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British Journal of Hospital Medicine... Mar 2022An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and... (Review)
Review
An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and vascular or plastic surgeons. Initial management involves haemorrhage control and stabilisation of the patient, reduction and splinting of the limb and careful reassessment. With ongoing vascular compromise, urgent surgery is indicated to restore arterial flow and stabilise the skeleton, and this should be performed at a centre with appropriate expertise. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of arterial injuries associated with extremity fractures and dislocations.
Topics: Angiography; Extremities; Fractures, Bone; Humans; Joint Dislocations; Vascular System Injuries
PubMed: 35377208
DOI: 10.12968/hmed.2021.0454 -
Clinical Medicine & Research May 2008Coronoid fractures of the ulna are relatively uncommon, yet critical injuries to recognize. They often occur in association with elbow dislocations and play an important... (Review)
Review
Coronoid fractures of the ulna are relatively uncommon, yet critical injuries to recognize. They often occur in association with elbow dislocations and play an important role in elbow instability. Historic recommendations are to fix all large coronoid fracture fragments, as well as small fracture fragments associated with instability. There is little data regarding management of small coronoid fracture fragments. The coronoid process acts as a bony buttress to prevent posterior dislocation and has three soft tissue insertions which lend stability as well: the anterior joint capsule of the elbow, the brachialis muscle and the medial ulnar collateral ligament. Injured patients often present with swelling, tenderness and limited range of motion. After obtaining a detailed history and performing a careful physical examination, plain radiographs should be obtained. If present, dislocations are reduced and post-reduction stability is assessed. If the elbow is unstable, management usually consists of a combination of bony and soft-tissue repairs often including coronoid process repair. Loss of motion is the most common complication of these injuries. The current recommendation is to repair virtually all coronoid fractures associated with instability.
Topics: Arm Bones; Collateral Ligaments; Elbow Joint; Female; Fractures, Bone; Humans; Joint Dislocations; Male; Radiography; Elbow Injuries
PubMed: 18591378
DOI: 10.3121/cmr.2008.753 -
BMJ Case Reports Jan 2013Subtalar dislocation is the simultaneous dislocation of the talocalcaneal and talonavicular joints of the foot, typically caused by falls from heights, twisting leg...
Subtalar dislocation is the simultaneous dislocation of the talocalcaneal and talonavicular joints of the foot, typically caused by falls from heights, twisting leg injuries and motor vehicle accidents. The dislocation can occur medially, lateral, anterior or posterior, but most commonly occurs from inversion injury producing a medial dislocation. These dislocations may be accompanied by fractures. Careful physical examination must be performed to assess for neurovascular compromise. Most subtalar dislocations can be treated with closed reduction under sedation. However, if the dislocation is associated with an open fracture it may require reduction in the operating room. Treatment should include postreduction plain x-ray and CT scan to evaluate for proper alignment and for fractures. This article presents a case of medial subtalar dislocation in a 23-year-old football player.
Topics: Adult; Football; Humans; Joint Dislocations; Male; Radiography; Subtalar Joint; Young Adult
PubMed: 23355551
DOI: 10.1136/bcr-03-2012-3973 -
Ugeskrift For Laeger Aug 2018Phalangeal fractures are common in all ages. Stable, extra-articular fractures can be treated non-operatively by closed reduction and buddy taping, while surgical... (Review)
Review
Phalangeal fractures are common in all ages. Stable, extra-articular fractures can be treated non-operatively by closed reduction and buddy taping, while surgical fixation should be considered for unstable and displaced extra-articular fractures and most intra-articular fractures. The treatment should aim at early, active mobilisation in order to achieve the optimal functional outcome. Since intra-articular frac-tures, proximal interphalangeal joint fracture dislocations, open fractures and certain paediatric fractures can lead to poor functional outcome, referral to a hand surgeon is recommended.
Topics: Adult; Child; Collateral Ligament, Ulnar; Finger Injuries; Finger Joint; Finger Phalanges; Fracture Dislocation; Fractures, Bone; Humans; Joint Dislocations; Radiography
PubMed: 30070629
DOI: No ID Found -
Journal of Orthopaedic Surgery (Hong... 2021While the pathological manifestation of atlantoaxial rotatory dislocation has been well described in the medical literature, the combined dislocation of the atlantoaxial...
While the pathological manifestation of atlantoaxial rotatory dislocation has been well described in the medical literature, the combined dislocation of the atlantoaxial and atlanto-occipital joints, or OAARD - short for occipital-atlantoaxial rotatory dislocation - is a condition which has been poorly elucidated and probably underdiagnosed. We believe that the pathogenesis of combined atlantoaxial and atlanto-occipital dislocation is most likely a result of untreated atlantoaxial rotatory dislocation leading to chronic secondary compensation measures occurring at the occiput-C1 joints. Unique clinical and radiological features lead to difficulty in diagnosis, and conventional treatment algorithms may not apply. This paper describes a combination of clinical and radiological features which can help clinicians correctly diagnose and treat OAARD.
Topics: Atlanto-Axial Joint; Atlanto-Occipital Joint; Cervical Vertebrae; Child; Humans; Joint Dislocations; Rotation; Spinal Diseases
PubMed: 33998343
DOI: 10.1177/23094990211015502 -
The Medical Journal of Malaysia Oct 2003While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end...
While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end and a dislocation at the other. We present two cases; a patient with a bipolar clavicular dislocation, and another with a fracture in both medial and lateral ends of the clavicle with anterior dislocation of the sternoclavicular joint. Both were treated conservatively, with fairly good range of motion and return to normal activity.
