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PubMed1997

Felt augmentation for thumb dislocation.

OBJECTIVE: To describe a nonsurgical approach for the treatment of an isolated dorsal dislocation of the carpometacarpal joint of the thumb that remained unstable immediately following closed reduction and casting. BACKGROUND: An isolated dorsal dislocation of the thumb is an uncommon injury. The dislocation that remains stable following closed reduction has been treated conservatively with immobilization. Dislocations that remain unstable following closed reduction have been stabilized surgically with favorable results. DESCRIPTION: Materials and application guidelines for a thumb spica cast are presented. Anatomic alignment of the dislocation can be revealed with postcasting radiographs. Possible complications from the immobilization are also presented. CLINICAL ADVANTAGES: This nonsurgical approach can be used to avoid percutaneous pinning, to return the athlete to competition without loss of playing time, to provide an effective closed reduction, and also to allow full range of motion of the elbow and uninvolved fingers.

Journal Article↗
PubMed1991

[A clinical study and analysis of congenital lenticular dislocation (35 cases)].

Thirty-five cases of congenital lenticular dislocation seen in our Center since 1985 have been studied and analyzed clinically. By the survey of pedigrees and examination of these patients, including ocular, systemic, skeletal X-ray, psychocardiogram, and urinary sodium-nitroprusside test, 21 cases were diagnosed as Marfan's syndrome, 6 cases as simple ectopia lentis, 3 cases as Weill-Marchesani's syndrome, 4 cases as aniridia and 1 case as homecys tinuria. We found that the most significant ocular manifestation of congenital lenticular dislocation was reduction in visual acuity. The severity of visual disturbance varied with the types of dislocation and the visual deficiency was closely related to the intermediate-grade (II) dislocation of the lens. Examination of ERG showed normal function in most of the patients. From this, we believe that the major cause of visual reduction in congenital lenticular dislocation is lenticular myopia and astigmatism. There fore, early diagnosis and effective correction of vision should be emphasized to prevent the occurrence of amblyopia.

Amblyopia↗
PubMedDate not supplied

Bilateral posterior lens dislocation in Marfan's syndrome.

Complete dislocation of the lens is a rare feature of Marfan's Syndrome. We observed four cases of bilateral complete posterior dislocation of the lens in established cases of Marfan's Syndrome over a one year period. An ophthalmologist may encounter infrequently, unilateral posterior dislocation in one eye and ectopia lentis in the other, but bilateral spontaneous posterior dislocation is rare. All our cases had associated vitreous degeneration with vitreous herniating into the anterior chamber. The pathogenesis of complete posterior dislocation in Marfan's Syndrome is discussed.

Adult↗
PubMed1994

"Lens lasso" repositioning of dislocated posterior chamber intraocular lenses.

BACKGROUND: Dislocation of posterior chamber intraocular lenses poses unique surgical problems for the vitreous surgeon. Although many methods have been devised to correct this problem, none are easily accomplished. A new technique that simplifies this task is described. METHODS: Six patients with complete posteriorly dislocated posterior chamber intraocular lenses underwent this procedure. Five lenses had prolene haptics and one was all polymethylmethacrylate. All except one traumatic case were spontaneous dislocations. A 9-0 prolene suture was transocularly placed through opposite sides of the ciliary sulcus; slip knots were tied on the internal ends and these knots then used to "lasso" the intraocular lens haptics. This achieved, the lens was easily pulled back up into the ciliary sulcus. RESULTS: All patients tolerated the procedure well without any complications. Lens centering was excellent and the externalized sutures showed no erosion through the conjunctiva. Visual acuity was 20/40 or better in all but the one patient with traumatic dislocation, who had a final visual acuity of 20/100. Average length of follow-up period was 17 months. CONCLUSIONS: This surgical technique offers distinct advantages to the surgeon by eliminating cumbersome manipulation of the dislocated intraocular lens, more accuracy in lens replacement, and secure suture attachment to the lens haptics.

Cataract Extraction↗
PubMed1994

Ipsilateral hip and knee dislocation.

Hip and knee dislocations individually are two of the relatively limited orthopaedic emergencies. Long-term results of treatment of these two types of injury are associated with avascular necrosis of the femoral head, knee instability, and knee stiffness. Correct early diagnosis, including arteriography in the case of knee dislocation, is crucial. Prompt treatment consisting of closed or open reduction of the dislocations is necessary. Additional treatment involving knee ligament reconstruction is warranted to maximize knee function in healthy, active patients. Simultaneous occurrence of ipsilateral hip and knee dislocations is a particularly morbid injury. We report such a case to emphasize that early, aggressive treatment and extensive physical therapy can result in a functional and painless lower extremity.

