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At least 91 records · Page 5Linked to original sources
PubMed1997

Perilunate dislocation and fracture dislocation: a critical analysis of the volar-dorsal approach.

A combined volar-dorsal approach was used to treat 11 perilunate dislocations and fracture dislocations between 1989 and 1994. The mean average age of the patients was 38 years, and the mean average time between injury and surgery was 13 hours. Outcome was assessed after an average of 30 months. Results were based on measurements of grip strength, range of motion, radiographs, and patient satisfaction. Patient satisfaction was high in 9 of 11 patients. Seven had satisfactory pain relief, and 5 had returned to their previous occupation without limitation. The wrist flexion-extension arc and grip strength averaged 71% and 77%, respectively, compared to the opposite side. Follow-up radiographs demonstrated complete union of all 8 wrist fractures. For all 11 patients, the carpal height ratio averaged 0.50. Neither scapholunate dissociation nor significant dorsal intercalated segmental instability existed, but 1 wrist developed scapholunate advanced collapse arthritis. Although perilunate instability patterns of injury create significant derangement in carpal anatomy and are among the most challenging of traumatic wrist injuries to correct, our results show that a combined volar-dorsal approach can be used safely and effectively to restore normal intercarpal relationships and provide fixation for accompanying fractures. For the majority of patients, the outcome after this procedure is characterized by acceptable pain relief as well as functional motion and grip strength.

Adult↗
PubMed1984

Transient vascular compromise of the lunate after fracture-dislocation or dislocation of the carpus.

Although classic avascular necrosis of the lunate is rare after fracture-dislocation or dislocation of the carpus, these severe carpal injuries can compromise the vascular supply of the lunate. The lunate thus develops a relative increase in radiodensity. Our finding of an incidence of 12.5%--three of 24 cases--suggests a relatively frequent occurrence. The clinical course was transient with resolution of abnormal radiodensity and subjective findings. Moreover, none of the three cases progressed to classic avascular necrosis of the lunate, Kienböck's disease. The clinician should not confuse this transient vascular compromise of the lunate with Kienböck's disease, but should be aware of the entity and its benign, self-limited course and should treat it expectantly.

Adult↗
PubMed2000

Dorsal perilunate dislocations and fracture-dislocations: questionnaire, clinical, and radiographic evaluation.

Twenty-two consecutive patients (23 wrists) underwent open reduction internal fixation of dorsal perilunate dislocations and fracture-dislocations through combined dorsal and volar approaches. One of 5 experienced wrist surgeons performed these procedures within an average of 3 days of injury (range, 0-26 days) and intercarpal fixation was kept within the proximal carpal row. Motion was instituted an average of 10 weeks (range, 5-16 weeks) after injury. All patients were males. The average age at the time of injury was 32 years (range, 16-60 years). The average follow-up period was 37 months (range, 13-65 months). Average flexion-extension motion arc and grip strength in the injured wrist were 57% and 73%, respectively, compared with the contralateral wrist. The scapholunate angle increased and the revised carpal height ratio decreased over time, which was statistically significant for both measurements. Three patients (3 wrists) required wrist arthrodesis and a fourth patient had an immediate scaphoid excision and 4-corner arthrodesis secondary to an irreparable scaphoid fracture. One patient required a proximal row carpectomy to treat septic arthritis. Nine of the remaining 18 wrists had radiographic evidence of arthritis, most often at the capitolunate or scaphocapitate articulations. Short form-36 mental summary scores were significantly greater than age- and gender-matched US population values; physical summary scores were significantly less. The disabilities of arm, shoulder, and hand evaluation, Mayo wrist score, and patient-rated wrist evaluation all reflected loss of function. Seventy-three percent of all patients had returned to full duties in their usual occupations and a total of 82% were employed.

Adolescent↗
PubMed1999

[Conservative versus surgical therapy of perilunar dislocation and dislocation fractures].

18 perilunate dislocations and fracture-dislocations were treated at the Trauma Center of the Vienna General Hospital during the period from 1992 to 1995. Only five cases were treated without surgery. 15 of these 18 patients returned for follow-up after an average of 16 months. In ten cases good results were achieved. Radiologically, eight patients were classified as good. Overall better results were seen after surgical treatment.

Adolescent↗
PubMed1996

Stabilization of ulnar carpometacarpal dislocations or fracture dislocations.

For the management of ulnar carpometacarpal dislocations or fracture dislocations, various authors have suggested closed reduction and percutaneous pin fixation, or open reduction and internal fixation with the use of transversely oriented pins. The methods can be problematic with failure of fixation or injury to tendons or nerves. A stable internal fixation alternative uses intramedullary metacarpal Steinmann pins or Kirschner wires, passed across the carpometacarpal joint into the hamate. If the fixation devices exit through the triquetrum and the lunate, then the finger metacarpal phalangeal joints may be left with full active motion. This method has provided ease of placement, stability, and no loss of fixation in 9 cases. An associated coronal fracture of the hamate may be fixed with small Kirschner wires or with a small lag screw, which can be placed through the same incision.

Adolescent↗
PubMed1983

Fracture-dislocation of the ankle with anterior dislocation of the fibula.

