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PubMed1998

Pavlik harness applications for congenital dislocation of the hip. How short can they be made?

We studied the results of different durations of application of the Pavlik harness for congenital dislocation or subluxation of the hip. For this, 110 hips in 106 patients were successfully reduced and examined when 6 years old. Dislocation and subluxation cases were divided into two groups: a long-term (4 months for dislocation and 3 months for subluxation) and a short-term (3 months for the former and 2 months for the latter) group. We compared them by roentgenographic analysis. The association between the long- and short-term groups was tested using statistical analyses. There were no significant differences between them, except for one item in subluxation. Therefore, we can say that the duration of application of the Pavlik harness should be reduced to 3 months for dislocation and 2 months for subluxation.

Braces↗

PubMed1989

The epidemiology of shoulder dislocations.

In an urban population of a quarter of a million, all shoulder dislocations that occurred in a 5-year period were recorded. A total of 216 shoulder dislocations were seen, 53.3% in men. The overall incidence rate was 17/100,000 per year. Incidence peaks were found in the age-group 21-30 years among men and in the age-group 61-80 years among women. Significantly more patients in the older age groups, and especially women, dislocated at home by falling on an outstretched arm, whereas the younger age-groups most frequently dislocated outside the home, e.g., on sports fields. A considerable number of patients (18.6%) were hospitalized, and 85.5% of the patients required outpatient follow-up. Prophylactic measures should be taken especially to increase the safety of the elderly in their homes.

Accidental Falls↗

PubMed1981

[Fractures and dislocation fractures of os calcis, tarsi, metatarsi, and hallux (author's transl)].

During a 25-year period, 24995 total patients were treated in the Unfallkrankenhaus in Meidling including: 3502 fractures of the os calcis, 919 dislocation fractures of the ossea tarsalea, 9675 fractures and dislocation fractures of the os metatarsalia, and 10899 fractures of the halux. For example, a walking cast was used for undislocated fractures; for unstable dislocated fractures, reduction and fixation with percutaneous wires were used. The same treatment was applied to fractures of the os calcis, with special consideration paid to circulation and age (limitation of 50 years). The treatment results are given for 197 fractures of the os calcis fixated by wire and for 32 Lisfranc dislocation fractures.

Adult↗

PubMed1992

Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology.

Recent studies have suggested that ultrasound examinations may improve diagnostic accuracy in congenital dislocation of the hip, but there is differing opinion whether ultrasound diagnosis should be based on morphology or stability. Ultrasound was added to the routine clinical screening in 1503 newborns (1291 girls and 212 boys). Hip morphology was classified according to Graf (type 1-4), while sonographic stability was based on a modified Barlow maneuver, and classified as stable, elastic deflection (normal finding), unstable (provocating a gap between the femoral head and the acetabulum) and dislocated. Among 80 morphologically dysplastic hips, 73 (91%) were sonographically unstable or dislocated, while seven dysplastic hips were stable. On the other hand, in 49% of the sonographic unstable hips (69 out of 142) the acetabulum was either normal or just physiologically immature. 38 of these hips were left untreated and normalized spontaneously. There was a close correlation between sonographically and clinically determined hip stability (gamma = 0.95). Our study shows that the majority of morphologically dysplastic hips is sonographically unstable or dislocated, but also that morphologically dysplastic hips may be stable. Morphologically normal hips showing minor sonographic instability do probably not require treatment, and thus morphology seems to be an important diagnostic criterion.

Acetabulum↗

PubMed1991

[Elbow joint dislocation. Diagnosis, therapy, results].

Thorough knowledge of the anatomy and biomechanics in the elbow joint together with an special reference to constitutional variations is an important factor in understanding the pathomechanisms of its dislocation. We are presenting 27 case-reports of elbow-dislocations treated at the I. University Clinic for Traumatology in Vienna between 1979 and 1983. The so-called carrying angle showed no pathological deviation besides a tendency to cubitus valgus and hence elbow-joint to dislocation. Our results showed clearly that conservative treatment is possible and advisable in most cases. Only dislocation with osseous lesions and/or a tendency to redislocation after reduction should be operated on.

Elbow Joint↗

PubMed1980

[Fresh and habitual dislocation of the shoulder joint (author's transl)].

