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PubMed1999

[Hip dislocation. Organization of screening and follow-up].

Early detection and low-risk treatment are the two main objectives of the management of developmental dislocation of the hip. The best way to evaluate neonatal hips is to perform clinical and ultrasound examinations at the same time, and to confront their results. Early diagnosis allows to restrict treatment to infants with neonatal dislocation who do not improve by 4 weeks of age. On the other hand, neonates with reductible dislocated hips must be treated at birth and followed at the joint consultation. Early diagnosis and management must not decrease later efforts to detect dislocated hip until walking age.

Follow-Up Studies↗
PubMed2003

Total knee arthroplasty for neglected permanent post-traumatic patellar dislocation--case report.

Permanent post-traumatic patellar dislocation is a rare entity resulting from recurrent trauma. This uncommon condition is often confused clinically with congenital dislocation of the patella. Treatment options, although not well defined, include observation, various soft tissue and bony procedures for realigning the patella and patellectomy. To our knowledge, this is the first case reporting the use of conventional non-constrained total knee arthroplasty with patellar resurfacing and soft tissue realignment procedure for long-standing patellar dislocation in a single stage. An interesting feature of this case was the patient's ability to function reasonably well for nearly 40 years with a dislocated patella until the development of secondary osteoarthritis, and the surprisingly good recovery after total knee replacement.

Arthrography↗
PubMedDate not supplied

Extensive shoulder capsule tearing as a main cause of recurrent anterior shoulder dislocation.

Anterior capsular and ligamentous injuries occur frequently at initial traumatic shoulder dislocation. However, these injuries have not been considered to be one of the main causes of recurrent anterior dislocation, which is believed to heal spontaneously. We evaluated five joints of five patients in which tears in the middle portion of the anterior capsule including the inferior glenohumeral ligament were considered to be the main cause of recurrent dislocation. History of present illness and physical and plain x-ray results were not specific. The only specific finding was a diverticulum-like expansion at the anteroinferior portion of the joint on arthrographic computed tomography. Treatment consisted of anatomic repair of the capsule and concurrent injuries. The outcome of the three cases in which at least 2 years had passed after surgery was excellent. The point of emphasis is that tears of the anterior capsule are one of the primary lesions in recurrent anterior dislocation.

Adult↗
PubMedDate not supplied

A prevalence study of recurrent shoulder dislocations in young adults.

The computerized database of the Israeli Defence Forces Medical Corps monitors recurrent shoulder dislocations before citizens are eligible for military induction, during the years of regular military service, and during the time of eligibility for reserve army service. With the computerized database of the Israeli Defence Forces Medical Corps, between the years of 1978 to 1995 the prevalence rate of subjects with recurrent shoulder dislocations less than or equal to 21 years of age was found to be 19.7 of 10,000 for men and 5.01 of 10,000 for women. The prevalence rate of subjects with a history of shoulder dislocations in the male population between the ages of 22 and 33 years was 42.4 of 10,000. Forty-four percent were judged to be sufficiently unstable to warrant surgery, but only 55% of these actually underwent surgery. These epidemiologic data may be important if arthroscopic shoulder surgery is being considered after a first shoulder dislocation.

Adult↗
PubMedDate not supplied

Lateral subtalar dislocation: review of the literature and case presentation.

Lateral subtalar joint dislocations are rare injuries which are usually the result of a violent eversional force, driving the talar head medially and displacing the rest of the foot laterally. Associated fractures and obstruction to closed reduction are more common with lateral than medial dislocations. Avascular necrosis of the talus and navicular as well as subtalar instability may result from these injuries. Severe post-traumatic subtalar arthritis may warrant triple arthrodesis. Prompt closed reduction of lateral subtalar dislocation is recommended to avoid soft-tissue or neurovascular compromise. A short period of immobilization limits loss of subtalar range of motion. Open reduction may be required, particularly with entrapment of the posterior tibial tendon or obstructing fracture fragments. A case of lateral subtalar joint dislocation is presented.

Aged↗
PubMed2002

Hip dislocation revealing hip tuberculosis. A case report.