A fracture-dislocation of the ankle with fixed anterior displacement of the proximal fibular fragment is reported. The mechanism of this injury was likely eversion of the foot which produced rupture of the deltoid ligament and distal tibiofibular diastasis, and lateral dislocation of the talus. The proximal fibular fragment was probably displaced laterally and returned to a position anterior to the fibular notch of the tibia. This injury was extremely unstable and required open reduction with internal fixation, not only to reduce the anterior displacement of the fibula but also to repair the associated disruption of the syndesmotic ligament and anterior capsule. The key radiographic finding was anterior displacement of the distal fibula seen on the lateral view.

Ankle Injuries↗
PubMed1975

Neonatal septic "dislocation" of the hip: true dislocation or pathological epiphyseal separation?

The clinical and roentgenologic appearance of septic dislocation of the hip may be caused by either a true dislocation or a pathological epiphyseal separation due to osteomyelitis. Arthrography of the hip permits differentiation in the neonate. The significance of these two anatomical possibilites is discussed in terms of follow-up and results of neonatal infections about the hip, and a case of pathological epiphyseal separation at the hip diagnosed in the neonatal period by aspiration and arthrography and followed up for 3 years is presented.

Child, Preschool↗
PubMed2004

Multiple carpometacarpal dislocations and an ipsilateral scapho-trapezium-trapezoid fracture-dislocation: a rare pattern of injury.

We report a rare case of simultaneous dorsal dislocation of 4 ulnar carpometacarpal joints and dorsoradial dislocation of the trapezium with an associated fracture of the scaphoid tuberosity. The injuries were diagnosed early and treated successfully with closed reduction and transfixation using Kirschner wires. The functional results were excellent at 17-month follow-up.

Accidents, Traffic↗
PubMed1991

Unilateral facet dislocations and fracture-dislocations of the cervical spine.

We treated 36 patients with unilateral facet dislocations or fracture-dislocations of the cervical spine at the Mayo Clinic between 1975 and 1986. Adequate records were available for 34: ten patients were treated by open reduction and posterior fusion, and 24 by nonoperative management. Of these, 19 had halo traction followed by halo-thoracic immobilisation, four had a simple cervicothoracic orthosis, and one received no active treatment. Anatomical reduction was achieved more frequently in the operative group (60% compared with 25%). Nonoperative treatment was more likely to result in cervical translation on flexion/extension lateral radiographs, and in significant symptoms. Only 36% of the patients treated by halo traction achieved anatomical alignment; in 25% halo traction failed to achieve or maintain any degree of reduction. During halo-thoracic immobilisation, half of the patients lost some degree of reduction and patient satisfaction with the appliance was low. Open reduction and internal fixation of unilateral facet injuries gave better results. 6

Adolescent↗
PubMed1992

Unilateral facet dislocations and fracture-dislocations of the cervical spine: a review.

Unilateral facet dislocations or fracture-dislocations of the cervical spine constitute an important subgroup of cervical spine injuries. According to the literature, the diagnosis of this entity is often missed and the treatment is controversial. On the basis of our patient review, we conclude that operative intervention appears superior to nonoperative treatment of these injuries. Nonoperative management is often fraught with inability to obtain and maintain anatomic reduction and, in addition, late pain and instability frequently ensue. Alternatively, operative intervention provides the greatest probability for achieving and maintaining anatomic reduction and appears to eliminate chances of late symptoms.

Adolescent↗
PubMed2005

[Modern ideas on the treatment of dislocations and fracture-dislocations in the elbow joint].

The authors describe the causes and surgical methods of treatment of fresh and long-standing dislocations and fracture-dislocations in the elbow joint. The indications to using different operative methods and technical-surgical interventions are described in details as well as long-term results of treatment by the literature data. The current methods and the authors' methods of prophylactics and treatment of postoperative complications are analyzed. The methods of rehabilitation of such patients are also described.

Adolescent↗
PubMed1991

[The treatment of fresh Lisfranc dislocations and fracture-dislocations].

Dislocations and fracture dislocations of the tarsometatarsal joint are usually the result of a high energy trauma to the forefoot. A missed diagnosis or an insufficient treatment or a massive destruction of the tarsometatarsal joint result in a high rate of late morbidity. An appropriate radiological assessment, open anatomical reduction and temporary K-wire arthrodesis followed by a functional after-treatment can improve the long-term results of this severe forefoot injuries. The long term results (7 months to 20 years) of 24 tarsometatarsal injuries are analysed and a concept of their treatment presented.

Adolescent↗
PubMed1978

[A case of open carpo-metacarpal dislocation complicated by dislocation of the trapezoid bone].

A case of open carpo-metacarpal dislocation complicated by dislocation of the os trapesium is reported in this paper. The patient's wrist healed with good functional results, despite a partial mistake in diagnosis. The authors draw attention to the fact, that X-ray films taken at admission must be analysed carefully and intraoperative X-rays films must be taken. By demonstration their own mistake in diagnosis and treatment, the authors hope that a similar mistake will be avoided. Following early open or closed reduction, a temporary wire fixation of the metacarpal bones to the carpal bones is recommended in order to prevent redislocation.

Accidents, Occupational↗