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Sample records for acute knee dislocations

  1. Acute Thrombotic Occlusion of the Popliteal Artery following Knee Dislocation: A Case Report of Management, Local Unit Practice, and a Review of the Literature

    Science.gov (United States)

    Hindi, Fadi; Ettles, Callum; Pemberton, Mark

    2017-01-01

    Arterial complications following traumatic knee injury are relatively rare but mandate timely recognition and treatment to avoid significant comorbidity and medicolegal ramifications. In this report we describe a case of acute thrombotic occlusion of the popliteal artery occurring after knee dislocation, successfully repaired by intimal fixation and a limited venous patch reconstruction. We present a review of local practice in screening vascular injuries following knee dislocation, aligned with a review of the literature and considerations for practice. PMID:28246569

  2. Knee Dislocations in Sports Injuries

    Science.gov (United States)

    Pardiwala, Dinshaw N; Rao, Nandan N; Anand, Karthik; Raut, Alhad

    2017-01-01

    Knee dislocations are devastating when they occur on the athletic field or secondary to motor sports. The complexity of presentation and spectrum of treatment options makes these injuries unique and extremely challenging to even the most experienced knee surgeons. An astute appreciation of the treatment algorithm is essential to plan individualized management since no two complex knee dislocations are ever the same. Moreover, attention to detail and finesse of surgical technique are required to obtain a good functional result and ensure return to play. Over the past 10 years, our service has treated 43 competitive sportsmen with knee dislocations, and this experience forms the basis for this narrative review. PMID:28966379

  3. Radiographic Assessment of Anatomic Risk Factors Associated with Acute, Lateral Patellar Dislocation in the Immature Knee

    Directory of Open Access Journals (Sweden)

    Thai Trinh

    2016-04-01

    Full Text Available Acute patellar dislocation remains a common injury in both adult and pediatric patients. Non-operative management has been advocated for patients without a history of recurrent instability. Although pathologic thresholds for consideration of operative management have previously been reported in adults, it is largely unknown in children. A retrospective review of all skeletally immature patients diagnosed with acute lateral patellar dislocation who had MRI imaging were included for analysis. An age-based control group was also identified. Six radiographic measurements were compared: lateral trochlear inclination (LTI, trochlear facet asymmetry (TFA, trochlear depth (TD, tibial tuberosity–trochlear groove (TT–TG, sulcus angle (SA and patellar height ratio. A total of 178 patients were included for analysis (study: n = 108, control: n = 70. The mean age of patients in the study and control groups was 13.7 and 12.1 years respectively (p ≤ 0.001. Study group patients had significant differences in all radiographic measurements including a decreased LTI (p < 0.001, increased TFA (p < 0.001 and SA (p < 0.001. The mean trochlear depth was 3.4 mm and 5.6 mm for patients in the study and control groups respectively (p < 0.001. Study group patients had an increased patellar height ratio (p < 0.001 and TT–TG distance (p < 0.001. Morphologic abnormalities may predispose skeletally immature patients to an increased risk of acute lateral patellar instability.

  4. Dislocation of the knee: imaging findings.

    Science.gov (United States)

    Shearer, Damon; Lomasney, Laurie; Pierce, Kenneth

    2010-01-01

    Dislocations of the knee are relatively uncommon injuries. However, the incidence of this injury appears to be increasing. Knee dislocations are most often high velocity blunt injuries, with motor vehicle accidents being a frequent etiology. Other causes include falls from height, athletic injuries, farming and industrial accidents, and even low velocity mechanisms such as a misstep into a hole. Likewise, minor trauma in the morbidly obese is increasingly recognized as a mechanism of knee dislocation. Multiple forms of dislocation exist, with the common factor being disruption of the tibiofemoral articulation. Dislocation can occur in a variety of directions depending on the mechanism of injury. The most common dislocation is anterior, which may be seen in hyperextension injuries such as martial arts kicking. The "dashboard injury" of motor vehicle accidents can result in a posterior dislocation of the knee. Lateral and rotary dislocations are less common. Knee dislocation is more commonly diagnosed in men, with a mean age of 23 to 31 years old. This is the very patient population encountered by Special Operations Forces (SOF) healthcare providers. Given the mechanisms of injury noted above, it is reasonable to conclude that knee dislocations may be seen in a young, active SOF patient population, particularly those engaged in parachuting, fast-roping/rappelling, driving at high speeds during military operations, and mixed martial arts.

  5. Bioabsorbable Pins for Treatment of Osteochondral Fractures of the Knee after Acute Patella Dislocation in Children and Young Adolescents

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    A. Gkiokas

    2012-01-01

    Full Text Available A retrospective study was performed on the use of bioabsorbable pins in the fixation of osteochondral fractures (OCFs after traumatic patellar dislocation in children. Eighteen children (13 females, 5 males aged 11 to 15 years (mean age 13.1 years with osteochondral fracture (OCF of the knee joint were treated at the authors’ institution. Followup ranged from 22 months to 5 years. Diagnosis was verified by X-ray and magnetic resonance imaging (MRI of the knee and patella. In seven patients the osteochondral fragment was detached from the patella and in 11 it was detached from the lateral femoral condyle. All patients were subjected to open reduction and fixation of the lesion with bioabsorbable pins. Postoperatively, the knee was immobilized in a cast and all patients were mobilized applying a standardized protocol. Bone consolidation was successful in 17 of the 18 patients. Bioabsorbable pins reliably fix OCF in children and adolescents, demonstrating a high incidence of consolidation of the detached osteochondral fragment in short- and middle-term followup without requiring further operative procedures.

  6. Congenital dislocation of the knee in Ibadan, Nigeria | Omololu ...

    African Journals Online (AJOL)

    We conclude that congenital knee dislocation when discovered early and without any other congenital malformation can be managed conservatively with excellent results. Keywords: Congenital, Knee dislocation, children. Résumé Entre janvier 1996 et décembre 2001, 41 cas de dislocation congénitales d' articulation de ...

  7. Complicated Congenital Dislocation of the Knee: A Case Report

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    Firooz Madadi

    2016-10-01

    Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally and posterior bowing of both femur distally, demonstrating a complicated congenital knee dislocation. Two-staged open reduction with proximal tibial osteotomy was performed to align the reduced knee joints. The patient was completely independent in her daily activities after surgical correction.

  8. Complicated Congenital Dislocation of the Knee: A Case Report.

    Science.gov (United States)

    Madadi, Firooz; Tahririan, Mohammad A; Karami, Mohsen; Madadi, Firoozeh

    2016-10-01

    Congenital dislocation of the knee (CDK) is a rare disorder. We report the case of a 7-year-old girl with bilateral knee stiffness, marked anterior bowing of both legs, and inability to walk without aid. Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally and posterior bowing of both femur distally, demonstrating a complicated congenital knee dislocation. Two-staged open reduction with proximal tibial osteotomy was performed to align the reduced knee joints. The patient was completely independent in her daily activities after surgical correction.

  9. CONGENITAL KNEE DISLOCATION IN A 49,XXXXY BOY

    NARCIS (Netherlands)

    SIJMONS, RH; VANESSEN, AJ; VISSER, JD; IPRENBURG, M; NELCK, GF; VOSBENDER, ML; DEJONG, B

    We report on a 12 year old mentally retarded boy who presented at birth with bilateral knee dislocations, dislocation of the right hip, and general joint laxity. Cytogenetic studies showed a 49,XXXXY karyotype. Hyperlaxity of joints is known to occur in 49,XXXXY patients, but congenital knee

  10. [Trampoline accident with anterior knee dislocation caused popliteal artery disruption].

    Science.gov (United States)

    Pedersen, Peter Heide; Høgh, Annette Langager

    2011-10-17

    Only a few reports describe the risk of neurovascular damage following knee dislocation while trampolining. A 16 year-old male in a trampoline accident, sustained multi-ligament damage and occlusion of the popliteal artery. The occlusion did not show clinically until 24 hours after the trauma. He underwent vascular surgery (short saphenous bypass). We recommend implementing algorithms, for the management of suspected knee dislocation and possible accompanying neurovascular injuries in all trauma centers.

  11. An Unexpected Complication of Hip Arthroplasty: Knee Dislocation

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    Serdar Yilmaz

    2015-01-01

    Full Text Available An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis. Although knee dislocation is related to high-energy trauma, low-grade injuries can also lead to knee dislocation which is defined as “ultra-low velocity dislocation.” The case reported here is of an 82-year-old patient who presented with a left intertrochanteric hip fracture. Partial arthroplasty was planned because of osteoporosis. In the course of surgery, degenerative arthritic knee was dislocated during the hip reduction maneuver with the application of long traction. The neurovascular examination was intact, but the knee was grossly unstable and was dislocated even in a brace; thus a hinged knee prosthesis was applied nine days after surgery. The patient was mobilized with crutches after the knee prosthesis but exercise tolerance was diminished. In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee.

  12. Radiological difficulty in identifying unicompartmental knee replacement dislocation

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    Mr Oruaro Adebayo Onibere, MBBS, MRCS

    2017-09-01

    Full Text Available Unicondylar knee replacement is a relatively common elective orthopedic procedure but is not often seen in the Emergency Department setting. Familiarity with normal clinical and radiological appearances is difficult to gain. Dislocation of the mobile bearing component “spacer” is a known complication of unicondylar knee replacements, and these patients will initially present to the accident and Emergency Department. In this setting, an accurate and prompt diagnosis is necessary to appropriately manage the patient's condition. There is normally a radiological challenge in identifying dislocated mobile bearings on plain radiographs. These patients may need to have further imaging, such as a computer tomographic scan to identify the dislocated mobile bearing.

  13. Congenital dislocation of knee with ipsilateral developmental dysplasia of hip

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    Sameer Kakar

    2017-01-01

    Full Text Available We present a rare case of a newborn having congenital knee dislocation (CDK with ipsilateral developmental dysplasia of hip (DDH. This case report shows how abnormal intrauterine pressure leads to dislocation of various joints in utero. We managed this conservatively with Pavlik Harness for DDH and serial corrective casting with manipulation for CDK with a satisfactory result after follow-up of 6 months.

  14. [Congenital dislocation of the knee: report of 2 cases].

    Science.gov (United States)

    Ochoa Gómez, L; Sánchez Gimeno, J; García Barrecheguren, E; Marulanda Del Valle, K; Almonte Adón, K; Guerrero Laleona, C

    2015-01-01

    Congenital dislocation of the knee is a rare disease. The diagnosis is made at birth by clinical findings, and confirmed radiologically. It has been associated with various etiologies from intrauterine fetal malpositions to genetic disorders. The prognosis depends on early treatment and whether there are other congenital anomalies. We report two new cases of congenital dislocation of the knee, observed in our hospital during the period of a month, diagnosed immediately after birth, and both with a good clinical outcome. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  15. Dislocation following total knee arthroplasty: A report of six cases

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    Villanueva Manuel

    2010-01-01

    Full Text Available Background: Dislocation following total knee arthroplasty (TKA is the worst form of instability. The incidence is from 0.15 to 0.5%. We report six cases of TKA dislocation and analyze the patterns of dislocation and the factors related to each of them. Materials and Methods: Six patients with dislocation of knee following TKA are reported. The causes for the dislocations were an imbalance of the flexion gap (n=4, an inadequate selection of implants (n=1, malrotation of components (n=1 leading to incompetence of the extensor mechanism, or rupture of the medial collateral ligament (MCC. The patients presented complained of pain, giving way episodes, joint effusion and difficulty in climbing stairs. Five patients suffered posterior dislocation while one anterior dislocation. An urgent closed reduction of dislocation was performed under general anaesthesia in all patients. All patients were operated for residual instability by revision arthroplasty after a period of conservative treatment. Results: One patient had deep infection and knee was arthrodesed. Two patients have a minimal residual lag for active extension, including a patient with a previous patellectomy. Result was considered excellent or good in four cases and fair in one, without residual instability. Five out of six patients in our series had a cruciate retaining (CR TKA designs: four were revised to a posterior stabilized (PS TKA and one to a rotating hinge design because of the presence of a ruptured MCL. Conclusion: Further episodes of dislocation or instability will be prevented by identifying and treating major causes of instability. The increase in the level of constraint and correction of previous technical mistakes is mandatory.

  16. Congenital dislocation of the knee in Ibadan, Nigeria

    African Journals Online (AJOL)

    and serial casting in plaster of Paris immobilization for a pe- .... Anterior dislocation of the knee before plaster immobilisation ... Larsens syndrome. These different options make the treatment of CDK confus- ing but like most authorsfls'9 we subscribe to the early manage- ment of the patients with excellent results as can be ...

  17. Congenital dislocation of the knee in Ibadan, Nigeria.

    Science.gov (United States)

    Omololu, B; Ogunlade, S O; Alonge, T O

    2002-01-01

    Between January 1996 and December 2001, 41 congenital dislocations of the knee joints (30 patients) were reduced with closed methods by immediate reduction without anaesthesia and serial casting in plaster of Paris immobilization for a period of six to eight weeks. The patients' age ranged from the age of one week to four weeks with a male to female ratio of 1.5:1. The right knee was involved in 46.65% the left in 16.6% and bilateral involvement in 36.65% of patients. Routine check of the hip did not reveal any patient with hip instability. All the patients followed up after 2 years showed excellent results. We conclude that congenital knee dislocation when discovered early and without any other congenital malformation can be managed conservatively with excellent results.

  18. Knee Dislocation: A Case Report, Diagnostic Vascular Work-Up, and Literature Review

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    Matthijs R. Douma

    2017-01-01

    Full Text Available Knee dislocation is an uncommon, potentially limb-threatening, knee injury. Most often caused by high-velocity trauma, it can also result from low- or even ultra-low-velocity trauma. Rapid identification of the injury, reduction, and definitive management are necessary to minimize neurovascular damage. We present a case of rotatory anterolateral knee dislocation sustained during a twisting sports-related event. Special emphasis is placed on diagnosing vascular injuries associated with knee dislocations.

  19. A RARE CASE OF IPSILATERAL HIP AND KNEE DISLOCATION

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    Deepak

    2015-06-01

    Full Text Available High velocity road traffic accidents leads to complicated lower limb injuries. Such injuries demand highly experienced surgeon and are associated with high morbidity and mortality. Hip or knee dislocations are two different orthopaedic emergencies. Concomitant fracture dislocation of the hip and knee is rare and very few cases have been reported in the literature. A 45 year old man with history of fall from motorcycle came to the casualty. He had ipsilateral hip and knee dislocation. Immediately patient was shifted to operation theatre and closed reduction was performed under general anaesthesia. Reduction was confirmed under fluoroscopy and post-operative x-rays were taken. The functional results were excellent. After 2 months patient made an uncomplicated recovery and had satisfactory functional outcome with right hip having 110⁰ flexion and right knee flexes to 120⁰.There was no neurological deficit. The urgency, that the treating surgeon shows in managing these injuries, significantly affects the prognosis and outcome finally achieved by these patients (golden period in reducing the hip joint has been described to be 6 hours.

  20. Medial Injury in Knee Dislocations: What Are the Common Injury Patterns and Surgical Outcomes?

    National Research Council Canada - National Science Library

    Werner, Brian C; Hadeed, Michael M; Gwathmey Jr, F Winston; Gaskin, Cree M; Hart, Joseph M; Miller, Mark D

    2014-01-01

    ... knees.Over a 12-year period, we treated 65 patients with knee dislocations involving bicruciate ligament injury and concomitant medial ligament injuries, without or with posterolateral corner injuries...

  1. Open Reduction of Neglected Knee Dislocation: Case Report of a Rare Injury

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    Kapil Mani KC

    2016-11-01

    Full Text Available Old neglected dislocation of knee joint is a rare injury. Any orthopaedic surgeon would have faced only a few cases of unreduced neglected dislocation in his life time practice. We report the case of a 30-year old male patient with one month old unreduced knee dislocation which was managed with open reduction and stabilization with two intra-articular crossed Steinman pins for six weeks, followed by removal of the pins and gradual weight bearing in hinged knee brace. At the end of one year, range of movement of knee joint was 0 to 50 degree with minimal knee pain on walking.

  2. A non-contact complete knee dislocation with popliteal artery disruption, a rare martial arts injury

    OpenAIRE

    Viswanath, Y; Rogers, I

    1999-01-01

    Complete knee dislocation is a rare injury and an associated incidence of popliteal artery damage ranges from 16-60% of cases. It occurs commonly in road traffic accidents and in high velocity trauma where significant contact remains as the usual mode of injury. We describe a rare case of non-contact knee dislocation with popliteal artery injury sustained while practising Aikido, a type of martial art. This patient successfully underwent closed reduction of the knee with an emergency vein byp...

  3. Long-standing unreduced anterior dislocation of the knee - a case ...

    African Journals Online (AJOL)

    A case of long standing unreduced anterior dislocation of the knee for 2 months has been reported which was treated first with open reduction and external fixation at 70° flexion of knee followed by gradual extension of knee. Once full extension was achieved, the cylindrical cast was applied for 3 months. The final range of ...

  4. Ipsilateral hip and knee dislocation: Case report and review of literature.

    Science.gov (United States)

    Sharma, Gaurav; Chahar, Deepak; Sreenivasan, Ravi; Verma, Nikhil; Pankaj, Amite

    2016-01-01

    Hip and knee dislocations are not uncommon but simultaneous ipsilateral dislocation of the hip and knee joint is rare; consequently, there is an inadequate amount of literature on the subject. We identified only 11 such cases reported in English literature. In the present report, we describe the case of a 23-year-old male patient who presented with ipsilateral hip and knee dislocation on the right side after being involved in a road traffic accident. The hip dislocation was associated with a posterior wall acetabular fracture. The hip as well as the knee joints was reduced in the emergency bay. The patient underwent an urgent fixation of the posterior wall acetabular fracture with delayed ligament reconstruction for the knee dislocation. At one-year follow-up, he had no pain in the hip or knee. There was grade 1 posterior sag but no symptoms of knee instability. Radiographs revealed no evidence of avascular necrosis or arthritis of the femoral head. The normal treatment protocol for individual injury is affected by the simultaneous occurrence of hip and knee dislocation.

  5. NEGLECTED POSTERIOR KNEE DISLOCATION TREATED WITH CLOSED MANIPULATION AND UNIPLANAR EXTERNAL FIXATOR : A CASE REPORT

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    Manikumar

    2015-06-01

    Full Text Available Neglected traumatic posterior knee dislocations were rare in orthopaedic literature more so after a surgical intervention . Majority of the injuries are associated with vascular trauma and distal or proximal fractures and complete disruption of anterior and posterior cruciate ligaments and nerve traction injuries. Traumatic knee dislocations are therefore treated as an orthopaedic emergency. There were no definitive guide lines to open reduction as well as conservative methods of treatment. The end results of functional recovery are still controversial with residual posterior subluxation. Here we present a case of neglected posterior knee dislocation treated with closed manipulation and uni planar external fixator

  6. A magnetic resonance imaging study of abnormalities of the patella and patellar tendon that predispose children to acute patellofemoral dislocation.

