic lateral dislocation of the patella after total knee replacement were treated at The Hospital for Special Surgery by realignment of the extensor mechanism. All of the patients were women. Their average age was sixty-two years and average weight, eighty-seven kilograms. The diagnosis was osteoarthritis in seven knees and rheumatoid arthritis in five. Most of the patients had had preoperative valgus deformity (average, 18 degrees). The cause of dislocation was trauma in three knees, incorrect tracking of the patella after replacement in six, and malrotation of the tibial component in three. Four different prosthetic designs had been used. The design of the implant did not appear to be a factor causing dislocation in this group. The patellar dislocation was treated by proximal realignment of the quadriceps in ten knees, lateral retinacular release alone in one, and revision of the tibial and femoral components combined with proximal realignment in one. After an average follow-up of thirty-four months (range, twenty-four to fifty-seven months), the results according to The Hospital for Special Surgery knee-rating scale were excellent in ten knees and good in two, and there had been no redislocations.

Arthritis, Rheumatoid↗
PubMed1979

[Treatment of the relapsing dislocation of the patella (author's transl)].

From 1970-1977, twenty-five patients were given surgical treatment for relapsing dislocation of the patella. The mean age of the patients was 22 years. The case material consisted of 18 female and 7 male patients. The average frequency rate of dislocation was three to fifteen times. (Reported from the BB-Accident Hospital Tübingen). The combined surgical method with gracilis muscle restraint described by Krogius, was used in this clinic in view of its traditionally successful application. Additional antepositioning of the patella according to Bandi was effected in intraoperatively discovered retropatellar arthrosis. Relapses of dislocation were reported in two cases. Good postoperative results were obtained in 14 patients, satisfactory results in 5 patients, and an unsatisfactory outcome in three patients. Redislocation was reported twice. Since this disease occurs preferably in juveniles, surgical treatment to prevent further dislocations should be effected well in time to avoid early retropatellar arthrosis. Since dislocations of the patella are frequently adjusted spontaneously without any treatment, critical and detailed anamnesis is imperative in every patient with a distorted knee joint.

Adult↗
PubMed1979

Vascular and orthopedic complications of knee dislocation.

Experience with complete dislocation of the knee in 22 consecutive patients during a six year period was analyzed. Major vascular complications occurred in nine of 13 extremities with anterior dislocation, one of seven extremities with posterior dislocation and none of two extremities with lateral dislocation. Liberal use of trans-femoral ateriography for diagnosis disclosed significant arterial injuries in four of 15 limbs, despite postreduction pedal pulses which were apparently normal. Limb salvage was accomplished in 20 of 21 survivors and in eight of nine with associated vascular complications. All patients demonstrated severe instability of the ligamentous structures of the knee consistent with the type of dislocation. Posterior instability was severe in all patients, an indication of disruption of the posterior cruciate ligament in every instance. Adequate follow-up information was available on 12 knees that had primary ligamentous repair, ten of which were stable to stress testing. Postoperative immobilization was accomplished by external skeletal fixation, skeletal traction or long leg posterior plaster splint.

Adolescent↗
PubMed1978

Traumatic sternoclavicular dislocation.

Traumatic dislocations of the sternoclavicular joint may be anterosternal or retrosternal. Anterior dislocation is due to forces which retract and depress the clavicle. Posterior dislocation is due to either direct force on the medial end of the clavicle or to a force acting on the posterolateral aspect of the shoulder. From 1950 to 1974 we treated 16 patients with traumatic complete sternoclavicular dislocations. Twelve patients were followed and their cases are discussed. Treatment may be closed or open. In some cases we did not attempt reduction because it may be very difficult to maintain and dislocation may recur. Open reduction is extremely difficult and not recommended unless a serious intrathoracic problem also exists. Based on our cases, we conclude that stability of the sternoclavicular joint is not necessary to ensure normal function of the involved limb. The residual prominence of the medial portion of the clavicle does not cause pain and does not interfere with chest or shoulder function.

Adolescent↗
PubMed1978

Dislocations after total hip-replacement arthroplasties.

In a series of 300 total hip replacements, nine (3 per cent) dislocated. Precise measurements of the orientation of the acetabular cup were made and it was found that anterior dislocations were associated with increased acetabular-component anteversion. There was no significant correlation between cup-orientation angle and posterior dislocation. The dislocation rate for cup orientation with anteversion of 15 +/- 10 degrees and lateral opening of 40 +/- 10 degrees was 1.5 per cent, while outside this "safe" range the dislocation rate was 6.1 per cent. Other factors that were documented include time after surgery (with the greatest risk in the first thirty days) and surgical history (with a greater risk in hips that have had prior surgery).

Adult↗
PubMed1982

[Atlantoaxial dislocation in neurofibromatosis.--Report of three cases--].

Atlantoaxial dislocation has received little attention in many studies of spinal deformity in neurofibromatosis. The only four cases of atlantoaxial dislocation associated with neurofibromatosis has been previously reported in the literature. We reported three rare cases of atlantoaxial dislocation associated with neurofibromatosis. These characteristics in roentgenogram were as follows; (1) marked narrowing of sagittal diameter at C1 level without instability (instability index 0%) (2) association with other mesodermal dysplasia, such as posterior vertebral body scalloping, vertebral body dysplasia, dural ectasia etc. Neurofibromatous tissue was found around the anterior region of the odontoid process in one of our three patients. We speculate that atlantoaxial dislocation in neurofibromatosis may be due to mesodermal dysplasia. On the other hand, a neurofibroma was found around the anterior region of the odontoid process in our third case. Therefore, there is a possibility that atlantoaxial dislocation in the instance was caused by the neurofibroma involving transverse atlantal ligament.

Adult↗