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At least 1,045 records · Page 58Linked to original sources
PubMed1998

Ulnar styloid malunion with dislocation of the distal radioulnar joint.

Four patients with dorsal dislocation of the distal radioulnar joint and ulnar styloid malunion had corrective osteotomy of the ulnar styloid. Dislocation of the distal radioulnar joint was reduced in three of four patients. Subluxation persisted in the remaining patient. Wrist function improved in all patients. These results support the contention that a displaced ulnar styloid fracture with distal radioulnar joint dislocation should be reduced and internally fixed. Corrective osteotomy is recommended for malunion of the ulnar styloid associated with dislocation of the distal radioulnar joint.

Adolescent↗
PubMed1990

Coincident rupture of the scapholunate and lunotriquetral ligaments without perilunate dislocation: pathomechanics and management.

Wrist injuries causing coincident disruptions of the scapholunate and lunotriquetral ligaments commonly result in perilunate dislocations. This article (1) describes our management of eight patients with wrist pain after coincident scapholunate and lunotriquetral ligament disruptions in the absence of perilunate dislocation; and (2) reports the results of biomechanical testing of some of the extrinsic and intrinsic wrist ligament and interprets these data to explain the injury seen clinically. The diagnosis of ligament failure was made on the basis of history, physical examination, arthrography and surgical exploration. Surgical treatment of seven patients consisted of concomitant scapho-trapezio-trapezoid fusion and lunotriquetral fusion. Three of seven patients were free of pain, two had pain only at the extremes of motion, and two required additional surgery. Biomechanical analysis of the scapholunate and lunotriquetral ligaments and two extrinsic wrist ligaments, the radiolunotriquetral and the radioscaphocapitate, confirmed the clinical suspicion that the intrinsic ligaments could be completely disrupted while the extrinsics are only partially injured. Such a scenario could account for the residual stability that prevents the development of perilunate dislocations. Coincident disruption of the scapholunate and lunotriquetral ligaments in the absence of perilunate dislocation is an unusual injury. Treatment with lunotriquetral fusion and scapho-trapezio-trapezoid fusion restored functional use in five of seven wrists while maintaining wrist motion.

Adult↗
PubMed1979

The mechanism of dorsal fracture dislocation of the fifth carpometacarpal joint.

Fracture dislocation at the base of the fifth metacarpal is a rare injury. Fewer than 25 cases have been published in the English-language literature. A force acting along the longitudinal axis of the fifth metacarpal causes a fracture dislocation at the base of the bone in a dorsal-ulnar direction, because of the anatomy of the joint and the mechanical properties of the bone and the intermetacarpal ligament. The mechanism of other types of injury to this joint, namely dorsal-radial or palmar-radial dislocation of the base of the fifth metacarpal is different. A case is presented which demonstrates the mechanism of the fracture dislocation.

Adult↗
PubMed1980

Carpal dislocations: pathomechanics and progressive perilunar instability.

The pathomechanics, ligamentous damage, and degree of carpal instability in perilunate and lunate dislocations were analyzed by experimentally loading 32 cadaver wrists to failure. Thirteen perilunate and two lunate dislocations were produced. The mechanism of injury was extension, ulnar deviation, and intercarpal supination. These dislocations occurred in a sequential fashion due to progressive and specific ligamentous disruptions and were classified according to the degree of perilunar instability (PLI). Stage I perilunar instability (scapholunate diastasis) had the least degree of carpal instability. Lunate dislocations (stage IV PLI) had the highest degree of carpal instability. Radial styloid fractures were produced in seven as a result of avulsion. Scaphoid rotation was created in eight and was due to rupture of the radioscaphoid and scapholunate ligaments. Reduction was accomplished by reversing the mechanism of injury--that is, intercarpal pronation, radial deviation, and palmar flexion. Stress roentgenograms employing longitudinal carpal compression in radial and ulnar deviation were helpful in determining the degree of associated carpal instability.

