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Orthopaedics & Traumatology, Surgery &... Feb 2023Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be... (Review)
Review
Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be overlooked, due to young age and the cartilaginous nature of the joint. There is little bone remodeling in the elbow and displacement fracture, and especially supracondylar or lateral condyle fracture, has to be corrected rigorously, notably in older children. In case of lateral tilt in fracture of the neck of the radial head, on the other hand, remodeling is effective. Deformity in cubitus varus and cubitus valgus leads to neurological lesions and instability. Treatment should be early, with adapted surgery in expert hands. Post-traumatic stiffness is rare. Early intensive physiotherapy is unsuited to children and could worsen the stiffness due to inflammation. Lateral condyle non-union is a classic complication of fracture. Simple percutaneous screwing is a useful option. The equivalent in the medial epicondyle is well-tolerated, and simple monitoring now suffices. Late posterolateral rotational instability is a poorly known complication. It should be considered in case of cubitus varus that becomes painful after a long asymptomatic course. Radiocapitellar subluxation is seen on X-ray. Residual radial head dislocation after primary treatment (Monteggia lesion) responds well to the Bouyala technique of ulnar flexion osteotomy associated to annular ligament repair, without requiring ligament reconstruction.
Topics: Child; Humans; Elbow Fractures; Fractures, Bone; Elbow Joint; Ulna; Joint Dislocations
PubMed: 36302449
DOI: 10.1016/j.otsr.2022.103454 -
BioMed Research International 2019Traumatic atlantoaxial dislocation due to ligamentous and combined osseous injuries rarely occurs in adults. There are only few cases published in the literature. In...
Traumatic atlantoaxial dislocation due to ligamentous and combined osseous injuries rarely occurs in adults. There are only few cases published in the literature. In this level 4 study, a cohort of nine consecutive patients suffering from traumatic atlantoaxial dislocation has been analyzed regarding morphology of injury, trauma mechanism, and outcome since 2007. Three types of those injuries have been found regarding direction of dislocation indicating the underlying ligamentous injuries as well as the accompanying grade of instability. Firstly, there was rotatory dislocation, if the alar ligaments were injured. Secondly, there occurred horizontal dislocation, when transverse atlantal ligament was damaged additionally. Thirdly, excessive ligamentous injury led to distraction of the atlantoaxial complex resulting in dissociation of the atlas against the axis. Additionally fractures of the atlas as well as of the odontoid process (type II or III according to Anderson/D'Alonzo) were diagnosed frequently. Atlantoaxial dislocation injuries, especially distraction injuries, offer a high risk for accompanied neurovascular disorders deserving reduction followed by surgical fixation. Only rotatory injuries leading to ligamentous damage solitarily can safely be successfully treated conservatively. Understanding of the injuries' morphology is essential, in order to set the correct diagnosis and to implicate the most advantageous treatment regime.
Topics: Adult; Aged; Aged, 80 and over; Atlanto-Axial Joint; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Ligaments, Articular; Male; Middle Aged; Odontoid Process; Retrospective Studies
PubMed: 31011575
DOI: 10.1155/2019/5297950 -
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 -
Orthopedics Jul 2009A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous...
A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. Subtalar dislocation can occur in any direction and produces significant deformity. This article presents a case of pure posterior subtalar dislocation in an 80-year-old man who presented with pain and deformity in his left ankle following a motorcycle accident. Radiographs demonstrated dislocation of both the talonavicular and talocalcaneal joints. The calcaneus was displaced posteriorly without medial or lateral displacement. No rotational component of the calcaneus was noted, suggesting the trauma was in pure hyperplantar flexion. We hypothesize that pure hyperplantar flexion could lead to a progressive subtalar ligament weakening that may result in a complete ligament rupture if the plantar flexion force is prolonged. This could be observed in the presence of good bone quality and if the force is applied distally at the navicular bone.
Topics: Aged; Ankle Injuries; Humans; Joint Dislocations; Radiography; Talus; Treatment Outcome
PubMed: 19634836
DOI: 10.3928/01477447-20090527-25 -
BMJ Case Reports Mar 2022
Topics: Humans; Joint Dislocations; Lunate Bone; Wrist Injuries
PubMed: 35256377
DOI: 10.1136/bcr-2022-248917 -
American Family Physician Apr 2012Finger fractures and dislocations are common injuries that are often managed by family physicians. A systematic physical examination is imperative to avoid complications... (Review)
Review
Finger fractures and dislocations are common injuries that are often managed by family physicians. A systematic physical examination is imperative to avoid complications and poor outcomes following these injuries. Radiography (commonly anteroposterior, true lateral, and oblique views) is required in the evaluation of finger fractures and dislocations. Dorsal dislocation of the proximal interphalangeal joint is the most common type of finger dislocation. Finger dislocations should be reduced as quickly as possible and concurrent soft tissue injuries treated appropriately. Referral to a hand specialist is needed if a dislocation cannot be reduced; is unstable following reduction; or involves significant ligament, tendon, or soft tissue injury. Some common finger fractures can be treated conservatively with appropriate reduction and immobilization. Referral to a hand specialist is required if a fracture is unstable, involves a large portion (greater than 30 percent) of the intra-articular surface, or has significant rotation.
