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At least 1,099 records · Page 61Linked to original sources
PubMed1996

Primary fusion of fracture dislocations of central carpometacarpal joints.

Six patients with dislocations or fracture dislocations of at least the second and third carpometacarpal joints are presented. Closed reduction was attempted in all cases. Two dislocations with minimal periarticular fractures were stable and were treated with cast immobilization. Four fracture dislocations were unstable and were treated with primary arthrodesis of the injured joints. One patient was lost to followup and the other 5 were observed for an average of 24 months. Establishment of a stable or rigid central carpometacarpal joint produced an excellent result in 4 patients and a satisfactory result in 1 patient.

Adolescent↗
PubMed1996

Delayed reduction of traumatic knee dislocation. A case report and literature review.

Knee dislocation after high energy trauma poses a major challenge to patients and treating physicians. The case presented documents the history and treatment of an unreduced posterior knee dislocation discovered 24 weeks after injury. Delayed surgical reduction was achieved, and satisfactory results were obtained with 22 months of followup of the patient. A detailed review of the literature found no comparable examples of longstanding traumatic dislocations of the knee but shed light on the probable cause for this unusual case. Close clinical followup, even after appropriate initial treatment of knee dislocations, is needed to eliminate similar occurrences.

Adolescent↗
PubMed1996

Pathomechanics of complex dislocations of the first metatarsophalangeal joint.

Because only 10 complex dislocations of the first metatarsophalangeal joint have been reported to date, a retrospective review was initiated to study the pathomechanics of 11 new cases (9 patients) and to report on the clinical and functional outcomes. Concomitant ipsilateral injuries were frequent: 6 tarsometatarsal joint partial disruptions and 8 cases with multiple midfoot or forefoot fractures or dislocations occurred. Clinical and radiographic assessments suggested that forefoot hyperextension combined with axial loading of the foot in a heel to toe or toe to heel direction produced all. Six cases required open reductions (5 were compound), and 5 cases were managed by closed methods. Associated tarsometatarsal joint disruptions facilitated closed management. The most common complaints at followup assessment (average, 7 years) were sensitive plantar wounds, partial joint ankylosis, and sesamoid sensitivity. All but 1 patient resumed the same or modified work. The data in this series suggest that most complex dislocations of the first metatarsophalangeal joint probably occur frequently with a concurrent tarsometatarsal joint sprain or disruption, and that the primary mechanism of injury is that of axial loading of the foot causing midfoot hyperflexion and forefoot hyperextension. Contrary to current opinion, not all complex dislocations of the first metatarsophalangeal joint are resistant to closed management.

Adolescent↗
PubMed1998

A finite element analysis of factors influencing total hip dislocation.

A previously validated three-dimensional finite element model was used to study how several total hip component design and surgical placement variables contribute to resisting the propensity for posterior dislocation in the case of leg crossing in an erectly seated position. The computational formulation incorporated treatments of polyethylene material nonlinearity and large displacement sliding contact. The primary outcome measures were the peak intrinsic moment developed to resist dislocation, and the ranges of motion before neck on lip impingement and before frank dislocation. Modifications of the acetabular linear design (chamfer bevel angle, lip breadth, head center inset) involved trading off improved peak resisting moment for compromised range of motion and vice versa. Increases of head size led to substantial improvements in peak resisting moment, but if the head to neck diameter ratio was held constant, had almost no influence on the component range of motion. For the leg crossing event studied, increased component anteversion, and even more so increased tilt (less net abduction), achieved improvements in range of motion and in peak resisting moment, but these changes imply diminished resistance to anterior dislocation from extension and adduction motion inputs.

Arthroplasty, Replacement, Hip↗
PubMed2000

The pathologic features and mechanism of traumatic dislocation of the hip.

The term traumatic dislocation of the hip encompasses a heterogenous group of dislocations, and more commonly, fracture-dislocations which have been subclassified. The current study describes the pathologic features in terms of an anatomic description of the displaced parts of the joint and what is known of the associated injured structures in each of the subtypes. The events that lead to traumatic dislocation of the hip are well documented, but understanding of the mechanics of the injury can only be presumptive.