    Science.gov (United States)

    Yılmaz, Barış; Çiçek, Esin Derin; Şirin, Evrim; Özdemir, Güzelali; Karakuş, Özgün; Muratlı, Hasan Hilmi

    This study compared 20 children hospitalised with acute patellofemoral dislocation with an age-matched healthy control group with no history of knee problems or patellar dislocation. The following morphological parameters were significantly different between the groups: the mean patellar width and length, mean sulcus depth, mean patellar tendon width and total patellar volume. The magnetic resonance imaging findings of this study suggested that structurally smaller than normal patella and patellar tendon volumes are predisposing factors for acute patellofemoral dislocation. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Primary traumatic patellar dislocation

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    Tsai Chun-Hao

    2012-06-01

    Full Text Available Abstract Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute patellar dislocation. Numerous operative and non-operative methods have been described to treat the injuries; however, the ideal management of the acute traumatic patellar dislocation in young adults is still in debate. This article is intended to review the studies to the subjects of epidemiology, initial examination and management.

  8. Spontaneous Relocation of a Posterior Dislocation of Mobile Bearing in a Medial Unicompartmental Knee Replacement

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    Hussein Noureddine

    2012-01-01

    Full Text Available We describe a case of spontaneous relocation of a posterior dislocation of the mobile bearing in a medial unicompartmental knee replacement, prior to surgical intervention. We are unaware of any similar cases in the published literature. This paper highlights some clinical issues around this type of dislocation.

  9. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations.

    Science.gov (United States)

    Arendt, Elizabeth A; England, Kristin; Agel, Julie; Tompkins, Marc A

    2017-10-01

    Various knee anatomic imaging factors have been historically associated with lateral patellar dislocation. The characterization of these anatomic factors in a primary lateral patellar dislocation population has not been well described. Our purpose was to characterize the spectrum of anatomic factors from slice imaging measurements specific to a population of primary lateral patellar dislocation. A secondary purpose was to stratify these data by sex/skeletal maturity to better detail potential dimorphic characteristics. Patients with a history of primary lateral patellar dislocation between 2008 and 2012 were prospectively identified. Ten MRI measurements were analysed with results stratified by sex/skeletal maturity. A '4-factor' analysis was performed to detail the number of 'excessive' anatomic factors within a single individual. This study involved 157 knees (79 M/78 F), and 107 patients were skeletally mature. The measurements demonstrate more anatomic risk factors in this population than historical controls. Patella height and trochlear measurements are the most common 'dysplastic' anatomic factors in this population. There were differences based on sex for some patellar height measurements and for TT-TG; there were no differences based on skeletal maturity. Primary lateral patellar dislocation patients have MRI measurements of knee anatomic factors that are generally more dysplastic than the normal population; however, there is a broad spectrum of anatomic features with no pattern predominating. Characterizing knee anatomic imaging factors in the patient with a primary lateral patellar dislocation is a necessary first step in characterizing the (potential) differences between the primary and recurrent patellar dislocation patient. IV.

  10. Complete 180° rotatory dislocation in a mobile-bearing knee prothesis.

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    Turki, Hussein W; Trick, Lorence

    2011-06-01

    Dislocation of the rotator platform in mobile-bearing total knee arthroplasty is a well-documented, albeit uncommon, phenomenon. A review of the literature has revealed multiple case reports describing spin out to 90° or complete extrusion of the polyethylene component. Closed reduction may be attempted in the acute presentation followed by revision if instability persists. We present a case of a 57-year-old woman who had a partial rotatory subluxation of her polyethylene component and underwent closed reduction resulting in a full 180° spinout. To our knowledge, this has not been described in the literature and should be considered as a possibility after closed reduction attempts. She was treated successfully with open exploration and poly exchange using a larger component. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. A non-contact complete knee dislocation with popliteal artery disruption, a rare martial arts injury.

    Science.gov (United States)

    Viswanath, Y K; Rogers, I M

    1999-09-01

    Complete knee dislocation is a rare injury and an associated incidence of popliteal artery damage ranges from 16-60% of cases. It occurs commonly in road traffic accidents and in high velocity trauma where significant contact remains as the usual mode of injury. We describe a rare case of non-contact knee dislocation with popliteal artery injury sustained while practising Aikido, a type of martial art. This patient successfully underwent closed reduction of the knee with an emergency vein bypass graft. Similar injury in association with Aikido has not been described in the English literature previously. Various martial art injuries are briefly discussed and safety recommendations made.

  12. A non-contact complete knee dislocation with popliteal artery disruption, a rare martial arts injury

    Science.gov (United States)

    Viswanath, Y; Rogers, I

    1999-01-01

    Complete knee dislocation is a rare injury and an associated incidence of popliteal artery damage ranges from 16-60% of cases. It occurs commonly in road traffic accidents and in high velocity trauma where significant contact remains as the usual mode of injury. We describe a rare case of non-contact knee dislocation with popliteal artery injury sustained while practising Aikido, a type of martial art. This patient successfully underwent closed reduction of the knee with an emergency vein bypass graft. Similar injury in association with Aikido has not been described in the English literature previously. Various martial art injuries are briefly discussed and safety recommendations made.


Keywords: Aikido; knee dislocation; popliteal artery disruption; sports injury PMID:10616692

  13. Unilateral Congenital Knee and Hip Dislocation with Bilateral Clubfoot - A rare Packaging disorder

    Science.gov (United States)

    Tiwari, Mukesh; Sharma, Nishith

    2013-01-01

    Introduction: Reduced intrauterine space gives rise to ‘packaging disorder’ which may involve joint dislocations or contractures. We present an unique case where mutiple joints were dislocated involving left congenital knee dislocation (CDK), bilateral congenital hip dislocation (CDH) and congenital talipes equino varus (CTEV)deformities. Case Report: A preterm baby boy born to mother with diagnosed oligohydramios presented with left CDK bilateral DDH and CTEV. The knee dislocation was treated first with gradual streaching and weekly above knee cast. At 7th week good flexion was achieved at both knees and abduction splint for DDH (using double diaper) with ponseti cast for CTEV was done. At one year follow up all joints were reduced and maintained well with baby able to stand with support. Conclusion: Packaging disorders may present with multiple dislocations and deformities. Early intervention with serial casting and manipulation minimises disability and prevents ambulatory problems. In our case there was a good response to manipulation and serial casting. This differs from cases with inherent pathology like arthrogryposis where response to treatment is not so good PMID:27298901

  14. Unilateral Congenital Knee and Hip Dislocation with Bilateral Clubfoot – A rare Packaging disorder

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    Mukesh Tiwari

    2013-04-01

    Full Text Available ntroduction: Reduced intrauterine space gives rise to ‘packaging disorder’ which may involve joint dislocations or contractures. We present an unique case where mutiple joints were dislocated involving left congenital knee dislocation (CDK, bilateral congenital hip dislocation (CDH and congenital talipes equino varus (CTEVdeformities. Case Report: A preterm baby boy born to mother with diagnosed oligohydramios presented with left CDK bilateral DDH and CTEV. The knee dislocation was treated first with gradual streaching and weekly above knee cast. At 7th week good flexion was achieved at both knees and abduction splint for DDH (using double diaper with ponseti cast for CTEV was done. At one year follow up all joints were reduced and maintained well with baby able to stand with support. Conclusion: Packaging disorders may present with multiple dislocations and deformities. Early intervention with serial casting and manipulation minimises disability and prevents ambulatory problems. In our case there was a good response to manipulation and serial casting. This differs from cases with inherent pathology like arthrogryposis where response to treatment is not so good. Keywords: Congenital genu recurvatum, Develpmental dysplasia hip, CTEV, Clubfoot, serial manipulation, packaging disorders

  15. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

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    Singh Alka

    2010-01-01

    Full Text Available Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in a 63-year-old Caucasian man of British origin with patellar tendon injury. The patient was treated successfully through a revision of the patellar component and tendon repair. In two years follow-up the patient is asymptomatic with no sign of loosening of his patellar prosthesis. Conclusions A thorough understanding of knee biomechanics is imperative in performing total knee arthroplasty in order to achieve a better functional outcome and to prevent early prosthetic failure.

  16. 'Acute bilateral anterior shoulder dislocation following domestic as

    African Journals Online (AJOL)

    'Acute bilateral anterior shoulder dislocation following domestic as- sault - case report. *N. E. Ngiml, E. G. Udorroh2 and A. M. Udosen1. I University of Calabar Teaching Hospital, Calabar. 2University of Uyo Teaching Hospital, Uyo, Akwa Ibom State. E—mail: nngimic@yah00.c0m. Summary. A rare case of acute bilateral ...

  17. [Effectiveness of traumatic dislocation of knee joint combined with multiple ligament injuries treated by stages].

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    Chen, Zhiwei; Liu, Chunlei; Yang, Lezhong; Dai, Zhu; Cao, Shengjun

    2011-02-01

    To observe the effectiveness of traumatic dislocation of the knee joint combined with multiple ligament injuries treated by stages. Between june 2005 and November 2008, 13 cases of traumatic dislocation of the knee joint combined with multiple ligament injuries were treated by stages, including 9 males and 4 females with an average age of 30.7 years (range, 18-54 years). The dislocations were left knee in 3 cases and right knee in 10 cases. The causes of injury were sports injury in 8 cases, traffic accident injury in 2 cases, falling from height injury in 2 cases, and sprain injury in 1 case. The average time from injury to hospitalization was 9 hours (range, 6 hours to 2 days). Anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL) were involved in 8 cases; ACL, PCL, and lateral collateral ligament (LCL) in 3 cases; and ACL, PCL, MCL, and LCL in 2 cases. The valgus stress testing results of 10 knees were ++ to +++; the varus stress testing results of 5 knees were ++ to +++; all knees showed positive in the anterior or the posterior drawer test and ++ to +++ in Lachman test. The nerve, vessel, MCL, LCL, PCL, meniscus were repaired in the first operation. The functional exercise of knee joint was done after fixation for 3-4 weeks. During the second operation, the ACL was reconstructed under arthroscopy after the range of motion (ROM) of knee joint was good with anterior instability of knee within 4-6 months. All wounds healed by first intention after two operations; no complications of infection and compartment syndrome occurred. All cases were followed up 12-60 months with an average of 36 months. Joint effusion of knee occurred in 2 cases at 4 weeks after the first operation and was cured after removal of fluid. At 3 months after the second operation, the results of valgus stress testing and Lachman test were ++ in 1 case, respectively; the results of valgus stress testing, varus stress testing, and Lachman test

  18. Recurrent locked knee caused by an impaction fracture following inferior patellar dislocation: a case report

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    Sutcliffe William

    2011-08-01

    Full Text Available Abstract Introduction Locked knee caused by inferior patellar dislocation is considered rare in elderly patients. It was originally thought that, in the osteoarthritic knee, osteophytes on the pole of the patella become entrapped in the inter-condylar notch, which is managed by performing closed reduction and immobilization in a knee splint for three to four weeks. We present an unusual case of a locked knee with an impaction fracture. To the best of our knowledge, there have been no previous reports of such impaction fractures managed with arthroscopy. Case presentation We present an unusual case of an 88-year-old Caucasian woman with moderate arthritis who had a locked knee caused by an impaction fracture of the patella into the lateral femoral condyle. In this case report, we describe the need for arthroscopic surgery to prevent relocking of the knee in these patients. Conclusions This case report emphasizes the need for careful assessment of locked knees in elderly patients. Impaction fractures should be considered in all rare cases of patellar dislocation, and we advocate arthroscopic assessment of the articular cartilage in these patients. This is an important consideration, as the population demographics change and such impaction fractures may become more common in patients with degeneration in the knees.

  19. Treatment of habitual dislocation of patella in an adult arthritic knee

    Directory of Open Access Journals (Sweden)

    Raghuveer K Reddy

    2013-01-01

    Full Text Available Habitual dislocation of the patella (HDP is a common presentation in pediatric age unlike adults. Many surgical procedures using proximal realignment and distal realignment have been reported to treat HDP in children with satisfactory results. However, late presentation of habitual patellar dislocation with osteoarthritis is rare and treatment plan has not yet been established. We present a case of neglected iatrogenic habitual patellar dislocation with osteoarthritis in a 50-year-old woman. Two-staged procedure was planned, first with patellar realignment and later with definitive total knee arthroplasty. Quadricepsplasty, medial patello-femoral ligament reconstruction, lateral release and tibial tuberosity transfer was done as primary procedure and total knee arthroplasty, which was planned as secondary procedure, was deferred as the patient improved functionally.

  20. Total knee arthroplasty with subvastus approach in patient with chronic post-traumatic patellar dislocation.

    Science.gov (United States)

    Junqueira, Jader Joel Machado; Helito, Camilo Partezani; Bonadio, Marcelo Batista; Pécora, Jose Ricardo; Demange, Marco Kawamura

    2016-01-01

    Chronic lateral dislocation of the patella is a rare condition and acquired causes are usually secondary to knee trauma. The neglected chronic dislocation leads to progressive genu valgum and external tibial torsion deformities with subsequent gonarthrosis, which becomes painful and debilitating. There is no consensus regarding treatment of these patients, but total knee arthroplasty (TKA) is a useful therapy in cases of painful symptomatic gonarthrosis. Few reports have shown that subvastus approach and lateral release may be a valid option for TKA, since it allows the correction of valgus deformity and patellar tracking without interrupting vascular blood supply of patella. This article reports a case of TKA and extensor mechanism realignment without patellar resurfacing in a patient with genu valgum and chronic post-traumatic patellar dislocation with satisfactory results after two years of follow-up.

  1. High incidence of acute and recurrent patellar dislocations

    DEFF Research Database (Denmark)

    Gravesen, Kasper Skriver; Kallemose, Thomas; Blønd, Lars

    2017-01-01

    PURPOSE: The purpose of this study was to investigate the Danish population as a whole from 1994 to 2013 to find the incidence of acute and recurrent patellar dislocation. METHODS: The study was performed as a descriptive epidemiological study. The Danish National Patient Registry was retrospecti......PURPOSE: The purpose of this study was to investigate the Danish population as a whole from 1994 to 2013 to find the incidence of acute and recurrent patellar dislocation. METHODS: The study was performed as a descriptive epidemiological study. The Danish National Patient Registry...... was retrospectively searched from 1994 to 2013 to find the number of acute and recurrent patellar dislocation. National population data were collected from Statistics Denmark. RESULTS: The period 1994-2013 saw a total registration of 24,154 primary patellar dislocations. A mean incidence of 42 (95% CI 37-47) per 100......,000 person-years at risk was found, and young females aged 10-17 had the highest incidence of 108 (95% CI 101-116). In a 10-year follow-up, patients were at an overall risk of 22.7% (95% CI 22.2-23.2) of suffering a recurrent dislocation, with young girls aged 10-17 experiencing the highest risk, namely 36...

  2. Popliteal artery thrombosis associated with trampoline injuries and anterior knee dislocations in children.

    Science.gov (United States)

    Kwolek, C J; Sundaram, S; Schwarcz, T H; Hyde, G L; Endean, E D

    1998-12-01

    Recent reports have emphasized the benign nature of trampoline-associated injuries. However, this study describes the limb-threatening problem of popliteal artery thrombosis occurring in association with anterior knee dislocation and trampoline injuries. Three children (ages 11, 13, and 17) were referred to the emergency room within the past 12 months with anterior dislocations of the knee, which occurred while jumping on trampolines. All patients had reduction of their dislocations at outside facilities and were referred within 6 to 12 hours after their injuries, with pulse, motor, and sensory deficits. All patients were taken directly to the operating room, where arteriography confirmed thrombosis of the popliteal artery below the knee. One patient had transection of the artery, whereas two patients had stretch injuries with intimal separation. Each patient required interposition grafting with reversed saphenous vein and underwent concomitant four-compartment fasciotomy. All patients had persistent sensory and motor deficits postoperatively, which were presumed to be a combination of ischemic injury and neuropraxia. All patients have functioning grafts with an average follow-up of 1 year (range, 9-15 months). One patient required a second interposition graft to treat an area of intimal hyperplasia, which developed at the proximal anastomosis, at 6 months postoperatively. Eighty per cent of trampoline injuries are associated with minor injuries with minimal long-term complications. However, dislocations of the knee may be associated with significant arterial injury and amputation rates of up to 30 per cent in many blunt trauma series. Based on our experience, physicians should recognize the possibility of significant arterial injuries occurring in children with anterior knee dislocations while jumping on trampolines.

  3. Dislocation

    Science.gov (United States)

    Joint dislocation ... are emergencies that need first aid treatment. Most dislocations can be treated in a doctor's office or ... deep sleep is needed. When treated early, most dislocations do not cause permanent injury. You should expect ...

  4. Reconstruction of the medial patellofemoral ligament in cases of acute traumatic dislocation of the patella: current perspectives and trends in Brazil1,

    Directory of Open Access Journals (Sweden)

    Gustavo Gonçalves Arliani

    2014-10-01

    Full Text Available Objective:To evaluate the approaches and procedures used by knee surgeons in Brazil for treating medial patellofemoral lesions (MPFL of the knee in cases of acute traumatic dislocation of the patella.Materials and methods:A questionnaire comprising 15 closed questions on topics relating to treating MPFL of the knee following acute dislocation of the patella was used. It was applied to Brazilian knee surgeons during the three days of the 44th Brazilian Congress of Orthopedics and Traumatology, in 2012.Results:106 knee surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them were from the southeastern region of Brazil. The majority (57% reported that they perform fewer than five MPFL reconstruction procedures per year. Indication of non-surgical treatment after a first episode of acute dislocation of the patella was preferred and done by 93.4% of the sample. Only 9.1% of the participants reported that they had never observed postoperative complications. Intraoperative radioscopy was used routinely by 48%. The professionals who did not use this tool to determine the point of ligament fixation in the femur did not have a statistically greater number of postoperative complications than those who used it (p > 0.05.Conclusions:There are clear evolutionary trends in treatments and rehabilitation for acute dislocation of the patella due to MPFL, in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefit of these trends.

  5. Treatment of acute and subacute dorsal perilunate fracture dislocations

    Directory of Open Access Journals (Sweden)

    Levent Kucuk

    2014-04-01

    Outcomes: Results of the perilunate fracture dislocations treated in acute or subacute phase by open reduction and internal fixation via dorsal approach are satisfactory. There is a strong demand for prospective, randomized studies to compare the results of different treatment modalities. [Hand Microsurg 2014; 3(1.000: 1-7

  6. LONG-STANDING UNREDUCED ANTERIOR DISLOCATION OF THE KNEE - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Dr. Navin Kumar Karn

    2010-01-01

    Full Text Available A case of long standing unreduced anterior dislocation of the knee for 2 months has been reported which was treated first with open reduction and external fixation at 70° flexion of knee followed by gradual extension of knee. Once full extension was achieved, the cylindrical cast was applied for 3 months. The final range of movement of knee at one year follow up was 5-70º along with painless weight bearing. To conclude, this conservative treatment could be one of the valuable option for the patients who can not undergo major surgery because of genreral health problem, or unable to afford for the surgery especially in developing countries, or not willing for arthrodesis.

