Injuries of the wrist; dislocation of the lunate, dislocation of the lunate with fracture of the scaphoid, perilunar dislocation, transcapho-perilunar dislocation.
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Humans↗
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Results for “DISLOCATIONS”
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[Traumatic dislocations and fracture-dislocations of the hip, with the exception of fracture-dislocations with depression of the cotyloid].
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Child↗
LISFRANC'S FRACTURE-DISLOCATION: A CLINICAL AND EXPERIMENTAL STUDY OF TARSO-METATARSAL DISLOCATIONS AND FRACTURE-DISLOCATIONS.
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Ankle↗
[Case of divergent carpometacarpal dislocation; dorsal dislocation of the middle metacarpals and palmar dislocation of the fifth metacarpal].
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Humans↗
The results of treatment of dislocation and fracture--dislocation of the elbow--a review of 41 patients.
Forty-one patients with 42 elbow dislocations, of which 13 had acute simple dislocations, 21 had fracture-dislocations and 8 had neglected elbow dislocations, were evaluated with regard to limitation of motion, pain, instability and residual neurovascular deficit. All patients with acute simple dislocation were treated with closed reduction, but the duration of immobilization before commencement of active motion varied. Open-reduction was indicated for failed closed reduction and neglected-dislocations. Internal fixation as a primary procedure was only performed for displaced fracture-dislocation. Excision of radial head or tricepsplasty were performed if the reduction was impossible in neglected elbow dislocation. Despite a good results in acute simple dislocation, 33.07% had flexion contracture of between 5 to 30 degrees. In fracture dislocation, satisfactory results were seen in whom the elbow was immobilized for three weeks or less. Neglected-dislocation is associated with poor functional outcome, 37.5% were good and 62.5% were poor. Prolonged immobilization after injury was strongly associated with an unsatisfactory result. The results indicate that early properly supervised active motion is a key factor in the rehabilitation of elbow dislocation.
Adolescent↗
Dislocated Thompson hemiarthroplasty--the management of the recurrent dislocator.
Dislocation of a Thompson hemiarthroplasty of the hip is a serious complication with a high mortality rate. Previous papers have focused on surgical techniques to try and prevent dislocation. There is little in the literature on how to manage a patient after a dislocation. Patients with a dislocated Thompson hemiarthroplasty over a 5-year period from 1997 to March 2002 were analysed. Attempts were made to identify factors which may contribute to redislocation. Our strategies for preventing redislocation were evaluated. Of the 612 patients who received a Thompson hemiarthroplasty 23 patients (4%) dislocated. The average number of dislocations per patient was 2.4. Thirteen patients (57%) redislocated their prosthesis. Ten patients (43%) dislocated at least twice. Seven patients (30%) had either a total hip replacement, Girdlestone's procedure or the hip was left dislocated. Out of 15 patients fitted with an abduction brace 8 (60%) redislocated. Out of 8 patients treated with traction 6 (75%) redislocated. The 6-month mortality for patients suffering a dislocation was 7/23 (30%). If the prosthesis dislocates twice, the hip should be deemed unstable and consideration should be given to a revision procedure. Abduction braces and traction are ineffective in this condition and should be abandoned.
Adult↗
Perilunate dislocations and fracture-dislocations: a multicenter study.
A series of 166 perilunate dislocations and fracture-dislocations from 7 centers was retrospectively studied. The diagnosis was missed initially in 41 cases (25%). A classification system was presented. The perilunate fracture-dislocations were more frequent than the perilunate dislocations at a ratio of two to one. The displacement was dorsal in 161 cases (97%) and palmar in only 5 (3%). The dorsal transscaphoid perilunate fracture-dislocations represented 96% of the dorsal perilunate fracture-dislocations and 61% of the whole series. The clinical and radiologic outcome of 115 perilunate dislocations and fracture-dislocations with at least 1 year and an average of 6 years 3 months of follow-up was studied. Open injury and delay of treatment had an adverse effect on clinical results, whereas anatomical type had less influence. In cases treated early, the clinical results were satisfactory but the incidence of post-traumatic arthritis was high (56%). In the dorsal perilunate dislocation group of pure ligamentous injuries and in the dorsal transscaphoid group, the best radiologic results were observed after open reduction and internal fixation. In the latter group, the fixation of the scaphoid alone was not always sufficient and left occasionally scapholunate dissociation, lunotriquetral dissociation, ulnar translation of the carpus, or other carpal collapse patterns. The initial appraisal of both the osseous and ligamentous pathology was very important.