Hip dislocation is an uncommon presentation of hip tuberculosis. We report a case in an 18-year-old woman with active hip tuberculosis. An attempt to reduce the dislocation 7 weeks into antituberculous therapy was followed by necrosis of the femoral head. Although severe forms of hip tuberculosis are common in endemic areas, dislocation is exceedingly rare. Capsule laxity and/or synovial hypertrophy probably contribute more to the occurrence of dislocation than does the accumulation of pus.

Adolescent↗
PubMed2002

Hamatometacarpal fracture-dislocation: distinctive three dimensional computed tomographic appearance.

We report here two fully documented cases of hamatometacarpal fracture-dislocation following trauma and treated in our hospital. In our cases, the patients suffered hamate fracture in association with metacarpal dislocation. In the first case, a dorsal oblique fracture of the hamate was associated with a dorsal dislocation of the base of the fourth metacarpal. In the second case, a dorsal oblique fracture of the hamate was not associated with a dorsal dislocation of the base of the fifth metacarpal. This diagnosis should be suspected on initial review of plain radiographs, which must include an oblique view because of diagnostic difficulty for this injury. We recommend three dimensional computed tomography (3D-CT) in any patient presenting with pain after blunt trauma to the hand to prevent in diagnosis. Open reduction and internal fixation of the fracture is indicated and relevant for displaced fracture.

Adult↗
PubMed2002

[Posterior radiocarpal fracture-dislocation (eight case reports)].

The Authors report a retrospective series of eight cases of posterior radiocarpal fracture-dislocation. Average age of patients was 32 years (23/54), with a male predominance (7 men and a woman). Injury was often due to a fall on the hand in extension from an elevated place (5/8). The wrist in back of fork is the characteristic deformity. Diagnosis was confirmed by AP and lateral views of the wrist. Radial styloïd fracture, posterior dislocation of the carpus and posterior rim avulsion were constant. Ulnar styloïd fracture was present in half of the cases and distal radio-ulnar dislocation in two cases. Four patients were treated conservatively and four surgically. Whatever the treatment choice, results are satisfactory at a short follow-up. The two patients presenting a distal radio-ulnar dislocation resulted in a bad result.

Adult↗
PubMed2003

Ligamentous and capsular restraints to experimental posterior elbow joint dislocation.

Pathological external forearm rotation (PEFR) relates to posterolateral elbow joint instability, and is considered a possible requisite step in a simple posterior elbow joint dislocation. The aim of this study was to evaluate the capsuloligamentous restraint to PEFR. In all, 18 elbow joint specimens were examined in a joint analysis system developed for experimental elbow dislocation. Sequential cutting of capsule and ligaments followed by stability testing provided specific data relating to each capsuloligamentous structure. The primary stabilizers against PEFR in the extended elbow were the anterior capsule and the lateral collateral ligament complex (LCLC), whereas in the flexed elbow the anterior capsule did not have a stabilizing effect. In flexed joint positions, the LCLC seems to be the only immediate stabilizer against PEFR, and thereby against posterolateral instability and possibly against posterior dislocation. The medial collateral ligament did not have any immediate stabilizing effect, but it prevented the final step of the posterior dislocation.

Aged↗
PubMed1992

Recurrent dislocation of the hip in adult paraplegics.

Recurrent dislocation of the hip is rare and has not previously been reported in adult paraplegics. This paper describes 3 cases. In one patient it was spontaneous, occurring 16 years after the original injury and was associated with a flexion-adduction contracture of the hip and a shallow acetabulum. One case occurred after minor trauma in a patient who experienced flexion-adduction spasms of the hip. In the third patient the condition was secondary to posterior acetabular deficiency following a conservatively treated fracture dislocation. All 3 patients experienced symptoms of disabling autonomic dysreflexia during the episodes of dislocation. The importance of recognising and adequately treating hip injuries in patients presenting with paraplegia secondary to spinal cord injury is stressed. In patients with spastic paraplegia presenting with recurrent dislocation of the hip, operative treatment combining a soft tissue repair and a bone block to augment the acetabulum is recommended.

Adult↗
PubMedDate not supplied

Medical treatment of recurrent temporomandibular joint dislocation using botulinum toxin A.