  7. Acute Dislocation of the Metacarpal-Trapezoid Joint.

    Science.gov (United States)

    Cardozo, Diego Fernando Rincón; Plata, Guillermo Varón; Casas, Jairo Antonio Camacho; Rodríguez, Natalia Sauza

    2016-06-01

    The trapezoid metacarpal dislocation is a rare event. In the literature, it is found in case reports. This injury is caused by direct or indirect high energy trauma. In most cases, the dislocation is dorsal and is difficult to reproduce because the joint is not very mobile. Given the low incidence and little evidence supported in the literature regarding the management, this injury can be treated by open or closed reduction; however, it has been published that most authors use Kirschner wire fixation with good results. Here we present our experience in the management of a male patient with acute trapezoid metacarpal dislocation handled with a splint with good functional results at 6 weeks.

  8. [Reconstruction for knee dislocation with multiple ligaments injury at stage I].

    Science.gov (United States)

    Qiu, Jun-qin; Lin, Ren; Lin, Wei; Huang, Xian-gui; Xiong, Guo-sheng

    2015-12-01

    To investigate clinical outcomes of tendon allograft reconstruction with arthroscopy minimally invasive technique at stage I for the treatment of knee dislocation with multiple ligaments injury. Forty-eight patients with knee dislocation were reconstructed anterior and posterior ligament under arthroscopy at stage I from January 2008 to January 2012, and repaired ligaments injury of knee joint by minimally invasive technique. There were 38 males and 10 females aged from 20 to 59 years old with an average of 35.6 years old; 22 cases on the left side and 26 cases on the right side; the time from injury to operation ranged from 2 d to 2 weeks. Two cases combined with anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and posterolateral complex injuries, 36 cases combined with ACL, PCL, and MCL injuries, 10 cases combined with ACL, PCL and PLC injuries; 4 cases combined with peroneal nerve injury. Lysholm scoring were used to compared the cases before operation and final following-up to evaluate knee function. All patients were followed up from 12 to 30 months with an average of (18.2 ± 6.3) months. Activity and stability of joint were obviously improved. Lysholm score were improved from 40.3 ± 4.1 before operation to 87.0 ± 6.4 at final following-up. Reconstruction with arthroscopy minimally invasive technique at stage I for the treatment of knee dislocation with multiple ligaments injury could recover stability of joint better,reserve joint function. Preoperative training and postoperative individualized rehabilitation treatment is the key point of recover knee joint function.

  9. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings

    Energy Technology Data Exchange (ETDEWEB)

    Bui, Kimmie L. [Cleveland Clinic, Department of Radiology, Cleveland, OH (United States); Cleveland Clinic, Department of Radiology, HB6, Cleveland, OH (United States); Ilaslan, Hakan; Sundaram, Murali [Cleveland Clinic, Department of Radiology, Cleveland, OH (United States); Parker, Richard D. [Cleveland Clinic, Department of Orthopaedics, Cleveland, OH (United States)

    2008-07-15

    Our objectives were to determine retrospectively the prevalence, patients' demographics, mechanism of injury, combination of torn ligaments, associated intra-articular and extra-articular injuries, fractures, bone bruises, femoral-tibial alignment and neurovascular complications of knee dislocations as evaluated by magnetic resonance (MR) imaging. From 17,698 consecutive knee examinations by magnetic resonance imaging (MRI) over a 6-year period, 20 patients with knee dislocations were identified. The medical records of these patients were subsequently reviewed for relevant clinical history, management and operative findings. The prevalence of knee dislocations was 0.11% [95% confidence interval (95% CI) 0.06-0.16]. There were 16 male patients and four female patients, with ages ranging from 15 years to 76 years (mean 31 years). Fifteen patients had low-velocity injuries (75%), of which 11 were amateur sports related and four were from falls. Four patients (20%) had suffered high-velocity trauma (motor vehicle accidents). One patient had no history available. Anatomic alignment was present at imaging in 16 patients (80%). Eighteen patients had three-ligament tears, two had four-ligament tears. The four-ligament tears occurred with low-velocity injuries. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were torn in every patient; the lateral collateral ligament (LCL) was torn in 50%, and the medial collateral ligament (MCL) in 60%. Intra-articular injuries included meniscal tears (five in four patients), fractures (eight in seven patients), bone bruises (15 patients), and patellar retinaculum tears (eight partial, two complete). The most common extra-articular injury was a complete biceps femoris tendon tear (five, 25%). There were two popliteal tendon tears and one iliotibial band tear. One patient had received a vascular injury following a motor vehicle accident (MVA) and had been treated prior to undergoing MRI. Bone bruises

  10. Mobile Bearing Total Knee Arthroplasty for Valgus Knee Osteoarthritis with Permanent Patellar Dislocation: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Kohei Kamada

    2017-01-01

    Full Text Available Permanent patellar dislocation with tibiofemoral joint osteoarthritis is a relatively rare condition. To treat this condition, total knee arthroplasty with proximal or distal realignment of the extensor mechanism has been reported. We report a challenging case of an 80-year-old woman diagnosed with permanent patellar dislocation with tibiofemoral joint osteoarthritis treated by a mobile bearing total knee arthroplasty utilizing navigation system. Lateral retinaculum release was performed to improve patellar tracking; other proximal or distal realignment of the extensor mechanism was not necessary. Postoperative radiographs show stable patellar tracking and recurrent patellar dislocation was not observed. This clinical case indicates that the implant’s precise alignment and rotation during total knee arthroplasty could settle anatomical abnormalities of permanent patellar dislocation and the mobile bearing insert could contribute to stabilizing patellar tracking.

  11. Endobutton technique for the treatment of acute acromioclavicular joint dislocations

    Directory of Open Access Journals (Sweden)

    Raif Özden

    2014-06-01

    Full Text Available Objective: Acromioclavicular (AC joint dislocation is a common injury frequently affecting young athletes. The aim of this study is to evaluate postoperative functional results in cases diagnosed with acute AC joint dislocation stabilized with endobutton system. Methods: This fixation procedure has been applied on 10 patients. Indications of the technique included: a grade V AC joint dislocation (7 patients, and grade III AC joint dislocation (3 patient according to Rockwood classification. The coracoclavicular (CC interval and AC joint were reduced using two endobuttons. One endobutton was fitted on the clavicle and the second was placed at the undersurface of the coracoid. Outcomes were assessed with the Constant shoulder score and visual analog pain scale. Results: All the patients had powerful intraoperative fixation. Immediately after surgery, and 6 weeks, and 1 year postoperative radiographs showed adequate reduction of the CC distance and the AC joint. The mean Constant shoulder score was 89 (88–92 in the injured shoulder and 90 (88–93 in the uninjured shoulder. There was no statically significant difference between the injured and normal shoulder in terms of Constant shoulder score and there was no complication during the process. Conclusion: This technique is a safe and effective method for providing fixation for the AC joint.

  12. Dislocations

    Science.gov (United States)

    Dislocations are joint injuries that force the ends of your bones out of position. The cause is often a fall or a ... one, seek medical attention. Treatment depends on which joint you dislocate and the severity of the injury. It might include manipulations to reposition your bones, ...

  13. Dislocations

    Science.gov (United States)

    ... a young child's arm or shoulder, which can cause injury or dislocation. Reviewed by: Steven Dowshen, MD Date reviewed: April 2014 For Teens For Kids For Parents MORE ON THIS TOPIC Bones, Muscles, and Joints Broken Bones, Sprains, and Strains Nursemaid's Elbow Word! Dislocation Getting an ...

  14. Usefulness of the skyline view in the assessment of acute knee trauma in children

    Energy Technology Data Exchange (ETDEWEB)

    Black, G.B.; Mustapha, A. [Children' s Hospital of Winnipeg Health Sciences Centre, Section of Orthopedic Surgery, Winnipeg, Manitoba (Canada); Reed, M. [Children' s Hospital of Winnipeg Health Sciences Centre, Section of Pediatric Radiology, Winnipeg, Manitoba (Canada); Henderson, B. [Children' s Hospital of Winnipeg Health Sciences Centre, Section of Orthopedic Surgery, Winnipeg, Manitoba (Canada)

    2002-04-01

    We report a retrospective analysis of all cases of acute knee injuries in children presenting to the Winnipeg Children's Hospital, University of Manitoba, between Jan. 1, 1994, and Jan. 1, 1995. The mechanism of injury was recorded and all 3 radiographic views (i.e., anterioposterior, lateral and skyline) were available for 171 of 256 total cases. We found a significant association between mechanism of injury and visualization of damage on skyline view radiographs (p < 0.01). The skyline view showed damage in only 1 of the 158 cases involving direct or indirect injury not involving subluxation or dislocation. However, damage was visualized on skyline view radiographs in 7 (54%) of the 13 cases that included a history of subluxation or dislocation. We conclude that in acute knee trauma in children, a skyline view radiograph of the patella should be obtained only when the mechanism of injury includes subluxation or dislocation. When the mechanism does not suggest subluxation or dislocation, the skyline view is unlikely to reveal damage; it adds unnecessary radiation, cost and possible added discomfort for the child. (author)

  15. An evidence-based algorithm for the management of common peroneal nerve injury associated with traumatic knee dislocation

    Science.gov (United States)

    Samson, Deepak; Ng, Chye Yew; Power, Dominic

    2016-01-01

    Traumatic knee dislocation is a complex ligamentous injury that may be associated with simultaneous vascular and neurological injury. Although orthopaedic surgeons may consider CPN exploration at the time of ligament reconstruction, there is no standardised approach to the management of this complex and debilitating complication. This review focusses on published evidence of the outcomes of common peroneal nerve (CPN) injuries associated with knee dislocation, and proposes an algorithm for the management. Cite this article: Deepak Samson, Chye Yew Ng, Dominic Power. An evidence-based algorithm for the management of common peroneal nerve injury associated with traumatic knee dislocation. EFORT Open Rev 2016;1:362-367. DOI: 10.1302/2058-5241.160012. PMID:28461914

  16. Is peroneal nerve injury associated with worse function after knee dislocation?

    Science.gov (United States)

    Krych, Aaron J; Giuseffi, Steven A; Kuzma, Scott A; Stuart, Michael J; Levy, Bruce A

    2014-09-01

    Peroneal nerve palsy is a frequent and potentially disabling complication of multiligament knee dislocation, but little information exists on the degree to which patients recover motor or sensory function after this injury, and whether having this nerve injury--with or without complete recovery--is a predictor of inferior patient-reported outcome scores. The purposes of this study were to (1) report on motor and sensory recovery as well as patient-reported outcomes scores of patients with peroneal nerve injury from multiligament knee dislocation; (2) compare those endpoints between patients who had partial versus complete nerve injuries; and (3) compare patient-reported outcomes among patients who sustained peroneal nerve injuries after knee dislocation with a matched cohort of multiligament knee injuries without nerve injury. Thirty-two patients were identified, but five did not have 2-year followup and are excluded (16% lost to followup). Twenty-seven patients (24 male, three female) with peroneal nerve injury underwent multiligament knee reconstruction and were followed for 6.3 years (range, 2-18 years). Motor grades were assessed by examination and outcomes by International Knee Documentation Committee (IKDC) and Lysholm scores. Retrospectively, patients were divided into complete (n = 9) and partial nerve palsy (n = 18). Treatment for complete nerve palsy included an ankle-foot orthosis for all patients, nonoperative (one), neurolysis (two), tendon transfer (three), nerve transfer (one), and combined nerve/tendon transfer (one). Treatment for partial nerve palsy included nonoperative (12), neurolysis (four), nerve transfer (one), and combined nerve/tendon transfer (one). Furthermore, patients without nerve injury were matched by Schenck classification, age, and sex. Data were analyzed using univariate and multivariate models. Overall, 18 patients (69%) regained antigravity ankle dorsiflexion after treatment (three complete nerve palsy [38%] versus 15 partial

  17. The iliotibial band in acute knee trauma: patterns of injury on MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mansour, Ramy; Yoong, Philip; McKean, David; Teh, James L. [Oxford University Hospitals NHS Trust, Department of Radiology, Nuffield Orthopaedic Centre, Oxford (United Kingdom)

    2014-10-15

    To delineate the spectrum of knee injuries associated with sprains and tears of the distal iliotibial band (ITB). A retrospective review of 200 random MRI scans undertaken for acute knee trauma was performed. Scans were excluded if there was a history of injury over 4 weeks from the time of the scan, septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. In each scan, the ITB was scored as normal, minor sprain (grade 1), severe sprain (grade 2), and torn (grade 3). The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 27.4 years (range, 9-69 years) and 71.5 % (n = 143) of the patients were male. The ITB was injured in 115 cases (57.5 %). The next most common soft tissue structure injured was the anterior cruciate ligament (ACL) in 53.5 % of cases (n = 107). Grade 1 ITB injury was seen in 90 of these 115 cases (45 %), grade 2 injury in 20 cases, and grade 3 injury in only five cases. There is a significant association between ITB injury and ACL rupture (p < 0.05), as well as acute patellar dislocation (p < 0.05). There were ten cases of significant posterolateral corner injury, and all were associated with ITB injury, including four ITB tears. Only two cases of isolated ITB injury were seen (1 %). ITB injury is common in acute knee trauma and is associated with significant internal derangement of the knee, especially cruciate ligament rupture, posterolateral corner injury, and patellar dislocation. (orig.)

  18. Acute Single-Stage Reconstruction of Multiligament Knee Injuries Using the Ligament Advanced Reinforcement System

    Science.gov (United States)

    Tao, Jie; Li, Xia; Zhou, Zihui; Zhu, Zhenan

    2013-01-01

    Objective The purpose of the study was to report our early outcome in the management of multiligament knee injuries with the ligament advanced reinforcement system (LARS). Subjects and Methods Between 2007 and 2010, 9 of 11 patients operated on for multiligament knee injuries were included in this study; 2 patients were excluded due to complicated neurovascular injuries, open knee dislocations and severe comorbidities. All patients were managed acutely (ligaments with LARS ligament and were followed up for an average of 30 months (18–46 months). Results The mean Lysholm score of the 9 patients at final follow-up was around 90 (range 88–94) with an average Tegner activity score of 5.5. The postoperative function of 1 case of KD-11 and 2 cases of KD-111 was rated as ‘A,’ while the remaining cases were rated ‘B’. At final follow-up, minor osteoarthritic degeneration was detected in 1 case of KD-III and 2 cases of KD-IV. Superficial infection developed in 1 case, and no cases of knee synovitis and premature osteoarthritis were recorded. Conclusion A creditable outcome at mean of 30 months’ follow-up was obtained in acute single-stage reconstruction of uncomplicated multiligament knee injuries with LARS ligament. PMID:23428973

  19. All arthroscopic stabilization of acute acromioclavicular joint dislocation with fiberwire and endobutton system.

    Science.gov (United States)

    Spoliti, Marco; De Cupis, Mauro; Via, Alessio Giai; Oliva, Francesco

    2014-01-01

    acromioclavicular (AC) joint dislocation is common in athletes and in contact sports and about 9% of shoulder injuries involves this joint. The majority of these AC lesions can be successfully treated conservatively but high grade dislocation and some cases of type III dislocation need a surgical treatment. Many different operative techniques have been described over the years. The purpose of this study is to evaluate the results of arthroscopic stabilization of AC joint dislocation with TightRope® system. nineteen patients with acute AC dislocation were treated by arthroscopic fixation with TightRope® system. Any associated lesions were repaired. All patients were assessed before surgery (T0), at 3 months (T1), at 6 months (T2) and at 1 year after the surgery (T3) using a visual analogic scale (VAS) and Constant-Murley Score (CMS). All patients were evaluated with X-ray. six AC-joint dislocations involved the right shoulder and thirteen the left shoulder. Ten were type III dislocation, three were type IV and six were type V dislocation. We found a statistically significant reduction of pain (pshoulder showed a good reduction of the AC joint dislocation. We had 1 case of recurrence and 2 cases of loss of intraoperative reduction. arthroscopic technique for acute AC joint dislocations with the use of the TightRope® device is minimally invasive and it allows an anatomic restoration of the joint. It is a safe and effective procedure ensuring stable AC joint reconstruction and good cosmetic results.

  20. All arthroscopic stabilization of acute acromioclavicular joint dislocation with fiberwire and endobutton system

    Science.gov (United States)

    Spoliti, Marco; De Cupis, Mauro; Via, Alessio Giai; Oliva, Francesco

    2014-01-01

    Summary Introduction: acromioclavicular (AC) joint dislocation is common in athletes and in contact sports and about 9% of shoulder injuries involves this joint. The majority of these AC lesions can be successfully treated conservatively but high grade dislocation and some cases of type III dislocation need a surgical treatment. Many different operative techniques have been described over the years. The purpose of this study is to evaluate the results of arthroscopic stabilization of AC joint dislocation with TightRope® system. Materials and methods: nineteen patients with acute AC dislocation were treated by arthroscopic fixation with TightRope® system. Any associated lesions were repaired. All patients were assessed before surgery (T0), at 3 months (T1), at 6 months (T2) and at 1 year after the surgery (T3) using a visual analogic scale (VAS) and Constant-Murley Score (CMS). All patients were evaluated with X-ray. Results: six AC-joint dislocations involved the right shoulder and thirteen the left shoulder. Ten were type III dislocation, three were type IV and six were type V dislocation. We found a statistically significant reduction of pain (pdislocation. We had 1 case of recurrence and 2 cases of loss of intraoperative reduction. Conclusion: arthroscopic technique for acute AC joint dislocations with the use of the TightRope® device is minimally invasive and it allows an anatomic restoration of the joint. It is a safe and effective procedure ensuring stable AC joint reconstruction and good cosmetic results. PMID:25767774

  1. Haemodynamics in acute arthritis of the knee in puppies

    DEFF Research Database (Denmark)

    Bünger, C; Hjermind, J; Harving, S

    1984-01-01

    In order to study the haemodynamic changes of the juvenile knee in acute arthritis, an experimental model was developed in puppies by unilateral intra-articular injections of Carragheenin solution into the knee. Tissue blood flow was studied by the tracer microsphere technique in eight dogs and s...

  2. Evaluation of the coracoclavicular reconstruction using LARS artificial ligament in acute acromioclavicular joint dislocation.

    Science.gov (United States)

    Lu, Nan; Zhu, Lei; Ye, Tianwen; Chen, Aimin; Jiang, Xi; Zhang, Zhiling; Zhu, Qinghua; Guo, Qinghe; Yang, Di

    2014-09-01

    The most appropriate procedure for surgical treatment of severe acromioclavicular (AC) joint dislocation was still not clear. The purpose of this study is to evaluate the outcomes of coracoclavicular (CC) reconstruction with ligament augmentation and reconstruction system (LARS) artificial ligaments for the treatment of acute complete AC joint dislocation. Twenty-four patients (16 male and 8 female, ages ranged from 21 to 45) with acute complete AC joint dislocations were treated with CC reconstruction using LARS artificial ligaments. All these dislocations were unstable injuries. Clinical evaluation was used by the Constant scores and VAS. The radiographic evaluation consisted of Zanca radiographs for bilateral AC joint and axillary radiographs for the injured shoulder. All patients had follow-up times of 36 months (range 6-60). The Constant scores rose from 62.3 ± 6.9 preoperatively to 94.5 ± 9.3 at final evaluation (P dislocations. IV.

