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American Family Physician Jul 2016Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle... (Review)
Review
Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures, and rotator cuff tears. Acromioclavicular joint injuries and clavicle fractures mostly occur in young adults as the result of a sports injury or direct trauma. Most nondisplaced or minimally displaced injuries can be treated conservatively. Treatment includes pain management, short-term use of a sling for comfort, and physical therapy as needed. Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and similar high-impact trauma. Patients will usually hold the affected arm in their contralateral hand and have pain with motion and decreased motion at the shoulder. Physical findings may include a palpable humeral head in the axilla or a dimple inferior to the acromion laterally. Reduction maneuvers usually require intra-articular lidocaine or intravenous analgesia. Proximal humerus fractures often occur in older patients after a low-energy fall. Radiography of the shoulder should include a true anteroposterior view of the glenoid, scapular Y view, and axillary view. Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training. Rotator cuff tears can cause difficulty with overhead activities or pain that awakens the patient from sleep. On physical examination, patients may be unable to hold the affected arm in an elevated position. It is important to recognize the sometimes subtle signs and symptoms of acute shoulder injuries to ensure proper management and timely referral if necessary.
Topics: Acromioclavicular Joint; Clavicle; Conservative Treatment; Fractures, Bone; Humans; Immobilization; Joint Dislocations; Pain Management; Physical Examination; Physical Therapy Modalities; Radiography; Range of Motion, Articular; Rotator Cuff Injuries; Shoulder Dislocation; Shoulder Injuries
PubMed: 27419328
DOI: No ID Found -
The Journal of Bone and Joint Surgery.... May 2007Crescent fracture dislocations are a well-recognised subset of pelvic ring injuries which result from a lateral compression force. They are characterised by disruption...
Crescent fracture dislocations are a well-recognised subset of pelvic ring injuries which result from a lateral compression force. They are characterised by disruption of the sacroiliac joint and extend proximally as a fracture of the posterior iliac wing. We describe a classification with three distinct types. Type I is characterised by a large crescent fragment and the dislocation comprises no more than one-third of the sacroiliac joint, which is typically inferior. Type II fractures are associated with an intermediate-size crescent fragment and the dislocation comprises between one- and two-thirds of the joint. Type III fractures are associated with a small crescent fragment where the dislocation comprises most, but not all of the joint. The principal goals of surgical intervention are the accurate and stable reduction of the sacroiliac joint. This classification proves useful in the selection of both the surgical approach and the reduction technique. A total of 16 patients were managed according to this classification and achieved good functional results approximately two years from the time of the index injury. Confounding factors compromise the summary short-form-36 and musculoskeletal functional assessment instrument scores, which is a well-recognised phenomenon when reporting the outcome of high-energy trauma.
Topics: Adolescent; Adult; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Male; Middle Aged; Recovery of Function; Sacroiliac Joint; Tomography, X-Ray Computed; Trauma Severity Indices; Treatment Outcome
PubMed: 17540753
DOI: 10.1302/0301-620X.89B5.18129 -
BMJ Case Reports Jan 2021A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from...
A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from case reports. In this case, we present a 51-year-old right-hand dominant male who sustained the injury after a fall. He attended the emergency department on the same day and a closed reduction was able to be performed under a haematoma block. On review in follow-up clinic the patient's symptoms had completely resolved.
Topics: Accidental Falls; Casts, Surgical; Closed Fracture Reduction; Humans; Joint Dislocations; Male; Middle Aged; Pisiform Bone; Treatment Outcome; Wrist Injuries
PubMed: 33408102
DOI: 10.1136/bcr-2020-237482 -
American Family Physician Jul 2021
Topics: Acromioclavicular Joint; Humans; Joint Dislocations; Shoulder Dislocation
PubMed: 34264594
DOI: No ID Found -
Neurology India 2012Atlanto-axial dislocations (AADs) may be classified into four varieties depending upon the direction and plane of the dislocation i.e. anteroposterior, rotatory,... (Review)
Review
Atlanto-axial dislocations (AADs) may be classified into four varieties depending upon the direction and plane of the dislocation i.e. anteroposterior, rotatory, central, and mixed dislocations. However, from the surgical point of view these are divided into two categories i.e. reducible (RAADs) and irreducible (IAADs). Posterior fusion is the treatment of choice for RAAD. Transarticular screw fixation with sub-laminar wiring is the most stable& method of posterior fusion. Often, IAAD is due to inadequate extension in dynamic X-ray study which may also be due to spasm of muscles. If the anatomy at the occipito-atlanto-axial region {O-C1-C2; O: occiput, C1: atlas, C2: axis} is normal on X-ray, the dislocation should be reducible. In case congenital anomalies at O-C1-C2 and IAAD are seen on flexion/extension studies of the cervical spine, the C1-C2 joints should be seen in computerized tomography scan (CT). If the C1-C2 joint facet surfaces are normal, the AAD should be reducible by cervical traction or during surgery by mobilizing the joints. The entity termed "dolichoodontoid" does not exist. It is invariably C2-C3 (C3- third cervical vertebra) fusion which gives an appearance of dolichoodontoid on plain X-ray or on mid-saggital section of magnetic resonance imaging (MRI) or CT scan. The central dislocation and axial invagination should not be confused with basilar invagination. Transoral odontoidectomy alone is never sufficient in cases of congenital IAAD, adequate generous three-dimensional decompression while protecting the underlying neural structures should be achieved. Chronic post-traumatic IAAD are usually Type II odontoid fractures which get malunited or nonunited with pseudoarthrosis in dislocated position. All these dislocations can be reduced by transoral removal of the offending bone, callous and fibrous tissue.