This paper describes a new technique for prophylactic treatment of recurrent mandibular dislocation using injection of botulinum toxin A (BtA) into the lateral pterygoid muscles. BtA temporarily weakens muscles by blocking acetylcholine release, and thus operates through a principle different from established treatments such as joint sclerosant therapy, eminectomy or Dautry's procedure. The patient suffered recurrent mandibular dislocations caused by tardive dystonia. We injected 75 mu BtA percutaneously into each lateral pterygoid muscle under electromyographic guidance. No further dislocations occurred over the subsequent 10 months, and follow-up continues. There were no immediate or delayed side effects. More experience is required before this becomes an established treatment. BtA is usually given in outpatients, and is less invasive or destructive than previous options. It may not be suitable if dislocation is due to lax ligaments or weak muscles. Operators must be aware that other BtA preparations require a different dose.

Acetylcholine↗
PubMed2001

The use of the Spaso technique in a patient with bilateral dislocations of shoulder.

Although anterior shoulder dislocation is a common traumatic condition managed in the accident and emergency department, bilateral anterior shoulder dislocations are rare. We report a patient with bilateral anterior shoulder dislocations after electric shock and stress the need for a high index of suspicion required for the diagnosis of this condition. For this patient, we have adopted a new reduction method to reduce the dislocated shoulders. A brief review on the new method-the Spaso technique-is presented in the discussion.

Adult↗
PubMed2001

Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes.

PURPOSE: To compare the results of arthroscopic repair in acute anterior shoulder traumatic dislocation with those of nonoperative treatment. TYPE OF STUDY: A prospective nonrandomized study was performed. METHODS: Between August 1989 and April 1997, 46 patients were seen after a first episode of traumatic anterior shoulder dislocation. The average age was 21 years (range, 17 to 27 years). Most dislocations were in rugby players (36 patients). There were 18 patients treated by nonoperative methods and 28 patients treated by acute arthroscopic repair; 22 patients using transglenoid suture and 6 patients with bone anchor suture fixation. RESULTS: Of the patients treated nonoperatively, 94.5% suffered a redislocation between 4 and 18 months (average, 6 months). In the operative group, 96% of the patients (27) obtained excellent results according to the Rowe scale. Only 1 patient suffered a redislocation 1 year after surgery. Three different types of lesions were found during surgery: group I, capsular tear with no labrum lesion (4%); group II, capsular tear with partial labrum detachment (32%); and group III, capsular tear and full anterior labrum detachment (64%). The average follow-up was 67.4 months (range, 28 to 120). There were no surgical complications. CONCLUSIONS: The operative group obtained 96% excellent results, but the nonoperative group only obtained 5.5% excellent results, according to the Rowe scale. The nonoperative group showed a high incidence of redislocation (94.5%) compared with the operative group (4%). Based on the findings of this study, we recommend using an arthroscopic evaluation and repair after an initial anterior traumatic shoulder dislocation in young athletes.

Adolescent↗
PubMedDate not supplied

Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation.

This article describes a medial patellofemoral ligament (MPFL) reconstruction procedure using an artificial ligament for recurrent patellar dislocation. The MPFL has been shown biomechanically to be the primary restraint among the medial patellar stabilizers. Although various predisposing factors are involved in lateral patellar dislocation, we believe that the MPFL, as a primary restraint, should undergo primary reconstruction for patellar dislocation. The results of MPFL reconstruction using a mesh-type artificial ligament and medial retinaculum slip coverage for recurrent patellar dislocation were as good as we had expected. In this article, we describe the detailed surgical technique and its rationale. We believe technique has also wide applications in MPFL reconstruction using autogenous tendons.

Arthroscopy↗
PubMed2003

The use of a constrained acetabular component for recurrent dislocation.

The poor results of surgical treatment of chronic instability after total hip arthroplasty (THA) led to the development of a constrained acetabular component. In this study, 87 constrained THAs implanted for recurrent instability were reviewed retrospectively. Eighty-five hips were available for follow-up evaluation, with an average follow-up period of 58 months. These 85 hips were evaluated at a minimum of 3 years. Two recurrent dislocations were seen, caused by dissociation of the liner from the shell. Four acetabular components and 1 femoral component were revised. Overall, a 2.4% dislocation rate and an 8.2% revision rate were seen. The recurrent dislocation rate of 2.4% represents a significant improvement over other methods reported. Repeat dislocation was only seen in dissociation of cemented liners into well-fixed shells. We do not recommend this mode of fixation.