  3. Management of acute dislocation of the temporomandibular joint in dental practice.

    LENUS (Irish Health Repository)

    McGoldrick, David M

    2010-12-01

    Acute dislocation of the temporomandibular joint is a situation that, although rare, may present to the dentist in practice at any time. A number of activities, such as removal of a tooth, may cause dislocation. The event is painful and distressing for the patient, their family and the dental team. Prompt management minimises discomfort, distress and long-term morbidity to the patient. We describe the aetiology of acute dislocation and outline a number of techniques that will aid the clinican in dealing with this event.

  4. Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations.

    Science.gov (United States)

    Lädermann, Alexandre; Grosclaude, Maxime; Lübbeke, Anne; Christofilopoulos, Panayiotis; Stern, Richard; Rod, Thierry; Hoffmeyer, Pierre

    2011-04-01

    Little information is available on the results of the different stabilization techniques described for treatment of acute acromioclavicular (AC) joint injuries. Additionally, no studies have analyzed isometric performance of the shoulder after AC stabilization. The objective of our study was to present functional outcome including isokinetic testing and radiographic evaluation of patients treated with stabilization of AC joint dislocations. Thirty-seven patients with acute type III to V AC joint disruption underwent open coracoclavicular (CC) and AC stabilization with nonabsorbable sutures. The mean follow-up was 4.5 ± 2.5 years (range, 2-10.5). The mean Constant score (CS) was 96. There were 34 (91.9%) excellent results, 1 good (2.7%), 1 satisfactory (2.7%), and 1 fair (2.7%). The disabilities of the arm, shoulder, and hand (DASH) questionnaire revealed good overall subjective evaluation with a mean of 7 points. The mean visual analog scale (VAS) pain score was 0.8. Patients with a CC distance <5 mm, or an anterosuperior AC reduction less than 50%, showed significantly better results in CS and DASH score in comparison to patients with a subluxated AC joint (P < .005). Twenty-two patients agreed to undergo isokinetic evaluation. We were unable to demonstrate any clinically significant difference between the involved and the uninvolved side. The described technique of cerclage augmentation offers an attractive alternative in AC joint stabilization, with good to excellent results. In comparison to other techniques, there were no complications related to any implants, no graft donor site morbidity, or need for implant removal. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  5. Normal pedal pulses in a popliteal artery thrombosis after a trampoline-associated knee dislocation: a case report.

    Science.gov (United States)

    Harb, Z; Harb, A; Kammoona, Ishan; Huber, C

    2011-04-01

    In lower extremity trauma, it is routine to check the neurovascular status of the affected limb. Failure to recognise a vascular injury can have catastrophic consequences for the patient. The frequent observation of the distal pulses at regular intervals after a traumatic knee dislocation is absolutely mandatory for the early recognition and management of popliteal artery thrombosis. A limb-threatening complication of popliteal artery thrombosis occurring in association with a palpable dorsalis pedis pulse after a trampoline-related knee dislocation is reported here to emphasise some important teaching points. These lessons are a learning tool to help in the early recognition of the potential complications associated with such injuries and thus minimise their occurrence.

  6. Risk factors for acute knee injury in female youth football.

    Science.gov (United States)

    Hägglund, Martin; Waldén, Markus

    2016-03-01

    To prospectively evaluate risk factors for acute time-loss knee injury, in particular ACL injury, in female youth football players. Risk factors were studied in 4556 players aged 12-17 years from a randomised controlled trial during the 2009 season. Covariates were both intrinsic (body mass index, age, relative age effect, onset of menarche, previous acute knee injury or ACL injury, current knee complaints, and familial disposition of ACL injury) and extrinsic (no. of training sessions/week, no. of matches/week, match exposure ratio, match play with other teams, and artificial turf exposure). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from individual variable and multiple Cox regression analyses. Ninety-six acute knee injuries were recorded, 21 of them ACL injuries. Multiple Cox regression showed a fourfold higher ACL injury rate for players with familial disposition of ACL injury (HR 3.57; 95% CI 1.48-8.62). Significant predictor variables for acute knee injury were age >14 years (HR 1.97; 95% CI 1.30-2.97), knee complaints at the start of the season (HR 1.98; 95% CI 1.30-3.02), and familial disposition of ACL injury (HR 1.96; 95% CI 1.22-3.16). No differences in injury rates were seen when playing on artificial turf compared with natural grass. Female youth football players with a familial disposition of ACL injury had an increased risk of ACL injury and acute knee injury. Older players and those with knee complaints at pre-season were more at risk of acute knee injury. Although the predictive values were low, these factors could be used in athlete screening to target preventive interventions. II.

  7. Outcomes Following Acute Metacarpophalangeal Joint Arthroplasty Dislocation: An Analysis of 37 Cases.

    Science.gov (United States)

    Wanderman, Nathan; Wagner, Eric; Moran, Steven; Rizzo, Marco

    2017-11-11

    There remains a paucity of information regarding the treatment outcomes of dislocation after metacarpophalangeal (MCP) joint arthroplasty. The purpose of this study was to assess the outcomes of surgical and nonsurgical treatment modalities of MCP arthroplasty dislocations. Of 816 MCP joint arthroplasties over a 14-year period, there were 37 (4%) acute MCP joint dislocations that required intervention by a health care professional. Implants involved included 28 nonconstrained implants including pyrocarbon (n = 17) and surface replacement arthroplasty (n = 11), and 9 silicone implants. The analysis included the treatment of dislocations after primary (n = 30) and revision (n = 7) MCP joint arthroplasty. Dislocation was defined as clinical and radiographic evidence of MCP joint prosthetic acute dislocation diagnosed and treated by a fellowship trained hand surgeon. Etiologies underlying the dislocations included implant fracture (n = 6), component loosening (n = 2), and soft tissue deficiency (n = 29). Of the 37 dislocations, treatments included 14 nonsurgical (closed reduction, orthosis fabrication) all of which ultimately failed. Surgically, including some of the failed prior procedures, 18 soft tissue stabilization procedures and 21 revision arthroplasties were performed, with 6 that had failed soft tissue stabilization. The soft tissue stabilization procedures had a 28% success rate in achieving a stable MCP joint. Revision arthroplasty had a 71% success rate. Subgroup analysis showed an 86% success rate for silicone revisions and a 43% success rate with nonconstrained revisions, with 80% and 36% 5-year survival free of instability, for the 2 types of implants, respectively. The treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by

  8. Management of acute acromioclavicular joint dislocations: current concepts.

    Science.gov (United States)

    Tauber, Mark

    2013-07-01

    Acromioclavicular joint (ACJ) injuries represent a common injury to the shoulder girdle. In the management algorithm of acute ACJ injuries complete radiological evaluation represents the key to a successful therapy. According to the classification of Rockwood the presence of a horizontal component in addition to vertical instability has to be detected. Using axillary functional views or Alexander views dynamic horizontal ACJ instability can be diagnosed in a simple, efficient and cost-effective manner reducing the number of mis-/underdiagnosed ACJ injuries. MRI should not be the imaging modality of first choice. The treatment of ACJ dislocations must consider two aspects. In addition to the correct type of injury therapy strategies should be adapted to patient's demands and compliance. Low grade AC injuries types I and II are treated non-operatively in terms of "skilful-neglect". High-grade injuries types IV-VI should be treated operatively within a time frame of 2-3 weeks after injury. A certain debate is still ongoing regarding type III injuries. Out from the literature, non-operative treatment of type III injuries results to provide at least equal functional outcomes as compared to surgical treatment associated with less complications and earlier return to professional and sports activities. If surgical treatment is indicated, open surgical procedures using pins, PDS-slings or hook plates are still widely used concurring with recently raising minimally invasive, arthroscopic techniques using new implants designed to remain in situ. Combined coracoclavicular and acromioclavicular repair are gaining in importance to restore horizontal as well as vertical ACJ stability.

  9. Ipsilateral fracture dislocations of the hip and knee joints with contralateral open fracture of the leg: a rare case and its management principles

    Directory of Open Access Journals (Sweden)

    Sen Ramesh Kumar

    2011-06-01

    Full Text Available 【Abstract】This paper discussed the injury mecha- nism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracture- dislocations of the left hip (Pipkin’s type IV and knee (Moore II joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin’s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabi- lized with lateral buttress plate and a transarticular span- ning fixator. The open fracture on the other leg was de- brided and fixed with an external fixator. There was no insta- bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appro- priate intervention can provide good functional outcome to the patient in this situation. Key words: Hip dislocation; Knee dislocation; Fractures, bone

  10. The external rotation method for reduction of acute anterior shoulder dislocations

    Science.gov (United States)

    Marinelli, Mario

    2009-01-01

    Background Shoulder dislocations account for almost 50% of all joint dislocations, and are most commonly anterior (90–98%) and occur due to trauma. This prospective study was conducted to report our experiences of using the external rotation method (ERM) in the reduction of acute anterior shoulder dislocation. Materials and methods Between August 2006 and April 2007, ERM was applied to 31 patients who presented with traumatic anterior shoulder dislocation to the Emergency Department of our Hospital which is a level 2 trauma centre. We evaluated 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 31 patients, 29 had a successful reduction. No premedication was required in 25 patients who had a successful reduction, and the average time required for reduction in 25 was less than 2 min. Only five patients reported severe pain during the process of reduction. The method was not successful in two patients in whom the reduction was achieved under narcosis. We experienced a success rate of 89% at the first attempt. None of the patients encountered any complication. Conclusions ERM for the reduction of acute anterior dislocation of the shoulder is a safe and reliable method, mainly without requirement for any sedatives or opiate analgesics, that can be performed relatively painlessly for anterior shoulder dislocations. As no single method has a 100% success rate, ERM is a useful one to know. PMID:19384630

  11. Primary total knee arthroplasty for acute fracture around the knee.

    Science.gov (United States)

    Parratte, S; Ollivier, M; Argenson, J-N

    2018-02-01

    Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high

  12. Kneecap dislocation

    Science.gov (United States)

    ... make you more likely to dislocate your knee. Alternative Names ... Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

  13. Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction/repair

    Directory of Open Access Journals (Sweden)

    Lorez Lukas G

    2010-05-01

    Full Text Available Abstract Background The purpose of our study was to analyze the clinical and radiological long-term outcomes of surgically treated traumatic knee dislocations and determine prognostic factors for outcome. Methods Retrospective consecutive series of patients treated surgically for traumatic knee dislocation with reconstruction/refixation of the anterior (ACL and posterior cruciate ligaments (PCL and primary complete repair of collaterals and posteromedial and posteromedial corner structures. 68 patients were evaluated clinically (IKDC score, SF36 health survey, Lysholm score, Knee Society score, Tegner score, visual analogue scale - VAS pain and satisfaction, Cooper test and radiologically (weight bearing and stress radiographs with a mean follow up of 12 ± 8 years. Instrumented anterior-posterior translation was measured (Rolimeter, KT-1000. Pearson correlation and stepwise regression analysis was used. Results 82% of patients (n = 56 returned to their previous work. At final follow-up 6 patients (9% suffered from pain VAS > 3. The mean side-to-side difference of anterior/posterior translation (KT-1000, 134N was 1.6 ± 1.6 mm and 2.6 ± 1.4 mm. Valgus and varus stress testing in 30° flexion was 40 days were significantly associated with worse outcome (p Conclusions Early complete reconstruction can achieve good functional results and patient satisfaction with overall restoration of sports and working capacity. Negative predictive factors for outcome were injury pattern, type of surgical procedure and timing of surgery.

  14. A retrospective review over 1999 to 2007 of head, shoulder and knee soft tissue and fracture dislocation injuries and associated costs for rugby league in New Zealand.

    Science.gov (United States)

    King, D; Hume, P; Gianotti, S; Clark, T

    2011-04-01

    King et al. reported that of 5 941 moderate to serious claims resulting in medical treatment for rugby league injuries, the knee, shoulder, and head and neck body sites and soft tissue and fracture-dislocation injuries were most frequent and costly in the New Zealand national no-fault injury compensation corporation database during 1999 to 2007. However, additional analyses of knee, shoulder and head and neck body sites by soft tissue and fracture-dislocation injury types was required to enable a greater understanding of the nature of injuries most likely to be seen by sports medical personnel dealing with rugby league players. From 1999 to 2007 the injury claims and costs for head and neck soft tissue, fracture-dislocations, shoulders soft tissue significantly increased. Knee soft tissue injury claims and costs significantly decreased from 1999 to 2007. There was no significant difference in knee fracture-dislocation injury claims but there was a significant increase in knee fracture-dislocation injury costs from 1999 to 2007. Changes in the nature of injuries may be related to changes in defensive techniques employed in rugby league during this time. Sports medical personnel dealing with rugby league players should focus their injury prevention strategies on reducing musculoskeletal injuries to the head and shoulder. There should be a focus on increasing awareness of correct tackling technique, head injury awareness and management of suspected cervical spine injuries. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Arthroscopic treatment of acute acromioclavicular joint dislocation by coracoclavicular ligament augmentation.

    Science.gov (United States)

    Liu, Xudong; Huangfu, Xiaoqiao; Zhao, Jinzhong

    2015-05-01

    Coracoclavicular (CC) ligament augmentation has been a method to treat acromioclavicular (AC) joint dislocation in recent years. The purpose of this paper is to describe our arthroscopic CC ligament augmentation technique in treating type III and V acute AC joint dislocations and to report the early clinical and radiological results. From 2010 to 2011, twelve patients suffering from acute type III or V AC joint dislocations were arthroscopically treated in our department, by CC ligament augmentation after AC joint reduction. The post-operative outcomes were assessed through physical examination, radiographic examination and the Constant-Murley Shoulder Score. All patients post-operatively experienced anatomical reduction in their AC joint dislocation. No intraoperative complications occurred. At a mean follow-up at 24 months (ranging from 18 to 32 months), the mean Constant-Murley Shoulder Score significantly improved from 24.3 pre-operatively to 91.1 post-operatively. No neurovascular complications or secondary degenerative changes of the AC joint were detected in any of the patients. In one case, a second dislocation occurred 1 month post-operation because the patient had had another traumatic injury. This patient accepted a revision operation, but his AC joint eventually fixated into a subluxated position after his second injury. Based on the resultant successful repair in all cases, the arthroscopic CC ligament augmentation method has thus far proven to be a safe and reliable technique for treatment of acute type III or V AC joint dislocation. The arthroscopic CC ligament augmentation with a flip button/polyethylene belt repair is an efficient method to treat acute type III and V AC joint dislocations which should be popularized. IV.

  16. Knee dislocation: descriptive study of injuries Luxação do joelho: estudo descritivo das lesões

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    Fabiano Kupczik

    2013-04-01

    Full Text Available OBJECTIVE: Describe the ligamentous and associated injuries that occur in the traumatic knee dislocation, relating them to the mechanisms of trauma and to identify patterns of injuries. METHODS: Twenty three knee dislocations were described in the period between March 2010 and March 2011. After the diagnosis of the lesions, the reduction and transarticular external fixation of the dislocated knees were done. At the second moment, the patients were evaluated with physical examination under anesthesia and the surgical exploration of peripheral lesions was perfomed by a surgeon of the knee surgery group of this institution.The patients data with the description of the injuries were found and registered. RESULTS: 65% of patients were male, the average age was 35 years and the most common mechanism of trauma was the motorcycle accident (60%. The lesion of the anterior cruciate ligament (ACL occurred in 75% of the cases, and the lesion of posterior cruciate ligament (PCL in 95%. The medial peripheral injuries happened in 65% of the dislocations, and the lateral lesions in 40%. The most common dislocations were classified as KDI (25% and as KDIIIm (25%. The arterial injury was present in 15% of the cases, and the nervous injury where registered in one patient (5%. At the initial radiographic evaluation, 45% of the dislocations presented reduced. CONCLUSION: The characteristics of the knee dislocations described showed a great range of variability demonstrating that an individualized evaluation of each case is mandatory. The surgeon should be able to recognize and choose the correct treatment to these lesions. OBJETIVO: Descrever as lesões ligamentares e associadas ocorridas nas luxações traumáticas do joelho, relacioná-las aos mecanismos de trauma e identificar padrões de lesões. MÉTODOS: Foram descritas 23 luxações do joelho entre março de 2010 e março de 2011. Após o diagnóstico das lesões, foi procedida a redução e fixação externa

  17. Arterial damages in acute elbow dislocations: which diagnostic tests are required?

    Science.gov (United States)

    Lutter, Christoph; Pfefferkorn, Ronny; Schoeffl, Volker

    2016-07-19

    Blunt vessel injuries of peripheral arteries caused by a direct trauma are rare. Studies have described the frequency of arterial ruptures following closed elbow dislocations in 0.3-1.7% of all cases. However, arterial damage does not always necessarily appear as a complete rupture of the vessel with a loss of peripheral circulation and ischaemic symptoms; a relatively strong periarticular system of collaterals can maintain circulation. Furthermore, the traumatic dislocation can also cause intimal tears, arterial dissections and aneurysms or thrombosis. In all cases of vessel injury, including total disruption, a peripheral pulse might still be palpable. 3 weeks after an acute elbow dislocation, we have diagnosed a patient with a long-segment stenosis of the brachial artery and a thrombosis of the radial artery. Therefore, the close anatomic proximity to the neurovascular structures should always be considered in cases of elbow dislocations, even if peripheral pulses are traceable. 2016 BMJ Publishing Group Ltd.

  18. Is dislocation rate higher in total hip arthroplasty done for acute displaced fracture neck of femur?

    Directory of Open Access Journals (Sweden)

    Ganesan Ram Ganesan

    2015-01-01

    Full Text Available Background Hip replacement has transformed the lives of hundreds of thousands of people regardless of the underlying aetiology. Debate about the role of arthroplasty for an acute displaced femoral neck fracture has been ongoing for decades. In this article we are going to evaluate whether dislocation rate is higher in total hip replacement done for acute displaced fracture neck of femur. Materials and Methods: Retrospective study of sixty two patients who underwent total hip replacement in Sri Ramachandra medical center. The minimum follow-up was taken as 5 years. Patients were divided into two group; traumatic and non traumatic group. We had 38 patient who underwent hip replacement for non traumatic indications. Traumatic group had 24 patients. The inclusion criteria for the traumatic group were acute displaced fracture neck of femur above 50 years and fracture neck with fracture head with dislocation above 50 years. We used the Harris hip score (Modified for clinical and functional evaluation. Results: We had 89% excellent/good results in non traumatic group 75% excellent/good result in traumatic group. We had one dislocation in non-traumatic group and four dislocations in traumatic group. Conclusions: There is an increase rate of dislocation in patient who underwent total hip replacement for a traumatic condition when compared to their non traumatic counterpart.

  19. Endoscopically assisted reconstruction of acute acromioclavicular joint dislocation using a synthetic ligament. Outcomes at 12 months.