Adolescent↗
PubMed1985

Nonoperative treatment of traumatic dislocations of the extensor digitorum tendons in patients without rheumatoid disorders.

Traumatic subluxation and dislocation of the extensor digitorum tendons are uncommon in patients without rheumatoid disorders. Management of the acute injury is not well defined in the orthopedic literature. Two cases of traumatic dislocations of the extensor digitorum tendon were seen acutely in young persons without rheumatoid disease. These patients were successfully managed by early closed reduction and immobilization. This treatment had yielded good hand function to date, without recurrence of the dislocation. One of these cases was particularly unusual in that the direction of the tendon dislocation was radial. This particular injury has not been previously described.

Adult↗
PubMed1986

Carpometacarpal dislocations: report of five cases and review of the literature.

Carpometacarpal dislocations occur in less than 1% of hand injuries. Since 1973, five cases were treated at Henry Ford Hospital. Three of the dislocations were unstable and required internal fixation. Of these dislocations only one needed open reduction. The other two dislocations were successfully treated by closed reduction and cast immobilization. Follow-up ranged from 2 to 13 months. Three patients were asymptomatic, and the other two, both of whose injuries had been treated by internal fixation, reported pain with activity.

Adult↗
PubMed2000

Posterior shoulder dislocation: avoiding a missed diagnosis.

Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1% to 4% of all shoulder dislocations. Because of the infrequency of this condition, the diagnosis is often missed, with significant consequences to the patient Injury in the athlete is usually from a direct blow or fall onto an outstretched arm. After such an injury, symptoms may be confused with a shoulder contusion or rotator cuff injury. Significant complications such as chronic posterior dislocation and degenerative disease of the shoulder can occur if the diagnosis is missed. A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. Treatment consists of prompt closed reduction, or operative repair if this is unsuccessful.

Accidental Falls↗
PubMed2002

Comparative study of intra-articular lidocaine and intravenous meperidine/diazepam for shoulder dislocations.

The purpose of this study was to compare the analgesic effectiveness of intra-articular lidocaine versus intravenous meperidine and diazepam during the reduction of anterior shoulder dislocations. Patients were randomized to one of the two methods before the reduction of shoulder dislocations. Patients marked a visual analog pain scale at baseline, after anesthesia just before reduction, and at the time of discharge. Interference with the procedure caused by pain or lack of muscle relaxation, perception of adequacy of analgesia by the patient, adverse effects, and time to discharge from the Emergency Department (ED) were measured. Differences of outcomes, relative risks (RR), and 95% confidence intervals (CIs) were derived. Fifty-four patients with anterior shoulder dislocations presenting from May 21, 1998 through January 21, 1999 were included in this study; 29 were randomly assigned to receive intra-articular lidocaine (IAL) and 25 to receive intravenous meperidine/diazepam (IVMD). IAL was less effective than IVMD in relieving pre-reduction pain (p = 0.045) but equally effective in overall pain relief (p = 0.98). IAL was more effective than IVMD in shortening recovery time (p = 0.025). There was an indication favoring IVMD in terms of physician-perceived muscle relaxation and patient's perception of analgesia adequacy. In conclusion, although the IVMD method appears to have some clinically and statistically significant advantages, IAL possesses some favorable features that render it to be an analgesia alternative in shoulder dislocation reduction.

Adult↗
PubMedDate not supplied

Transverse bayonet dislocation of the distal interphalangeal joint--a case report.

Transverse bayonet dislocation of an interphalangeal joint is an unstable injury caused by the disruption of both collateral ligaments. This injury pattern in proximal interphalangeal joint was first described by Patel et al. (Clin Orthop Rel Res. 1978;133:219), who coined the term "bayonet dislocation" to describe this particular type of injury. The case of a distal interphalangeal transverse dislocation is presented. This dislocation was successfully treated by closed reduction and immobilization with an aluminum splint and buddy taping to the adjacent finger.