Adult↗
One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study II-the evolution of dislocation arthropathy.
Dislocation arthropathy after surgical treatment of recurrent anterior dislocation of the shoulder has been a subject of discussion over the years. The objective of this prospective study was to evaluate the Bristow-Latarjet repair at 2 and 15 years after surgery with respect to arthropathy and to evaluate factors responsible for this development. At 2 and 15 years after a Bristow-Latarjet repair for recurrent anterior dislocation, we prospectively analyzed the radiographs of 115 of 118 shoulders. The majority of the patients also had radiography of the nonindex shoulder (111/118). Dislocation arthropathy was found on ordinary anteroposterior views in 46 of 115 shoulders (mild in 39, moderate in 5, and severe in 2). The anteroposterior view angulated 45 degrees from above gave the best visualization of the humeral osteophyte and, together with the axial view, doubled the incidence of moderate and severe arthropathy at follow-up (mild in 40, moderate in 11, and severe in 5). Of 38 shoulders with a postoperative position of the transferred coracoid process 2 to 4 mm medial to the glenoid rim and the screw and transplant parallel to the glenoid, 3 had moderate arthropathy (8%) compared with 8 shoulders with moderate arthropathy and 5 with severe arthropathy out of 77 shoulders with a nonoptimal position of the coracoid (17%) (P = not significant). The degree of restriction of outward rotation at 2 years did not influence the degree of arthropathy after 15 years. Global assessment of the operative result was not related to arthropathy at follow-up. When the first dislocation occurred before age 23 years, the incidence of arthropathy was significantly lower than when it occurred in age 23 years or older (P = .006). When all views were included, moderate or severe dislocation arthropathy was found in 14% of the shoulders, and a further 35% had mild arthropathy. When follow-up studies of operated series of shoulder dislocations with the Bristow-Latarjet method are done, it is important to have the same radiologic views to compare the incidence of dislocation arthropathy correctly.
Adolescent↗
Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study.
OBJECTIVE: Traumatic dislocation and fracture-dislocation of the hip is an absolute orthopedic emergency that is steadily increasing in incidence. Early recognition and prompt, stable reduction is the essence of successful management. A delay in recognition and reduction leads to preventable complications and morbidity. The purpose of this retrospective study is to identify prognostic factors that predict long-term outcome after hip dislocation. METHODS: Between 1980 and 1994, 107 patients with traumatic dislocation of the hips were treated, and 62 are reviewed in this study. There were 57 posterior fracture-dislocations and 5 anterior-obturator dislocations. All of the patients' charts were reviewed. The physical examinations and radiologic controls of the patients who were called for last follow-up examination were performed by the first two authors (V.S. and E.K.). Anterior and posterior fracture-dislocations were classified according to the classification system developed by Steward and Milford and femoral head fractures were classified according to the Pipkin classification. All of the hips were classified as very good, good, medium, fair, and poor according to the functional evaluation system described by Merle d'Aubigne. Statistical analysis of the results was performed. RESULTS: There were 47 male patients and 15 female patients, with ages ranging from 14 to 72 years (mean, 34.5 years). Traffic accidents constituted the leading cause of traumatic dislocation in this series (52 cases [83.9%]). Associated injuries were found in 44 cases (71%). Fifty patients were treated with closed reduction, and 12 patients were treated with open reduction. Thirty-five hips (56.5%) were reduced within 12 hours. Full weight-bearing was resumed between 2 and 10 weeks (average, 8 weeks) after injury. In follow-up periods ranging from 3.6 years to 18.4 years (mean, 9.6 years), 44 patients (71%) had very good or good to medium results. Ten patients (16.1%) developed late posttraumatic osteoarthritis of the hip, and 5 patients (9.6%) developed osteonecrosis of the femoral head. In this study, it is found that the time between injury and reduction and the associated injuries are the most important factors in long-term prognosis. CONCLUSION: We believe that good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods. Concentric reduction absolutely should be confirmed by radiographs of the pelvis and, if necessary, by computed tomographic scan. The routine use of seat belts could have prevented many of these injuries.