Hip Dislocation↗
PubMed2000

Classification of traumatic hip dislocation.

The commonly used classification systems of hip dislocation are based on the direction of the dislocation and the presence of associated lesions. However, no rating system can reliably predict the patient's outcome and prognosis based on the initial presentation and classification. In general, patients with anterior dislocations have the best prognosis. Other factors affecting the prognosis are the associated injuries and more importantly the delay between dislocation and reduction.

Hip Dislocation↗
PubMed2001

Effect of posterior capsular repair on early dislocation in primary total hip replacement.

Formal repair of the posterior capsule and short external rotator tendons has been described as a surgical approach to reduce the incidence of posterior dislocation after posterolateral surgical approach to primary total hip replacement. The purpose of the current study was to compare the incidence of early posterior dislocation (within the first 6 months after surgery) using a complete posterior capsulectomy versus a formal posterior capsular repair. In patients with a complete posterior capsulectomy, 52 of 1078 primary total hip replacements (4.8%) had an early posterior dislocation. In patients with posterior capsular repair, three of 437 primary total hip replacements (0.7%) had an early posterior dislocation. This difference was statistically significant. The only complication in the capsular repair group was an avulsion fracture of the greater trochanter in four of 437 total hip replacements (0.9%).

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Closed treatment of hip dislocation in Down syndrome.

Two young children (three hips) with Down syndrome and dislocation of the hip were successfully treated by nonoperative methods by using the principle of prolonged immobilization or bracing. A 5-year, 6-month-old patient with bilateral habitual dislocation used an ambulatory abduction orthosis full-time for 6 months and then part-time for 4 months. Complete dislocation of the right hip in a 4-year, 6-month-old patient was managed by closed reduction, spica cast immobilization for 4 months, and then an ambulatory abduction orthosis for 8 months. Both patients developed stable, well-contained hips. Nonoperative management of hip dislocation in Down syndrome can be successful and avoids the complications associated with operations previously recommended for these patients.

Braces↗
PubMedDate not supplied

Surgical treatment of congenital dislocation of the patella.

Eleven patients with 17 involved knees were surgically treated for congenital dislocation of the patella between 1978 and 1993. Ten patients with 13 involved knees followed up for a minimum of 2 years postoperatively composed the study group. Six patients had both involved knees operatively treated. In four patients, congenital dislocation of the patella was associated with a recognizable syndrome. All patients had fixed, painful lateral dislocation of the patella that could not be reduced. The average age at presentation was 7 years and 9 months (range, 2 months to 15 years). All patients underwent an extensive procedure including lateral release and advancement of the vastus medialis obliquus. Skeletally immature children underwent medial transfer of the entire patellar tendon. Skeletally mature patients underwent medial transfer of the tibial tubercle. Ten patients with 13 involved knees were followed up for > or = 2 years. Mean follow-up was 5.1 years (range, 1-17.5). At last follow-up, all patients reported a marked increase in activity tolerance and relief of pain. Average extension lag improved from 15 degrees before to 2 degrees after surgery. One superficial wound infection occurred; no patient developed a deep infection. One peroneal neurapraxia occurred but resolved with observation. Redislocation of the patella occurred in the immediate postoperative period in one patient. Operative treatment of congenital dislocation of the patella can predictably improve knee function when all aspects of the complex pathologic anatomy are addressed.

Adolescent↗
PubMedDate not supplied

Congenital dislocation of the patella. Part II: orthopaedic management.

Five patients (eight knees) with diagnosed congenital dislocation of the patella and well-documented charts were reviewed. Age at diagnosis ranged from 4 days to 6 years. A flexion contracture of the knee and femorotibial rotatory dislocation of varying degrees were present in all the cases. The quadriceps was active in all the cases, producing knee flexion in four cases. Foot deformity was associated in all the cases (clubfoot, calcaneovalgus, or congenital vertical talus). Gradual correction of knee flexion contracture with serial casting was attempted in five cases leading to an almost complete extension in two cases. Treatment of patellar dislocation was surgical in all the cases, consisting in extensive quadriceps release (seven knees) or V-Y lengthening (one knee), division of lateral soft tissues, and reefing of the medial retinaculum and capsule. Intraoperative anomalies were recorded. At an average follow-up of 6.9 years, all the patients are able to walk on their operated limb, and the patella is centered in the trochlea in all the cases. Knee mobility, rotatory dislocation, and daily function were improved in seven cases.

