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At least 343 records · Page 19Linked to original sources
PubMed2006

Traumatic dislocations and instability of the trapeziometacarpal joint of the thumb.

The surgeon treating traumatic injuries to the TMC joint should be aware of the fundamental misconceptions and pervasive axiomatic myths perpetuated in the medical literature: namely that the volar beak ligament is the prime stabilizer, that the dorsal ligament complex plays no significant role in TMC joint function, and that the APL is a deforming force in Bennett fractures. On the contrary, stability of the TMC joint in power pinch and power grasp depends on the TMC joint's two prime stabilizers, the volar beak of the thumb metacarpal and the dorsal radial ligament complex; and the APL is not a deforming force in a Bennett fracture. Screw-home-torque occurs in the final phase of opposition; the acute Bennett fracture can be treated closed and percutaneously fixed if the screw-home-torque technique is used to anatomically reduce the fracture. After soft tissue interposition, if a semi-acute Bennett fracture is diagnosed late, it should be treated open with a volar approach, the screw-home-torque reduction technique, and screw or pin fixation. Rolando multipart fractures of the thumb metacarpal into the TMC joint are best treated closed, with traction in opposition with pin fixation; pure dislocations of the TMC joint that tear the dorsal ligament complex and Bennett fractures with an associated dorsal ligament complex tear (as diagnosed by the screw-home-torque technique) require open reduction and dorsal ligament complex repair. The current literature is so replete with myths and folklore regarding the anatomy that a conscientious surgeon treating a traumatic dislocation or in-stability of the TMC joint should return to the cadaver room and carefully review and understand TMC joint anatomy.

Carpal Joints↗
PubMed2004

Sports and osteoarthritis.

PURPOSE OF REVIEW: Participation in sports improves general health but increases the risk of osteoarthritis. This review analyzes the relationships among increased joint use, joint injuries, and injury-induced joint degeneration that causes posttraumatic osteoarthritis. The purpose is to help people who participate in sports minimize their risk of joint degeneration. RECENT FINDINGS: Participation in sports that cause minimal joint impact and torsional loading by people with normal joints and neuromuscular function may cause osteophyte formation, but it has minimal, if any, effect on the risk of osteoarthritis. In contrast, participation in sports that subject joints to high levels of impact and torsional loading increases the risk of injury-induced joint degeneration. People with abnormal joint anatomy or alignment, previous joint injury or surgery, osteoarthritis, joint instability, articular surface incongruity or dysplasia, disturbances of joint or muscle innervation, or inadequate muscle strength have increased risk of joint damage during participation in athletics. SUMMARY: Gaining the benefits of participation in athletics while minimizing the risk of osteoarthritis requires understanding of the relationships between sports participation and joint injury and the relationships between joint injury and joint degeneration. People who wish to participate in sports should have an evaluation of their joint structure and function, muscle strength, and neuromuscular function, and people with a history of joint injury or mild osteoarthritis should select sports that have limited risk of accelerating joint degeneration.

Animals↗
PubMedDate not supplied

Athletics and osteoarthritis.

Athletes, and an increasing number of middle aged and older people who want to participate in athletics, may question whether regular vigorous physical activity increases their risk of developing osteoarthritis. To answer this, the clinical syndrome of osteoarthritis must be distinguished from periarticular soft tissue pain associated with activity and from the development of osteophytes. Sports that subject joints to repetitive high levels of impact and torsional loading increase the risk of articular cartilage degeneration and the resulting clinical syndrome of osteoarthritis. However, moderate habitual exercise does not increase the risk of osteoarthritis; selected sports improve strength and mobility in older people and people with mild and moderate osteoarthritis. People with abnormal joint anatomy or alignment, previous significant joint injury or surgery, joint instability, above-average body weight, disturbances of joint or muscle innervation or inadequate muscle strength probably have increased risk of osteoarthritis. These people and those with early osteoarthritis can benefit from regular physical activity, but they should have a careful evaluation of their joint structure and function before participation. They should consider measures that decrease the intensity and frequency of impact and torsional loading of joints, including use of sports equipment that decreases joint impact loading, maintaining or improving muscle strength, tone, and general conditioning so that muscle contractions help protect joints from injury and high impact, and decreasing body weight.

