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At least 163 records · Page 9Linked to original sources
PubMed2005

Outcome of pelvic support osteotomy with the Ilizarov method in the treatment of the unstable hip joint.

Instability of the hip joint in the young adult is a difficult problem. Patients with an unstable hip secondary to any aetiology usually have loss of bone from the proximal femur or shortening of the limb or both. In this study we report our results in the treatment of the unstable hip joint in young adults by pelvic support osteotomy using the Ilizarov method. From 1997 to 2004, 25 patients (17 females and 8 males) with an unstable hip joint were treated in the Orthopaedic department of Mansoura University Hospital, Egypt. Their mean age was 22.4 years (range: 19 to 35). The main complaints were pain, leg length discrepancy, limping, and limited abduction of the hip. All patients underwent valgus extension osteotomy in the proximal femur and distal femoral osteotomy for lengthening. The average follow-up ranged from 2 to 7 years. All hips were pain free at follow-up. The Trendelenburg sign became negative in 20 patients. There was no limb length discrepancy and alignments of the extremity were re-established. Five patients had a lurch gait. Valgus extension osteotomy has provided stability of the hip joint and maintained some motion of the hip joint. By using the Ilizarov technique, we could prevent the valgus effects created by the valgus extension osteotomy while achieving lengthening of the femur through the distal osteotomy in the femur.

Adult↗
PubMed2004

Ligamentous stabilization of the distal radioulnar joint.

Instability of the distal radioulnar joint results from fracture and/or malunions of the forearm bones, disruption, or laxity of the ligaments of the triangular fibrocartilage. Such instability often-times is not diagnosed acutely and presents as a chronic problem. When these ligaments fail to heal adequately after injury, distal radioulnar joint instability develops into mechanical problems resulting in pain, limited range of motion, and decreased grip strength. In this case, reconstruction of the disrupted distal radioulnar joint ligaments is essential to restore proper function. In this presentation, a technique of ligament reconstruction using palmaris longus, plantaris, or toe extensor tendon graft is outlined with mid-term functional results.

Journal Article↗
PubMed1990

Ulnar styloid fixation in the treatment of posttraumatic instability of the radioulnar joint: a biomechanical study with clinical correlation.

Biomechanical displacement testing was done on nine fresh human upper extremities to define the stabilizing influence of the triangular fibrocartilage on the radioulnar joint and the efficacy of triangular fibrocartilage-ulnar styloid avulsion fracture repair in restoring lost stability. Test data confirmed that the triangular fibrocartilage is a major stabilizer of the radioulnar joint and internal fixation of triangular fibrocartilage-ulnar styloid avulsion fractures can restore preavulsion stability in all positions of forearm rotation. On the basis of this data and a successful clinical experience, primary repair of displaced ulnar styloid avulsion fractures is advised as a means of stabilizing the radioulnar joint and preventing the disability associated with chronic radioulnar joint instability.

Biomechanical Phenomena↗
PubMed1989

[Instability of the wrist joint--diagnosis and therapy].

Wrist-joint instability can be caused by injuries to ligaments or bones, it can be intermittent or permanent. Clinical symptoms and pain sensations are non-characteristic. The X-ray findings are the clue to the diagnosis. In this article recommendations are given for exact X-ray positions of the hand and their evaluation. The classification of instability is corresponding to the X-ray findings. Further investigations like radiographs under stress, dynamic investigations or the arthrography of the wrist-joint can be helpful to find out the exact pathologic changes. They are variable and are ranging from dysharmonic movement to a complete destruction of the carpal bones. Treatment is according to the pathologic changes and their causes. Fresh ligamentous injuries (e.g. additional injuries to a Colles' fracture or a perilunate luxation) should not be discarded lightly. Most cases we saw presented very late, the patients showed already osteoarthritic changes of the carpal bones with destruction of the cartilage. The late results of ligamentous reconstructions have not fulfilled their expectations, the current trend is towards a partial arthrodesis of the carpal joints in order to reconstruct the joint stability under preservation of partial mobility. This method of treatment has certain disadvantages: Pathologic wrist-joint movements, impingement syndromes and undue stress reactions within the neighbouring joints. Recommendations for the different indications are given.

Arthrodesis↗
PubMedDate not supplied

Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint.

Two anatomic reconstructions for correction of chronic lateral ankle joint instability were compared. In a prospective, randomized study, 60 patients were allocated to one of two treatment groups: reconstruction of the ligaments as described by Karlsson et al. (Group I) or with the modification of the Broström procedure as described by Gould et al. (Group II). The functional results were evaluated with a scoring scale, and the mechanical stability with standardized stress radiographs. The minimum follow-up period was 2 years. The functional results were satisfactory in 27 of 30 (90%) patients in Group I and 25 of 30 (83%) in Group II. There was no significant difference between the groups regarding mechanical stability. The mean anterior talar translation in Group I was 7.1 mm (range, 4 to 10) at followup, compared with 6.7 mm (range, 3 to 9) in Group II. The corresponding values for talar tilt were 4.9 degrees (range, 0 degree to 8 degrees) in Group I and 4.4 degrees (range, 0 degree to 8 degrees) in Group II. The duration of operation time was significantly longer in Group II and surgical complications were more frequent, probably due to the more extensive surgical exposure. This study showed that the majority of patients with chronic ankle instability can be successfully treated with anatomic reconstruction of the lateral ankle ligaments. Mechanical stability was restored with both methods.