Accidents, Traffic↗
Factors predisposing to dislocation of the Thompson hemiarthroplasty: 22 dislocations in 338 patients.
In a series of 338 patients, we have retrospectively analyzed technical and anatomical factors, which may predispose to a dislocation of the Thompson hemiprosthesis. 22 patients (7%) had at least 1 dislocation during the 6-month follow-up. The most significant independent factor predisposing to dislocation was the use of a posterior approach (dislocation rate 16%). We examined the radiographs and data on operations in the 22 patients, using 79 random patients without dislocation as controls. Factors correlating with an increase in the incidence of dislocation were the length of the residual femoral neck > 0.5 cm in short patients (< 165 cm), and considerable change in the postoperative offset of the hip. Acetabular measurements showed no correlation to the dislocation. Our findings suggest that the main factors predicting dislocation are technical and not related to anatomical measurements.
Aged↗
Histology of dislocations in endothelial keratoplasty (DSEK and DLEK): a laboratory-based, surgical solution to dislocation in 100 consecutive DSEK cases.
PURPOSE: Laboratory studies were performed to evaluate the histologic differences between the recipient bed after deep lamellar endothelial keratoplasty (DLEK) surgery and Descemet's-stripping endothelial keratoplasty (DSEK) surgery. Relevant new surgical strategies to prevent dislocation in DSEK surgery were initiated in our first 100 consecutive clinical cases. METHODS: Ten pairs of cadaver eyes had a DLEK in 1 eye and a DSEK in the fellow eye, and the posterior stromal surface was analyzed by scanning electron microscopy at x50 magnification. Based on the findings in these cadaver eyes, our DSEK procedure was modified to include surgical roughening in the peripheral recipient bed in 100 consecutive eyes. One hundred percent of these eyes were followed for at least 60 days after surgery to determine the rate of donor dislocation. RESULTS: In all 10 pairs of cadaver eyes, the DSEK stromal interface showed a smoother surface than DLEK eyes, without the presence of cut stromal fibrils. The DLEK surface was less smooth than the DSEK eyes, but with the presence of uniformly cut fibrils over the entire surface. Subsequent surgical modifications to the DSEK procedure to include scraping and roughening of the recipient peripheral bed in humans resulted in only a 4% (4/100) dislocation rate of the donor tissue into the anterior chamber. One of these 4 dislocated donors was seen on the first postoperative day and was the only primary graft failure in the series. The other 3 cases were fully attached on the first postoperative day with no interface fluid, but they dislocated later on postoperative days 2, 3, and 4. CONCLUSION: The high rate of dislocation of the donor disc in DSEK may be caused by the absence of recipient stromal fibrils to initially bind to the donor stromal fibrils. Clinical success with a surgical technique of selectively scraping the peripheral recipient bed to promote donor edge adhesion (while leaving the central bed untouched for vision) may aid in the prevention of donor dislocation in DSEK surgery. Reduction of dislocation in DSEK surgery has also been associated with a reduced rate of iatrogenic primary graft failure (PGF) to 1%.
Corneal Diseases↗
[Concomitant osseous and ligamentous injuries of traumatic shoulder dislocation and its significance for the pathogenesis of habitual dislocation].
