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At least 991 records · Page 55Linked to original sources
PubMed2005

Superior dislocation of the patella with early onset patellofemoral arthritis: a case report and literature review.

Among the traumatic patellar dislocations, superior dislocation of patella without patellar ligament injury is very rare. We present in this article, a case of superior dislocation of the patella trapped by interlocked osteophytes in a 38-year-old female who had concurrent bilateral knee arthrosis. Successful reduction was achieved by closed manipulation without anesthesia. Neither redislocation nor symptoms of instability was seen after 36 months of follow-up, although some progression of arthritis was observed. A new classification including all traumatic patellar dislocation was also proposed.

Adult↗
PubMed2004

Imaging of traumatic dislocation of the hip in childhood.

BACKGROUND: Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction. OBJECTIVE: To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy. MATERIALS AND METHODS: A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions. RESULTS: In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis. CONCLUSIONS: It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.

Acetabulum↗
PubMed2005

Study of hip joint dislocation after total hip arthroplasty.

The present study was undertaken to identify the factors responsible for hip joint dislocation after total hip arthroplasty, laying emphasis on analysis of the background variables of the patients. Of the 317 hips included in the study, ten (3.2%) dislocated. Only the anteversion angle of the cup differed significantly between the dislocation group and the dislocation-free group. The safe zone of the anteversion angle seems to be between 20 and 30 degrees. but it is also essential to set the antetorsion angle of the stem to match the shape of individual bones to create a more stable hip joint. This safe zone may be expanded by the additive effect of antetorsion angle of the stem.

Adult↗
PubMed2006

Complications after posterior dislocation of the hip.

Thirty-five consecutive patients with unilateral posterior dislocation of the hip were studied for complications at an average follow-up of 4.6 years (range 2-10 years). Thompson-Epstein type IV dislocation was most frequent (10/35), reflecting an increase in high-speed motor vehicles in the developing countries. It is also a severe injury that leads to a maximum number of complications, which include avascular necrosis, osteoarthosis, sciatic nerve injury and heterotrophic ossification. Avascular necrosis and osteoarthritis of the hip were observed maximally in type IV patients, even when reduction was achieved in less than twelve hours and may reflect the severity of initial injury. Heterotrophic ossification was observed in five of the ten patients with type IV dislocation and was associated with multiple attempts at reduction. Sciatic nerve injury did not recover completely in all cases, especially when reduction was delayed over twelve hours. Observing that the greatest numbers of complications were seen among patients with type IV dislocations, it may be prudent to warn such individuals about the likely prognosis at the outset, especially in today's world when the demands and expectations are high.

Adolescent↗
PubMed2006

Has the management of shoulder dislocation changed over time?

Anterior shoulder dislocation is a disabling injury affecting all ages, young and old alike. Recently, the treatment of traumatic shoulder dislocation has included immobilisation for varying periods of time followed by physiotherapy. This study is the first in this country to address the demographic data and recurrence rates of shoulder dislocation. Three hundred and eight patients (170 men and 138 women) were followed up for an average of 5.9 years. The most frequent mechanism of injury was a fall (65.66% of cases), and in 92.1% of the patients, the shoulder was reduced in the Emergency Department without the need for sedation or general anaesthesia. The overall recurrence rate in all ages was 50%, but rose to 88.9% in the 14-20-year age group. The duration of immobilisation did not affect the rate of re-dislocation of the humeral head. We believe that conventional shoulder immobilisation in a sling offers no benefits, and it would be preferable not to immobilise the shoulder at all.

Adolescent↗
PubMed1997

Osteoarthritis and recurrences after Putti-Platt and Eden-Hybbinette operations for recurrent dislocation of the shoulder.

Thirty-five patients who had operations for recurrent anterior dislocation of the shoulder were reviewed, with a further 26 answering a questionnaire; the results were not as good as reported by others. The mean follow up was 26.9 years. Ten out of 43 patients had recurrent dislocations after the Putti-Platt and 6 out of 18 after the Eden-Hybbinette operation. Osteoarthritis developed in 15 shoulders of 26 patients who were followed-up after the former procedure and in 8 out of 9 shoulders after the latter. These sequelae depend on the age at the first dislocation rather than the number of dislocations. The overall satisfaction rate was acceptable for both procedures.

Adolescent↗
PubMed1999

Classification of lesions of the medial patello-femoral ligament in patellar dislocation.