Topics: Atlanto-Axial Joint; Cervical Vertebrae; Humans; Joint Dislocations
PubMed: 22406773
DOI: 10.4103/0028-3886.93582 -
British Journal of Hospital Medicine... Feb 2023Although uncommon, subtalar joint dislocations remain a frequently missed orthopaedic emergency. Detailed soft tissue and neurovascular assessment is important and these... (Review)
Review
Although uncommon, subtalar joint dislocations remain a frequently missed orthopaedic emergency. Detailed soft tissue and neurovascular assessment is important and these should be documented as appropriate. Failure of urgent reduction might lead to increased risk of conversion to an open injury as a result of pressure necrosis of the overlying skin, risk of talar avascular necrosis and risk of neurovascular compromise. A computed tomography scan is needed in all cases following successful closed or open reduction to identify associated occult foot and ankle fractures. The goal of treatment is to reduce the risk of soft tissue and neurovascular compromise and achieve a supple, painless foot. This article highlights the importance of early identification of this injury and institution of appropriate management according to the latest evidence, to reduce the risk of complications and lead to the best outcomes.
Topics: Humans; Joint Dislocations; Subtalar Joint; Ankle Fractures; Lower Extremity; Necrosis
PubMed: 36848162
DOI: 10.12968/hmed.2022.0211 -
Sports Health 2016Posterior shoulder instability has become more frequently recognized and treated as a unique subset of shoulder instability, especially in the military. Posterior... (Review)
Review
CONTEXT
Posterior shoulder instability has become more frequently recognized and treated as a unique subset of shoulder instability, especially in the military. Posterior shoulder pathology may be more difficult to accurately diagnose than its anterior counterpart, and commonly, patients present with complaints of pain rather than instability. "Posterior instability" may encompass both dislocation and subluxation, and the most common presentation is recurrent posterior subluxation. Arthroscopic and open treatment techniques have improved as understanding of posterior shoulder instability has evolved.
EVIDENCE ACQUISITION
Electronic databases including PubMed and MEDLINE were queried for articles relating to posterior shoulder instability.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
In low-demand patients, nonoperative treatment of posterior shoulder instability should be considered a first line of treatment and is typically successful. Conservative treatment, however, is commonly unsuccessful in active patients, such as military members. Those patients with persistent shoulder pain, instability, or functional limitations after a trial of conservative treatment may be considered surgical candidates. Arthroscopic posterior shoulder stabilization has demonstrated excellent clinical outcomes, high patient satisfaction, and low complication rates. Advanced techniques may be required in select cases to address bone loss, glenoid dysplasia, or revision.
CONCLUSION
Posterior instability represents about 10% of shoulder instability and has become increasingly recognized and treated in military members. Nonoperative treatment is commonly unsuccessful in active patients, and surgical stabilization can be considered in patients who do not respond. Isolated posterior labral repairs constitute up to 24% of operatively treated labral repairs in a military population. Arthroscopic posterior stabilization is typically considered as first-line surgical treatment, while open techniques may be required in complex or revision settings.
Topics: Arthroscopy; Humans; Joint Dislocations; Joint Instability; Magnetic Resonance Imaging; Military Personnel; Range of Motion, Articular; Recurrence; Shoulder Dislocation; Shoulder Joint; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27697889
DOI: 10.1177/1941738116672446 -
Ugeskrift For Laeger Oct 2022Traumatic dislocation of the knee is a rare orthopaedic injury with often severe concomitant damage. In addition to the ligamentous injuries there is a significant risk... (Review)
Review
Traumatic dislocation of the knee is a rare orthopaedic injury with often severe concomitant damage. In addition to the ligamentous injuries there is a significant risk of vascular injury, which can be potentially limb-threatening if undiagnosed or late recognized. It is therefore crucial with a correct and safe diagnostic method in the acute phase. Dislocation is caused by both high- and low-velocity mechanisms. Obesity is a single risk factor of low-velocity knee dislocation. Other than nerve and vascular damage, dislocation is associated with numerous intra- and extraarticular injuries, as argued in this review.