161 consecutive patients with traumatic shoulder luxation between 1975 and 1983 are followed, concerning their evolution to recurrent shoulder dislocation. In 26 patients there was a recurrent shoulder dislocation in a mean time of 19 months after the first luxation. In literature the common level of recurrent dislocation is higher than our 16.1%, despite of the shorter immobilising time after the first shoulder luxation in our center. When there is no evolution to recurrent dislocation, a stable shoulder and a normal shoulder function without pain can be expected in 95%. The compression fracture of the humeral head and the avulsion of the glenoid margin were made responsible for the recurrent dislocation, mostly appearing in adult men, younger than 35 (55% of all recurrent dislocations). Because avulsion fractures of the tuberculum majus don't lead to an unstable fracture neither the existence of a compression defect in the humeral head is pathognomonic for an unstable shoulder, nor a lack of such radiological appearance excludes a recurrent dislocation. In first instance rotatory cuff injuries could be responsible for the instability of the shoulder joint. All patients with this invalidating injuries should be stimulated to an operative procedure, because after correction of an unstable shoulder by a derotation osteotomy of Weber or the elevation of the anterior margin of glenoid in the technique of Trillat good results with normal functional capacities of the shoulder can be expected.
Adolescent↗
[Dislocated multiple fragment fractures of the head of the humerus. Does dislocation of the humeral head fragment signify a worse prognosis?].
PROBLEM: The vascularity of the articular fragment is of key importance for the final outcome in three- and four-part fractures of the humeral head. Displacement of the articular segment may compromise the arterial blood supply to the humeral head and result in avascular necrosis. There is still controversy as to whether three-and four-part fracture dislocations (articular fragment outside the glenoid) have an even worse prognosis than displaced three- and four-part fractures. PATIENTS AND METHODS: Between January 1985 and May 1993, 102 patients with three- and four-part fractures of the humeral head were treated by ORIF (mostly tension band wiring) at our institution. In a retrospective study we analysed the functional (Constant 100 point score) and radiological outcome of 67 (66%) of these patients. There were 21 patients with fracture dislocations (FD), n = 5 type B2X, n = 5 type B3X, n = 3 type C2X, n = 8 type C3X, according to the classification of Habermeyer [7]. The "X" represents the dislocation of the articular fragment, whereas the classification to each type is done after reduction of the head. The remaining 46 patients presented with displaced, but not dislocated, three- and four-part fractures (DF), n = 24 type B2, n = 7 type B3, n = 3 type C2, n = 12 type C3. Average follow-up was 25 months (7-72 months). Patients with FD were significantly younger (average age 50 years) than patients with DF (average age 63 years, P < 0.05) and showed a significantly higher incidence of traumatic nerve or plexus lesions (FD 19%, DF 2%, P < 0.05). RESULTS: Concerning the functional results, there was no statistically significant difference between the two groups. The FD patients even showed a slight tendency to better results than patients with DF. This was true for the three-part fractures (average Constant score 78 versus 67 points), as well as for the four-part fractures (average Constant score 62 versus 55 points). The significantly younger age of the FD patients may explain their better results. The entire group of patients with three-part fractures showed a significantly better functional outcome (average Constant score 68 points) than patients with four-part fractures (average Constant score 55 points, P < 0.05). The rate of partial and total avascular necrosis of the humeral head was strongly correlated to the fracture type (number of fragments, fracture of the anatomical or surgical neck, according to the classification of Habermeyer),but again there was no difference between the FD and DF group (B2X: 20%, B3X: 20%, C2X: 33%, C3X: 63%; B2: 25%, B3: 29%, C2: 33%, C3: 67%). Astonishingly, the FD were not associated with an increased rate of avascular necrosis of the humeral head. Three (axillary nerve) out of the five observed primary nerve and plexus lesions had a full neurological recovery after 6-12 months; the two patients with alterations of the brachial plexus showed a slow tendency of improvement at follow-up (12 and 18 months), but still had gross muscular atrophy and impaired sensory function. CONCLUSION: In displaced three-and four-part fractures of the humeral head the dislocation of the articular segment does not seem to increase the risk of avascular necrosis, if treated by timely and careful ORIF with respect to the vascularity. Even with the increased risk of primary nerve and plexus lesions in fracture dislocations, good functional results can be achieved by early operative nerve decompression and fracture stabilization in this middle-aged patient group. However, older patients with displaced or dislocated four-fragment fractures through the anatomical neck (type C3) have a poor chance of a favourable outcome, and therefore primary prosthetic replacement should be considered.