    Science.gov (United States)

    Cohen, G; Boyer, P; Pujol, N; Hamida Ferjani, B; Massin, P; Hardy, P

    2011-04-01

    The treatment for acute acromioclavicular (AC) joint dislocation remains controversial because of the elevated level of complications and related morbidity. The objective of this study was to evaluate clinical outcomes, radiographic results, and the complications after arthroscopic stabilization of acute stages III or IV (Rockwood classification) acromioclavicular dislocations. Sixteen patients (15 males and one female) found to have Rockwood stage III or IV AC joint dislocation were operated. All the patients were stabilized arthroscopically with a synthetic ligament placed between the clavicle and the coracoid. The application of the synthetic ligament reduced the dislocation and stabilized the AC joint, allowing healing of the coracoacromial ligament. Results were assessed clinically (Constant score) and radiographically before and a mean 12 months after the treatment. Despite the excellent clinical results at the last follow-up both in terms of the Constant score (mean, 91 points; range, 60-100) and patient satisfaction, two patients required revision surgery while some had pain over the clavicular button. The X-rays showed three cases of partial loss of reduction due to distal migration of the flip button. Arthroscopically assisted treatment of acute AC joint dislocation is advantageous because it provides good clinical results and few complications. The rate of recurrence and the postoperative loss of reduction requires better definition of the indications and improvement of the surgical implants and technique. Level IV. Prospective cohort study. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  20. Arthroscopically Assisted Treatment of Acute Dislocations of the Acromioclavicular Joint

    Science.gov (United States)

    Braun, Sepp; Beitzel, Knut; Buchmann, Stefan; Imhoff, Andreas B.

    2015-01-01

    Arthroscopically assisted treatments for dislocations of the acromioclavicular joint combine the advantages of exact and visually controlled coracoid tunnel placement with the possibility of simultaneous treatment of concomitant injuries. The clinical results of previous arthroscopically assisted techniques have been favorable at midterm and long-term follow-up. The presented surgical technique combines the advantages of arthroscopically positioned coracoclavicular stabilization with an additional suture cord cerclage of the acromioclavicular joint capsule for improved horizontal stability. PMID:26870646

  1. Acute elbow dislocation with arterial rupture. Analysis of nine cases.

    Science.gov (United States)

    Ayel, J-E; Bonnevialle, N; Lafosse, J-M; Pidhorz, L; Al Homsy, M; Mansat, P; Chaufour, X; Rongieres, M; Bonnevialle, P

    2009-09-01

    Elbow dislocations are the most frequently encountered dislocations after shoulder dislocations. In their vast majority these injuries involve only the joint and carry a good prognosis. Close anatomic proximity to the joint of neurovascular structures put them at risk of concomitant injury but this occurrence remains, actually very rare. The objective of this study is to retrospectively analyze the results of nine cases of elbow dislocations with brachial artery complications and to propose coherent therapeutic guidelines derived from this experience. From 1999 to 2004, 357 elbow dislocations were treated by the traumatology team at the Purpan University Hospital and 340 at the Rangueil University Hospital in Toulouse, France. These two teaching institutions combined their series, contributing to seven dislocations associated with a brachial artery partial rupture, resulting in ischemia. Between 2001 and 2006 at the Le Mans Regional Hospital Center, 138 dislocations of the elbow were treated, and included two cases involving rupture of the brachial artery. In all these institutions' emergency departments, elbow dislocations were mainly treated on an outpatient basis: closed reduction under ultra short-acting products general anesthesia, with stability evaluation followed by cast immobilization. In the rare instances of ischemia, the artery was repaired in concert with the vascular surgery team. All the nine cases had a similar treatment protocol and were submitted to an identical outcome evaluation method. The patients were all males with a mean age of 37.3 years (range, 18-58 years). The combined injury occurred at sports in two cases, because of a fall in three cases and as a result of a traffic accident in four cases. Ischemia was complete in three cases (no radial or ulnar pulse and devascularized hand). In the six other cases, the clinical presentation was subacute. An arteriogram was obtained in five cases after reduction of the dislocation, confirming the

  2. Low-Energy Traumatic Obturator Hip Dislocation with Ipsilateral Femoral Shaft Fracture in a Patient with Omolateral Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    G. Gazzotti

    2016-01-01

    Full Text Available Ipsilateral obturator hip dislocation and femoral shaft fracture are rare. We report such a case in an older woman after a low-energy injury. She had a knee prostheses in the same limb. The patient was treated by open manipulative reduction of the luxation without opening joint and open reduction and internal fixation of the femur with angular stability plate and screws. We could not find a similar case in the literature. An early diagnosis of the dislocation is crucial in order to obtain good results. Great awareness and radiologic examination are fundamental to achieve precocious diagnosis of both these rare combined injuries, as treatment in these cases is considered an emergency. The first step was an attempt to reduce the dislocation by closed means but it failed. Then we performed a short approach at the trochanteric region and used Lambotte forceps to manoeuvre the proximal femur without opening the joint achieving reduction. Thereafter the femoral shaft fracture underwent open reduction and internal fixation with an angular stable plate. After a 2-year follow-up the outcome was very good.

  3. Total knee replacement in acute and chronic traumatic events.

    Science.gov (United States)

    Benazzo, Francesco; Rossi, Stefano M P; Ghiara, Matteo; Zanardi, Alessandro; Perticarini, Loris; Combi, Alberto

    2014-12-01

    Total knee replacement (TKR) is a widely used procedure for the treatment of post-traumatic arthritis. This type of solution has also been used recently for the treatment of acute fractures around the knee, particularly in joints that were already arthritic before the trauma. The purpose of this paper is to present our experience with TKR in both acute and chronic traumatic events, highlighting the main problems associated with these conditions and focussing on the indications, principles of technique, tips, tricks and pitfalls of this procedure. The main issues related to post-traumatic arthritis and the problem of TKR in acute fractures are discussed, and our case series of both groups of patients is presented. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

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    Ali Torkaman

    2016-01-01

    Full Text Available Background: Surgical treatments for acromioclavicular (AC joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH, constant and visual analogue scale (VAS scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71% were male and four (14.28% were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements (P=0.001, P=0.0001, P=0.0001, respectively. There were not any significant differences between right and left coracoclavicular (P=0.238, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments.

  5. Triple endobuttton technique for the treatment of acute complete acromioclavicular joint dislocations: preliminary results.

    Science.gov (United States)

    Wei, Hai-Feng; Chen, Yun-Feng; Zeng, Bing-Fang; Zhang, Chang-Qing; Chai, Yi-Min; Wang, Hai-Ming; Lu, Ye

    2011-04-01

    Numerous procedures have been described for the operative management of acromioclavicular (AC) joint injuries. Some of these techniques, including hardware fixation and non-anatomical reconstructions, are associated with serious complications and high failure rates. Recently, AC joint reconstruction techniques have focused on anatomical restoration of the coracoclavicular ligaments to achieve optimal clinical outcomes. We used a triple endobutton technique to separately reconstruct the trapezoid and the coronoid portions of the coracoclavicular ligament. We evaluated the preliminary clinical and radiological results of this technique in patients with acute complete dislocation of the AC joint. All patients achieved a significant improvement in the pain and function of shoulder at a mean follow-up interval of 12 months (range, 8-14 months). Excellent reduction of the AC joint was maintained. The triple endobutton technique may be safe and effective for the treatment of acute complete AC joint dislocations.

  6. [Appraise operative outcome for acute central cervical spinal cord injuries without fracture and dislocation].

    Science.gov (United States)

    Jiang, Jian-yuan; Ma, Xin; Lü, Fei-zhou; Xu, Zheng-feng

    2007-03-15

    To evaluate the surgical outcome for acute central cervical spinal cord injuries without fracture and dislocation. A retrospective study was performed on 52 patients with acute central cervical cord injuries without fracture and dislocation from 2000 to 2005. All of patients underwent cervical anterior or posterior decompression, fusion and inter fixation. Spinal function was evaluated by ASIA (American Spinal Injury Association) guidelines. Pre- and post-operation ASIA scores were analyzed using liner correlation and regression. The neurological function was recorded during followed-up. The average follow-up was 29 months (range, 12 to 42). After operation, the ASIA scores increased significantly (P<0.01). Finally, ASIA motor, pin pricking and light touching scores of the 41 patients were 91 +/- 7, 107 +/- 6 and 107 +/- 6 respectively. Decompression and inter fixation for injured segment can make a stable and broad space for spinal cord, promoting early neurological recovery and long-term improvement.

  7. Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button.

    Science.gov (United States)

    Murena, L; Vulcano, Ettore; Ratti, C; Cecconello, L; Rolla, P R; Surace, M F

    2009-12-01

    The ideal treatment for acute acromioclavicular joint dislocation is still controversial, both in terms of indications and surgical technique. The clinical and radiographic outcomes of 16 patients affected by acute AC joint dislocation (type III-V) and arthroscopically treated with a coracoclavicular double flip button are presented. Despite the excellent clinical results both in terms of Constant score (mean 97 points) and patient satisfaction, at a mean follow-up of 31 months the radiographs showed partial loss of reduction due to distal migration of the flip button within the upper third of the clavicle in one-fourth of the cases. The technique presented here proved to be safe and minimally invasive while delivering good aesthetic results and allowing for the treatment of associated lesions. Furthermore, the technique could benefit from more advanced retention devices, which ought to reduce or avoid migration of the flip buttons.

  8. Fixation of an osteochondral fragment after acute patellar dislocation in an immature skeleton,

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    Rodrigo Pires e Albuquerque

    2014-04-01

    Full Text Available Fixation of an osteochondral fracture after acute patellar dislocation is an infrequent form of treatment. Likewise, the location of this fragment in the lateral region of the lateral femoral condyle, functioning as a free body, is uncommon. The aim of this study was to present a case of osteochondral fracture of the patella at an unusual site, along with the therapy used and the clinical follow-up.

  9. Acute limb ischemia following closed reduction of a hip arthroplasty dislocation.

    Science.gov (United States)

    Marsh, Jonathan P; Turgeon, Thomas; Guzman, Randolph

    2010-10-11

    Hip dislocation is a well-described complication of total hip arthroplasty (THA) and dislocation rates are substantially higher following revision hip arthroplasty. Vascular complications following closed reduction of hip dislocations are exceedingly rare, but a high index of suspicion is essential for patients with underlying vascular abnormalities. Popliteal artery aneurysms are the most common peripheral arterial aneurysms with a prevalence of 1% and they should be suspected in patients with prominent popliteal pulses. This article presents a case of an 84-year-old man with a revision total THA who sustained a posterior hip dislocation. The hip was reduced under conscious sedation using the Bigelow technique. The leg was distally neurovascularly intact based on the clinical exam immediately before and after the reduction. Over the next few hours, the foot became progressively ischemic and an urgent computed tomography angiogram revealed bilateral popliteal artery aneurysms with acute thrombosis of the aneurysm on the affected limb. The patient underwent emergent femoral popliteal bypass using a Dacron supported interpositional graft. The majority of the foot was salvaged but the toes eventually became necrotic. Direct compression of the aneurysm during reduction of the hip dislocation in conjunction with transiently decreased blood pressure from conscious sedation likely resulted in a low flow state within the artery leading to thrombosis of the aneurysm. To our knowledge, this is the first reported case of such an event. This case emphasizes the need for a high index of suspicion for vascular injuries following manipulation of limbs with underlying arterial aneurysms. Reduction maneuvers for hip dislocations should be modified to minimize compression of the popliteal fossa in limbs with vascular abnormalities. Serial postreduction neurovascular exams are essential for identification and prompt management of vascular complications. Copyright 2010, SLACK

  10. Vascular graft employment in the surgical treatment of acute and chronic acromio-clavicular dislocation.

    Science.gov (United States)

    Vitali, Matteo; Pedretti, Alberto; Naim Rodriguez, Nadim; Franceschi, Alessandro; Fraschini, Gianfranco

    2015-10-01

    To show the efficiency and safety of a surgical treatment in both acute and chronic acromio-clavicular junction (ACJ) dislocations. Retrospective. Department of Orthopedics and Traumatology at IRCCS San Raffaele Hospital. This study was performed on 37 subjects classified as Rockwood grade III-V or Tossy III ACJ dislocation. The surgical treatment was carried out by placing a vascular graft (GorePropaten(®)) between the tip of the coracoid process and the mid-lateral side of the clavicle with two temporary percutaneous K-wires positioned in a parallel manner in the AC ligament through the acromion and clavicle for 30 days to improve stability. Outcomes were assessed using the Constant Shoulder (CS) score, DASH score, subjective satisfaction, and stability of AC joint at 24 months. UCLA scores taken preoperatively and at 15-month follow-up were used to perform statistical analysis significance using a control group treated conservatively. Postoperative X-rays were examined to assess joint stability after 24 months. Preoperative CS score was 51 ± 12 in the acute group and 55 ± 15 in the chronic group. Follow-up mean CS score was 88 ± 11 in the acute group and 82 ± 20 in the chronic group at 24 months. Preoperative DASH score was 19 ± 3 in the acute group and 14 ± 5 in the chronic group. Mean DASH score was 3.60 ± 7 in the acute group and 6.42 ± 6 in the chronic group. Preoperative UCLA scores were 14.6 ± 2 and 15 ± 7 in the acute group and chronic group, respectively. At 15-month follow-up, UCLA scores of 28.1 ± 1.9 and 27.7 ± 1 in the acute and chronic group, respectively, showed a significant improvement (p partial re-dislocation at the 24-month X-ray follow-up. No infections, either deep or superficial, or nerve palsies were reported. Given the results obtained during the study and the response of the patients in both acute and chronic groups, the authors found that the employment of a vascular graft combined with temporary percutaneous K-wires is

  11. Displacing lateral meniscus masquerading as patella dislocation.

    Science.gov (United States)

    Arendt, Elizabeth A; Fontboté, Cristián A; Rohr, Sara R

    2014-10-01

    To alert the treating clinician to an uncommon knee meniscal condition that often masquerades as a more common patella condition. Retrospective chart review of a series of cases was undertaken. A series of 12 knees in 11 patients were referred to an orthopaedic surgeon with a diagnosis of recurrent lateral patella dislocation. Three knees had undergone patella realignment surgery with continuance of symptoms. Eight patients had prior magnetic resonance images read as no meniscal pathology and no acute patella/patella retinacular injury. All patients presented for a consult with a similar history. Under anaesthesia, all knees had a stable patella as judged by physical examination. At the time of surgery, six patients had a frank tear in the lateral meniscus, all of which were readily displaceable. Six knees showed a displaceable lateral meniscus with attenuation but not a visible frank tear. Ten menisci were treated with repair, and two knees underwent partial lateral meniscectomies. Patient follow-up of minimally 18 months revealed no further episodes of "knee-cap dislocation" or symptoms of catching and locking. The clinician treating a patient with a history of a knee locking in flexion should have a high index of suspicion for a lateral meniscus tear or an unstable hypermobile lateral meniscus, despite patient report of perceived patella movement. History of symptoms occurring in knee flexion and attention to patella physical examination should be key factors in this diagnostic conundrum. Retrospective chart review, Level IV.

  12. Hemi-hamate autograft arthroplasty for acute and chronic PIP joint fracture dislocations.

    Science.gov (United States)

    Lindenblatt, N; Biraima, A; Tami, I; Giovanoli, P; Calcagni, M

    2013-02-01

    Treatment of fracture dislocations of the PIP joint represents a hand surgical challenge. In hemi-hamate arthroplasty, the palmar joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. We performed hemi-hamate reconstructions in 10 patients (mean age 34.9 years), who sustained fractures of the base of the middle phalanx of ≥50% surface and dorsal PIP dislocations. Outcomes were assessed by clinical exam and X-ray. Evaluation criteria were range of motion of PIP and DIP joints, grip strength, joint alignment, complications and donor site morbidity. Mean follow-up was 8.6 months (range 3-14). Fractures mostly involved the 4th and 5th fingers, all patients were male. Indications were subluxation and comminuition in acute cases of dislocations. It restores the comminuted articular surface in chronic injuries and in the acute injury it is a challenging but valuable alternative to extension block splinting. However, donor site morbidity and revision surgery have to be taken into account. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Pitch-side management of acute shoulder dislocations: a conceptual review

    Science.gov (United States)

    Shah, Rohi; Chhaniyara, Puja; Wallace, W Angus; Hodgson, Lisa

    2016-01-01

    The shoulder, specifically the glenohumeral joint, by virtue of its anatomical characteristics and biomechanics confers a large range of movement, which ultimately results in a joint that is inherently prone to becoming unstable. The incidence of acute traumatic shoulder dislocation varies within the sporting environment, commonly occurring following direct trauma. Anterior dislocations account for nearly 90% of all dislocations. While most are referred and managed in the emergency department, pitch-side relocation by experienced clinicians does occur prior to referral. The aim of this study was to delineate a guideline specifically for the pitch-side management of this common injury. A literature search of PubMed and Medline using the keywords ‘prehospital’, ‘pitch-side’, ‘shoulder dislocation’ and ‘reduction’ or ‘relocation technique’ was performed, and the available literature was reviewed and collated. Articles focusing on reduction techniques were then reviewed, with particular consideration on their applicability to a pitch-side setting. While studies exist that compare and contrast examination and reduction techniques, most are based in a hospital setting. To date, there is no standardised management protocol published for the initial management of an anterior dislocated shoulder in a pitch-side setting. This article addresses this discrepancy and proposes a structured, algorithmic approach to the pitch-side management of a shoulder dislocation. The article addresses factors to consider in a pitch-side setting, suitable techniques and postreduction care. While a systematic approach has been delineated in this article, we recommend those pitch-side medical practitioners who provide this form of support should have attended appropriate training and ensure adequate malpractice cover. PMID:28879022

  14. Multicenter Randomized Clinical Trial of Nonoperative Versus Operative Treatment of Acute Acromio-Clavicular Joint Dislocation.

    Science.gov (United States)

    2015-11-01

    To perform a randomized clinical trial of operative versus nonoperative treatment of acute acromio-clavicular (AC) joint dislocations using modern surgical fixation and both patient-based and surgeon-based outcome measures to determine which treatment method was superior. Prospective, randomized. Multicenter. Eight-three patients with acute (dislocations of the AC joint. Patients were randomized to operative repair with hook plate fixation versus nonoperative treatment (operative repair, 40; nonoperative treatment, 43). Disabilities of the Arm, Shoulder and Hand (DASH) score at 1 year after injury. Assessment also included a complete clinical assessment, evaluation of the constant score, and a radiographic evaluation at 6 weeks, and at 3, 6, 12, and 24 months. There were no demographic differences between the 2 groups, and the mechanisms of injury were similar between the 2 groups. The DASH scores (a disability score, lower score is better) were significantly better in the nonoperative group at 6 weeks (operative, 45; nonoperative, 31; P = 0.014) and 3 months (operative, 29; nonoperative, 16; P = 0.005). There were no significant differences between the groups at 6 months (operative, 14; nonoperative, 12; P = 0.442), 1 year (operative, 9; nonoperative, 9; P = 0.997), or 2 years (operative, 5; nonoperative, 6; P = 0.439) after injury. Constant scores were similar (better scores in the nonoperative group at 6 weeks, 3 months, and 6 months; P = 0.0001; and no difference thereafter). Although radiographic results were better in the operative group, the reoperation rate was significantly lower in the nonoperative group (P dislocations of the AC joint. The nonoperative group had better early scores, although both groups improved from a significant level of initial disability to a good or excellent result (mean DASH score, 5-6; mean constant score, 91-95) at 2 years. At present, there is no clear evidence that operative treatment with the currently available hook plate

  15. Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V.