The remnants of the medial patello-femoral ligament (MPFL) of 67 knees, 18 with acute patellar dislocation and 49 with chronic patellar dislocation, were studied. The MPFL injuries of the acute cases were categorised into 2 groups: an avulsion tear type and a substantial tear type. The chronic cases were put into 3 groups: those with loose femoral attachment (9 knees), those with scar tissue formation or abnormal scar branch formation (29 knees), and those with no evidence or continuity of the ligament (absent type) (11 knees). It is concluded that incompetence of the medial patello-femoral ligament is a major factor in the occurrence of recurrent patellar dislocation and/or an unstable patella following an acute patellar dislocation.

Acute Disease↗
PubMed2002

Conservative treatment of subtalar dislocations.

Forty-five patients who presented between 1983 and 1998 with acute closed dislocation of the subtalar joint were selected for this study. There were 37 medial and eight lateral dislocations. The mean follow-up was 7.5 years (range: 2-17 years). The mean American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS) at follow-up was 84. Subtalar fusion was required in one patient with persistent severe hind-foot instability. There was no significant difference in the AOFAS score between medial and lateral subtalar dislocations. We conclude that pure subtalar dislocation produced by low energy trauma, promptly reduced and immobilised for 4 weeks has a favourable long-term outcome.

Adolescent↗
PubMed2005

Uncovertebral joint injury in cervical facet dislocation: the headphones sign.

The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases this sign was not detectable. In the five cases with UCFJD, four demonstrated the reverse hamburger bun sign on both CT and MRI. In one case the reverse hamburger bun sign was not seen adequately with either image modality, but the facet dislocation was identified on sagittal imaging. The uncovertebral mal-alignment was detected in all 12 cases. Normally, the two components of the uncovertebral joint enjoy a concentric relationship that in the axial plane is reminiscent of the relationship of headphones with the wearer's head. We name this appearance the 'headphones' sign. Radiologists should be aware of the headphones sign as a reliable indicator of facet joint dislocation on axial imaging used in the assessment of cervical spine injuries.

Adult↗
PubMed2005

Opposite-direction bilateral fracture dislocation of the shoulders after an electric shock.

Injuries after an electric shock, such as dermal burns, motor and sensory nerve deficits, fractures and dislocations, are reported in the literature. Posterior dislocation of the shoulder after electric-shock is the common musculoskeletal injury. Bilateral dislocation, either anterior or posterior, is rarely seen and reported. We report a case of bilateral shoulder fracture dislocation in opposite directions following an electric-shock and discuss the mechanism, the diagnosis and the treatment.

Adult↗
PubMed1998

Recurrent dislocation of tibialis posterior tendon. A report of two cases.

We successfully treated two patients with recurrent dislocation of the tibialis posterior tendon by creating a bone block. Sudden resistive contraction of the tibialis posterior muscle is considered to be the mechanical cause of the initial traumatic injury, and a shallow tibialis posterior tendon sulcus may be the predisposing factor. Once the flexor retinaculum is torn during the initial trauma, recurrent dislocation is inevitable, and surgical treatment is mandatory. When treating patients with a complaint of long-standing pain around the medial malleolus, we must bear in mind the possible diagnosis of recurrent dislocation of the tibialis posterior tendon. If the patient can voluntarily dislocate the tendon by active plantar flexion and inversion of the ankle, the diagnosis is definitive.

Adult↗
PubMed2000

Neglected traumatic posterior dislocations of the shoulder: controversies on indications for treatment and new CT scan findings.

We report seven missed traumatic posterior dislocations of the shoulder in six patients. In all seven shoulders, anteroposterior radiographs did not provide the diagnosis in the emergency room after the trauma (epileptic seizure in four patients) and diagnosis was delayed for at least 24 h. The final diagnosis was reached by clinical suspicion and computed tomography (CT) scan of the seven shoulders. Two shoulders were treated by closed reduction and three were treated by closed reduction and percutaneous pinning, although four of these five shoulders presented a defect in the humeral head involving 20%-25% of the articular surface. Two shoulders dislocated for more than 6 months were treated according to Mc Laughlin's technique modified by Hawkins instead of an arthroplasty. At a minimum follow-up of 2 years and 2 months, the functional results according to Hawkins were good in all seven shoulders. There was no recurrence of the dislocation in any patient. Radiographs showed mild degenerative changes. The establishment of indications for treatment, based on the proportion of articular surface of the humeral head involved and the time of evolution of the dislocation, needs more clinical or experimental evidence. In epileptic patients, strict control of medication is of the utmost importance.