Child↗
PubMed1988

Traction bow for acute reduction of fracture and/or dislocation of the thoracic or thoracolumbar spine.

Treatment of acute fractures and/or fracture dislocations of the thoracic or thoracolumbar spine has traditionally involved bedrest or the use of traction devices with external hanging weights, until surgical correction can be accomplished. A fiberglass tubular traction bow with continuous adjustable elastic tension has been designed for the application of skeletal traction. When used to treat thoracic or thoracolumbar fractures and/or dislocations, it can maintain distraction forces in an uninterrupted fashion. Ten patients with acute fractures and/or dislocations of the thoracic or thoracolumbar spine were treated with this traction bow. All of the spinal deformities showed dramatic improvement within the first 3 h of treatment. The patients all showed immediate lessening of acute severe pain, and those with incomplete neurologic loss showed improvement of their neurologic function. The patients all tolerated the device well and were able to undergo radiologic examination and, ultimately, spinal fusion while they were stabilized in the traction bow. We believe this device is especially valuable for immediate reduction of spine and care of patients with fractures or fracture dislocations of the thoracolumbar spine.

Adolescent↗
PubMed1988

Tarsometatarsal fractures and dislocations.

A total of 32 cases of tarsometatarsal fracture dislocations, treated during a 15-year period, have been retrospectively reviewed. Results were assessed in 29 patients with a mean age of 33.8 years and a mean follow-up of 6.3 years. On the basis of Quénu and Küss' classification, five patients had homolateral dislocations, three had divergent dislocations, and 21 had partial dislocations (seven medial partial and 14 lateral partial). Treatment included closed manipulative reduction, occasionally followed by Kirschner (K)-wire fixation. If closed reduction was not achieved, open reduction was performed. Results were assessed according to Hardcastle's scoring system. On that basis, 20 good, 5 fair, and 3 poor results were obtained and there was one early amputation. Good results were associated with an accurate reduction. Open treatment is advocated if minor displacement persists. Routine K-wire fixation is advised for all cases.

Adolescent↗
PubMed1990

Late posttraumatic carpometacarpal dislocation of the ring and little finger.

A case of late post-traumatic dislocation of the ring and little finger carpometacarpal joints is described. An avulsion fracture from the base of the ring finger metacarpal was noted, but normal alignment was demonstrated by radiographs in the acute postinjury period. However, 3 months repeat radiographs showed a fixed dorsal dislocation. Although late spontaneous carpometacarpal dislocations are rarely encountered, they may develop following an untreated injury that disrupts the ligamentous stability of the joint. Therefore, an index of suspicion should exist for this possibility. The patient described here had pain and decreased grip strength and, therefore, treatment with open reduction and internal fixation was recommended. At the patient's follow-up examination, his pain has resolved and he had normal motion and grip strength. This treatment is advised when the articular cartilage of the carpometacarpal joint surface has been preserved, although sufficient cast immobilization when the avulsion fracture was initially noticed might have prevented the late dislocation.

Adult↗
PubMed1991

Dislocations of the sternoclavicular joint: anatomic basis, etiologies, and radiologic diagnosis.

Dislocations of the sternoclavicular joint are relatively uncommon, but diagnosis and management can be difficult, with posterior dislocations being potentially very serious. The anatomy of the joint, and the mechanisms of dislocation, are described. The radiologic diagnosis is discussed and three case reports are presented to illustrate varieties of dislocation. Although computed tomography is the ideal method of demonstrating the sternoclavicular joint, some specialized plain film projections are often useful. These should be more widely known and are described and illustrated. Treatment is briefly discussed.

Adolescent↗
PubMed1992

Chronically unreduced traumatic anterior dislocation of the hip: a report of four cases.