    Science.gov (United States)

    Tischer, Thomas; Salzmann, Gian Max; El-Azab, Hosam; Vogt, Stephan; Imhoff, Andreas B

    2009-01-01

    Traumatic acromioclavicular (AC) joint dislocations are common injuries among the active population. The injury mechanism requires excessive force delivered by a fall or blow to the shoulder. Associated injuries may occur and remain undetected if they are masked by the painful and prominent AC joint injury. Intra-articular injuries associated with high-grade AC joint dislocations are common. Case series; Level of evidence, 4. Between 2002 and 2007, 77 patients (68 male, 9 female; average age, 35.5 years; range, 17-62 years) were surgically treated for acute AC joint dislocations (Rockwood type III, 5; type IV, 30; and type V, 42). All patients underwent diagnostic glenohumeral joint arthroscopy. Concomitant intra-articular injuries were identified and treated. Intra-articular injuries were found in 14 of 77 patients (18.2%). Superior labral anterior posterior (SLAP) lesions were observed in 11 of 77 patients 14.3% (SLAP I, 3; II, 2; III, 3; and IV, 3). Nineteen percent of Rockwood V lesions had associated SLAP lesions (SLAP I excluded), whereas only 3.4% of Rockwood IV lesions showed SLAP lesions. A complete supraspinatus tear was detected in 1 case, and partial articular-sided supraspinatus tears were detected in 2 cases. Four patients sustained an accompanying fracture. Concomitant injuries to the shoulder girdle obtained during traumatic AC joint separation may be more frequent than previously thought. Clinical diagnosis may be difficult in the setting of an acute and painful dislocated AC joint. Shoulder arthroscopy during arthroscopic AC joint stabilization may aid in detecting associated injuries.

  16. Dynamic radiologic evaluation of horizontal instability in acute acromioclavicular joint dislocations.

    Science.gov (United States)

    Tauber, Mark; Koller, Heiko; Hitzl, Wolfgang; Resch, Herbert

    2010-06-01

    Biplane radiologic evaluation is indispensable for the correct diagnosis of acute acromioclavicular (AC) joint injuries. Thus far, no functional radiographic techniques have been quantified to evaluate horizontal instability in acute AC joint dislocations. Supine dynamic axillary lateral shoulder views detect horizontal instability of the distal clavicle in patients with acute AC joint dislocations. Cohort study (Diagnosis); Level of evidence, 2. Twenty-five consecutive patients with a mean age of 39 +/- 14 years with acute AC joint injury underwent biplane radiologic evaluation, including a conventional Zanca view and an axillary lateral view in a sitting position. In addition, supine axillary lateral views with the arm in 90 degrees of abduction and 60 degrees of flexion and extension were taken to evaluate the horizontal dynamics of the distal clavicle. The gleno-acromio-clavicular angle (GACA) was introduced and used to quantify the horizontal clavicular dynamics in terms of angle differences. The unaffected shoulders served as the control group. Superior dislocation of the lateral clavicle in the Zanca view was classified as Rockwood type II in 7 patients, type III in 15, and type V in 3. The axillary lateral view in a sitting position showed posterior dislocation of the distal clavicle in 8 patients (Rockwood type IV injury). Dynamic radiologic evaluation revealed an average GACA difference between the neutral and anterior position of the arm of 7.1 degrees +/- 5.5 degrees for the unaffected shoulder. In the injured AC joints, 11 patients showed no radiologic evidence of horizontal instability (group A) with a GACA difference of 7.1 degrees +/- 4.8 degrees . Increased anteroposterior translation was evident in 14 patients (group B) with a GACA difference of 30.3 degrees +/- 14.3 degrees (P < .001). Functional axillary radiologic evaluation seems to represent a simple imaging tool to reveal dynamic horizontal instability. Horizontal instability of the distal

  17. Congenital dislocation of the knee at birth - Part 2: Impact of a new classification on treatment strategies, results and prognostic factors.

    Science.gov (United States)

    Rampal, V; Mehrafshan, M; Ramanoudjame, M; Seringe, R; Glorion, C; Wicart, P

    2016-09-01

    An original classification of congenital dislocation of the knee (CDK) was drawn up, based on neonatal semiology. The objective of the present study was to assess impact on treatment decision-making and prognosis. Fifty-one CDKs in 40 patients were classified neonatally into 3 types: I, reducible (n=28); II, recalcitrant (n=16); and III, irreducible (n=7). Number of anterior skin grooves, range of motion (RoM), flexion deficit and reduction stability were recorded. Depending on reducibility, treatment comprised: physiotherapy with splints, traction with cast immobilization, or surgery. At follow-up, knees were assessed in terms of RoM and stability. Mean age at first consultation was 5.6 days (range: 0-30). Mean age at follow-up was 9 years (range: 1-26). Physiotherapy with splinting achieved stable reduction in all type-I knees. Five type-II knees (31%) required traction, none of which needed surgery. Four type-III knees (57%) required surgery. Outcome was good or excellent in 82% of type-I knees, good in 68% of type II and poor in all type-III knees. The study confirmed the relevance of the present neonatal classification to treatment, with increasing rates of surgical indication and decreasing rates of satisfactory outcome from types I to III. Therapeutic attitude can be graded according to severity of CDK. IV, single-center retrospective series. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. MRI for the initial evaluation of acute wrist, knee, and ankle trauma

    NARCIS (Netherlands)

    J.J. Nikken (Jeroen)

    2003-01-01

    textabstractIn this thesis we study the application of MRI in acute trauma of wrist, knee, and ankle, evaluating its potentials, its effects, and its costs. Our aim was to use MRI in all patients with acute trauma of wrist, knee, and ankle, without increasing the overall costs to society,

  19. Magnetic resonance imaging findings in acute elbow dislocation: insight into mechanism.

    Science.gov (United States)

    Schreiber, Joseph J; Potter, Hollis G; Warren, Russell F; Hotchkiss, Robert N; Daluiski, Aaron

    2014-02-01

    To identify with magnetic resonance imaging the location and severity of ligamentous injury after acute elbow dislocations. Based on observations that many elbow dislocations arise from an initial acute valgus load, we hypothesized that all patients would have a high-grade medial injury but not all would demonstrate injury of the lateral ligaments. The medial collateral ligament was subdivided into anterior bands of the anterior bundle of the medial collateral ligament (MCL) and posterior bands of the anterior bundle of the MCL, whereas the lateral collateral ligament was divided into the lateral ulnar collateral ligament and the radial collateral ligament. Distinction on magnetic resonance imaging was made between normal morphology and low-grade partial tear (partial tear (≥ 50%), and full-thickness disruption. The site of disruption was also characterized. Acute magnetic resonance imaging studies for 16 patients were included. No low-grade tears or intact evaluations of either the anterior or posterior bands of the anterior bundle of the MCL were observed; most demonstrated complete tears. The lateral ulnar collateral ligament most frequently showed complete disruption but was occasionally intact. The radial collateral ligament infrequently showed full disruption. Complete tears involving either the anterior or posterior portions of the anterior band of the MCL were significantly more common than complete tears involving the ligaments on the lateral side. After elbow dislocation, complete ligamentous tears were more common on the medial versus the lateral side. Whereas the lateral ligaments were occasionally preserved, this was never observed on the medial side. These data suggest a sequence of failure starting on the medial side with subsequent variable energy dissipation laterally. Diagnostic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. Transarticular plating for acute posterior sternoclavicular joint dislocations: a valid treatment option?

    Science.gov (United States)

    Quispe, Juan C; Herbert, Benoit; Chadayammuri, Vivek P; Kim, Ji Wan; Hao, Jiandong; Hake, Mark; Hak, David J; Stahel, Philip F; Mauffrey, Cyril

    2016-07-01

    Restoration of the sternoclavicular joint after posterior dislocation is important for upper limb function. The proximity of neuro-vascular mediastinal structures makes open reduction and internal fixation (ORIF) a high-risk procedure. The ideal treatment strategy is still debated. Our aim is to review the treatment of acute posterior sternoclavicular joint dislocation with a locking compression plate. We present our experience of transarticular plating using a locking compression plate for the treatment of three consecutive patients with posterior sternoclavicular dislocation (SCD). Our primary outcome measure was objective functional outcome using DASH (disability of the arm, shoulder and hand) and PROMIS (patient-reported outcomes measurement information system) questionnaires. All patients had a minimum follow-up of six months, and serial radiographs were reviewed to evaluate maintenance of reduction. All three patients presented a posterior SCD with instability refractory to closed reduction. In all three patients, we opted for surgical management using open reduction and fixation with a locking compression plate and allowed early mobilization at two weeks postoperatively. No complications were encountered during follow-up. Good functional outcomes were evidenced by DASH scores of 7.5, 20 and 30, and PROMIS scores were 53.8, 53.8 and 38.1 in each patient, respectively. Our experience of transarticular plating using a locking compression plate for posterior SCD is positive, as it allows early mobilization and resulted in good functional outcomes.

  1. Percutaneous double-button fixation method for treatment of acute type III acromioclavicular joint dislocation.

    Science.gov (United States)

    Acar, Mehmet Ali; Güleç, Ali; Erkoçak, Ömer Faruk; Yılmaz, Güney; Durgut, Fatih; Elmadağ, Mehmet

    2015-01-01

    The aim of this study was to evaluate the functional and radiological results of patients treated with the percutaneous double-button technique for acute acromioclavicular (AC) joint dislocation. A retrospective evaluation was performed of 13 patients surgically treated for acute Type III AC joint dislocation with the percutaneous double-button fixation method. The coracoclavicular (CC) distance of the affected side was compared with that of the healthy side on anterior-posterior radiographs obtained at the final follow-up. In the functional evaluation, Disabilities of the Arm, Shoulder and Hand (DASH), Constant, and visual analog scale (VAS) scores were used. The 13 patients in the study included 12 males and 1 female with a mean age of 43.4 years (range: 22-60 years). The mean follow-up period was 13.61 months (range: 9-24 months). The mean CC distance on the operated side was 9.23 mm (range: 8-15 mm), and when compared with the healthy side, no statistically significant difference was observed. Preoperative Constant scores of a mean of 30.3 (range: 18-42) increased to 84.4 (range: 70-90) at the final follow-up. Preoperative DASH scores had a mean of 14.1 (range: 11-28) and decreased to 0.4 (range: 0-3) at the final follow-up (pdislocations.

  2. A Two-stage procedure for the treatment of a neglected posterolateral knee dislocation: Gradual reduction with an Ilizarov external fixator followed by arthroscopic anterior and posterior cruciate ligament reconstruction.

    Science.gov (United States)

    Polyzois, Vasilios D; Stathopoulos, Ioannis P; Benetos, Ioannis S; Pneumaticos, Spyros G

    2016-01-01

    Neglected knee dislocations are extremely uncommon and their management cannot be evidence-based since only a few case reports have been published describing different treatment methods. We present the case of a young man with a neglected posterolateral knee dislocation and a concomitant sciatic nerve injury. A two-stage treatment strategy with gradual reduction using the Ilizarov technique and subsequent arthroscopic anterior and posterior cruciate ligament reconstruction was followed. The two-stage treatment approach led to a satisfactory clinical outcome. At the latest follow-up evaluation the patient was fully ambulatory and the knee was painless with no anteroposterior instability. In neglected knee dislocations treatment optios are guided by the severity of the concomitant injuries and the status of articulating surfaces. Gradual reduction with the Ilizarov technique and subsequent arthroscopic ligamentous reconstruction is a reliable alternative to open surgical procedures. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Habitual dislocation of patella: A review

    Science.gov (United States)

    Batra, Sumit; Arora, Sumit

    2014-01-01

    Habitual dislocation of patella is a condition where the patella dislocates whenever the knee is flexed and spontaneously relocates with extension of the knee. It is also termed as obligatory dislocation as the patella dislocates completely with each flexion and extension cycle of the knee and the patient has no control over the patella dislocating as he or she moves the knee1. It usually presents after the child starts to walk, and is often well tolerated in children, if it is not painful. However it may present in childhood with dysfunction and instability. Very little literature is available on habitual dislocation of patella as most of the studies have combined cases of recurrent dislocation with habitual dislocation. Many different surgical techniques have been described in the literature for the treatment of habitual dislocation of patella. No single procedure is fully effective in the surgical treatment of habitual dislocation of patella and a combination of procedures is recommended. PMID:25983506

  4. Operative Versus Nonoperative Management of Acute High-Grade Acromioclavicular Dislocations: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Chang, Nicholas; Furey, Andrew; Kurdin, Anton

    2018-01-01

    Management of high-grade acromioclavicular (AC) joint dislocations has been controversial. Recent studies suggest no difference in outcomes between operative and nonoperative management of Rockwood types III-V injuries. The objective of this meta-analysis is to compare outcomes between operative and nonoperative management of high-grade AC joint dislocations. Search was conducted using PubMed, Embase, and Cochrane databases through October 2016. A broad search strategy was used to identify English, comparative studies of AC joint dislocations. Inclusion criteria included comparative studies of AC joint dislocations in adult patients with acute, high-grade AC dislocations. Two authors independently reviewed and assessed for bias according to the U.S. Preventative Task Force Quality Rating Criteria. Data were extracted for validated functional scores, clinical and radiographic outcomes, and complications. Nineteen studies (n = 954) were included in the meta-analysis. Operative group had better cosmetic outcome (odds ratio [OR] = 0.05; P dislocations. Patients in the nonoperative cohort had a more rapid return to work, but were associated with a poorer cosmetic outcome. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  5. Demographic and Psychosocial Predictors of Acute Perioperative Pain for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Maya L Roth

    2007-01-01

    Full Text Available BACKGROUND: As the North American population ages, the prevalence of knee osteoarthritis and the surgical interventions (ie, total knee arthroplasty [TKA] aimed at correcting pain and disability will also rise proportionally. Therefore, efforts to better understand the factors associated with surgical outcomes are warranted. To date, no studies have examined the impact of psychosocial factors on acute postoperative TKA pain.

  6. Hemarthrosis of the knees following streptokinase therapy for acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Pimenta Eduardo

    2003-01-01

    Full Text Available A sixty-four-year-old male patient was studied who had acute coronary syndrome with ST segment elevation experienced bilateral hemarthrosis of the knees after administration of streptokinase and acetylsalicylic acid.

  7. Traction bow for acute reduction of fracture and/or dislocation of the thoracic or thoracolumbar spine.

    Science.gov (United States)

    Wang, G J; Eschenroeder, H C; Redler, M R; Stamp, W G

    1988-01-01

    Treatment of acute fractures and/or fracture dislocations of the thoracic or thoracolumbar spine has traditionally involved bedrest or the use of traction devices with external hanging weights, until surgical correction can be accomplished. A fiberglass tubular traction bow with continuous adjustable elastic tension has been designed for the application of skeletal traction. When used to treat thoracic or thoracolumbar fractures and/or dislocations, it can maintain distraction forces in an uninterrupted fashion. Ten patients with acute fractures and/or dislocations of the thoracic or thoracolumbar spine were treated with this traction bow. All of the spinal deformities showed dramatic improvement within the first 3 h of treatment. The patients all showed immediate lessening of acute severe pain, and those with incomplete neurologic loss showed improvement of their neurologic function. The patients all tolerated the device well and were able to undergo radiologic examination and, ultimately, spinal fusion while they were stabilized in the traction bow. We believe this device is especially valuable for immediate reduction of spine and care of patients with fractures or fracture dislocations of the thoracolumbar spine.

  8. Popliteal artery injury following traumatic knee joint dislocation in a 14-year-old boy: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Cvetković Slobodan

    2014-01-01

    Full Text Available Introduction. Posterior knee joint dislocation associated with injury of the popliteal artery in children is an extremely rare condition. Rapid diagnosis and treatment are essential for limb salvage and function. Case report. We reported a 14-year-old boy who suffered traumatic displacement of the right knee and contusion of the popliteal artery during motorcycle accident. The diagnosis was confirmed using Doppler and duplex ultrasonography and digital substraction transfemoral arteriography. The urgent surgical procedure was performed using posterior approach to the popliteal artery. During the surgical exploration, rupture of the posterior cruciate ligament associated with thrombosed popliteal artery have been found. The damaged popliteal artery was resected and replaced with autologous saphenous vein graft. The last stage of the procedure was a transosseous femoral fixation of posterior circuate ligament. A 3-year-follow-up after the surgery demonstrated intact arterial perfusion and very good function of the knee with a minimal difference as compared with the contralateral knee. Conclusion. Combined orthopedic and vascular injuries are very rare in children. They require combined treatment. [Projekat Ministarstva nauke Republike Srbije, br. 175008

  9. Open Compared with Arthroscopic Treatment of Acute Septic Arthritis of the Native Knee.

    Science.gov (United States)

    Johns, Brenton P; Loewenthal, Mark R; Dewar, David C

    2017-03-15

    Acute native knee septic arthritis is a joint-threatening emergency. Operative treatments by open or arthroscopic methods are available to surgeons. To our knowledge, the literature to date has primarily consisted of case series and no large study has yet compared these methods. The aim of this study was to compare open and arthroscopic treatment for acute native knee septic arthritis. All adult patients with acute native knee septic arthritis treated at our institution with either open or arthroscopic irrigation from 2000 to 2015 were retrospectively evaluated. The clinical findings, laboratory evidence, arthrocentesis and microbiology results, knee radiographs, and outcomes were compared. There were 161 patients (166 knees) with acute native knee septic arthritis treated between 2000 and 2015. Initially, 123 knees were treated by arthroscopic irrigation and 43 knees were treated by open irrigation; however, 71% in the open treatment group required repeat irrigation compared with 50% in the arthroscopic treatment group. The superiority of an arthroscopic procedure persisted after adjustment for potential confounders by multivariable analysis, with an odds ratio of 2.56 (95% confidence interval, 1.1 to 5.9; p = 0.027). After 3 irrigation procedures, the cumulative success rate was 97% in the arthroscopic treatment group and 83% in the open treatment group (p = 0.011). The total number of irrigation procedures required was fewer in the arthroscopic treatment group (p = 0.010). In the arthroscopic treatment group, the mean postoperative range of motion was greater (p = 0.016) and there was a trend toward a shorter median length of stay (p = 0.088). Arthroscopic treatment for acute native knee septic arthritis was a more successful index procedure and required fewer total irrigation procedures compared with open treatment. Long-term postoperative range of motion was significantly greater following arthroscopic treatment. Therapeutic Level III. See Instructions for

  10. Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation.