Adult↗
PubMed1984

The treatment of old unreduced traumatic dislocations of the hip.

Old unreduced traumatic dislocations of the hip present great difficulties in management, especially in countries where implants for reconstructive surgery are not readily available. Eleven patients were initially treated with continuous skeletal traction of 10-30 kg for a period of 3 weeks. All of five type I dislocations, were reduced by this method even though there had been 3 weeks-6 months delay before treatment. By contrast, traction was not successful in three Type II and three Type III dislocations even after extensive surgical mobilization of the head and neck of femur because they were so much more serious injuries. Acceptable results were achieved in these cases after arthrodesis or excision arthroplasty and excellent results comparable to those achieved by implants followed by temporary transfixion of the hip joint. From our experience of these results, we believe that the traditional pessimism about the effects of old, unreduced traumatic dislocation of the hip is not justified.

Adult↗
PubMed1994

Radiology in survivors of traumatic atlanto-occipital dislocation.

Traumatic atlanto-occipital dislocation is fatal, but survivals are reported. Six cases of survival after atlanto-occipital dislocation are presented. Lateral cervical spine radiographs demonstrated retropharyngeal swelling in all patients, and Powers' ratio was abnormal in five of six patients. Reformatted computed tomography (CT) images or three-dimensional CT were useful in confirming the diagnosis. Initial treatment consisted of immobilization with halo or collar, and, in one patient, Crutchfield tongs. Reduction of the dislocation was associated with decreasing Powers' ratio in five long-term survivors. Residual neurologic deficits, however, were seen in these patients. Atlanto-occipital dislocation should be suspected in trauma patients with findings of brain stem injury--especially agonal respirations, irregular heart rate, lower cranial nerve abnormality, and asymmetrical motor deficits.

Accidents, Traffic↗
PubMed1990

Comparison of audible sound transmission with ultrasound in screening for congenital dislocation of the hip.

In a comparative study ultrasound and the sound transmission test were used to seek congenital dislocation of the hip in 102 babies referred to a paediatric orthopaedic clinic. The sound transmission test correctly identified all those hips considered normal or dislocated on ultrasound. 17 babies underwent repeated ultrasound examination for hips considered abnormal but not dislocated. 12 improved and 5 required treatment. With a cut-off decibel difference between the hips of 5.8 dB the sound transmission test correctly identified the dislocated hips but did not detect some of the hips that needed treatment. A cut-off of 5.6 dB reduced the likelihood of a false-negative result while maintaining the sensitivity of the test.

Analysis of Variance↗
PubMed1986

Irreducible compound dorsal dislocations of the proximal interphalangeal joint of the finger.

Three cases of compound irreducible dorsal dislocation of the proximal interphalangeal joint of the finger are reported. The probable mechanism is discussed. The findings warrant the description "volar capsular boutonnière" as the condyles of the proximal phalanx buttonhole, through the volar structures. Open reduction combined with debridement, is the treatment for such compound irreducible dorsal dislocations. Dislocation of the proximal interphalangeal joints of the fingers are common and can usually be reduced by simple traction. Occasionally reduction by closed methods is unsuccessful because of interposition of volar or dorsal soft tissue structures (Lamb 1981). This study reports three cases of compound dorsal dislocation of the proximal interphalangeal joint with volar soft tissue interposition. Such lesions are sparsely mentioned in text books on fractures and hand injuries and hitherto only a few cases have been published (Lamb 1981, Bunnell 1956).

Adolescent↗
PubMed1989

Palmar dislocation of the radiocarpal joint.

Radiocarpal dislocation, with or without damage to the radial styloid process or to the distal radial rim, is extremely rare. Review of the literature reveals much confusion on the proper classification of radiocarpal dislocations or fracture-dislocations. A case of radiocarpal dislocation is reported, the classification is discussed, and a critical review of earlier reports is presented.

Humans↗
PubMed1993

Dynamic external finger fixator for fracture dislocation of the proximal interphalangeal joint.

The treatment of fracture dislocations of the proximal interphalangeal joint often results in pain and stiffness. A small dynamic external finger fixator was designed to maintain the reduced position of the dislocated middle phalanx and allow early active range-of-motion exercise. Four patients with acute unstable fracture dislocations and three with old malunited fracture dislocations of the proximal interphalangeal joint were treated with this apparatus. The average range of the proximal interphalangeal joint motion with this device was 88 degrees. The average follow-up period was 21 months.

Adolescent↗