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PubMed1983

Habitual dislocation of the hip. A new, simple classification and report of a case.

Habitual dislocation of the hip occurred in a nine-year-old girl. The nomenclature of the literature on this disorder and other related conditions is confusing. The following simple classification is therefore proposed: (1) recurrent dislocation (posttraumatic, nonvoluntary); (2) voluntary dislocation (nonhabitual, associated with ligamentous laxity or paralytic disease); (3) habitual dislocation (not associated with significant ligamentous laxity). The treatment significantly differs in each of the described conditions. The diagnosis of habitual dislocation precludes correct interpretation of the history and physical examination.

Child↗

PubMed1983

[Hip dislocation with femur head fracture].

It is talked about the classification, the therapy and the late results of the traumatic dislocation of the hip joint with a fracture of the femoral head. Twelve patients with an average age of 36 years (from 18 to 77 years) were treated between the years 1972 and 1982. The rarer anterior dislocation of the hip including a fracture of the femoral head should be specifically classified, in order not to cause any errors for the therapeutic and prognostic assessment following the Pipkin classification. Type I and II with posterior dislocation justify a closed trial of reposition. The miscarried trial, and a continuing fragmental dislocation with a disturbance of the joint's function, or fragments participating in the load area of the femoral head necessitate an open reposition. Small fragments may be taken away, the larger ones require the screwing osteosynthesis. Smaller fragments from the load area must be sustained in an anterior dislocation ("IIb"). The type III injury gives primarily--in exceptional cases sometimes secondarily--an indication for an alloplastic false hip joint. Injuries of type IV should be restored operatively, respectively, it is necessary to perform a secondary operation to set in an endoprosthetic substitute. With the operative therapy--that is: 5 times extirpation of fragments, 4 times screwing osteosynthesis of the femoral head, twice screwing osteosynthesis of the acetabulum--we obtained good results in injuries of type I, II and IV. We performed 3 times a primary total false hip joint in type III injuries.

Adolescent↗

PubMedDate not supplied

Dislocation after total hip arthroplasty. Treatment with an above-knee hip spica cast.

A study was undertaken of 32 dislocations occurring during a nine-year period in 25 of 1280 postoperative total hip arthroplasty patients. Dislocations occurred in 0.6% of 1030 primary procedures, 1.6% of 165 conversions of hemiarthroplasties to total arthroplasties, and 20% of 85 revisions of previous total hip arthroplasties. Average time to dislocation was 31 days after primary procedures and 106 days after revisions. Acetabular cup malposition and poor patient cooperation appeared to be the causes of dislocation after primary procedures. Trochanteric absence or compromise was a factor in dislocation after revision. Treatment consisted of 13 closed reduction and 19 open reductions. An above-knee hip spica cast was employed for six weeks following closed or open reduction in 16 patients. These 16 patients have been followed up for an average of 32 months (28-45 months). Only one redislocation has occurred.

Acetabulum↗

PubMedDate not supplied

Irreducible volar dislocation of the proximointerphalangeal joint.

Volar dislocations of the proximointerphalangeal joint are not injuries to be treated lightly. If the dislocation reduces easily, a tear of the central tendon would be indicated and immediate open repair of this structure then becomes mandatory. If the dislocation is irreducible, then a tear of the collateral ligament with button-holing of the head of the proximal phalanx through the interval between the central tendon and the lateral band should be suspected, and open reduction and replacement of these structures in their normal position is indicated. The results after open repair of irreducible dislocations may be more favorable than dislocations that reduce easily. The extensor mechanism is intact and as the joint need not be held for long periods of time, motion can be started early and stiffness avoided.

Adult↗

PubMed1980

[Traumatic dislocations of the hip in children under 6. Apropos of 10 cases].

In a group of 11 traumatic dislocations of the hip, treated between 1962 and 1979, the authors find and study 10 cases of pure dislocation in often mild traumatism, about children between 4 and 5 and half yeard old. They remembre the classic tests: the most frequent hit by the boy, frequency of the posterior dislocation, the relative geod pronostic of the hurt in the growth, at this age. In front of theses particular facts of happening, they look for predisposing bone-factors by anamnestic investigations, a coxometric study of the hip, and for 5 children, a tomodensitometric investigation. They cannot have a definitive conclusion, but the results seem to show an association of predisposing articular defects which they go to the dislocation. That would be explain the great frequency of pure dislocations and the rarety of the cephalic necrosis.

Child, Preschool↗

PubMed1995

[A case of dislocation of a double patella].