Aged↗
PubMed1992

[Instability of the atlantodental joint as a trauma sequela].

In the region of the upper cervical spine a wide variety of morphological and functional positions is possible. This makes diagnosis and expert evaluation of whiplash injuries to the cervical spine very difficult. The problem is discussed with reference to a case report of a so-called whiplash injury. The upper cervical spine must be investigated in flexion and extension by means of MRT and/or CT as soon as possible.

Adult↗
PubMed1991

[Corrective osteotomy of the femur in the treatment of the syndromes of dysplastic instability of the hip joint].

On the basis of analysis of short-term outcomes (1-5 years) of treatment of 139 patients (150 joints) with congenital dislocation and oluzation of the thigh, conclusion has been drawn that the application of corrective femur osteotomy with these patients should be limited with the cases of formation of pathology loading of the joint under conditions of negative intercomponental trophism. Restoration of correct anatomical interrelations between the components of the joint can be accompanied by the clinical decompensation of the hip joint state. Position of the cotyloid cavity and epiphysis of the head of the femur is of fundamental importance for further formation of the hip joint and its neck and diaphysis position is of minor importance. When positing indications for corrective femur osteotomy and its efficiency prognostication it is necessary to be orientated towards epidiaphysar and not cervicodiaphysar correlations. Removal of antetorsion of the head of the femur without due regard for the grade of its proximal epiphysis retroversion can lead to the development of external rotary contraction in hip joint.

Abnormalities, Multiple↗
PubMedDate not supplied

Massive osteoarticular allografts in the reconstruction of extremities following resection of tumors not requiring chemotherapy and radiation.

Since 1976, 70 osteoarticular allografts have been used to reconstruct extremities from which tumors not requiring chemotherapy or radiotherapy have been resected. Allografts excised from cadavers were stored in the vapor phase of liquid nitrogen in liquid nitrogen freezers (-150 degrees) after exposure to 15% glycerol. Prior to their use, the allografts were thawed rapidly in either tissue culture or balanced salt solutions. Following resection of the tumor, the excised bone was replaced with allografts that were rigidly internally fixed with plates and screws or, occasionally, with intramedullary rods. Patients were observed carefully for complications and were subjected to functional evaluations. Complications did not include alterations suggestive of a pronounced immunologic response to the graft. Five patients developed either local recurrences or distal metastasis. Of the remaining 65 patients, followed for one year or longer, osteochondral allografts performed satisfactorily in 55 (84.6%). This group included eight patients with initial complications that were successfully treated. The group of ten patients with unsatisfactory results included four patients with fractures of the grafts, one with fragmentation of the humeral head, three with infections, and two with joint instabilities. Since all patients had either hemi-joint or quarter joint replacements, the overall results achieved so far have been rewarding. However, continued long-term observations of patients with allografts are indicated, as are studies that would allow for the improvement of cartilage preservation, decrease the incidence of fractures, and improve rigidity of internal fixation. The incidence of infection can be reduced by the improvement in surgical technique, particularly with reference to the wound closure.

Adolescent↗
PubMed1996

Diagnosis of knee instability using sonography.

