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[Diagnosis and therapy of sternoclavicular joint dislocation].

Luxation of the sternoclavicular joint is described on the basis of the case histories and progress of patients with this very rare form of injury who underwent surgical treatment on the Orthopedic Clinic of Düsseldorf University Hospital in the years 1978 to 1988. Four of the 6 patients in our study were subjected to a follow-up examination as out-patients. After preliminary remarks on the anatomical and biomechanical peculiarities of the sternoclavicular joint, the various types of luxation and the customary Allmann I-III classification for degree of severity are discussed. Surgical treatment is essential only for injuries of the IIIrd degree. Dislocation of the sternal end of the clavicle is most frequently found ventrad, as was also the case in all 6 patients in our study; the rarest finding is dorsad. The symptoms and the necessary diagnostic measures are described. Surgical treatment of the retrosternal luxation of the sternoclavicular joint is indicated as absolutely essential on account of the possibility of life-threatening complications. A relative indication of operative treatment exists for anterior luxation of the sternoclavicular joint where severe functional impairment and pain are present, e.g. during work and sport. The various operative methods currently in use are described. Reference is made to the importance of imaging techniques. A warning is given that, because of the risk of fatal complications, Kirschner wiring should not be used for retention of the reduction unless the K-wires are reliably secured.

Adult↗
PubMed1992

Parasymphyseal fracture with an associated temporomandibular joint dislocation: case report.

A case of traumatic mandibular fracture with associated unilateral anterior dislocation of the temporomandibular joint in a child is described. Although anterior dislocation is common, this combination of fracture and separate dislocation to our knowledge has not been reported in a young child. The unusual management required in this case is discussed.

Accidents, Traffic↗
PubMed1988

Proximal interphalangeal joint dislocations without fractures.

Injuries to the proximal interphalangeal joint are extremely common. An understanding of the complex anatomy of this joint is essential for diagnosis and treatment of proximal interphalangeal joint sprains and dislocations. Lateral injuries are among the commonest injuries in the hand. These are often stable after reduction, requiring only closed treatment. Occasionally, however, the collateral ligament can be trapped in the joint and require open reduction. Dorsal dislocations represent the most common dislocation in the hand. These, too, are usually stable after reduction and can be treated by closed methods. On occasion, however, these dislocations will be open or irreducible by closed means, requiring surgical intervention and repair of damaged structures. Complex rotary dislocations are exactly that: complex. An exact understanding of the damaged structures and causes of irreducibility frequently makes this an injury often requiring open reduction and selective repair of damaged soft tissue structures. Fortunately, prompt diagnosis, reduction, and institution of appropriate treatment can usually afford the patient good function after these injuries. It must be noted that stiffness is more common than instability, and active range-of-motion exercises instituted at the proper time are essential. These joints will often remain permanently thicker after injury in spite of optimal care, and tenderness and soreness with use may persist for 6 to 12 months.

Adolescent↗
PubMed1992

Neglected Lisfranc's joint dislocation.

A 34-year-old man presented with a deformed and painful foot 14 months after surgery for a Lisfranc's dislocation; the procedure had been done elsewhere. Radiographs showed a lateral dislocation of the Lisfranc's joint that had not been reduced. At the time of reexploration, the split anterior tibial tendon was displaced between the medial and middle cuneiform bones, which was blocking reduction. After placing the anterior tibial tendon into its normal position, the reduction remained incomplete because of a deformed articular surface. Arthrodesis of the Lisfranc's joint was then performed. In a lateral dislocation of the Lisfranc's joint, which is irreducible by manipulation, an interposition of the anterior tibial tendon should be suspected.

Adult↗
PubMed2006

Reduction of prolonged bilateral temporomandibular joint dislocation by midline mandibulotomy.

Various surgical procedures have been used to reduce prolonged bilateral dislocation of the temporomandibular joint, but with some complications. A prolonged bilateral dislocation of the mandibular condyle was simply reduced by a midline mandibulotomy without any complications. One year postoperatively, joint function was unimpeded and there was no recurrence of condylar dislocation.

Accidents, Traffic↗
PubMed1979

Open complex metacarpophalangeal joint dislocation. Two cases: index finger and long finger.

Two patients with open complex dislocation of a metacarpophalangeal joint were treated by cleansing of the wound, open reduction, primary wound closure, and early motion. One dislocation occurred in the index finger, the other in the long finger which is only the second such case to be described. Antibiotics were given before and continued for 5 days after operation. There were no infections, and both patients regained an excellent range of motion without pain.

Adolescent↗
PubMed2005

Study of hip joint dislocation after total hip arthroplasty.

The present study was undertaken to identify the factors responsible for hip joint dislocation after total hip arthroplasty, laying emphasis on analysis of the background variables of the patients. Of the 317 hips included in the study, ten (3.2%) dislocated. Only the anteversion angle of the cup differed significantly between the dislocation group and the dislocation-free group. The safe zone of the anteversion angle seems to be between 20 and 30 degrees. but it is also essential to set the antetorsion angle of the stem to match the shape of individual bones to create a more stable hip joint. This safe zone may be expanded by the additive effect of antetorsion angle of the stem.

Adult↗
PubMed1989

Shoulder kinesthesia after anterior glenohumeral joint dislocation.