    Science.gov (United States)

    Shin, Sang-Jin; Kim, Nam-Ki

    2015-05-01

    The purpose of this study was to evaluate clinical and radiological outcomes after arthroscopically assisted coracoclavicular (CC) fixation using a single adjustable-loop-length suspensory fixation device for acute acromioclavicular dislocation and to report intraoperative and postoperative complications. Eighteen consecutive patients with acute acromioclavicular dislocation underwent arthroscopically assisted CC fixation using a single TightRope (Arthrex, Naples, FL). Using the Rockwood classification, 3 patients had grade III dislocations, one patient had a grade IV dislocation, and 14 patients had grade V dislocations. The preoperative CC distance of the injured shoulder was 16.1 ± 2.7 mm (range, 11.2 to 21.0 mm), and it increased by 99% ± 36% (range, 17% to 153%) on average compared with the contralateral shoulder. The average CC distance was 10.5 ± 2.5 mm (range, 7.7 to 15.5 mm), and it increased by 30% ± 30% (range, -9.4% to 90%) at the final follow-up. Compared with immediate postoperative radiographs, the CC distance was maintained in 12 patients, increased between 50% and 100% in 4 patients, and increased more than 100% in 2 patients at final follow-up. However, there was no statistical difference in Constant scores between 6 patients with reduction loss (95.6 ± 4.5) and 12 patients with reduction maintenance (98.4 ± 2.5; P = .17). Perioperative complications occurred in 8 patients, including one case of acromioclavicular arthritis, one case of delayed distal clavicular fracture at the clavicular hole of the device, 3 cases of clavicular or coracoid button failures, and 3 cases of clavicular bony erosion. Satisfactory clinical outcomes were obtained after CC fixation using the single adjustable-loop-length suspensory fixation device for acute acromioclavicular joint dislocation. However, CC fixation failure of greater than 50% of the unaffected side in radiological examinations occurred in 33% of the patients within 3 months after the operation

  11. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months

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    Paakkala, Antti; Paakkala, Timo [Tampere University Hospital, Department of Radiology, Tampere (Finland); Sillanpaeae, Petri; Maeenpaeae, Heikki [Tampere University Hospital, Department of Orthopaedics and Traumatology, Tampere (Finland); Huhtala, Heini [University of Tampere, School of Public Health, Tampere (Finland)

    2010-07-15

    The aim of the study was to assess volumetric analysis of bone bruises in acute primary traumatic patellar dislocation by magnetic resonance imaging (MRI) and resolving resolution of bruises in follow-up MRI. MRI was performed in 23 cases. A follow-up examination was done at a mean of 12 months after dislocation. Volumes of patellar and femur bruises for every patient were evaluated separately by two musculoskeletal radiologists, and mean values of the bruises were assessed. Other MRI findings were evaluated, together with agreement by consensus. Bone bruise volumes were compared with other MR findings. In the acute study 100% of patients showed bruising of the lateral femoral condyle and 96% bruising of the patella. The bruise was located at the medial femoral condyle in 30% and at the patellar median ridge in 74% of patients. The median volume of the femoral bruise was 25,831 mm{sup 3} and of the patellar bruise 2,832 mm{sup 3}. At the follow-up study 22% of patients showed bruising of the lateral femoral condyle and 39% bruising of the patella, the median volumes of the bruises being 5,062 mm{sup 3} and 1,380 mm{sup 3}, respectively. Larger patellar bruise volume correlated with larger femur bruise volume in the acute (r=0.389, P=0.074) and the follow-up (r=1.000, P<0.01) studies. Other MRI findings did not correlate significantly with bone bruise volumes. Bone bruising is the commonest finding in cases of acute patellar dislocation, being seen even 1 year after trauma and indicating significant bone trabecular injury in the patellofemoral joint. A large bruise volume may be associated with subsequent chondral lesion progression at the patella. We concluded that the measurement of bone bruise volume in patients with acute patellar dislocation is a reproducible method but requires further studies to evaluate its clinical use. (orig.)

  12. Epidemiological survey of orthopedic joint dislocations based on nationwide insurance data in Taiwan, 2000-2005.

    Science.gov (United States)

    Yang, Nan-Ping; Chen, Hou-Chaung; Phan, Dinh-Van; Yu, I-Liang; Lee, Yi-Hui; Chan, Chien-Lung; Chou, Pesus; Renn, Jenn-Huei

    2011-11-05

    The epidemiology of acute orthopedic dislocations is poorly understood. A nationwide database provides a valuable resource for examining this issue in the Taiwanese population. A 6-year retrospective cohort study of 1,000,000 randomly-sampled beneficiaries from the year 2005 was used as the original population. Based on the hospitalized and ambulatory data, the concomitant ICD9-CM diagnosis codes and treatment codes were evaluated and classified into 8 and 3 major categories, respectively. The cases matching both inclusive criteria of dislocation-related diagnosis codes and treatment codes were defined as incident cases. During 2000-2005, the estimated annual incidence (per 100,000 population) of total orthopedic dislocations in Taiwan was 42.1 (95%CI: 38.1-46.1). The major cause of these orthopedic dislocations was traffic accidents (57.4%), followed by accident falls (27.5%). The annual incidence dislocation by location was shoulder, 15.3; elbow, 7.7; wrist, 3.5; finger, 4.6; hip, 5.2; knee, 1.4; ankle, 2.0; and foot, 2.4. Approximately 16% of shoulder dislocations occurred with other concomitant fractures, compared with 17%, 53%, 16%, 76% and 52%, respectively, of dislocated elbow, wrist, hip, knee, and ankle cases. Including both simple and complex dislocated cases, the mean medical cost was US$612 for treatment of a shoulder dislocation, $504 for the elbow, $1,232 for the wrist, $1,103 for the hip, $1,888 for the knee, and $1,248 for the ankle. In Taiwan, three-quarters of all orthopedic dislocations were of the upper limbs. The most common complex fracture-dislocation was of the knee, followed by the wrist and the ankle. Those usually needed a treatment combined with open reduction of fractures and resulted in a higher direct medical expenditure.

  13. The acutely ACL injured knee assessed by MRI

    DEFF Research Database (Denmark)

    Frobell, R B; Roos, H P; Roos, E M

    2008-01-01

    depression fractures, meniscal injuries and patient characteristics. METHODS: One hundred and twenty-one subjects (26% women, mean age 26 years) with an ACL rupture to a previously un-injured knee were studied using a 1.5T MR imager within 3 weeks from trauma. Meniscal injuries and fractures were classified...... by type, size and location. BML location and volume were quantified using a multi-spectral image data set analyzed by computer software, edited by an expert radiologist. RESULTS: Fractures were found in 73 (60%) knees. In 67 (92%) of these knees at least one cortical depression fracture was found. Uni......-compartmental meniscal tears were found in 44 (36%) subjects and bi-compartmental in 24 (20%). One hundred and nineteen (98%) knees had at least one BML, all but four (97%) located in the lateral compartment. Knees with a cortical depression fracture had larger BML volumes (P

  14. Dislocated Shoulder

    Science.gov (United States)

    ... and be prone to repeat dislocations. Symptoms Shoulder dislocation Shoulder dislocation A dislocation is an injury to your joint in which ... their normal positions. One common site for a dislocation is your shoulder, which is a ball-and- ...

  15. Inter- and intraobserver reliability of the Rockwood classification in acute acromioclavicular joint dislocations.

    Science.gov (United States)

    Schneider, M M; Balke, M; Koenen, P; Fröhlich, M; Wafaisade, A; Bouillon, B; Banerjee, M

    2016-07-01

    The reliability of the Rockwood classification, the gold standard for acute acromioclavicular (AC) joint separations, has not yet been tested. The purpose of this study was to investigate the reliability of visual and measured AC joint lesion grades according to the Rockwood classification. Four investigators (two shoulder specialists and two second-year residents) examined radiographs (bilateral panoramic stress and axial views) in 58 patients and graded the injury according to the Rockwood classification using the following sequence: (1) visual classification of the AC joint lesion, (2) digital measurement of the coracoclavicular distance (CCD) and the horizontal dislocation (HD) with Osirix Dicom Viewer (Pixmeo, Switzerland), (3) classification of the AC joint lesion according to the measurements and (4) repetition of (1) and (2) after repeated anonymization by an independent physician. Visual and measured Rockwood grades as well as the CCD and HD of every patient were documented, and a CC index was calculated (CCD injured/CCD healthy). All records were then used to evaluate intra- and interobserver reliability. The disagreement between visual and measured diagnosis ranged from 6.9 to 27.6 %. Interobserver reliability for visual diagnosis was good (0.72-0.74) and excellent (0.85-0.93) for measured Rockwood grades. Intraobserver reliability was good to excellent (0.67-0.93) for visual diagnosis and excellent for measured diagnosis (0.90-0.97). The correlations between measurements of the axial view varied from 0.68 to 0.98 (good to excellent) for interobserver reliability and from 0.90 to 0.97 (excellent) for intraobserver reliability. Bilateral panoramic stress and axial radiographs are reliable examinations for grading AC joint injuries according to Rockwood's classification. Clinicians of all experience levels can precisely classify AC joint lesions according to the Rockwood classification. We recommend to grade acute ACG lesions by performing a digital

  16. Total hip arthroplasty for acute displaced femoral neck fractures via the posterior approach: a protocol to minimise hip dislocation risk.

    Science.gov (United States)

    Ricci, William M; Langer, Jakub S; Leduc, Stéphane; Streubel, Philipp N; Borrelli, Joseph

    2011-01-01

    Total hip arthroplasty (THA) is considered superior to hip hemiarthroplasty (HHA) in long term pain relief and functional outcome after femoral neck fracture; high early dislocation rates may however negate these advantages. This study elucidates whether a protocol of careful patient selection, surgical technique algorithm and use of modern implants could yield low dislocation rates in hip fracture patients treated with THA via the posterior approach. Over a seven year period all patients admitted to our institution that were cognitively lucid, independent ambulators and without Parkinson's disease underwent THA for acute displaced femoral neck fractures using a posterior approach, large femoral heads, elevated acetabular liners and a surgical technique algorithm. Twenty-nine THAs were performed in 26 patients (mean age of 71 years, range 50-87 years) and were followed for a mean of 32 months (range 13-48 months). There was one dislocation 7 weeks postoperatively in a non-compliant patient resulting in reoperation. There were no other reoperations or major complications. Our results indicate that low dislocation rates can be accomplished for displaced femoral neck fractures treated with THA via the posterior approach using a protocol that includes careful patient selection, surgical technique focused on intraoperative stability, and the use of modern implants.

  17. Modified Phemister procedure for the surgical treatment of Rockwood types III, IV, V acute acromioclavicular joint dislocation.

    Science.gov (United States)

    Verdano, M A; Pellegrini, A; Zanelli, M; Paterlini, M; Ceccarelli, F

    2012-12-01

    Acromioclavicular (AC) joint dislocations are common in young, active patients. In case of surgical indications, Rockwood type IV, type V and selected type III dislocation, we use modified Phemister procedure. At mid-term follow-up, by an average of 35.1 months, we reassessed the records of 14 patients surgically treated for acute AC dislocation from February 2007 to November 2010. In patients with a diagnosis of grade III lesion, indication for surgery was given on the basis of the patient's functional demand. Full recovery was obtained on average 3 months after surgery. Constant Score accounted for 92.7 points, mean Disabilities of the Arm, Shoulder and Hand Score for 3.2 points, and mean Simple Shoulder Test Score for 11.4 points. X-ray findings were partial loss of reduction (9 cases), subclinic re-dislocation (2 cases), calcification (5 cases) and post-traumatic arthritis (2 cases). Modified Phemister is a reliable technique, technically easy, a low learning curve procedure and cheap with low hardware's costs.

  18. Surgical treatment of a chronically fixed lateral patella dislocation in an adolescent patient

    Directory of Open Access Journals (Sweden)

    Xinning Li

    2013-06-01

    Full Text Available Acute patellar dislocation or subluxation is a common cause for knee injuries in the United States and accounts for 2% to 3% of all injuries. Up to 49% of patients will have recurrent subluxations or dislocations. Importance of both soft tissue\t(predominantly,\tthe medial patellofemoral ligament, MPFL, which is responsible for 60% of the resistance to lateral dislocation and bony constraint of femoral trochlea in preventing subluxation and dislocation is well documented. Acute patella dislocation will require closed reduction and management typically consist of conservative or surgical treatment depending on the symptoms and recurrence of instability. Most patients are diagnosed and treated in a timely manner. We present a 15 years old male with a missed traumatic lateral patella dislocation during childhood. The patient presented as an adolescent with a chronically fixed lateral patella dislocation and was management with surgery. The key steps in the surgical reconstruction of this patient required first mobilizing the patella with a lateral retinacular release and V-Y lengthening of the shortened or contracted quadriceps tendon. Then a combination of MPFL reconstruction using the semi-tendinosis autograft, tibial tubercle osteotomy with anterio-medialization, and lateral facetectomy was performed. At the one-year follow-up, our patient had improved knee range of motion and decrease in pain. Chronically fixed lateral dislocated patella is a rare and complex problem to manage in older patients that will require a thorough work-up and appropriate surgical planning along with reconstruction.

  19. Surgical treatment of acute type V acromioclavicular joint dislocations in professional athletes: an anatomic ligament reconstruction with synthetic implant augmentation.

    Science.gov (United States)

    Triantafyllopoulos, Ioannis K; Lampropoulou-Adamidou, Kalliopi; Schizas, Nikitas P; Karadimas, Eleftherios V

    2017-12-01

    Most acromioclavicular (AC) joint injuries occur in men in their third decade of life during high-speed or high-impact body contact sports. The management of acute complete AC joint dislocation is surgical. Current surgical techniques include anatomic reconstruction of the main restraints of the AC joint and aim to improve functional outcomes and to reduce the complication rate. We present 10 cases of acute type V AC joint dislocation in professional athletes treated surgically with anatomic reconstruction of the coracoclavicular and AC ligaments and augmentation with the use of a synthetic polyester tape. The minimum follow-up of the patients was 2 years (mean, 48 months; range, 24-86 months). The postoperative functional outcome was assessed at 1 year and 2 years using the Constant-Murley, American Shoulder and Elbow Surgeons, and modified University of California-Los Angeles scoring systems. In all cases, the postoperative scores were significantly improved (P dislocation Rockwood type V, in professional athletes, require anatomic fixation of both coracoclavicular and AC ligaments for return to sports as soon as possible and at the preinjury level of performance. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Arthroscopic Versus Open Treatment for Acute Septic Arthritis of the Knee in Children.

    Science.gov (United States)

    Johns, Brenton; Loewenthal, Mark; Ho, Eric; Dewar, David

    2017-09-21

    Acute septic arthritis of the knee in children may be treated by arthroscopic or open methods however paediatric data comparing these methods is limited regarding both short and long-term outcomes. This study aimed to compare outcomes following arthroscopic versus open surgery for acute paediatric septic knee arthritis. Paediatric patients with acute knee septic arthritis treated at our institution from 1996 to 2016 were retrospectively assessed. The clinical presentations, operations, micro-organisms, laboratory results, knee radiological findings and antibiotics administered were compared. Patients long-term outcomes were assessed at mean 6.9 (range 1.1-20.3) years. Twenty-four patients met the inclusion criteria. Eleven patients received arthroscopic irrigation and 13 had open irrigation. Five patients in the open group (38.5%) required a second irrigation compared to none in the arthroscopic group (95% C.I. 12%-65%, p = 0.041). Time to range the knee occurred earlier in the arthroscopic group (5.0 days; arthroscopic vs 10.6 days; open, difference 5.6 days: 95% C.I. 0.84-10.3, p = 0.023) as well as weightbearing (2.7 days; arthroscopic vs 10.3 days; open, difference 7.6 days: 95% C.I. 2.3-12.9, p = 0.008). Eighty-three percent of patients attended followup. No infections recurred. No significant differences were found in KOOS-Child scores, Lysholm scores, ROM, leg length, gait and radiological findings. For acute paediatric septic knee arthritis arthroscopic irrigation is associated with less repeat surgical irrigations and allows earlier knee ranging and weightbearing compared to open irrigation. At long-term followup no significant difference was found between groups.

  1. Sideline management of acute dislocation of the glenohumeral joint- a unique approach to athlete self-reduction.

    Science.gov (United States)

    Smith, Danny; Hoogenboom, Barbara

    2013-02-01

    The acute anterior dislocation of the glenohumeral joint (GHJ) poses a challenge to sports medicine providers at all levels and in all settings. This macrotraumatic injury occurs in athletes who participate in a wide variety of sports, most typically as a result of contact or collision mechanisms. Quick and effective relocation of the GHJ is an important skill for on the sideline or on the field management of this type of dislocation when appropriate and allowable by facility protocol. This clinical suggestion describes one possible technique for athlete self-reduction that may be appropriate in some circumstances. This is in contrast to forcible reduction by the health professional, which is outside of the scope of this clinical commentary. 5.

  2. Isolated Acute Traumatic Subtalar Dislocations: Review of 13 Cases at a Mean Follow-Up of 6 Years and Literature Review.

    Science.gov (United States)

    Ruhlmann, François; Poujardieu, Camille; Vernois, Joel; Gayet, Louis-Etienne

    Isolated acute traumatic subtalar dislocations are quite rare. They correspond to talotarsal dislocation, including the talonavicular and talocalcaneal joints. The purpose of the present study was to evaluate the functional and radiologic outcomes of the treatment of acute traumatic isolated subtalar dislocations. The present retrospective study included 13 patients who had sustained isolated subtalar dislocations during a 10-year period. Of the 13 cases, 10 (76.9%) were medial dislocations and 3 (23.1%) were lateral dislocations. All the patients underwent immediate closed reduction under anesthesia followed by immobilization. No open reduction was required. The mean follow-up period was 72.6 (range 24.4 to 124.8) months. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 80.1 of 100 (range 66 to 90). The score result was good in 69% of cases and poor in 31% of cases. The subtalar mobility was reduced for 8 (61.5%) patients and significantly affected the American Orthopaedic Foot and Ankle Society score (p = .002). Subtalar osteoarthritis was present in 6 (46.1%) cases with talonavicular osteoarthritis in 3 (23.1%) cases. No cases of avascular necrosis of the talus were noted. In accordance with the published data, the prognosis of isolated acute traumatic subtalar dislocations is favorable. Medial dislocations are more frequent than lateral dislocations. Emergent closed reduction makes it possible to remove soft tissue injuries. The risk of post-traumatic subtalar osteoarthritis is significant, even without an initial subtalar lesion. A postreduction computed tomography scan will enable the diagnosis of osteochondral lesions. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. [EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION OF TRAUMATIC DISLOCATION OF KNEE JOINT COMBINED WITH MULTIPLE LIGAMENT INJURIES].