Adult↗
PubMed1995

Congenital knee dislocation in a 49,XXXXY boy.

We report on a 12 year old mentally retarded boy who presented at birth with bilateral knee dislocations, dislocation of the right hip, and general joint laxity. Cytogenetic studies showed a 49,XXXXY karyotype. Hyperlaxity of joints is known to occur in 49,XXXXY patients, but congenital knee dislocation has not been reported. Rarely in 49,XXXXY and 49,XXXXX syndromes Larsen-like features may be seen. Patients with congenital joint dislocation or laxity, combined with other malformations, especially if psychomotor development is delayed, should be karyotyped to exclude chromosomal abnormalities.

Abnormalities, Multiple↗
PubMed2006

Concomitant ipsilateral traumatic dislocation of the hip and knee following high-energy trauma: a case report.

Traumatic dislocation of the hip or knee can occur after high-energy trauma and is often associated with concomitant injuries and secondary complications. Concomitant traumatic dislocation of both hip and knee is rare. We describe a case of combined ipsilateral posterior hip dislocation with a posterior acetabular fracture and a complete open knee dislocation with disruption of the popliteal artery that resulted in amputation.

Accidents, Traffic↗
PubMed1993

A syndrome of dislocated hips and radial heads, carpal coalition, and short stature in Puerto Rican children.

An orthopaedic syndrome that apparently had not been reported previously was identified in twenty-three children. Characteristics shared by all twenty-three children included Hispanic descent, residence in Puerto Rico, bilateral dislocation of the hip, dislocated radial heads, short stature, and other osseous anomalies. Twelve dislocated hips in six patients were not treated. All of these hips were functioning satisfactorily at the time of the review, but only four of the children had reached skeletal maturity. Sixteen hips in eight patients remained reduced after closed reduction. Of these eight patients, the four who were skeletally immature at the time of the review had a satisfactory result, and the four who were skeletally mature had an unsatisfactory result because of discomfort or fibrous ankylosis. Eighteen hips in nine patients were treated with a reduction augmented by some form of operation. All of these hips redislocated. Of the forty-six elbows in the twenty-three children, thirty-three were dislocated, as seen clinically and radiographically; eight were normal, both clinically and radiographically; and there was dysplasia at the radiocapitellar articulation of the remaining five. Twenty of the twenty-three children were found to have carpal coalitions. Fourteen children had scoliosis, and five of them were managed with spinal arthrodesis and correction. Three patients had an anomaly of the cervical spine, with one deformity causing symptoms and signs that were treated with decompression. Eight patients had talipes cavus bilaterally, which was not treated.

Abnormalities, Multiple↗
PubMed2006

Ipsilateral dislocation of the shoulder and elbow joints with contralateral comminuted humeral fracture.

Ipsilateral dislocation of the shoulder and elbow joints is a rare and complex injury. During the last 25 years, only 3 cases have been reported in the literature. We report a 50-year-old woman who suffered ipsilateral elbow and shoulder dislocation with contralateral comminuted humeral fracture. Both shoulder and elbow joints were reduced, but the elbow was dislocated subsequently at follow-up. The reduction in the elbow was stabilized by a Kirschner wire that was removed at 3 weeks, and the elbow was then stable. A U-shaped coaptation splint was applied for the contralateral comminuted humeral fracture. At 6 months, she had acquired a nearly full range of motion of both shoulder and elbow with complete healing in the contralateral humerus. Although rare and complex, ipsilateral shoulder and elbow dislocation, which is the result of a high-energy trauma, can be treated conservatively.

Elbow Joint↗
PubMed1983

Apparent or true neonatal hip dislocation? Radiologic differential diagnosis.

A case of neonatal separation of the proximal femoral epiphysis secondary to obstetric trauma is presented. The radiologic differential diagnosis, as in other cases of neonatal dislocation of the hip, included congenital and septic dislocation of the hip and epiphyseal separation - so-called apparent dislocation. When clinical and laboratory signs are minimal or equivocal, x-ray films and, in difficult cases, contrast arthrograms are needed for an accurate diagnosis of neonatal dislocation of the hip.