Four cases of unreduced (2-11 months postinjury) anterior hip dislocation are reported. One public dislocation 2 months postinjury was treated by open reduction with a fair result. A unique case of iliac dislocation 11 months postinjury, overlooked due to an associated femoral shaft fracture, was treated by valgus/derotation osteotomy. Two obturator dislocations 7.5 and 9.5 months postinjury were treated by a subcapital osteotomy and displacement of the femoral neck into the acetabulum (modified excision arthroplasty). Both of these patients had fairly stable, painless, and mobile hips at 2.1 and 2.8 years follow-up. By our method, subsequent total hip arthroplasty remains a viable option, in contrast to the previously described method of trochanteric osteotomy, whereby the proximal femoral anatomy is distorted.

Adult↗
PubMed1997

Anterior subtalar dislocation: case report.

Anterior subtalar dislocations are extremely rare. To our knowledge, only four cases have been reported in detail in the literature. A diagnosis of anterior subtalar dislocation should be confirmed by an anteroposterior view radiograph because lateral subtalar dislocation always includes some anterior displacement of the mid-foot. We report a case of anterior subtalar dislocation confirmed by both lateral and anteroposterior view radiographs and discuss its pathomechanism, diagnosis, and treatment.

Adult↗
PubMed1997

Transolecranon fracture-dislocation of the elbow.

OBJECTIVE: To characterize the prevalence, morphology, and prognosis of anterior (transolecranon) fracture-dislocations of the elbow. DESIGN: Retrospective case series. SETTING: A consecutive series of thirteen patients from a single level-one trauma center, plus four patients from the practices of two of the senior authors. PATIENTS: Three of seventeen patients had simple, oblique fractures of the olecranon, and fourteen had complex, comminuted fractures of the proximal ulna, including fragmentation of the olecranon in seven patients, large coronoid fragments in eight patients, and segmental fractures of the ulna in six patients. Fourteen patients were male and three were female, with an average age of thirty-eight years (range, 18 to 78 years). INTERVENTION: All fractures were treated by open reduction and internal fixation. Two one-third tubular plates had to be revised to 3.5-millimeter dynamic compression plates within six weeks of the initial operation. MAIN OUTCOME MEASURE: Elbow performance rating of Broberg and Morrey. RESULTS: At an average follow-up of twenty-five months, overall outcome was rated as excellent in seven patients, good in eight, and fair in two. Mild posttraumatic arthritis was noted in only two patients. Large coronoid fragments and extensive comminution of the trochlear notch did not preclude a good result provided that stable, anatomic fixation was achieved. CONCLUSIONS: Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparent radiocapitellar dislocation. Stable restoration of the appropriate contour and dimensions of the trochlear notch of the ulna will lead to a good result in most cases.

Adolescent↗
PubMed1998

Irreducible fracture-dislocation of the hip: a severe injury with a poor prognosis.

OBJECTIVE: To determine the outcome of and prognostic factors associated with irreducible fracture-dislocations of the hip. DESIGN: Retrospective review of a prospectively gathered trauma database. METHODS: Using a prospectively gathered trauma database, we identified twenty-five patients with fracture-dislocations of the hip that were irreducible with closed means under a general anaesthetic. All were victims of high-energy trauma with severe injuries (mean Injury Severity Score = 25, range 9 to 54). Eighteen patients had multiple fractures, fifteen had associated systemic injury, and only four sustained the hip injury in an isolated fashion. There were seven associated sciatic nerve injuries (28 percent) and nine associated femoral head or neck fractures (36 percent). The mean time from injury to open reduction was 15.3 hours (range 3 to 58 hours). RESULTS: Twenty-three patients (92 percent) were followed to definitive outcome. Despite accurate reduction, only six patients had satisfactory results (Thompson-Epstein = good or excellent). Poor results were associated with delay in reduction and an associated femoral head or neck fracture. Reasons for the poor results include avascular necrosis, posttraumatic arthritis or chondrolysis, persisting sciatic nerve injury, and heterotopic ossification. CONCLUSIONS: An irreducible fracture-dislocation of the hip is a severe injury with a poor prognosis and a high incidence of associated injuries. Outcome is best in patients who do not have an associated femoral head or neck fracture and those whose dislocation is promptly reduced.

Adolescent↗