Dislocation of the proximal tibiofibular joint after minor injury.
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This study investigated the effect of a special patella brace on patients with lateral subluxation of the patella using kinematic magnetic resonance imaging (MRI). Fifteen patients were assessed with and without application of the brace (Shields Patella Stabilizing Brace, Hely & Weber, Santa Paula, Calif) using active-movement, against-resistance kinematic MRI of the patello-femoral joint. Kinematic MRI examinations were evaluated using previously described qualitative criteria to determine patello-femoral relationships. Eleven (73%) patellofemoral joints had improvement (55%) or correction (45%) of lateral subluxation of the patella. The brace failed to alter the position of the patella in four (27%) patients who had patella alta (two patients) or were extremely overweight (two patients). This study provided objective findings that application of the brace improved or corrected lateral subluxation of the patella in the majority of patients. This information has important implications for the conservative treatment of patients with this form of patellar malalignment.
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On the basis of 5 cases the syndrome of post traumatic arthropathy is described. Like its other forms it shows radiographyically a high degree of osteolysis, fragmentation and para-articular calcification of soft parts. The picture is similar to that of syringomyelia and tabes. If trauma occurs in childhood there will also be developmental retardation. One has to assume that trauma may be responsible for these isolated arthropathies at its site. Since the further course corresponds to that of a neurogenous arthropathie it is likely that in these cases there is an underlying disturbance of the relationship between nervous system and bone and joint which, so far, cannot be proved clinically.
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Acute dislocation of the proximal tibiofibular joint is rare, and although most dislocations are treated by closed reduction, open reduction and internal fixation is sometimes required. We present the case of an injury to a professional football player where open reduction and internal fixation with bioabsorbable pins was performed.
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Clinical and radiographic follow-up was done on a group of patients with atraumatic patellofemoral joint disorders who had been treated surgically by realignment of the extensor apparatus at the authors' institution from 1985 to 1989. The preoperative radiographic examination in the 65 patients treated (for a total of 74 realignments) evaluated the following parameters: sulcus angle, Insall-Salvati index, and congruence angle. The 46 patients who returned for follow-up (after an average of 2 years and 3 months) were evaluated clinically according to a classification system proposed by the authors which is based on objective clinical data and a multi-factorial assessment of pain. Moreover, radiographic follow-up of the same 46 patients made it possible to quantify the degree of realignment achieved with each type of surgical technique. The clinical and radiographic data made it possible to determine more precise indications for each type of surgical procedure in relation to the disease involved, using a correct diagnostic approach and making a thorough evaluation of the clinical, anatomical and pathological features.
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The authors report four cases of inferior dislocation of the proximal tibiofibular joint. A literature search disclosed reports on superior, anterolateral and posterolateral dislocation, but none on inferior dislocation of the proximal tibiofibular joint. The latter was associated in these four cases with fracture of the tibia, as also noted in cases of superior dislocation, and with severe neurovascular lesions.
We report three cases of chronically dislocated joints of the lower extremities that were treated by the Ilisarov method. As the results show, it is possible to reduce such dislocations step by step, causing less operative trauma.
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