In case of the most common anterior-inferior dislocation of the shoulder joint the humeral head is forced out of the glenoidal cavity and tears the capsule. In about 20% of cases the dislocation is complicated by tears of the rotatory cuff, avulsion fractures and lesions of vessels and nerves. Reduction as soon as possible according to the method of Arlt or Hippokrates is recommended to avoid further damage. X-ray examination in 2 directions is necessary to confirm the position of the head. Clinical examination must be done to detect lesions of nerves or vessels caused by the procedure. In cases of recurrent dislocation a Hill-Sachs lesion and/or a Bankart lesion is responsible for instability of the shoulder joint. The elevation of the margin of the glenoid by autologous bone grafting (Eden-Hybinette, Trillat) and/or the derotation of the humeral head (Weber) reliably avoids redislocation. Except rare infections no severe complications are known. The operative correction of the severe disability should be recommended to all patients suffering from recurrent dislocation of shoulder joint.

Humans↗

PubMed1990

[Locked posterior dislocation of the shoulder].

Whereas anterior dislocation of the shoulder is very common, posterior dislocation occurs in less than 2% of all cases. The diagnosis of posterior shoulder dislocation - especially in locked position - is difficult. The exact knowledge of the position of the humeral head within the shoulder joint is extremely significant, as the following case shows. The posterior shoulder dislocation was primarily recognized and treated correctly, while radiographics after reduction were misinterpreted. In this paper diagnostic and therapeutic measures are described.

Adult↗

PubMed2002

A comparative study on the close reduction of arytenoid dislocation under indirect and direct laryngoscope.

To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation, indirect laryngoscope (IL) and direct laryngoscope (DL) were utilized for the closed reduction of the displaced arytenoid under local anesthesia. 23 patients who underwent the reduction for dislocated arytenoid under IL or DL from January 1991 to June 2001 were reviewed. The data were collected on the duration of the laryngeal injury, times of receiving reduction, side-effects after the treatment and the period for voice to return to normal. The relationship between the duration of the laryngeal lesion and the period of the voice rehabilitation was examined. 13 patients received the reduction under IL and 10 patients under DL. Except the times of the reduction, which showed significant difference, no differences were found between IL group and DL group in the course and the period of voice rehabilitation, as well as sore throat after the manipulation. The patients' voice recovery was positively related to their course of disease in both IL and DL group. It is concluded that the recovery of normal voice is obviously affected by the duration of arytenoid dislocation. The reduction under IL is as effective as under DL in the treatment of arytenoid dislocation. Reduction by DL is better suit the patients with long time course of disease.

Adult↗

PubMed2006

[Immobilization in external rotation after primary shoulder dislocation].

INTRODUCTION: The standard method of treating acute primary dislocation of the glenohumeral joint is immobilization of the arm in adduction and internal rotation with a sling. The recurrence rate for anterior instability after nonoperative treatment in young active patients is extremely high (up to 90%) and well reported. A new method of immobilization with the arm in external rotation improves the position of the displaced labrum on the glenoid rim. With the use of control MRI before and after immobilization in external rotation, a study on this new repositioning of the labrum is evaluated. METHODS: Ten patients (mean age 30.4 years) with primary anterior dislocation of the shoulder and Bankart lesion as shown on MRI but with no hyperlaxity of the contralateral side were immobilized in 10-20 degrees of external rotation for 3 weeks. Scans with MRI were taken in internal and external shoulder rotation post trauma and in internal rotation after 6 weeks. All patients were reevaluated after 6 and 12 months. RESULTS: Dislocation and separation of the labrum were both significantly less with the arm in external rotation due to the tension of the anterior capsule and the tendon of the subscapularis muscle. In the MRI taken in internal rotation 6 weeks post trauma, all Bankart lesions were fixed in reposition after three weeks of immobilization in external rotation. At 12-month follow-up, the average Constant Score was 96.1 points (range 63-100), and the Rowe Score was 91.5 points (range 25-100). One patient had traumatic redislocation after 8 months. CONCLUSION: After primary shoulder dislocation, immobilizing the arm in 10-20 degrees external rotation provided stable fixation of the Bankart lesion in an anatomic position. First long-term indications from an ongoing prospective study of recurrence rates after immobilization in external rotation are promising.

Adolescent↗

PubMed1999

[Dislocation of the elbow joint--therapy and treatment outcome].

At our hospital, closed dislocations of the elbow without neurovascular or osseous lesion are treated conservatively after successful reduction in the absence of a tendency to redislocation. Indications for surgery are irreducible dislocations and those with a tendency to redislocation as well as open soft tissue injuries, neurovascular and osseous concomitant injuries. During a period of 10 years 113 patients were treated according to this strategy. Of these patients, 46 had simple dislocations of the elbow and 67 suffered from dislocations with osseous lesions. In 95 patients follow-ups could be performed after a mean period of 55 months. In more than 75% of cases good or excellent functional results were documented; unfavourable results were seen only in patients with osseous lesions. Nearly all of the patients had a stable elbow joint at the end of therapy.