Acetabulum↗
PubMed1999

Arthroscopic eminoplasty for habitual dislocation of the temporomandibular joint: preliminary study.

A unique surgical technique, arthroscopic eminoplasty was undertaken in 16 joints of 11 patients with habitual dislocation of the temporomandibular joint (TMJ). There were 10 joints with subluxation and 6 joints with complete dislocation in 4 male and 7 female patients with a mean age of 33 +/- 20 years. The procedure consisted of conventional diagnostic arthroscopy, followed by shaving of approximately 3 to 5 mm in height of the articular eminence with an electric motorized shaver with bone files, depending on the bone thickness as detected by preoperative imaging. The arthroscopic eminoplasty was accomplished without any peri- or postoperative complication. During the postoperative follow-up period of 19 months on average (6-36 months), all patients were free of dislocation of the TMJ, except for one joint. The patients could open their mouth 42 +/- 6 mm without arthralgia 2 weeks after surgery, and finally 47 +/- 7 mm without any subjective symptom but small joint noises (clicking or crepitus) in 10 joints. On postoperative radiographs only minor changes of the mandibular condyle were apparent in four joints. Arthroscopic eminoplasty might become a significant procedure for habitual dislocation of the TMJ and seems to produce results comparable to open arthrotomy. Further study will be required to assess this method as an acceptable modality in the future.

Adult↗
PubMedDate not supplied

[Ultrasound in the early diagnosis of congenital dislocation of the patella].

INTRODUCTION: Congenital dislocation of the patella is defined as lateral dislocation of the patella present at birth, impossibility of closed reduction and diagnosis before the age of 10 years. We report about a rare case of a bilateral congenital dislocation of the patella. CASE REPORT: Physical examination of an eight-month- old boy showed bilateral knee flexion contractures associated with moderate genu varum. On both sides the patella could not be palpated easily. Radiographic diagnosis could not show the patella as the patella normally ossifies later. Ultrasound examination located the patella lateral to the lateral femoral condyle on both sides. Closed reduction was impossible. An open reduction with division of the lateral soft tissues, lateral release, and derotation of the quadriceps femoris and refining of the medial structures was performed. After cast removal the patellae were both located in the intercondylar grooves as confirmed by clinical and ultrasound examinations of both knees. Active and passive exercises were started. CONCLUSION: Failure of internal rotation of the myotome which contains the quadriceps femoris and the patella is the etiology of congenital dislocation of the patella. The quadriceps acts as flexor, exerting a valgus stress on the knee, causing external rotation of the tibia. Diagnosis is often delayed because of the lack of pathological findings on plain radiographs. Early diagnosis is enabled by ultrasonography. Surgical treatment is necessary and results are good, as long as there are no secondary changes.

Contracture↗
PubMed1998

[Ultrasound imaging of congenital knee joint dislocation. Value in diagnosis and therapy].

Congenital dislocation of the knee is a uncommon malformation. Frequently there is an association with other congenital deformities including congenital dislocation of the hip. The classification of Leveuf and Pais into three separate groups (Type A, Type B, Type C) is now widely accepted. Between October 1989 and April 1995 we evaluated ten children (five girls and five boys) with twelve dislocated knees. Clinical, radiographic and different ultrasonography examinations were carried out on both knees. The sonographic classification showed Type A in 3, Type B in 5 and Type C in 4 cases. The sonographic examination revealed the essential anatomic structures and their pathomorphology. The anterior and the posterior cruciate ligament could be demonstrated in the majority of the cases. Three dislocated knees showed an obliteration of the recessus suprapatellaris and fibrotic changes in the m. quadriceps. These cases required operative treatment. With conservative treatment we achieved a satisfactory result in eight children with nine disease knees. There was a good functional result with an average flexion of 106 degrees. Early conservative treatment recommend as the therapy of choice. Ultrasonography imaging offers the possibility of reliable differentiation into one of the three groups of the classification of Leveuf and Pais. Radiographic documentation during the therapy has become the exception. Ultrasonography imaging helped substantially in the decision making and the timing of operative treatment.

Female↗