Adult↗
Surgery for congenital dislocation of the hip in the UK as a measure of outcome of screening. MRC Working Party on Congenital Dislocation of the Hip. Medical Research Council.
BACKGROUND: Universal clinical screening for congenital dislocation of the hip to detect hip instability in neonates was introduced in the UK as a national policy in 1969, but its effectiveness is not known. We aimed to assess the extent to which surgery for congenital dislocation of the hip is the result of a failure of detection through screening or follows non-surgical treatment after detection by screening. METHODS: We established a national orthopaedic surveillance scheme and used routine hospital data for inpatients for 20% of births in the UK (Scotland and the Northern and Wessex regions) to ascertain the number of children aged under 5 years per 1000 livebirths who had received at least one operative procedure for congenital dislocation of the hip from April, 1993, to April, 1994. Estimates of the incidence of operative procedures were adjusted for under-ascertainment by capture-recapture techniques. FINDINGS: The ascertainment-adjusted incidence of a first operative procedure for congenital dislocation of the hip in the UK was 0.78 per 1000 livebirths (95% CI 0.72-0-84). Congenital dislocation of the hip had not been detected by routine screening in 222 (70%) of 318 children reported to the national orthopaedic surveillance scheme. In 112 (35%) children the diagnosis was made primarily as a result of parental concern. 67 (21%) children had previously received non-surgical treatment. In Scotland and the Northern and Wessex regions, 81 cases were notified to the national orthopaedic surveillance scheme, 62 cases were identified only through routine hospital data on inpatients, and an estimated 20 cases were not identified by either source, making a total of 163 cases. Thus, 81 (50%) of these 163 cases were identified by surveillance, 125 (77%) by routine data, and 143 (88%) by both sources. INTERPRETATION: The incidence of a first operative procedure for congenital dislocation of the hip in the UK was similar to that reported before screening was introduced. In most children who received surgery, congenital dislocation of the hip was not detected by screening. Formal evaluation of current and alternative screening policies, including universal primary ultrasound imaging, is needed.
Cross-Sectional Studies↗
The external rotation method for reduction of acute anterior dislocations and fracture-dislocations of the shoulder.
BACKGROUND: Several methods of reducing an acute anterior dislocation of the shoulder have been described. The aim of this study was to assess the effectiveness of the external rotation method in the reduction of acute anterior shoulder dislocations with and without fractures of the greater tuberosity and to evaluate the causes of failure. METHODS: Senior and junior orthopaedic residents attending in the Emergency Department were instructed in the external rotation method for the reduction of a shoulder dislocation in a classroom setting. Forty patients with an acute anterior dislocation of the shoulder, with or without an associated fracture of the greater tuberosity, who were treated with this method were evaluated prospectively. Data sheets completed by the orthopaedic residents when this method was used were evaluated with regard to the type of dislocation, the effectiveness of the procedure in achieving reduction, the need for premedication, the ease of performing the reduction, and complications, if any. RESULTS: Of the forty patients, thirty-six had a successful reduction. No premedication was required in twenty-nine patients who had a successful reduction, and the average time required for reduction in twenty patients was less than two minutes. Only four patients reported severe pain during the process of reduction. The method was not successful in four patients, two of whom had a displaced fracture of the greater tuberosity. CONCLUSIONS: The external rotation method for the reduction of an acute anterior dislocation of the shoulder is a safe and reliable method that can be performed relatively painlessly for both subcoracoid and subglenoid dislocations provided that a displaced fracture of the greater tuberosity is not present.
