Congenital aplasia of the scaphoid is a rare abnormality arising when the distal row of carpal bones is dislocated radially and proximally, the capitate replaces the scaphoid, and the lunate is triangular instead of quadrilateral in shape. The scaphoid bone which makes a functional bridge between the proximal and the distal row is a stabilising element under normal anatomical conditions. If it is absent, the carpus structure is disturbed and its radial part is prone to perilunar dislocation, because stability is provided only by the ligaments. However, a perilunar dislocation associated with aplasia of the scaphoid has not been described in the literature yet. In the case reported here, after arthroscopic examination ascertaining that the capsular ligaments are not interposed between the joints, the dislocation was managed by closed reduction and Kirschner wire transfixation for 8 weeks, and the wrist was immobilised with a below-elbow plaster splint for the same period. A 22-month follow-up did not show any signs of wrist instability or restriction in hand function.
- MeSH
- Scaphoid Bone abnormalities MeSH
- Joint Dislocations diagnosis surgery complications MeSH
- Adult MeSH
- Soccer injuries MeSH
- Humans MeSH
- Lunate Bone injuries MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Cíl: Atlantookcipitální dislokace (AOD) představuje vysoce nestabilní a často fatální poranění kraniovertebrální junkce. Vzhledem k současným možnostem integrovaného záchranného systému a propracované resuscitační péči se mohou pacienti s tímto poraněním dostat k definitivnímu ošetření do nemocnice. Tyto skutečnosti nás vedly ke zhodnocení vlastní série s cílem upozornit na úskalí tohoto vzácného poranění. Pacienti a metody: Byla provedena retrospektivní analýza dostupné dokumentace všech pacientů s AOD přijatých do Krajské nemocnice Liberec za období 1993–2010. Výsledky: Soubor tvořilo šest pacientů (čtyři ženy a dva muži, průměrného věku 36,2 let). Při příjezdu do nemocnice byli všichni pacienti intubováni a řízeně ventilováni, bez známek pohybu na končetinách, a to ani na algický podnět. U všech pacientů byly přítomny jasné radiologické známky AOD. Krátce po provedení základních diagnostických testů pět z nich zemřelo. Poslední pacientka po stabilizaci stavu podstoupila zadní stabilizaci C0–C2, po dvou měsících však podlehla ventilační pneumonii a sepsi. Závěr: Náš soubor potvrdil vysokou mortalitu AOD. Ideálním diagnostickým nástrojem je spirální CT dle protokolu pro polytrauma. Aplikace halo fixačního aparátu je možná u některých méně závažných forem, případě jako dočasná imobilizace. Pouze okcipitocervikální fúze však nabízí okamžitou a solidní stabilizaci kraniovertebrální junkce. Klíčová slova: atlantookcipitální dislokace – kraniovertebrální junkce – mortalita – poranění míchy
Objective: Atlantooccipital dislocation (AOD) represents highly unstable and usually fatal injury of craniovertebral junction. Improved prehospital emergency care enables AOD sufferers to actually reach a hospital alive. Consequently, we decided to analyse our own series of AOD patients with the aim to highlight the difficulties associated with this injury. Patients and methods: We conducted a retrospective analysis of patients admitted during 1993–2010 with the diagnosis of AOD to Regional Hospital Liberec. Results: This series included 6 patients (4 women and 2 men, mean age 36.2 years). Upon arrival, all patients were intubated and ventilated. There was no sign of movement on the extremities. All patients had clear radiological findings of AOD. Five patients succumbed to the injury shortly after the diagnosis was established. The sixth patient underwent C0–C2 fusion but died after two months due to ventilator-associated pneumonia and sepsis. Conclusion: Our series confirmed high mortality among AOD patients. Spiral CT is the diagnostic test of choice. External orthosis can be used in some selected cases or as a temporary measure. Occipitocervical fusion is the only approach providing immediate and solid stabilization of craniovertebral junction. Key words: atlantooccipital dislocation – craniovertebral junction – mortality – spinal cord injury The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- MeSH
- Atlanto-Occipital Joint * pathology MeSH
- Joint Dislocations * mortality MeSH
- Adult MeSH
- Spinal Fusion methods MeSH
- Glasgow Outcome Scale MeSH
- Coma, Post-Head Injury MeSH
- Craniocerebral Trauma * MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Neurosurgery MeSH
- Retrospective Studies MeSH
- Death MeSH
- Tomography, Spiral Computed MeSH
- Occipital Bone MeSH
- Treatment Outcome MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
Joint dislocation after total knee arthroplasty is a rare complication. It is described as the result of ligamentous instability. Here we report the case of an 82-year-old women who underwent primary total knee arthroplasty (TKA) for advanced primary grade III gonarthrosis. At 3 post-operative months the joint was stable and painless, with radiographic evidence of good TKA alignment and integration. At 4 months the patient suffered injury to the ankle involving a bimalleolar fracture and damage to knee soft tissues. The fracture was surgically treated. Subsequently, dorsal tibial dislocation was manifested. This was managed by individual intramedullary nail arthrodesis. At 8 months following the operation, the knee condition was satisfactory, with rigid arthrodesis and leg shortening of 4 cm. The patient was satisfied because she was free of pain and able to walk. Arthrodesis of the knee joint with an individual nail is an option for a definitive treatment of TKA instability. When other joints, such as ankle or hip joints, are injured, it is recommended to pay attention also to any TKA implanted previously because of potential development of instability or infection.