Adult↗
PubMed2000

Irreducible posterolateral dislocation of the knee.

Traumatic knee dislocations are relatively rare, often associated with neurovascular injury, and almost always amenable to closed reduction. However, over the years, several authors have recognized that the rare knee dislocation not reducible by closed manipulation usually involves posterolateral dislocation of the tibia and button-holing of the medial femoral condyle through the medial retinaculum. These cases present with a dimple sign, a characteristic invagination of tissues at the medial joint line. Open reduction entails extraction of the soft-tissue collar that becomes incarcerated in the trochlea and intercondylar notch. We present an interesting case of irreducible posterolateral knee dislocation and review many of the salient points associated with this entity. Additionally, we include intraoperative video footage available on the Journal Web site to promote a better appreciation of the dramatic visual presentation and physical examination of this unusual injury.

Follow-Up Studies↗
PubMed2003

High-energy knee dislocation without anterior cruciate ligament disruption in a skeletally immature adolescent.

Knee dislocations are rare injuries in any age group, but even more unusual in skeletally immature individuals. Such injuries often occur from high-energy mechanisms and are commonly associated with disruption of both anterior and posterior cruciate ligaments. Although there are several previous reports of knee dislocation without disruption of the posterior cruciate ligament, there is only one report citing 3 cases of knee dislocation with the anterior cruciate ligament remaining intact, each occurring in skeletally mature individuals. We present a high-energy knee dislocation in a skeletally immature girl without anterior cruciate ligament disruption. We also discuss the evaluation, management, and outcome. Treatment of this condition with arthroscopically assisted posterior cruciate ligament reconstruction using tibialis anterior allograft 2 weeks after the acute injury resulted in complete functional recovery.

Accidents, Traffic↗
PubMed1998

Dislocating anterior horn of the medial meniscus.

Dislocating anterior horn of the medial meniscus was found in 15 knees of 13 patients during arthroscopic examinations done between 1992 and 1995. All of them were available for follow-up evaluation (4 by telephone). There were 11 men and 2 women (average age, 28 years; range, 17 to 49 years). Nine knees had a history of trauma. Only 1 knee had had trauma in two bilateral cases. Duration of symptoms was an average of 3.3 years (range, 3 months to 10 years). The knees were stable clinically. Arthroscopy revealed associated lesions in 13 knees; hypertrophic medial plicae, meniscal, chondral and anterior cruciate ligament (ACL) lesions predominated. Three knees had unusually hypertrophic ligamentum mucosum. Eleven of 13 knees had more than one associated lesions. Only 2 knees (2 patients) had isolated dislocating anterior horn of the medial meniscus. Only the associated lesions were treated (except for ACL lesions) and dislocating anterior horns of the medial menisci were left alone. Follow-up averaged 21 months (7 to 40 months). At follow-up, 11 knees were graded as excellent, 3 as good, and 1 as fair according to the Lysholm scale. Eight knees had minor symptoms and 6 were asymptomatic; no improvement was noted in 1 knee. Overall, 12 patients (14 knees) were satisfied with their treatment. Dislocating anterior horn of the medial meniscus is a normal anatomic variant with little or no clinical significance. When seen during arthroscopy, a significant lesion should be looked for. It is an incidental finding and should be left alone.

Adolescent↗
PubMed1992

["Congenital" dislocation of the radial head. A bilateral case developing around the age of ten].

Dislocation of the head of the radius has important repercussions on pronation-supination, elbow stability and on the wrist joint. In the absence of a history of trauma, this anomaly is generally considered to be "congenital". Few authors have described the progressive acquisition of this dislocation during growth. The case of a 20 year old man is presented, corresponding to initial subluxation which gradually evolved towards dislocation of the head of the radius at about the age of 11 years. This type of dislocation appears to be related to abnormal growth of the proximal radial epiphysis, responsible for repercussions on the humero-radial articular relations and on the anatomy of the upper extremity of the radius. The patient was treated by ulnar osteotomy at the age of 17 years according to Hirayama's technique, when he was probably already too old. Surgical correction of the subluxation of the head of the radius at an earlier age would probably have been preferable.