The congenital dislocation of the patella is relatively rare and the duplicated patella associated is exceptional. The congenital character of the dislocation is unquestionable, but the etiology remains unknown. Before patellar ossification, the diagnosis is difficult and may be delayed for several years until progressive genu valgum, external tibial rotation and flexion deformity results. Radiographs are not useful in evaluating the dislocation until patellar ossification begins at approximately 4 years of age. CT scans and MR imaging reveal the diagnosis before patellar ossification and defines the magnitude of associated dysplasia and the presence of degenerative changes. Early treatment is recommended before the development of secondary bony deformity. We are reporting an unusual case of a woman with multiple epiphyseal dysplasia and bilateral congenital malformation of the patella (duplicated frontal type), associated with genu valgum and congenital dislocation of the patella. She was diagnosed at 31 years old. After surgical treatment (genu valgum correction by varus osteotomy, proximal and distal realignment of the extensor mechanism and osteosynthesis with screws of duplicated patella) and three years follow-up period, we have obtained a good result (painless knees, no recurrence of dislocation and active flexion of 100 degrees on the right knee and 120 degrees on the left knee).

Adult↗

PubMed1994

[PDS cord fixation of sternoclavicular dislocation and para-articular clavicular fractures].

Sternoclavicular joint dislocation and para-articular fractures of the clavicle are rare injuries. Because severe complications of dorsal dislocations have often been seen and because functional impairment has often followed ventral dislocations, we treat most patients with such injuries operatively. Internal fixation with K-wires frequently leads to severe complications. We present our operation techniques with a resorbable 2 mm polydioxanon cord. This pack up technique can be used in both dislocations and para-articular fractures with no risk of implant dislocation.

Clavicle↗

PubMed1993

[The initial traumatic shoulder dislocation. Prospective study].

The goal of this prospective study was to investigate possible factors which might prevent the recurrence of dislocation after a first time traumatic shoulder dislocation. Of the 504 patients initially recorded, 376 were followed up clinically and radiologically after 1 year, and 324 were followed up after 5 years. 20% (64/324) of the patients examined after 5 years sustained a recurrent dislocation of the shoulder. We can confirm age dependency in the occurrence dislocations (50% of the patients > 30 yrs; 15% > 30 yrs). However, we were unable to find a relationship between the duration of immobilization and the incidence of recurrence redislocation (20% recurrence for 0, 1, 2, 3, > 3 weeks of immobilization). A simultaneous avulsion fracture of the tuberculum majus seems to improve the prognosis for recurrent shoulder dislocation (3/114 = 3%), whereas other bony injuries detected using conventional radiology do not appear to influence the incidence of recurrence. A shoulder stabilisation operation had to be carried out in a total of 10% of the follow-up cases. Based on our experience, we recommend a sufficiently long immobilization period of the freshly injured shoulder. In young patients, extensive and invasive procedures (arthro-MRI, pneumo-arthro-CT, shoulder arthroscopy) should be carried out after the first redislocation.

Adult↗

PubMed1993

Brachial artery laceration with closed posterior elbow dislocation in an eight year old.

Elbow dislocations are relatively uncommon in children. Rupture of the brachial artery associated with closed elbow dislocations in children is rare. This is a report of an 8-year-old boy, the youngest patient ever to be reported to have a closed posterior dislocation of the elbow associated with a brachial artery laceration. The boy incurred a closed elbow dislocation after a fall onto his outstretched arm. On physical examination, both radial and ulnar (ulnar) pulses were absent. Radiographs showed a posterolateral dislocation of the right elbow and distal fractures of the radius and ulna. Operative exploration of the antecubital fossa showed complete transection of the brachial artery. Repair of the vessel was performed using an interposition vein graft. The distal forearm fractures were managed by closed reduction. At the two-year postoperative follow-up examination, the patient had a normal neurovascular examination with full range of motion of his elbow and wrist. Surgical treatment should include exploration of the antecubital fossa and reconstruction of the injured vessels.

Brachial Artery↗

PubMed1994

Iatrogenic displacement of fracture-dislocations of the shoulder. A report of seven cases.

We report seven cases in which open or closed reduction of a shoulder dislocation associated with a fracture of the humeral neck led to displacement of the neck fracture. Avascular necrosis of the humeral head developed in all six patients with anatomical neck fractures. All five anterior dislocations also had a fracture of the greater tuberosity and both posterior dislocations had a fracture of the lesser tuberosity. The neck fracture had not initially been recognised in three of the seven cases. In five cases attempted shoulder reduction led to complete displacement of the head segment, which was treated by open reduction and minimal internal fixation. In the other two cases, shoulder reduction caused only mild to moderate displacement which was accepted and the fracture was treated conservatively. We conclude that biplane radiography is essential before reduction of a shoulder dislocation. Neck fractures must always be ruled out, especially where there are tuberosity fractures. In our series, careful closed reduction under general anaesthesia with optimal relaxation and fluoroscopic control did not prevent iatrogenic displacement. Prophylactic stabilisation of the neck fracture should be considered before reduction of such a fracture-dislocation. It may be, however, that the prevention of displacement by prophylactic stabilisation does not always prevent late avascular necrosis; we observed this in one case.