OBJECTIVE: A sonographic method has been developed to diagnose knee joint instabilities and to gain exactly quantifiable and reproducible measurements. DESIGN: Based on biomechanical considerations, a new positioning device to analyse knee instabilities sonographically has been developed and tested in in vivo studies. BACKGROUND: Common instrumental testing techniques are difficult to reproduce and show a lack of reliability. METHOD: Using sonography the cortical line of the femur and tibia are observed. At the same time a translation of these two partners at the knee joint is provoked in a defined position using the special holding device and under a defined amount of stress. Using this method 142 healthy people, placed in different age groups, were tested to establish standard values for the physiological knee joint translation. A prearthroscopic stability analysis was performed on 101 patients. RESULTS: This study proves that the special device developed, together with the technique used, provides reliable and exact measurements for knee instability in different translation directions. In healthy subjects the lateral compartment always showed a larger translation than the medial compartment. A gradual increase in translation was determined in the age groups over 30 years. A significant difference of 0.0001 was shown between knee stability and instabilities. Moreover, a further differentiation between partial and total ACL ruptures and chronic instabilities was determined. This provides an important advantage not offered by usual instrumental testing techniques. CONCLUSIONS: The ability to diagnose even a very low extent of instability and to differentiate between different kinds of instabilities enables exact controls to be carried out for both conservative and operative treatment.

Journal Article↗
PubMed1998

[Simple tibiotalar luxation. Apropos of 16 cases].

Tibiotalar dislocations without fracture are extremely rare lesions. This series included 16 patients, 12 of whom have been examined clinically and radiographically. The purpose of this study was to specify the injury mechanism of the various anatomical types and to assess the long term outcome. The group included eight posteromedial dislocations (50%), four posterior dislocations (25%), one anterior dislocation, one high variety, one of the Huguier type, and one complex dislocation. The sex ratio was 14 males/2 females with an average age of 37 years. In half of the cases, dislocations were open. The average follow-up period was 11 years (range, 1 to 26 years). The eight closed dislocations and the open case type I according to the Cauchoix classification received non-operative treatment by reduction in the emergency room and immobilization in a plaster cast for 6 weeks. The seven patients who presented open dislocations Cauchoix type 2 and type 3 were treated by surgical debridement and ligament repair, followed in all cases by a plaster cast boot, and in two cases by temporary transplantar pinning. Twelve patients were reexamined clinically according to the Gay and Evrard modified score, and were radiographically evaluated with lateral and anteroposterior views focused on the tibiotalar joint, on both sides, static and dynamic. Anatomical factors resulting in predisposition such as medial malleolus shortness or lack of coverage of the talus have been evaluated. No patient presented tibiotalar joint instability. A 5 degrees to 10 degrees loss in the range of dorsiflexion was frequently observed. Two patients presented joint stiffness. In four cases, patients complained about paresthesias in the areas of the anterior tibial nerve or intermediary dorsal cutaneous nerve. Four cases of degenerative arthritis were radiographically observed, two of which presented an overall narrowing of the joint over 50%. Degenerative arthritis had occurred within the first four years in these 4 cases. The talus coverage index was similar to the standard population. Shortness of the medial malleolus was present in only two cases. The long-term prognosis after tibiotalar dislocation without fracture proves to be good. One should favor orthopedic treatment. The absence of tibiotalar instability argues against carrying out emergency ligamentous repair. Evolution towards degenerative arthritis is to be anticipated in 25% of cases, especially following open dislocations, or if transplantar pinning was required due to instability of the initial reduction.

Adolescent↗
PubMedDate not supplied

Predislocation syndrome: a review and retrospective analysis of eight patients.

Predislocation syndrome is defined as an either an acute, subacute, or chronic inflammatory process involving the lesser metatarsophalangealjoints. If left untreated, this process can lead to plantarplate and capsular attenuation and metatarsophalangeal joint instability. A retrospective analysis were performed on eight patients who were treated with a flexor tendon transfer for this condition. A subjective analysis and chart review were performed to determine the final outcome of these patients. All patients had a chief complaint of a painful second metatarsophalangeal joint with seven of eight patients having an associated hallux valgus deformity. Excellent results were achieved in six patients. Residual stiffness was the primary complaint of two patients following surgery, suggesting that metatarsophalangeal joint stiffness may be a potential problem after flexor digitorum longus tendon transfers. However, we concluded that the flexor digitorum longus tendon transfer remains an excellent procedure for second toe instability and late-stage predislocation syndrome. A literature review describing the epidemiology, symptom complex, physical findings, radiographic signs and therapies used to manage predislocation syndrome were also discussed.

Adult↗