Topics: Accidental Falls; Accidents, Traffic; Adult; Aged; Clavicle; Humans; Joint Dislocations; Male; Radiography
PubMed: 15190643
DOI: No ID Found -
Journal of Orthopaedic Research :... Mar 2022Dislocation remains the leading indication for revision of total hip arthroplasty (THA). The objective of this study was to use a computational model to compare the...
Dislocation remains the leading indication for revision of total hip arthroplasty (THA). The objective of this study was to use a computational model to compare the overall resistance to both anterior and posterior dislocation for the available THA constructs commonly considered by surgeons attempting to produce a stable joint. Patient-specific musculoskeletal models of THA patients performing activities consistent with anterior and posterior dislocation were developed to calculate joint contact forces and joint positions used for simulations of dislocation in a finite element model of the implanted hip that included an experimentally calibrated hip capsule representation. Dislocations were then performed with consideration of offset using +5 and +9 offset, iteratively with three lipped liner variations in jump distance (10°, 15°, and 20° lips), a size 40 head, and a dual-mobility construct. Dislocation resistance was quantified as the moment required to dislocate the hip and the integral of the moment-flexion angle (dislocation energy). Increasing head diameter increased resistive moment on average for anterior and posterior dislocation by 22% relative to a neutral configuration. A lipped liner resulted in increases in the resistive moment to posterior dislocation of 9%, 19%, and 47% for 10°, 15°, and 20° lips, a sensitivity of approximately 2.8 Nm/mm of additional jump distance. A dual-mobility acetabular design resulted in an average 38% increase in resistive moment and 92% increase in dislocation energy for anterior and posterior dislocation. A quantitative understanding of tradeoffs in the dislocation risk inherent to THA construct options is valuable in supporting surgical decision making.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Hip Dislocation; Hip Joint; Hip Prosthesis; Humans; Joint Dislocations; Prosthesis Design; Prosthesis Failure; Range of Motion, Articular; Reoperation
PubMed: 33928682
DOI: 10.1002/jor.25055 -
The Journal of the American Academy of... Feb 2013Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that... (Review)
Review
Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome. Three fracture-dislocation patterns are recognized: dorsal, volar, and pilon. Acceptable outcome is dependent on achieving and maintaining a well-aligned and well-reduced joint, re-establishing normal joint kinematics, and restoring motion. Anatomic articular surface reduction is desirable but not absolutely necessary for a good outcome. Treatment depends on both the type of injury and patient-dependent factors. Optimal outcome for a specific injury is predicated on expedient diagnosis and recognition of injury severity, which enables initiation of appropriate management.
Topics: Finger Injuries; Finger Joint; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Treatment Outcome
PubMed: 23378372
DOI: 10.5435/JAAOS-21-02-88 -
Canadian Journal of Surgery. Journal... Dec 2001To provide an overview of atlanto-occipital dislocation and associated occipital condyle fracturcs so as to alert physicians to this rare injury and potentially improve... (Review)
Review
OBJECTIVE
To provide an overview of atlanto-occipital dislocation and associated occipital condyle fracturcs so as to alert physicians to this rare injury and potentially improve patient outcome. The pertinent anatomy, mechanism of injury, clinical and radiologic evaluation and the management of these rare injuries are discussed in an attempt to alert physicians to this type of injury and to improve outcome.
DATA SOURCES
The data were obtained from a MEDLINE search of the English literature from 1966 to 1999 and the experience of 4 spine surgeons at a quaternary care acute spinal cord injury unit.
STUDY SELECTION
Detailed anatomic and epidemiologically sound radiology studies were identified and analyzed. Only small retrospective studies or case series were available in the literature.
DATA EXTRACTION
Valid anatomic, biomechanical and radiologic evaluation was extracted from studies. Clinical data came from limited studies and expert opinion.
DATA SYNTHESIS
Early diagnosis is essential and is facilitated by a detailed clinical examination and strict adherence to an imaging algorithm that includes CT and MRI scanning. When the dislocation is identified, timely gentle reduction and prompt stabilization throuigh nonoperative or operative means is found to optimize patient outcome.
CONCLUSIONS
Atlanto-occipital dislocation should be suspected in any patient involved in a high speed motor vehicle or pedestrian collision. Once suspected, proper imaging and appropriate management of these once fatal injuries can improve survival and neurologic outcome.
Topics: Atlanto-Occipital Joint; Humans; Joint Dislocations; Occipital Bone; Radiography; Skull Fractures; Survival Rate
PubMed: 11764873
DOI: No ID Found -
Journal of Athletic Training Jul 2020Joint dislocations account for a small but important portion of all athletic injuries, with most occurring at the glenohumeral, patellofemoral, and interphalangeal... (Review)
Review
Joint dislocations account for a small but important portion of all athletic injuries, with most occurring at the glenohumeral, patellofemoral, and interphalangeal joints. Athletic trainers are responsible for managing acute joint-dislocation injuries, which may include performing closed-reduction techniques when appropriate. To achieve optimal patient outcomes, the clinician should be formally trained and skilled in performing various techniques and familiar with the evidence supporting the selection of each technique. In this clinical review, we outline general reduction procedures and then summarize and synthesize the existing literature on common closed-reduction techniques for glenohumeral-, patellofemoral-, and interphalangeal-joint dislocations. When appropriate, the content has been adapted to be specific to the athletic trainer's scope of practice.
Topics: Athletic Injuries; Finger Injuries; Humans; Joint Dislocations; Patellofemoral Joint; Shoulder Dislocation; Shoulder Injuries
PubMed: 32688375
DOI: 10.4085/1062-6050-0311.19