- MeSH
- Arthrodesis MeSH
- Arthroplasty, Replacement MeSH
- Wound Healing MeSH
- Ankle surgery MeSH
- Humans MeSH
- Ligaments surgery injuries MeSH
- Knee Dislocation MeSH
- Leg Length Inequality MeSH
- Postoperative Complications surgery therapy MeSH
- Radiography utilization MeSH
- Reoperation methods utilization MeSH
- Aged, 80 and over MeSH
- Treatment Outcome MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Female MeSH
PURPOSE OF THE STUDY Acute knee dislocation is a less common injury of the knee joint. It is, however, a serious injury with a high rate of nerve and vascular damage and it is considered a limb threatening injury with long-term functional disability, which can ultimately lead to amputation. Knee dislocations constitute less than 0.5% of all joint dislocations. Most of these injuries occur in highenergy traumas and careful diagnosis can identify the patient at risk of this injury. MATERIAL AND METHODS The total number of patients with knee dislocation was 37. The incidence of knee dislocation was 2.5 patients per year. The mean age of patients was 49 years. After the evaluation of blood supply to the limb and before the examination of the ligament injury, routine X-ray views of the affected joint were performed. It was necessary to confirm good blood supply of the limb, in which knee dislocation had been suspected. In patients with reduced knee joint and asymmetric pulses in the lower limb, CT angiography was indicated. The absence of peripheral pulses and the presence of serious clinical signs of peripheral blood supply disruption in case of the reduced knee or irreducible knee dislocation necessitated immediate revision by a vascular surgeon performed in the operating room. RESULTS Dislocation of the knee without TKA (a total of 34 cases) was caused by a high-energy trauma in 19 cases (56%) and in 7 cases (21%) it was a part of polytrauma. The most common was a motorcycle accident, namely in 7 cases (21%). In 12 cases (35%), it was a low-energy trauma, a fall or a slip while walking. In three cases (9%), the patients suffered an open knee dislocation. In 18 patients (47%), no knee surgery was performed. The knee ligament injury was treated non-operatively through knee brace fixation. An open revision with sutures of injured ligament structures and knee capsule was performed in 16 patients (42%). In two cases, above-the-knee amputation was done. External fixation was performed in two polytrauma patients. Three cases of infectious complications were reported. Nerve lesions were observed in 9 cases (25%). Vascular lesions were recorded in 9 cases (25%). Deep vein thrombosis was observed in three cases in our study group. The Lysholm knee questionnaire was used to assess subjective difficulties. DISCUSSION In agreement with the literature, these injuries occur most frequently when riding on motorcycle. The patients, in whom a vascular lesion was identified and revascularisation performed within 8 hours, showed a significantly lower incidence of amputations (11%) compared to those who underwent surgery after 8 hours (86%). Majority of vascular surgeons consider 6 hours to be the time limit for the performance of vascular reconstruction since a surgery performed after 6 hours is accompanied by a higher complication rate. Currently, the aim of the final treatment is to perform anatomic suture or reconstruction of knee ligaments and meniscus to achieve a stable, pain-free, functional knee and to prevent any complications. CONCLUSIONS Knee joint dislocation ranks among less common injuries that can be accompanied by a vascular injury in 20% on average and a nerve lesion in 10-40% (around 25% on average). A negative X-ray in spontaneous reduction of knee dislocation can be misleading for proper diagnosis. It is crucial to rule out a vascular injury that might be a limb threatening. In case of a vascular lesion, an early reconstruction of vascular supply is necessary within 6 hours after the injury. The revascularisation performed later is accompanied by a high risk of complications and can ultimately lead to above-the-knee amputation. It is most appropriate to refer such serious injuries to specialised trauma centres that avail of necessary equipment and experience with treating the patients who sustained such complicated orthopaedic injuries. As to the ligament reconstruction, most surgeons prefer to postpone the procedure in majority of cases by 10-14 days. Key words: knee dislocation, vascular injury, neurologic injury, ligament reconstruction, irreducible dislocation.
The description of the unusual mechanism of the trauma to lumbosacral junction is given based on the analysis of the clinical case. The injury of a patient with unilateral dislocation at the L5-S1 intervertebral joint without a bone lesion in this segment is reported. The patient suffered the injury by falling on one side from a height of 8 m. The trauma mechanism is documented by MRI findings and a 3D CT reconstruction of the paravertebral muscles and soft tissues on the injured side, whilst showing intact structures on the contralateral side. This, together with the cause of injury (a fall on the side), provides evidence for forced lateral flexion-distraction being the major vector of the trauma event. Such mechanism of this injury was not taken in account by other authors yet. This type of injury is difficult to classify using the Magerl classification system. The very rare injury has been mentioned in the literature only occasionally.