Activities of Daily Living↗
PubMedDate not supplied

Stabilization of silastic implant arthroplasty at the trapezometacarpal joint.

Instability of the carpometacarpal joint of the thumb may accompany silastic implant arthroplasty. A collapse deformity of the thumb with resultant loss of pinch power impairs hand function. A procedure is described, which allows apical stabilization of the base of the thumb. Compressive forces may then act on the thumb to produce divergence in abduction without collapse instability and yet allow enough motion for convergence in oposition and restoration of asymptomatic three-point pinch.

Arthroplasty↗
PubMed2000

Scapular instability. The scapulothoracic joint.

Scapular instability may be the result of a variety of casues of which the clinician should be made aware. Work-up should include an initial radiographic evaluation and may require more in-depth investigation. Treatment should be prescribed dependent on the underlying diagnosis. In most cases, instability about the scapula can be treated with a careful plan of exercises to strengthen the involved musculature. It may take upwards of 12 to 18 months to achieve adequate results. Nonoperative failures may need to be treated with surgical techniques including nerve dissection and reconstruction with muscle flaps.

Biomechanical Phenomena↗
PubMed1992

[Salvage ligament repair following failure of arthrodesis of the lunate-triquetrum-hamate joint for internal instability of the joint. Apropos of a case report].

A case of posttraumatic carpal dislocation in volar inclination of the intermediary segment (VISI), treated by a lunate-triquetrum-hamate arthrodesis (LTH) is presented. This operation leaves the rupture of the radio-triquetrum dorsal ligament; rather the entire carpus rotates in supination postoperatively. This repair of the radio-triquetrum dorsal ligament permits realignment and stabilization of the carpus and results in resolution of pain.

Arthrodesis↗
PubMed2002

Muscles may contribute to shoulder dislocation and stability.

Joint instability is one of the most common human afflictions, affecting not only the hip, knee, and shoulder but all joints of the body. Surgical repair for joint instability is done commonly, yet has not been able to restore function consistently. Pain, recurrence of instability, joint stiffness, muscle injury, and degenerative joint disease are all too common sequelae. Because the glenohumeral joint is most commonly dislocated, efforts have been directed to understanding shoulder instability. Study has included not only the static restraints (capsulolabrum, articular surfaces, intracapsular pressure), but also their important interplay with the dynamic restraints (shoulder muscles). Furthermore, not only were muscles known to stabilize the joint studied but also may have contributed to dislocation. An in vitro, cadaveric model that included relevant shoulder muscles and a mechanism of dislocation similar to an in vivo mechanism was developed. The capsulolabral pathoanatomy that occurred after dislocation was studied. Increased understanding of joint dislocation may improve functional results after rehabilitation and surgical repair, not only at the shoulder, but also at all other joints.

Biomechanical Phenomena↗
PubMed2003

Sports, joint injury, and posttraumatic osteoarthritis.

Participation in sports increases the risk of joint injuries that can lead to posttraumatic osteoarthritis, a clinical syndrome caused by trauma-initiated joint degeneration that results in permanent and often progressive joint pain and dysfunction. Minimizing the risk of joint injuries and helping people with osteoarthritis participate in regular physical activity, including some sports, requires understanding of the relationships between joint use, joint injury, and joint degeneration. Lifelong participation in sports that cause minimal joint impact and torsional loading by individuals with normal joints and neuromuscular function does not increase the risik of posttraumatic osteoarthritis. In contrast, participation in sports that subject joints to high levels of impact and torsional loading increases the risk of joint injury and subsequent joint degeneration. Immediate diagnosis and appropriate treatment and rehabilitation following joint injuries decrease the risk of subsequent injuries and posttraumatic osteoarthritis. Individuals with abnormaljoint anatomy or alignment, previous significant joint injury, osteoarthritis, joint surgery, joint instability, disturbances of joint or muscle innervation or inadequate muscle strength have increased risk of joint damage during participation in athletics. These individuals can benefit from regular exercise, including selected sports, but they should have an evaluation of their joint structure and function, muscle strength, and neuromuscular function before participating in vigorous physical activity.

Animals↗
PubMed2004

Distal radioulnar joint dorsal instability treated with dorsal capsular reconstruction.