Topics: Humans; Joint Dislocations; Knee Dislocation; Knee Joint; Risk Factors; Vascular System Injuries
PubMed: 36254828
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Sep 2022Perilunate dislocations and fracture-dislocations are severe injuries that often have serious functional sequelae. Our goal was to evaluate the long-term clinical and... (Observational Study)
Observational Study
INTRODUCTION
Perilunate dislocations and fracture-dislocations are severe injuries that often have serious functional sequelae. Our goal was to evaluate the long-term clinical and radiological results of these perilunate injuries, and to look for prognostic factors of a poor clinical outcome.
HYPOTHESIS
All patients who suffered perilunate injuries in their wrist have functional sequelae and long-term radiographic changes despite optimal treatment with anatomical surgical reduction.
MATERIALS AND METHODS
We did a single-center, retrospective study of 32 patients who had either an isolated perilunate dislocation (n=7) or fracture-dislocation (n=25) in their wrist. Pain, range of motion, strength and functional scores (MWS, PRWE, QuickDASH) were evaluated. Radiographs were analyzed to look for signs of osteoarthritis or carpal instability.
RESULTS
The mean follow-up time was 9.9years (3.5-24). The wrist joint had a mean flexion-extension of 86° (0-140), radioulnar deviation of 38° (0-65) and pronosupination of 153° (120-180). The mean grip strength was 35kg (5-56). The mean MWS, PRWE and QuickDASH scores were 65/100, 32/100 and 29/100, respectively. At the final assessment, 23 patients (79%) had radiographic signs of osteoarthritis while 5 patients (16%) had residual carpal instability. Three patients subsequently underwent palliative treatment. Opening the carpal tunnel and the magnitude of the lunate's displacement are significant predictors of a poor long-term functional outcome (p<0.05). Older age at the time of injury was a predictor for the development of osteoarthritis.
DISCUSSION
Despite optimal treatment, perilunate dislocations and fracture-dislocations at the wrist cause functional sequelae such as pain, stiffness, strength deficit and posttraumatic arthritis in nearly 80% of patients. The functional outcomes are determined by the amount of lunate displacement (stage) and the patient's age. We do not recommend opening the carpal tunnel, even when signs of median nerve compression are present; reducing the dislocation helps to relieve the neurological symptoms.
LEVEL OF EVIDENCE
IV; retrospective observational study.
Topics: Carpal Tunnel Syndrome; Fracture Dislocation; Fractures, Bone; Humans; Joint Dislocations; Joint Instability; Lunate Bone; Osteoarthritis; Pain; Prognosis; Retrospective Studies; Wrist; Wrist Injuries; Wrist Joint
PubMed: 35609818
DOI: 10.1016/j.otsr.2022.103332 -
Musculoskeletal Surgery Dec 2022Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other... (Review)
Review
BACKGROUND
Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other involvement of the foot. Dislocation can occur medially (85%), laterally (15%), posteriorly (2.5%) and anteriorly (1%). Reduction can be performed by closed or open technique; lateral dislocations often require open reduction because of inclusion of soft tissues or bone fragments. Lateral dislocations are frequently complicated by bone exposure, risk of infection and associated soft tissues injuries.
AIM OF THE STUDY
The aim of this study is to explain main characteristics and to clarify the most important pitfalls of subtalar dislocations.
MATERIALS AND METHODS
We examined 47 articles published in the last thirty years (389 cases). For each dislocation we reviewed its main characteristics: direction, bone exposure, need for open reduction and for surgical stabilisation, associated injuries and method used for diagnosis.
RESULTS
Medial dislocations (68.1%) has greater incidence compared to lateral ones (27.7%). Bone exposure (44.5%), associated lesions (44.5%) and need for surgical reduction (48.2%) are much more represented in lateral dislocation than in the others.
CONCLUSIONS
Subtalar dislocations, especially the lateral one, represent a challenge for surgeons. Lateral subtalar dislocation occurs following high-energy trauma often involving associated injuries. Closed reduction could be unsuccessful and patients must undergo surgical reduction. After reduction CT scan is recommended. Our narrative review confirms these findings.
Topics: Humans; Subtalar Joint; Joint Dislocations; Fractures, Bone; Tomography, X-Ray Computed
PubMed: 35435636
DOI: 10.1007/s12306-022-00746-x