- MeSH
- Lumbar Vertebrae injuries radiography surgery MeSH
- Joint Dislocations radiography surgery MeSH
- Adult MeSH
- Sacrum injuries radiography surgery MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
Bosworth fracture (BF) is a special type of locked ankle fracture-dislocation, characterized by displacement of a fragment of the fractured fibula from the fibular notch behind the posterior surface of the distal tibia. BF is a complex injury affecting multiple structures of the ankle joint, which is still frequently misjudged even today, potentially leading to severe complications. CT examination, including 3D reconstructions, should be the diagnostic standard in BF, as it provides a complete picture of the fracture pathoanatomy, most prominently the morphology of the frequently associated posterior malleolar fracture. BF requires early reduction of the displaced fibular fragment without repeated attempts on closed reduction. Non-operative treatment of BF almost always fails. The standard treatment procedure is early open reduction internal fixation. Due to the relative severity and paucity of the injury, BF seems to be particularly prone to soft tissue complications, including compartment syndrome. The results of operative treatment are mixed. Many studies report persistent pain even after a short time interval, with limitations of the range of motion or even stiffness of the ankle joint, and development of degenerative changes. Larger studies with long-term results are still missing.
- Publication type
- Journal Article MeSH
- Review MeSH
Glenohumeral joint is the most frequently dislocated joint of the human body. Concomitant fractures of the coracoid process and tuberculum majus in humeral dislocation of the shoulder joint are rarely described. Concomitant fractures are results of a significant contraction of the surrounding muscles and rotator cuff during a cerebral paroxysm. Due to the small number of cases, the treatment of such injuries is not simple and it is based on an algorithm for treatment of isolated injuries of these anatomical structures. In this case report, we describe a concomitant fracture of the coracoid process and tuberculum majus during an anterior shoulder dislocation in 25-year-old patient after an epileptic seizure. The injury was treated in our department surgically, with a good functional result. The absolute Constant score for the operated arm is 95 points, the relative Constant score is 97%, DASH score 0, VAS score 0.
- MeSH
- Adult MeSH
- Fractures, Bone * complications MeSH
- Humerus MeSH
- Humans MeSH
- Shoulder Dislocation * complications surgery MeSH
- Coracoid Process MeSH
- Shoulder Joint * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- MeSH
- Atlanto-Axial Joint * surgery pathology MeSH
- Atlanto-Occipital Joint surgery pathology MeSH
- Pain MeSH
- Spinal Fusion * methods utilization MeSH
- Humans MeSH
- Neurologic Manifestations MeSH
- Orthopedic Procedures methods trends utilization MeSH
- Arthritis, Rheumatoid * surgery complications therapy MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Humans MeSH
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.
- MeSH
- Acetabulum MeSH
- Child MeSH
- Hip Joint surgery MeSH
- Humans MeSH
- Hip Dislocation * diagnostic imaging etiology surgery MeSH
- Adolescent MeSH
- Cerebral Palsy * complications surgery MeSH
- Follow-Up Studies MeSH
- Pelvis MeSH
- Child, Preschool MeSH
- Retrospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Child, Preschool MeSH
- Publication type
- Journal Article MeSH
INTRODUCTION: The aim of this study has been to present outcomes after cementless arthroplasty for developmental dysplasia Crowe type IV of the hip, with transverse subtrochanteric shortening osteotomy and using the S-ROM stem. METHODS: We evaluated radiographs, functional scores and complications in a consecutive series of 23 patients (28 hips) with high dislocation of the hip. The average age of patients at surgery was 49.9 (range 22-68) years. The operations were performed between 2007 and 2013. Patients were assessed retrospectively-clinically and radiographically during the year 2018. RESULTS: The mean follow-up period was 94 (range 60-134) months. The average Harris hip score improved from 39.9 to 84.0. The mean leg length discrepancy decreased from 5 cm preoperatively to 1.4 cm at the final follow-up. All acetabular components were implanted into the true acetabulum, and all prostheses were stable at the latest examination. No neurovascular damage was recorded. We have identified specific complications in seven hips (25%) in total: Intraoperative femoral fracture required fixation in four hips; three hips (10.7%) needed revision: Recurrent dislocation, with the need for cup reorientation, occurred in two hips (in one of them, this was followed by the subsequent need for resection of heterotopic ossification); there was one aseptic stem loosening with the need of one-stage revision. All the osteotomies healed within 8 months. CONCLUSION: Hip arthroplasty with transverse shortening femoral osteotomy, using S-ROM stem, is an acceptable, but not complication-free treatment method in patients with Crowe type IV developmental hip dysplasia, in the midterm.
- MeSH
- Joint Dislocations etiology surgery MeSH
- Adult MeSH
- Hip Joint * diagnostic imaging physiopathology surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Arthroplasty, Replacement, Hip * adverse effects methods MeSH
- Leg Length Inequality etiology surgery MeSH
- Osteotomy * adverse effects methods MeSH
- Postoperative Complications * diagnosis physiopathology surgery MeSH
- Radiography methods MeSH
- Reoperation * adverse effects methods statistics & numerical data MeSH
- Retrospective Studies MeSH
- Outcome and Process Assessment, Health Care MeSH
- Hip Dislocation, Congenital * diagnosis surgery MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