Six patients with post-traumatic distal radioulnar joint dorsal instability were treated with dorsal capsular reconstruction. This new technique of reconstruction requires less extensive dissection than the previously described methods in the literature and requires no tendon graft. A total of six patients treated from 1999 to 2001 were included in this study. Two were males and four were females. The average age of patients was 30 years and all the instabilities were secondary to trauma. One of them had associated minimally displaced distal radius fracture. All patients had arthrogram and arthroscopy done before the reconstruction and had no significant triangular fibrocartilage complex injury. The surgery consisted of duplication capsulorrhaphy of the dorsal capsular structures of the distal radioulnar joint. All patients had satisfactory results after the operations in terms of pain relief, range of motion and stability.

Adult↗
PubMed1986

Pronator muscle weakness in functional instability of the ankle joint.

Functional instability, i.e., recurrent sprains or a feeling of "giving way" of the ankle, is common after ankle sprains. These patients have been supposed to have peroneal muscle weakness based on manual methods for measuring muscle strength. We have confirmed this theory by an isokinetic method for testing pronator muscle strength. Pronator muscle weakness on the affected side was found among patients with unilateral functional instability of the ankle joint. Impaired postural control was demonstrated by stabilometry with the patient standing on either foot.

Adolescent↗
PubMed1975

Synovial chondromatosis and instability of the proximal tibiofibular joint.

A patient with synovial chondromatosis involving both posterior compartments of the right knee and proximal tibiofibular joint had continued pain and weakness after partial synovectomy. The "Helfet Test" for proximal tibiofibular joint instability was positive; the fibular head was prominent and tender. Following excision of the proximal fibula, the patient was symptom free. This case demonstrates that it is essential to evaluate all joints involved with a disease process prior to surgical intervention.

Adult↗
PubMed2002

Treatment of complete rupture of the lateral ligaments of the ankle: a randomized clinical trial comparing cast immobilization with functional treatment.

This study compared the therapeutic efficacy between cast immobilization and functional treatment of grade III ruptures of the lateral ankle ligaments. Subjects ( n=121) had closed physeal cartilage, age under 35 years, grade III rupture without previous or associated injuries, and practiced regular sports. Patients were randomized into an immobilization group (21 days plaster cast) or a functional one (15 days strapping plus early controlled mobilization). Symptoms (pain, swelling, stiffness, subjective instability), joint laxity, return to preinjury activity (time and level) and rate of reinjury were assessed 3, 6, and 12 months after sprain. Objective joint laxity was related to constitutional laxity, creating a new variable [talar tilt at injury - talar tilt at control]/contralateral talar tilt. The functional group showed significantly earlier and better return to physical activity, fewer symptoms at 3 and 6 months but no intergroup difference at 12 months. Functional treatment also showed better decrease in joint laxity. No intergroup differences were found in the reinjury rate. We conclude that functional treatment is safe, associated with a more rapid recovery, and particularly suitable in athletic populations.

Adolescent↗
PubMed2007

Muscle adaptation patterns of children with a trans-tibial amputation during walking.

BACKGROUND: Many studies have shown that trans-tibial amputation involves modifications of resultant muscle patterns during gait. However, these experiments did not estimate the contribution of simultaneous agonist and antagonist muscle action (co-contraction) during gait tasks. Diminution of co-contraction could create joint instability and, thus, change joint integrity, which is particularly important in the etiology of degenerative diseases, such as osteoarthritis, present at the knees of amputated limbs, and particularly in non-amputated limbs. The purpose of this study was to determine if there is any difference in the production of co-contraction about the knee between able-bodied children and children with a trans-tibial amputation during gait. METHODS: Six children with a trans-tibial amputation vs. six able-bodied children paired for gender, age, weight and height participated in this study. Four one-way ANOVAs (P<0.05) were used to observe differences in resultant, agonist and antagonist moments, power, and co-contraction index during different phases of gait between able-bodied children limbs, the amputated and the non-amputated limbs of children with trans-tibial amputation. FINDINGS: Children with a trans-tibial amputation modified muscle patterns at their amputated limb and produced smaller co-contraction (P<0.05) during single limb support, for both the non-amputated and amputated limbs when compared to able-bodied children. INTERPRETATION: These results suggest that children with a trans-tibial amputation altered their muscle patterns to perform locomotion. These changes produced a diminution of co-contraction during single limb support for both the amputated and non-amputated limbs and, thus, could create joint instability.

Amputation, Surgical↗
PubMed2000

[Arthrosis--a single or many diseases?].

The classical features of osteoarthritis (OA) include osteophytosis, joint space narrowing, subchondral cyst formation, sclerosis, deformity and low-grade synovitis. OA has been tacitly assumed to be a homogeneous disorder and dismissed as "degenerative". This short article will seek to challenge this traditional view and suggest that at least two major processes emerge from detailed radiological studies in patients with OA. One comprises osteophytosis associated with hyaline cartilage thinning and perhaps joint instability. This may represent a normal response to joint instability, and be seen as a healing mechanism. The other, when subchondral sclerosis and bone attrition predominate, may reflect joint failure.

Cartilage, Articular↗