Adult↗

PubMed1977

Blood supply of the head of the femur in traumatic hip dislocation.

Traumatic dislocation of the hip causes circulatory embarrassment in the femoral head in both adult and immature rabbits. Damage to the extraosseous epiphyseometaphyseal vessels of blood supply and drainage is a major causative factor. Disturbance of circulation is most severe in immature rabbits and worsens with continued dislocation to finally reach a maximum within a period of 24 hours. In adult rabbits, the intraosseous epithyseo-metaphyseal anastomoses across the obliterated growth plate minimize the effects of damage to the extraosseous epiphyseal nutrient system. Early reduction of the dislocated hip enhances early and complete recovery of blood supply to the femoral head. Reduction of the dislocated hip delayed to 12 hours or longer does not benefit the rate and extent of the circulatory recovery of the femoral head. Histologically demonstrable aseptic necrosis of the femoral head occurs in the majority of rabbits, regardless of skeletal maturity or reduction. It is more common and extensive in immature rabbits. Abnormal roentgenologic features within the femoral head are observed infrequently between five and ten weeks after dislocation, despite the high incidence of aseptic necrosis.

Animals↗

PubMed1993

[Delayed detection of hip dislocation: is the physician to blame?].

Despite the screening campaigns for early detection of congenital dislocation of the hip, some cases continue to be diagnosed late. The main reason for the failure to diagnose this disorder at an early stage is still unclear. A dislocated or a dislocatable hip is not always apparent during the initial newborn screening examination, and repeated clinical examinations throughout the first 12 months are necessary in order to establish the presence or absence of this disorder. At birth, radiographs are usually normal and a systematic pelvic radiograph of the neonate has no place in neonatal screening. Sonography helps to detect hip pathology early. However, owing to the dynamic nature of the disorder, a single early non-selective ultrasound has proved to be too sensitive and to lack specificity. In the United States, failure to diagnose the congenital dislocation of the hip is the most common musculoskeletal cause of litigation brought against pediatricians. In Europe, the system of fault liability implicates an obligation of ability and means. Failure to diagnose or misdiagnosis is not a fault in itself as long as a complete history, careful physical examination and adequate and appropriate complementary examinations have been performed by an adequately trained physician. If congenital hip dislocation is recognized and treated early, most of the affected children will develop functionally and radiologically normal hips. The longer the dislocation remains untreated, the harder it is to relocate the hip and the higher the incidence of secondary acetabular dysplasia, necessitating surgical correction. However, early treatment is not always successful or without complication. Consequently, the damages due to late onset of the treatment are difficult to assess.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMed1996

Surgical experience related to dislocations after total hip arthroplasty.

We studied the effect of surgical experience on the dislocation rate after 4230 primary total hip arthroplasties (THAs) all performed using the posterior approach at three orthopaedic centres at major county hospitals. There were 129 postoperative (3%) dislocations. Twice the number of dislocations were registered for inexperienced surgeons as for their more experienced colleagues. This frequency of dislocation levelled off with increasing numbers of operations and remained constant after approximately 30. For every ten primary THAs performed annually, the risk of dislocation decreased by 50%.

Clinical Competence↗

PubMed1996

Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound.

We analysed the incidence of avascular necrosis in 101 hips of 90 infants with congenital dislocation treated with Pavlik harness and followed up for more than one year. Using ultrasonography in the flexed-abducted position the hips were classified as type A when the femora head was displaced posteriorly, but within the socket and making contact with the posterior inner wall of the acetabulum; type B when it was in contact with the posterior margin of the acetabulum, with its centre at this level or anterior to it; and type C when it was displaced out of the socket, with its centre posterior to the posterior rim of the acetabulum. Eighty-seven hips were reduced by the harness (86%), and seven of these developed avascular necrosis (8%). All 69 hips with type-A dislocation were reduced and only one (1.4%) showed slight avascular necrosis. Eighteen (78.3%) of 23 hips with type-B dislocation were reduced, and six developed avascular necrosis (33.3%). In one hip, the femoral head was severely damaged. None of the nine hips with type-C dislocation was reduced in the harness. We concluded that the Pavlik harness is indicated for type-A but not for type-B or type-C dislocations.