Arthritis, Infectious↗
PubMed2006

Operative and non-operative treatment options for dislocation of the hip following total hip arthroplasty.

BACKGROUND: Dislocation following hip replacement is associated with significant morbidity and functional cost. The cause is usually multifactorial. A variety of treatment options are available which can broadly be classified into operative and non-operative. OBJECTIVES: To determine the best methods of treatment of recurrent dislocation following total hip replacement. SEARCH STRATEGY: The following databases were searched until August 2006: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Health Technology Assessment database (HTA), Database of Abstracts of Reviews of Effectiveness (DARE), International Standard Randomised Controlled Trial Number Register (ISRCTN), and MetaRegister of Controlled Trials (mRCT). SELECTION CRITERIA: Randomised and quasi-randomised trials comparing operative and non-operative treatments for recurrent dislocation following total hip replacement. DATA COLLECTION AND ANALYSIS: Two independent reviewers applied the inclusion criteria to identified studies. MAIN RESULTS: Searches identified 269 studies. None fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS: The authors invite researchers to perform RCTs comparing different treatment options for recurrent dislocation of the hip. The heterogeneity of the population and variety of underlying causes would favour a multi-centre study to achieve an adequate sample size.

Arthroplasty, Replacement, Hip↗
PubMed1993

Association of HLA-DR and HLA-DQ antigens with congenital dislocation and dysplastic osteoarthritis of the hip joints in Japanese people.

OBJECTIVE: To investigate the frequency of HLA-DR and DQ antigens among patients with congenital dislocation of the hip joint or dysplastic osteoarthritis (OA) and to determine whether tissue typing might contribute to better understanding of these disorders. METHODS: HLA-DR and DQ typing was undertaken in 18 patients with congenital dislocation of the hip joints, 65 patients with dysplastic OA of the hip, 42 patients with primary OA of the knee, and 40 normal controls. Typing for HLA-D antigens was performed using the standard microlymphocytotoxicity method. RESULTS: The frequency of HLA-DR4 in patients with congenital dislocation of the hip joint (61.1%) and patients with dysplastic OA of the hip (58.5%) was significantly increased compared with normal controls (27.5%) (Pcorr < 0.05 and P < 0.01, respectively). The relative risk for HLA-DR4 was 4.1428 and 3.7104, respectively, in these 2 disease groups. The frequency of HLA-DR4 in the patients with primary OA of the knee (35.7%) did not differ significantly from that in normal controls. CONCLUSION: The results strongly indicate that development of congenital dislocation of the hip joint and progression of dysplastic OA of the hip are associated with genes of the HLA-D region.

Aged↗
PubMed1988

Realignment and surgical fixation of atlanto-axial and subaxial dislocations in rheumatoid arthritis (RA) patients.

One hundred consecutive patients with atlanto-axial dislocation(s) were subjected to posterior occipito-cervical fusion and followed up to 16 1/2 years postoperatively (mean: 4 1/2 years). The mean age at surgery was 60.3 years. At the time of follow-up, 45 patients had died, mostly due to cardiopulmonary disease. Out of the 100 patients, 67% showed a major improvement and in an additional 14% there was a slight or moderate improvement. Some patients with a stable fusion later developed subaxial dislocation(s) necessitating an anterior fusion which in patients with RA is difficult due to poor bone quality. MRI revealed pannus formation around the odontoid peg in many patients, in several to such a degree that cord compression was evident. Following the posterior fixation, the pannus disappeared or was reduced which may at least partly explain the generally favourable operative outcome following the fixation procedure. Early occipito-cervical fusion appears to prevent further vertical dislocation or upwards migration of the odontoid which is a more severe condition, and does not appear to result in increased incidence of subsequent subaxial dislocation(s). Such luxation(s) pose a technically difficult problem since the quality of the patients' own bone usually does not permit a common anterior fusion procedure with autologous graft. In such cases with cord compression, acrylic cement may be used to obtain a normalized realignment.

Adult↗
PubMed1992

Case report 725. Posterior displacement of proximal end of the right radius and capitulum with supracondylar fracture causing a displaced fracture rather than a fracture dislocation.