Acute Disease↗
[The treatment of severe talus fracture-dislocations and peritalus dislocations].
Twenty-eight cases with severe talus fracture-dislocation and 17 cases with peritalus dislocations were treated and were followed up with an average of 7 years and 2 years plus 5 months for these two groups respectively. Comparison of the results of treatment in the cases with severe talus fracture-dislocations with 3 different methods (reduction and immobilization, total talus resection and arthrodesis) was made. Satisfactory result was obtained only in cases treated with arthrodesis, therefore, this method should be considered at first in the treatment of severe talus fracture-dislocations. Impaction of intraarticular fragments and soft tissues are usually the indications of open reduction for peritalus dislocations. Severity of injury accompanied with intraarticular fractures, and open injury are the factors influencing the prognosis. Different from severe talus fracture-dislocations, talus avascular necrosis did not occur in cases with peritalus dislocations.
Adolescent↗
[Reduction of traumatic dislocations and facet fracture-dislocations in the lower cervical spine].
BACKGROUND: Traumatic facet dislocations and facet-fracture dislocations in the lower cervical spine (C2/C3 to C7/T1) are frequently associated with devastating neurological symptoms. A good outcome can only be achieved if the operator has wide and sound knowledge of reduction techniques and the best possible strategy is devised for the subsequent treatment of these severe lesions. PATIENTS AND METHODS: Between 1973 and 1997 a total of 117 of our patients met at least one of the following inclusion criteria: unilateral locked facet dislocation (48%), bilateral locked facet dislocations (23%), unilateral "perched" facet subluxation (14%), bilateral perched facet subluxation (12%), uni- or bilateral dislocation/perched subluxation with facet fractures (3%). RESULTS: Most of the lesions were located at the levels of C5/C6 and C6/7 (n=46 for each). Associated neurological deficits were present initially in 65% of patients: 35% had complete or incomplete spinal cord injuries (tetraplegia), 2% were paraplegic, and 28% had cervical radiculopathies. CONCLUSIONS: Closed reduction (e.g. with the aid of a halo ring) should be carried out as soon as possible after lower cervical spine dislocation or facet-fracture dislocation, as both the success rate of reduction and the potential for recovery from neurological deficits are clearly higher when reduction is achieved within the first 4 h after the initial injury.
Adolescent↗
Posterior fracture dislocation of the hip joint: the value of the obturator-oblique view with the hip still dislocated.
OBJECTIVES: To determine the value of the Judet oblique views taken while the hip is still dislocated. STUDY DESIGN: Radiological review. SETTING: Level I trauma center. METHOD: In addition to the traditional views in fifty of 110 fracture-dislocations, Judet views were carried out with the hip still dislocated. Each of the respective views was viewed with the reviewer blinded to diagnosis and the fracture classified according to the information available on that view. The percent accuracy of each view was then calculated by comparing radiologic with intraoperative classification. Under the pretext that if any view enabled a more accurate classification of the fracture, it must be providing more information, we assessed the quantitative value of each radiologic view according to our ability to accurately classify the fracture. RESULTS: Using the CT scan alone, classification was accurate in 82 percent of cases because the CT often overdemonstrated the degree of comminution. When the added information available from the traditional radiographs was included, there was only a slight improvement (82 percent versus 84 percent). This was increased to 96 percent when the obturator-oblique dislocated view was included. CONCLUSION: Because it provides an uninterrupted view of the posterior wall, demonstrates the displacements of fragments, and provides a comparison for the reduced view, which greatly augments the available information, the obturator-oblique dislocated view should be done routinely in the assessment of all posterior fracture dislocations of the hip joint.
Hip Dislocation↗