Contraindications↗

PubMed1996

[Isolated hip dislocation of traumatic origin].

The final outcome following isolated traumatic dislocation of the hip that is reduced within 6 h is generally believed to be excellent. Forty-nine patients with an isolated dislocation of the hip were treated between 1974 and 1989 at the Department of Traumatology of the Hannover Medical School. The majority of patients were involved in traffic accidents, and 42 had associated injuries. All dislocations primarily treated at our hospital were reduced by closed methods within 3 h, (average 85 min, range 10-180 min), followed by early mobilisation with partial weight-bearing for 2-3 weeks. 42 patients were evaluated after an average follow-up period of 7.7 years. Radiological signs of partial necrosis were seen in two patients. Mild arthrosis was found in seven patients, moderate degeneration in two and heterotopic ossifications in four patients (two Brooker II, one Brooker III, one hip ankylosed). Twenty-nine of 33 MRI examinations were normal. Despite early reduction only 9/12 anterior and 14/30 posterior dislocations revealed excellent and good results according to the Thompson and Epstein classification. According to the present study the important prognostic factors are the direction of dislocation, the overall injury severity and the age at the time of injury.

Adolescent↗

PubMed1995

[Pure dislocations of the tibio-talar joint. Apropos of 9 cases].

PURPOSE OF THE STUDY: The authors relate nine cases of pure traumatic dislocation of the tibio talar joint and propose to evaluate the clinical and radiological results at a long term follow-up (mean 12 years). MATERIAL AND METHODS: The series included 9 patients (7 men and 2 women) the average age was 33,2 years. The injury was a road traffic accident in 5 cases. Pure dislocation variety of the ankle joint was medial and posteromedial in 6 cases. Open skin injury was found in 7 cases. The mean follow-up was 12 years (5-19 years). 6 patients were reviewed by the same surgeon, 6 patients were examined clinically and with ankle X-rays. All patients except one were treated by reduction, immobilization with a plaster cast for 6 to 8 weeks. The joint was examined radiographically to detect the presence of tibio talar diastasis and degenerative arthritis. RESULTS: At term we had two very good results and 3 good results (no pain or pain occasionally). We have found in 5 cases a degenerative arthritis to the ankle joint (joint narrowing <50 per cent in 3 cases, > to 50 per cent in 2 cases). No joint instability was noted at revision. DISCUSSION: Pure traumatic dislocation of the tibio talar joint is a rare injury. Medial and posteromedial variety are not frequent. Immediate gravity is dominated by vascular and septic complications and long term result by degenerative arthritis. CONCLUSION: The authors think that closed dislocations need orthopedic treatment (closed reduction and immobilization with a plaster cast for 6 weeks), on the other hand, open dislocation need surgical treatment (reduction, ligamentous reconstruction and immobilization in a plaster cast for 6 weeks).

Adult↗

PubMed1996

Diagnosis and treatment of posterior sternoclavicular joint dislocations in children.

Posterior dislocation of the sternoclavicular joint is uncommon in children, difficult to diagnose, and may be confused with a physical injury of the medial clavicle. We reviewed our experience with posterior dislocations of the medial clavicle over a 10-year period, and found 5 children who had sustained this injury. The computed tomography (CT) scan was found to be the best diagnostic procedure to assess the integrity of the sternoclavicular joint. The cause of the dislocation was most commonly lateral compression of the shoulders sustained during contact sports, particularly football and hockey. Reduction was usually obtained by retraction of the shoulders; for persistent dislocations, a towel clip was used to lift the medial end of the clavicle into its reduced position with the patient under general anesthesia. Reduction was maintained with a figure-of-eight bandage. Any child presenting with pain and swelling in the region of the sternoclavicular joint and no evidence of obvious fracture of the clavicle should have the possibility of dislocation of the sternoclavicular joint investigated with a CT scan.

Adolescent↗

PubMed1996

Traumatic hip dislocation during childhood. A case report and review of the literature.

Traumatic hip dislocations rarely occur during childhood. Males sustain pediatric hip dislocations four times more often than do females. Posterior hip dislocations comprise 87% of all pediatric hip dislocations. A soft, pliable acetabulum and ligamentous laxity predispose the immature hip joint to a dislocation secondary to minimal trauma. Potential associated injuries include fractures and neurovascular injury, whereas avascular necrosis (AVN) and degenerative joint disease are potential sequelae. Optimal treatment should be prompt reduction of the hip in order to minimize the risk of AVN of the femoral head.

Accidental Falls↗