Adolescent↗

PubMed2003

[Ipsilateral femoral fracture and anterior hip dislocation in a 15-year-old girl: case report].

Operative management of concomitant ipsilateral femur fracture and anterior hip dislocation has not been previously described in the literature. We report the case of a 15-years-old girl who was injured in a motorcycle accident and presented with a femoral shaft fracture and a concomitant ipsilateral anterior hip dislocation. Operative management consisted of an attempted closed reduction of the femoral fracture, which was unsuccessful; thus, an external fixator was temporarily applied. Subsequently, the hip dislocation was treated by open reduction through an anterolateral approach. Finally, the femoral fracture was securely stabilized using an unreamed femoral intramedullary nail. The postoperative course was uneventful. MRI follow-up after 6 weeks did not reveal any sign of mangled vascularization of the femoral head and radiographs demonstrated normal bony healing of the shaft fracture. Due to the fact that there is no definitive surgical strategy for this rare combination of injuries, concomitant ipsilateral femoral fracture and anterior hip dislocation is an interesting and challenging situation for the trauma surgeon which requires a subtle and exact surgical technique in order to achieve satisfying results.

Aged↗

PubMed2005

[Simultaneous bilateral ventral and dorsal shoulder dislocation following an epileptic convulsion--a rare combination of injuries].

We report about a 29 year old male patient who had a simultaneous bilateral ventral and dorsal shoulder dislocation. The dislocation happened during a first incident of an epileptic convulsion, previously not diagnosed. On the right shoulder following a closed reduction manoeuvre a dislocation fracture was seen. It needed operative open reduction and fixation with angular stable plate osteosynthesis. The locked dorsal shoulder dislocation on the left was operated dorsally secondary via a dorsal approach. In a first step the reduction was carried out and in the same intervention the humeral head defect was lifted and supported in a closed technique under radiographic control.6 months postoperatively the patient was free of pain in both shoulder joints. The range of motion was unimpeded on the left and only with slight deficits in abduction and anteversion on the right. The diagnostics and the treatment strategy for this rare injury combination are described critically in this paper.

Adult↗

PubMed2006

[Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures].

BACKGROUND: Proximal fracture of the humeral head is the third most frequent fracture in humans. Most (70%) of those affected are over 60 years old. It is hoped that advanced locking medullary screws or plates will reduce the risk of secondary dislocation of screws or fracture segments when the bone of the humeral head is osteoporotic. METHODS: From January 2002 to August 2005, 225 displaced humeral head fractures in 223 patients aged on average 66+/-15 years were treated with a new locking proximal humeral plate. RESULTS: In 176 patients in whom follow-up was possible, the average Constant Score after 9 months was 70+/-19 points (raw data), or 81+/-22% in the normalized score. No significant difference was detected between the younger group up to 65 years of age (73% points) and those over 65 years of age (80% points). Axial deviations by more than 30 degrees were noted in 11 (5%), and of 159 displaced tubercles, malreduction by more than 5 mm was noted in 14 (9%). Two infections and two haematomas had to be treated so far. Primary screw perforations were seen in 24 (11%) cases as well as further implant dislocations in 3 (1,7%). Plate dislocations out of the shaft existed in 4 (2,4%) and 14 collapses of the humeral head with secondary screw perforations were recorded. All other complications arose out of technical faults, such as 24 screw perforations (11%) into the glenohumeral joint and 3 (1.7%) cases of secondary implant dislocation from the humeral head and 5 (3%) from the shaft, and 14 (8%) sinterings with glenohumeral screw perforation. So far, in addition to 1 case of pseudarthrosis with a broken plate, 5 (3%) cases of total and 9 (5%) of partial avascular humeral head necrosis have been observed. CONCLUSION: The new implant provides superior stability in the fixation of humeral head fragments and has proved its worth in everyday clinical practice when additional indirect fixation of the tubercle is needed, as it frequently is in elderly patients.

Aged↗

PubMed2001

[Injury pattern in shoulder dislocation in the elderly patient].

PROBLEM: Recurrent shoulder dislocation is reported to be rare in older patients. While injuries of the glenoid labrum and the anterior capsule following primary dislocation in younger patients seem to determine the rate of instability, the pattern of damages in the elderly has rarely been studied. METHODS: 91 patients with an age older than 40 years with the diagnosis of primary (group A, n = 50) or recurrent (group B, n = 41) anterior shoulder dislocation were included in a prospective study. By analysis of the findings in x-rays, MRI, CT-scans and in 36 patients of diagnostic arthroscopy the pattern of intra- and periarticular pathology was evaluated. RESULTS: While the incidence of bony Bankart- and Hill-Sachs lesions was constantly spread over the age groups the pattern of soft tissue damages was different. Up to the age of 60 years lesions of the glenoid labrum were leading while in older patients the prevalence of rotator cuff tears became about 70 percent. CONCLUSIONS: The development of secondary osteoarthritis and persisting symptoms in older patients with rotator cuff tears after traumatic shoulder dislocation requires early diagnosis and appropriate treatment.