The purpose of this study was to examine kinesthesia in normal (uninjured) shoulders and in shoulders with a history of glenohumeral joint dislocations. Both shoulders of 10 healthy subjects and 8 subjects with a history of unilateral anterior dislocation were tested for accuracy of angular reproduction, threshold to sensation of movement, and end-range reproduction using a motor-driven shoulder-wheel apparatus. An analysis of variance revealed significant differences (p less than .001) between the injured and uninjured shoulders for all three tests. Post hoc analysis showed significant differences (p less than .02) between the involved shoulders and all uninvolved shoulders. No significant difference was found among the uninvolved shoulders. The results of this study indicate that kinesthetic deficits occur after glenohumeral dislocation and may result in abnormal neuromuscular coordination and subsequent reinjury of the shoulder. Clinicians should consider rehabilitation of shoulder kinesthesia using therapeutic activation of the shoulder joint and muscle receptors when treating patients with previous dislocations.

Adult↗
PubMed1996

Diagnosis and treatment of posterior sternoclavicular joint dislocations in children.

Posterior dislocation of the sternoclavicular joint is uncommon in children, difficult to diagnose, and may be confused with a physical injury of the medial clavicle. We reviewed our experience with posterior dislocations of the medial clavicle over a 10-year period, and found 5 children who had sustained this injury. The computed tomography (CT) scan was found to be the best diagnostic procedure to assess the integrity of the sternoclavicular joint. The cause of the dislocation was most commonly lateral compression of the shoulders sustained during contact sports, particularly football and hockey. Reduction was usually obtained by retraction of the shoulders; for persistent dislocations, a towel clip was used to lift the medial end of the clavicle into its reduced position with the patient under general anesthesia. Reduction was maintained with a figure-of-eight bandage. Any child presenting with pain and swelling in the region of the sternoclavicular joint and no evidence of obvious fracture of the clavicle should have the possibility of dislocation of the sternoclavicular joint investigated with a CT scan.

Adolescent↗
PubMed1997

[Treatment of fresh Tossy III acromioclavicular joint dislocation by ligament suture and temporary fixation with the clavicular hooked plate].

PURPOSE: Retrospective analysis of the functional and radiographic outcome of a new temporary fixation device in the surgical treatment of acromioclavicular joint dislocation stage Tossy III. MATERIAL AND METHODS: Between 1986 and 1993, 19 patients with acute acromioclavicular (AC) dislocation (stage Tossy III) were treated with the clavicle hook-plate as a temporary fixation device combined with suture of the ligaments. Active shoulder mobilization started three days postoperatively. The mean follow-up was 3.9 years (range, 2 to 9.5 years). RESULTS: The mean Constant Score was 94 points (range, 83 to 100 points). All of the patients were able to resume their occupational activities and seventeen (89.5%) could completely resume their prior program of physical fitness. Radiological signs of an AC arthritis were found in 21% of the cases, but only 1 patient had a painful AC-joint. The average distance between the superior aspect of the coracoid process and the inferior aspect of the clavicle in the stress x-ray (5 kp each side) of both AC-joints was preoperatively 20.7 mm (range, 12-50 mm) comparing to 9.5 mm (range, 6-15 mm) for the operated shoulder and to 9 mm (range, 4 to 12 mm) for the nonoperated side in the follow-up. No reluxation was found. Two superficial wound infections (10.5%) were treated successfully with antibiotics without removal of the implant. Neither breakage nor loosening of the clavicle hook-plate were observed. CONCLUSION: Our mid- and longterm results confirm the value of the clavicle hook-plate as an alternative to other temporary fixation devices in the surgical treatment of acromioclavicular dislocation stage Tossy III.

Acromioclavicular Joint↗
PubMed2003

Sacroiliac joint dislocation in 11 years old boy treated by open reduction and internal fixation.

Pelvic fractures in children are relatively rare, especially unstable pelvic ring disruptions. Generally, nonoperative treatment has been recommended for children with these injuries because healing is rapid and remodeling extensive in children. Treatment generally is a period of recumbency until the fractures heal, followed by gradual weight bearing. Various methods of operative treatment were advised by some authors. They reported a higher incidence of residual problems after pelvic disruption such as malunion, hemipelvic undergrowth, low back pain and leg length discrepancy. These authors are of opinion, that principles of treatment should not differ from the treatment of adults if the pelvis is unstable and if there is significant displacement. We describe a case of a vertically unstable pelvic ring injury with sacroiliac joint dislocation and limb length discrepancy in 11 year old boy. Patient was received for treatment 14 days after trauma. He was treated by open reduction from anterior approach and percutaneous screw fixation. In one year follow-up he has very good functional result.

Child↗
PubMed1999

Symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy associated with McRoberts' maneuver. A case report.

BACKGROUND: McRoberts' maneuver is often used prophylactically with the onset of active maternal expulsive efforts or immediately before delivery of the fetus. CASE: A 31-year-old woman, gravida 1, para 0, at 39 + 2 weeks' gestational age, was continuously maintained in an exaggerated lithotomy position while actively pushing during the second stage of labor. Immediately following spontaneous vaginal delivery of a 3,598-g infant, the patient noted left gluteal pain and left anterior thigh dysesthesia. Orthopedic evaluation revealed a 5-cm symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy. The patient underwent closed reduction of the left hemipelvis, followed by open reduction and internal fixation of the symphysis pubis two weeks later after failing conservative treatment. CONCLUSION: Although McRoberts' maneuver is generally safe, care should be exercised with use of excessive force or prolonged placement of the patient's legs in a hyperflexed position.

Adult↗