Age Factors↗
PubMed1998

Irreducible dorsal dislocation of the interphalangeal joint of the thumb due to the palmar plate. A case report.

Dorsal dislocation of the thumb interphalangeal joint is rare. Only very few cases of irreducible dislocation has been reported at this joint. The authors report a case of compound irreducible dislocation due to the palmar plate interposition. The sesamoid, the flexor pollicis longus have been reported to block reduction of the dorsal dislocation of the thumb interphalangeal joint doctors on casualities should not insist if reduction is not easily obtained, the patient should then be guide towards a surgical team for surgical treatment.

Adult↗
PubMed2004

Treatment of recurrent dislocation of total hip arthroplasty using a ligament prosthesis.

Recurrent dislocation of total hip arthroplasty (THA) has a poor prognosis when the cause of dislocation cannot be ascertained. We present the successful use of a synthetic ligament prosthesis to treat 4 patients with recurrent posterior dislocation of THA. After an average follow-up period of 28 months, none of the patients had any further episode of dislocation. We believe that this is a simple and low-risk method of treating selected patients and avoids the poor outcome associated with surgery to revise components.

Aged↗
PubMed1995

Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult. Preliminary report and description of a new surgical technique.

Total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult has been associated with high rates of complications, including acetabular component loosening, femoral or sciatic nerve palsy, and prosthetic dislocation. Placement of the acetabular component in the true acetabulum has yielded the most durable results, but leads to significant limb lengthening, which is associated with sciatic and femoral nerve palsy. Femoral shortening with a transverse osteotomy tends to be torsionally unstable. Increased femoral anteversion complicates femoral component placement and, if not corrected, can lead to postoperative anterior instability and component dislocation. A new surgical technique that combines total hip arthroplasty with a femoral subtrochanteric shortening derotational double-chevron osteotomy in complete congenital hip dislocation using standard components is described. This procedure has been successfully performed in seven hips.

Aged↗
PubMed1998

Capsular replacement with synthetic mesh: effectiveness in preventing postoperative dislocation after wide resection of proximal femoral tumors and prosthetic reconstruction.

We describe a surgical technique for replacing the hip joint capsule using synthetic mesh after oncological resections of the proximal femur that resulted in gross intraoperative instability of the prosthetic reconstruction. The results of its use in 13 patients, 6 of whom also had pelvic resections, are described. These patients were selected from a total group of 88 patients undergoing proximal femoral replacement, 75 of whom did not require capsular replacement (none of these 75 patients have experienced dislocation). In the group requiring capsular reconstruction, 1 of 4 patients with bipolar hemiarthroplasty and 4 of 9 patients with total hip replacements experienced dislocation after operation. Of the dislocated total hip replacements, 1 remains chronically dislocated, and 3 were successfully stabilized by open reduction with further capsular augmentation. Given that the resections involved removal of most of the soft tissues stabilizing the hip joint, we believe that the technique of capsular reconstruction is useful in this difficult group of patients.

Adult↗
PubMed1999

Muscular and neurologic function in patients with recurrent dislocation after total hip arthroplasty: a matched controlled study of 65 patients using dual-energy X-ray absorptiometry and postural stability tests.

Twenty-two patients with recurrent dislocation after primary total hip arthroplasty (THA) were compared with 43 randomly selected, stratified THA patients without dislocation with regard to radiographic cup position; body composition of bone, fat, and muscle (lean body mass) as determined by dual-energy x-ray absorptiometry; strength in abduction and adduction; range of motion; balance; and vibration sense. Balance and sensitivity to vibration were impaired in the patients with dislocation. No differences were found in any other variables except a subset of tall men in the dislocation group.

Absorptiometry, Photon↗