Topics: Finger Injuries; Finger Joint; Fingers; Fractures, Bone; Humans; Joint Dislocations; Manipulation, Orthopedic; Medical History Taking; Physical Examination; Radiography; Referral and Consultation; Splints
PubMed: 22534390
DOI: No ID Found -
Deutsches Arzteblatt International Feb 2018The estimated incidence of temporomandibular joint dislocation in Germany is at least 25/100 000 per year. A correct diagnosis and the initiation of appropriate... (Review)
Review
BACKGROUND
The estimated incidence of temporomandibular joint dislocation in Germany is at least 25/100 000 per year. A correct diagnosis and the initiation of appropriate treatment without delay are essential if permanent damage to the joint is to be avoided.
METHODS
This review is based on pertinent publications retrieved by a systematic search in the PubMed, Cochrane, Embase, and ZB Med databases.
RESULTS
The initial search yielded 24 650 hits; duplicates were removed and 136 studies were chosen for further analysis. The diagnosis of temporomandibular joint dislocation is generally made clinically from the finding of a lower jaw that is fixed in the open position. Acute dislocations are manually repositioned at once. The most common method is Hippocratic repositioning, in which the physician's thumb is placed laterally next to the teeth and the other fingers are placed on the lower surface of the lower jaw. The physician then exerts pressure, first caudally, then dorsally. Repositioning is carried out in two steps. For dislocations that have been present for a longer time, manual repositioning may be ineffective and surgery may be needed. Recurrent dislocation can be treated in a minimally invasive way with botulinum toxin injections or autologous blood therapy. Surgery may be needed if these methods are ineffective.
CONCLUSION
There have been no more than a few randomized, controlled trials of treatments for temporomandibular joint dislocation, in particular concerning minimally invasive and open surgical treatments, and therefore only limited evidence-based conclusions can be drawn. Nonetheless, the diagnostic and therapeutic standards that have been established in recent years have gained wide international acceptance.
Topics: Blood Transfusion, Autologous; Botulinum Toxins; Germany; Humans; Joint Dislocations; Recurrence; Temporomandibular Joint
PubMed: 29439762
DOI: 10.3238/arztebl.2018.0059 -
Australian Family Physician Jun 2011Bennett fracture dislocation is an intra-articular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. The... (Review)
Review
BACKGROUND
Bennett fracture dislocation is an intra-articular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. The fracture is unstable, and with inadequate treatment leads to osteoarthritis, weakness and/or loss of function of the first carpometacarpal joint.
OBJECTIVE
This article reviews the current literature on Bennett fracture and describes the clinical assessment and management of a Bennett fracture.
DISCUSSION
Bennett fractures usually result from falling on an extended or abducted thumb or an impact onto a clenched fist. The patient presents with pain and loss of function of the first carpometacarpal joint. Management can involve closed reduction, with or without percutaneous Kirschner wire fixation, or open reduction and internal fixation, with adequate reduction and the maintenance of reduction being the key to a successful outcome. Due to the difficulty of management it is recommended that patients be referred to a specialist hand surgeon.
Topics: Carpometacarpal Joints; Humans; Intra-Articular Fractures; Joint Dislocations; Metacarpal Bones
PubMed: 21655486
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Oct 2016Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most...
Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most common and best-known manifestation of carpal dislocation, typically occurring after hyperextension trauma. Other forms are very rare and have different causative mechanisms. Carpometacarpal (CMC) dislocations are also uncommon and may affect isolated or multiple CMC joints. These lesions are prone to wrist instability if not treated promptly. The aim of this article is to provide a systematic radiologic approach to the evaluation of wrist injury and to present two acute cases of rare CMC dislocations.
Topics: Accidents, Traffic; Adult; Bone Nails; Carpometacarpal Joints; Female; Humans; Joint Dislocations; Male; Metacarpophalangeal Joint; Middle Aged
PubMed: 27210506
DOI: 10.1016/j.otsr.2016.04.003 -
BMJ Case Reports Mar 2022Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department....
Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department. The majority of patella dislocations can be reduced with simple manoeuvres or even spontaneously and can be managed conservatively by bracing and rehabilitation. The aim of this study is to identify and review the main causes of the unique and unexpected event of irreducible patella dislocation and their characteristic presentations. Irreducible patella dislocations can happen but are very rare. Currently, a limited number of case reports are available, prompting for a need for research on this topic. This case study can shed light on the possible pathogenesis and pathognomonic features of irreducible patella dislocations and provide insight on the available therapeutic approaches.
Topics: Humans; Joint Dislocations; Knee Injuries; Patella; Patellar Dislocation
PubMed: 35264391
DOI: 10.1136/bcr-2021-248398