An 11-month-old boy with a swollen, painful right elbow demonstrated a supracondylar fracture on plain film radiographic studies. Sonography was subsequently performed to exclude dislocation of the elbow and demonstrated the supracondylar fracture as well as a normal relationship of the capitulum and radius, signifying a displaced fracture without associated dislocation. A bone dislocation would generally require dosed reduction alone, whereas distal humeral epiphyseal separation usually requires open reduction or percutaneous (pin) fixation. This case demonstrates the utility of ultrasound in the evaluation of physeal disruption and dislocation in the elbow prior to ossification of the secondary centers of ossification.

Diagnosis, Differential↗
PubMed1981

Traumatic hip dislocation with fracture of the ipsilateral femoral shaft in childhood. Report of a case and review of the literature.

Ipsilateral concomitant hip dislocation and femoral shaft fracture in childhood is extremely rare. A further case and a literature review, with 35 additional observations are presented. The dislocation was initially missed in more than 50% of cases, but when immediately diagnosed, closed reduction manoeuvres were effective in all observations but one, and results were rated normal. As delayed reduction predisposes to avascular necrosis, every child with a femoral shaft fracture should be given a routine X-rays of pelvis, including lateral hip views, as a safeguard against missing an associated hip dislocation. If present, its urgent closed reduction is imperious. In case of failure, closed or open purchasing of the proximal shaft fragment to allow a sort of skeletal-handling is to be used. Open reduction of the dislocation is to be regarded as the third-line procedure.

Child, Preschool↗
PubMed1997

Pathological and hemodynamic study in a new model of femoral head necrosis following traumatic dislocation.

The blood of the femoral head is thought to be supplied by vessels originating from the medial and lateral circumflex femoral arteries and via the marrow cavity of the neck. Therefore, it is difficult to induce osteonecrosis of the femoral head when the marrow cavity of the neck is preserved. In the present study, we established a new model of femoral head necrosis by dislocating the hip joint and ligating the medial and lateral circumflex femoral arteries and veins. Measurement of femoral head blood flow revealed that a marked decrease to 14.7% of the control value was achieved by both hip dislocation and ligation of blood vessels. Pathologic examination showed no necrosis with either dislocation or ligation alone, whereas at 2 and 4 weeks 80% of the animals subjected to both procedures showed widespread necrosis. These pathologic findings considered in the light of results of the blood flow measurements suggest that a decrease in femoral head blood flow below 20% of the control value is needed to cause osteonecrosis. In addition, magnetic resonance images (MRI) of the model were evaluated in the combined dislocation and ligation group at 4 weeks (n = 5). Changes on MRI were seen in 3 of 5 dogs. The necrotic changes of the femoral head are thought to be detectable on MRI within 4 weeks after ischemia without enhancement.

Animals↗
PubMed1988

Pitfalls of early diagnosis and treatment of congenital dislocation of the hip joint.

The efficiency of the routines for early diagnosis and treatment of congenital dislocation of the hip joint (CDH) practiced in the 1960s in the city of Göteborg were reviewed. Between 1961 and 1970 there were 65,875 live births in Göteborg. Eighty-five percent of the estimated number of cases of CDH were diagnosed during the first month of life. Of the children "missed" at the primary screening on the maternity wards, 75% (15/20) were premature babies and/or had been delivered during weekends. In all, 475 newborn children were judged to have unstable hips (dislocated or dislocatable hips), corresponding to an incidence of 7.2 per thousand live births. In 19 children, abduction treatment with braces commenced during the first 10 days of life failed to prevent dislocation. Eighteen of these children were treated primarily with a Frejka pillow and one with a von Rosen splint. A history of CDH among relatives was obtained in 47% of these 19 children including four of five children who had developed pathological hips after supplementary treatment with a hip spica cast and/or surgery. Radiological examination at the age of 1-4 months was helpful in revealing failure of early abduction treatment to prevent dislocation, which in most cases was difficult to detect by clinical examination at this early age.

Female↗
PubMed1993

Results of conservative treatment of unilateral cervical spine dislocations.

Unilateral cervical dislocations are less common and have fewer accompanying neurological complications than bilateral dislocations. Being therefore rated as "less serious", these injuries are often treated non-operatively. A review of 292 patients presenting with acute spine injuries revealed 32 cases of unilateral dislocation (11%). Analysis of their management showed that non-operative treatment was mostly unsatisfactory. Twenty-four of the 32 (75%) eventually required surgical correction. Surgery led to good results in all of these cases. We recommend surgery as a method of choice for patients with unilateral cervical dislocations.

Cervical Vertebrae↗