Adult↗

PubMed2001

[Medial patella dislocation].

A patellar dislocation is usually understood to mean a lateral dislocation of the patella. Medial patellar dislocations have mainly been described after surgical treatment, such as release of the lateral retinaculum. Here a case of medial patellar dislocation is reported which did not occur subsequent to surgery. Wilberg-III patella, genu recurvatum with patella alta and a m. vastus medialis insertion widely distal to the patella were predisposing factors.

Adolescent↗

PubMed2005

[Fixed posterior subluxation with lateral rotation of the knee joint caused by congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. Case report and review of the literature].

Congenital dislocation of the patella is very rare. In this anomaly, the patella is dislocated to the side of the lateral femoral condylus and cannot be repositioned manually. Diagnosis is often made by clinical examination and observation of an abnormal gait. We describe the long-term course of treatment in a young girl with fixed posterior subluxation with lateral rotation of the knee joint caused by congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. These anomalies of the knee joint were corrected incrementally. First, recentralization of the patella was performed by open surgery. Subsequently, distraction of the shortened ischiocrural muscles and the posterior capsules and ligaments was conducted. This is the first case to be described, to the best of our knowledge, of a patient with congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. We describe the successful treatment of such a fixed posterior subluxation and lateral rotation of the knee joint.

Child↗

PubMed2005

[Shoulder dislocation in the newborn. Report of 12 cases and review of the literature].

Shoulder dislocation in the newborn is a rare entity. Therefore, a therapeutic regimen does not exist. This retrospective clinical study (1967-2003) includes 9 newborns with 12 dislocations of the shoulder. The data focus in particular on the therapeutic strategy and its success. The position of the joint and its functionality were monitored with a questionnaire. Publications from 1904 to 2003 were reviewed and served for comparison. Results of calculations showed that 0.018-0.07% of newborns suffer from shoulder dislocations. The diagnosis was made on average at the age of 22 days. Our data include four cases each of congenital and paralytic and two cases each of spastic and traumatic shoulder dislocations. All of them were initially treated conservatively, but because of inadequate results one patient finally had to be operated. In the follow-up of 19.4 years, none of them developed a redislocation and all shoulder functions were suitable for daily life. We propose that patients primarily be treated conservatively; however, if therapy fails, surgery has to be performed.

Birth Injuries↗

PubMed1997

[Injury classification and surgical approach in hip dislocations and fractures].

During the last few decades, traumatic injuries of the hip joint have significantly increased in number, and traffic accidents have also increased. Depending on the speed, direction of the forces and the position of the femur at the moment of impact, different patterns of injury occur. Basically, they are classified as hip dislocations, dislocation fractures and acetabular fractures. These injuries have in common a high rate of concomitant lesions. Several classification systems have been developed for these injuries. Commonly, Stewart and Milford's or Levin's classification is used for dislocations and dislocation fractures. For acetabular fractures, Judet and Letournel's classification and its newer version developed by Helfet (AO classification) are generally accepted. Fractures of the femoral head, though included in these classifications, are typically described by separate classifications like the one presented in 1957 by Pipkin. The multitude of injuries occurring in the hip joint requires vast knowledge of various operative approaches. No single approach exists that would permit the treatment of all injuries in an ideal fashion. Approaches are either considered limited (Kocher-Langenbeck, ilioinguinal iliofemoral) when they permit access only to a restricted segment of the joint, or extended (extended iliofemoral, Maryland, Ruedi) when they allow all-round visualization of the hip joint. The choice of the best approach for an individual patient depends on the type of injury and also on patient variables like age, preexisting disease, and concomitant injuries. The decision is further influenced by the timing of surgery, the kind of fracture stabilization intended and by complications typically seen with certain approaches. The indication for extended procedures is only seen in patients with complex injury patterns involving both the anterior and the posterior column or in delayed cases undergoing surgery more than 3 weeks after trauma. Extended approaches permit excellent visualization of the fracture, but the extent of the soft tissue trauma is reflected in a high rate of postoperative complications. After a phase in which extended procedures were favored, recently a trend towards more limited approaches can be recognized because of their lower complication rate. This is facilitated by modern fracture-reduction methods using indirect techniques.

Acetabulum↗