    Science.gov (United States)

    Jiang, Wu; Yao, Jianhua; Kong, Dejia; Sun, Wei; Huang, Yan; Zheng, Huayong; Liu, Chen; Bao, Xianguo

    2014-07-01

    To investigate the effectiveness of one-stage repair and reconstruction of multiple ligament injuries of the knee under arthroscopy. Between March 2007 and March 2009, 25 patients (25 knees) with multiple ligament injuries of the knee underwent one-stage repair and reconstruction under arthroscopy. Of 25 cases, 16 were male and 9 were female with an average age of 29.6 years (range, 18-43 years). The causes of injury were traffic accident injury in 20 cases, falling injury from height in 3 cases, and sport injury in 2 cases. The time between injury and surgery was 8-14 days (mean, 10.5 days). The preoperative Lysholm score was 37.92 ± 3.57. The X-ray film and MRI examinations showed that 17 patients had tears of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament, and 8 patients had tears of ACL, PCL, and posterolateral corner (PLC); 5 cases had medial meniscus injury and 7 cases had lateral meniscus injury. The ACL, PCL, and PLC were reconstructed under arthroscopy with autologous tendon or allogeneic tendon, and the MCL was repaired. Early active and passive functional exercises were done postoperatively. All the incisions healed by first intention, and there was no complications of infection and deep venous thrombosis. Twenty-five patients were followed up 24-78 months (mean, 50.9 months). Six patients had knee stiff postoperatively; after manipulation under anesthsia, 5 patients lost less than 15° of flexion and only 1 patient lost 26° of flexion. At last follow-up, the stability of the knee joint was significantly improved. There were significant differences in the anterior drawer test, posterior drawer test, Lachman test, and varus stress and valgus stress testing at 30° between at last follow-up and at preoperation (P Knee Documentation Committee (IKDC) rating was nearly normal in 16 cases (64%), abnormal in 8 cases (32%), and obviously abnormal in 1 case (4%). One-stage repair and reconstruction of

  4. Kinematic Analysis of Gait Following Intra-articular Corticosteroid Injection into the Knee Joint with an Acute Exacerbation of Arthritis.

    Science.gov (United States)

    Mehta, Saurabh; Shay, Barbara L; Szturm, Tony; El-Gabalawy, Hani S

    2011-01-01

    The objective of this study was to examine the effects of intra-articular corticosteroid injection (ICI) on ipsilateral knee flexion/extension, ankle dorsiflexion/plantarflexion (DF/PF), and hip abduction/adduction (abd/add) during stance phase in people with an acute exacerbation of rheumatoid arthritis (RA) of the knee joint. The study also assessed the effects of ICI on spatiotemporal parameters of gait and functional status in this group. Nine people with an exacerbation of RA of the knee were recruited. Kinematic and spatiotemporal gait parameters were obtained for each participant. Knee-related functional status was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Spatiotemporal gait parameters and joint angles (knee flexion, ankle DF/PF, hip abd/add) of the affected side were compared pre- and post-ICI. Data for eight people were available for analysis. Median values for knee flexion and ankle PF increased significantly following ICI. Gait parameters of cadence, velocity, bilateral stride length, bilateral step length, step width, double-support percentage, and step time on the affected side also showed improvement. Pain and knee-related functional status as measured by the KOOS showed improvement. This study demonstrated a beneficial short-term effect of ICI on knee-joint movements, gait parameters, and knee-related functional status in people with acute exacerbation of RA of the knee.

  5. Kinematic Analysis of Gait Following Intra-articular Corticosteroid Injection into the Knee Joint with an Acute Exacerbation of Arthritis

    Science.gov (United States)

    Mehta, Saurabh; Szturm, Tony; El-Gabalawy, Hani S.

    2011-01-01

    ABSTRACT Purpose: The objective of this study was to examine the effects of intra-articular corticosteroid injection (ICI) on ipsilateral knee flexion/extension, ankle dorsiflexion/plantarflexion (DF/PF), and hip abduction/adduction (abd/add) during stance phase in people with an acute exacerbation of rheumatoid arthritis (RA) of the knee joint. The study also assessed the effects of ICI on spatiotemporal parameters of gait and functional status in this group. Methods: Nine people with an exacerbation of RA of the knee were recruited. Kinematic and spatiotemporal gait parameters were obtained for each participant. Knee-related functional status was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Spatiotemporal gait parameters and joint angles (knee flexion, ankle DF/PF, hip abd/add) of the affected side were compared pre- and post-ICI. Results: Data for eight people were available for analysis. Median values for knee flexion and ankle PF increased significantly following ICI. Gait parameters of cadence, velocity, bilateral stride length, bilateral step length, step width, double-support percentage, and step time on the affected side also showed improvement. Pain and knee-related functional status as measured by the KOOS showed improvement. Conclusions: This study demonstrated a beneficial short-term effect of ICI on knee-joint movements, gait parameters, and knee-related functional status in people with acute exacerbation of RA of the knee. PMID:22942516

  6. Dor aguda no joelho do paciente idoso Acute knee pain in elderly patients

    Directory of Open Access Journals (Sweden)

    Gilberto Luís Camanho

    2008-09-01

    Full Text Available A dor aguda no joelho de pacientes idosos é freqüente, sendo caracterizada por seu aparecimento súbito, sem causa aparente, com exame radiográfico dentro dos padrões da normalidade, na maioria dos casos. A etiologia da dor aguda no joelho é decorrente de insuficiência das estruturas, e seu quadro clínico difere completamente daquele determinado pela osteoartrose, sendo sempre unilateral e ocorre na grande maioria em pacientes do sexo feminino, após a quinta década de vida, e na região medial do joelho (local de maior carga. Com o propósito de analisar as possíveis etiologias para a dor aguda do joelho de pacientes acima de 60 anos de idade, suas características e tratamento, os autores discutem as etiologias relacionadas à dor aguda: lesão meniscal, fratura por fadiga e osteonecrose idiopática.Acute knee pain in elderly patients is not uncommon, and is characterized by a sudden onset, no apparent cause, and by normal radiographic findings in most cases. The etiology of acute knee pain is the result of insufficient structures, and clinical symptoms are totally different from the symptoms seen in osteoarthrosis. This acute pain in the knee is always unilateral and in the medial region of the knee joint (site with the heaviest load, predominantly in females after the fifth decade of live. In order to consider the possible etiologies for acute knee joint pain in patients older than 60 years, its characteristics and treatment, the authors discuss etiologies related to acute pain: lesion of the meniscus, stress fracture, and idiopathic osteonecrosis.

  7. Arthroscopic treatment of acute acromioclavicular dislocations using a double button device: Clinical and MRI results.

    Science.gov (United States)

    Loriaut, P; Casabianca, L; Alkhaili, J; Dallaudière, B; Desportes, E; Rousseau, R; Massin, P; Boyer, P

    2015-12-01

    Arthroscopic treatment of acute grade 3 and 4 acromioclavicular dislocation is controversial, due to the risk of recurrence and of postoperative reduction defect. The purpose of the present study was to investigate whether the healing of the acromioclavicular (AC) and coracoclavicular (CC) ligaments and the accurate 3D positioning parameters of the AC joint using MRI were correlated with satisfactory functional outcome. Thirty-nine patients were enrolled from 2009 to 2011 and managed arthroscopically by CC lacing using a double-button device. Clinical assessment included the Shoulder and Hand (QuickDash) score, Constant-Murley score and visual analog scale (VAS) for residual pain. Time and rate to return to work and return to sport were assessed according to type of sport and work. Postoperative complications were recorded. Radiological examination consisted of anteroposterior clavicle and lateral axillary radiographs. AC ligament healing and 3D joint congruency were assessed on MRI and correlated to the clinical results. Mean patient age was 35.7 years (range, 20-55). Mean follow-up was 42.3±10.6 months (range, 24-60). At final follow-up, mean QuickDash score, Constant score and VAS were respectively 1.7±4 (range, 0-11), 94.7±7.3 (range, 82-100) and 0.5±1.4 (range, 0-2). Thirty-five (90%) patients were able to resume work, including heavy manual labor, and sport. Radiology found accurate 3D joint congruency in 34 patients (87%) and CC and AC ligament healing in 36 (93%). Complications included reduction loss at 6 weeks in 3 patients, requiring surgical stabilization. Satisfactory functional results were associated with accurate AC joint congruency in the coronal and axial planes (P<0.05) and good AC and CC ligament healing (P<0.04). An initial 25% reduction defect in the coronal plane was not associated with poor functional results (P=0.07). Arthroscopic treatment by CC lacing satisfactorily restored ligament and joint anatomy in the present series. These

  8. Intra-articular lidocaine versus intravenous analgesia and sedation for manual closed reduction of acute anterior shoulder dislocation: an updated meta-analysis.

    Science.gov (United States)

    Jiang, Nan; Hu, Yan-jun; Zhang, Kai-rui; Zhang, Sheng; Bin, Yu

    2014-08-01

    To compare intra-articular lidocaine (IAL) with intravenous analgesia and sedation (IVAS) for manual closed reduction of acute anterior shoulder dislocation. Meta-analysis. Metropolitan medical university. A literature search was conducted of PubMed, Ovid and Cochrane Library, to identify randomized controlled trials (RCTs) published from January 1, 1990 to September 1, 2012, that compared IAL with IVAS for manual closed reduction of acute anterior shoulder dislocation. Effective data were pooled using fixed-effects or random-effects models with mean differences (MDs) and risk ratios (RRs) for continuous and dichotomous variables, respectively. Nine RCTs comprising 438 patients were analyzed. Statistical analyses showed that IAL was superior to IVAS with respect to lower complication risk (P respiratory depression (P techniques are similarly effective for manual closed reduction of acute anterior shoulder dislocation. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Isolated osteochondral fracture of the patella without patellar dislocation.

    Science.gov (United States)

    Bhatt, Jay; Montalban, Antonio Santa Cruz; Wang, Kook Hyun; Lee, Hee Du; Nha, Kyung Wook

    2011-01-03

    Chondral fractures of the patella are associated with acute dislocation of the patella. Osteochondral fracture in patellar dislocation is located in the medial facet of the patella. This article presents a case of a 15-year-old female ballerina with isolated displaced osteochondral fracture of the patella without patellar dislocation. She had no history of trauma. A Merchant's view of both knees showed mild subluxation of the patella, a small fragment on the lateral aspect of the knee, and a small defect of the centromedial patella. Axial magnetic resonance imaging (MRI) revealed an osteochondral fragment measuring 13 mm medial to the patella. However, the medial patellofemoral ligament and medial retinaculum were intact. An effusion on the medial side of the patella consistent with hemarthrosis was observed. An absence of a contusion or bone bruise on the lateral femoral condyle was shown. The loose body was removed arthroscopically. Intraoperative findings included a 1.5×2 cm osteochondral fragment. It is unusual that the osteochondral patellar defect site in this patient was in the inferior and central areas of the patella. Patellar chondral fractures without dislocation or patella fracture are rare. Therefore, the possibility of a trivial trauma leading to an osteochondral fracture should be kept in mind in adolescent and young adults who present with knee pain and hemarthrosis. Copyright 2011, SLACK Incorporated.

  10. Rare carpometacarpal dislocations.

    Science.gov (United States)

    Lefere, M; Dallaudière, B; Omoumi, P; Cyteval, C; Larbi, A

    2016-10-01

    Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most common and best-known manifestation of carpal dislocation, typically occurring after hyperextension trauma. Other forms are very rare and have different causative mechanisms. Carpometacarpal (CMC) dislocations are also uncommon and may affect isolated or multiple CMC joints. These lesions are prone to wrist instability if not treated promptly. The aim of this article is to provide a systematic radiologic approach to the evaluation of wrist injury and to present two acute cases of rare CMC dislocations. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Reliability of the Knee Smartphone-Application Goniometer in the Acute Orthopedic Setting.

    Science.gov (United States)

    Pereira, Luís Carlos; Rwakabayiza, Sylvia; Lécureux, Estelle; Jolles, Brigitte M

    2017-03-01

    The standard goniometer (SG) is the most commonly used tool to assess range of motion (ROM) in patients with knee restrictions. Several medical applications have been designed to measure joint ROM. Little data are available on their reliability in the postoperative clinical setting. The purpose of this study was to assess whether a smartphone accelerometer-based knee goniometer application (App) is as reliable as the SG to measure knee ROM in clinical settings. A total of 60 subjects were included in this cross-sectional reliability trial. Overall, 20 healthy subjects (HS) and 20 acute postoperative patients (PO) underwent three active and three passive measurements in knee flexion and extension, using the SG and the smartphone knee goniometer App. To determine the fatigability of postoperative patients, a third group of 20 patients underwent a single active measurement in knee flexion and extension (PO1). Measurements were performed by three clinicians. For intraobserver reliability, mean intraclass correlation coefficient (ICC) values were higher for the App in all circumstances (overall mean SG 0.85, App 0.91), indicating an excellent correlation. For interobserver reliability, the highest ICC scores were in the PO1 group, with the App more consistent than the SG in all movements. Interobserver reliability was lower in the PO group versus PO1. Interobserver reliability was better for active ROM than for passive measurements. The overall concordance coefficient was very good to excellent with active measurements (range, 0.60-0.97). In conclusion, the App is a reliable tool for use in acute orthopedic care and offers better intra- and interobserver correlation scores for a single active measurement. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait.

    Science.gov (United States)

    Ota, S; Ueda, M; Aimoto, K; Suzuki, Y; Sigward, S M

    2014-06-01

    Restrictions in range of ankle dorsiflexion (DF) motion can persist following ankle injuries. Ankle DF is necessary during terminal stance of gait, and its restricted range may affect knee joint kinematics and kinetics. The purpose of this study was to investigate the acute influence of varied levels of restricted ankle DF on knee joint sagittal and frontal plane kinematics and kinetics during gait. Thirty healthy volunteers walked with a custom-designed ankle brace that restricted ankle DF. Kinematics and kinetics were collected using a 7-camera motion analysis system and two force plates. Ankle dorsiflexion was restricted in 10-degree increments, allowing for four conditions: Free, light (LR), moderate (MR) and severe restriction (SR). Knee angles and moments were measured during terminal stance. Real peak ankle DF for Free, LR, MR, and SR were 13.7±4.8°, 11.6±5.0°, 7.5±5.3°, and 4.2±7.2°, respectively. Peak knee extension angles under the same conditions were -6.7±6.7°, -5.4±6.4°, -2.5±7.5°, and 0.6±7.8°, respectively, and the peak knee varus moment was 0.48±0.17 Nm/kg, 0.47±0.17 Nm/kg, 0.53±0.20 Nm/kg, and 0.57±0.20 Nm/kg. The knee varus moment was significantly increased from MR condition with an 8-degree restriction in ankle DF. Knee joint kinematics and kinetics in the sagittal and frontal planes were affected by reduced ankle DF during terminal stance of gait. Differences were observed with restriction in ankle DF range of approximately 8°. level III. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Acute aquatic treadmill exercise improves gait and pain in people with knee osteoarthritis.

    Science.gov (United States)

    Roper, Jaimie A; Bressel, Eadric; Tillman, Mark D

    2013-03-01

    To examine the acute effects of aquatic and land treadmill exercise on gait kinematics as well as the level of disease-specific and movement-related pain for individuals with osteoarthritis. Quasi-experimental crossover design. Biomechanics laboratory. Participants (N=14; age, 43-64y) diagnosed with osteoarthritis at the knee (n=12), osteoarthritis at the knee and ankle (n=1), or osteoarthritis at the knee and hip (n=1). Participants performed 3 exercise sessions separated by at least 24 hours in 1 week for each mode of exercise (aquatic treadmill and land treadmill). Gait kinematics and pain were measured before and after each intervention. The angular velocity gain score during stance for left knee extension was improved by 38% after aquatic treadmill exercise (P=.004). Similarly, during swing, the gain scores for angular velocity were also greater for left knee internal rotation and extension by 65% and 20%, respectively (P=.004, P=.008, respectively). During stance, the joint angle gain score for left hip flexion was 7.23% greater after land exercise (P=.007). During swing, the angular velocity gain score for right hip extension was significantly greater for aquatic exercise by 28% (P=.01). Only the joint angle gain score for left ankle abduction during stance was significantly higher after land exercise (4.72%, P=.003). No other joint angle gain scores for either stance or swing were significantly different for either condition (P=.06-.96). Perceived pain was 100% greater after land than aquatic treadmill exercise (P=.02). Step rate and step length were not different between conditions (P=.31-.92). An acute training period on an aquatic treadmill positively influenced joint angular velocity and arthritis-related joint pain. Acute aquatic treadmill exercise may be useful as a conservative treatment to improve angular speed of the lower-extremity joints and pain related to osteoarthritis. Copyright © 2013 American Congress of Rehabilitation Medicine. Published

  14. All-Arthroscopic Technique for Reconstruction of Acute Acromioclavicular Joint Dislocations

    Science.gov (United States)

    Cutbush, Kenneth; Hirpara, Kieran M.

    2015-01-01

    Acromioclavicular joint dislocations are a common injury particularly among contact sports players. There has been an increasing trend toward arthroscopic management of these injuries. To date, these reconstructions have primarily addressed superoinferior instability by reconstructing the coracoclavicular ligaments. We describe an all-arthroscopic technique for reconstruction of the coracoclavicular ligaments using Arthrex ABS TightRopes (Arthrex, Naples, FL), with additional stabilization of the superior acromioclavicular joint capsule using an anchor-based suture bridge to address anteroposterior instability. PMID:26697307

  15. Acute Effects of Antagonist Stretching on Jump Height and Knee Extension Peak Torque

    OpenAIRE

    Sandberg, John B.

    2012-01-01

    A great deal of research has shown decrements in force and power following static stretching. There has been little research investigating the acute effects of static stretching of the antagonist on the expression of strength and power. The purpose of this study was to investigate the effects of static stretching of the antagonist muscles on a variety of strength and power measures. Sixteen active males were tested for vertical jump height and isokinetic torque production in a slow knee exten...

  16. Acute scaphoidectomy and four-corner fusion for the surgical treatment of trans-scaphoid perilunate fracture dislocation with pre-existing scaphoid non-union.

    Science.gov (United States)

    Roberts, Darren; Power, Dominic Michael

    2015-07-16

    This paper presents a rare case of trans-scaphoid perilunate fracture dislocation with concurrent scaphoid non-union of the left wrist following a motorcycle accident. Emergent CT identified scaphoid non-union advanced collapse and an acute scaphoidectomy, four-corner fusion, denervation and radiocarpal ligament repair was performed. 2015 BMJ Publishing Group Ltd.

  17. A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study

    NARCIS (Netherlands)

    te Slaa, Ron L.; Brand, Ronald; Marti, Rene K.

    2003-01-01

    A prospective arthroscopic study was conducted on 31 patients with an acute first-time anterior shoulder dislocation (AFASD). The patients were aged between 16 and 39 years. The mean age was 24 years. None had a history of shoulder problems. All were evaluated after 1, 2, and 5 years. The Constant

  18. Acute Knee Trauma: Analysis of Multidetector Computed Tomography Findings and Comparison with Conventional Radiography

    Energy Technology Data Exchange (ETDEWEB)

    Mustonen, A.O.T. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Koskinen, S.K. [Research Inst. of Military Medicine, Helsinki (Finland); Kiuru, M.J. [ORTON Orthopaedic Hospital, Helsinki (Finland)

    2005-12-01

    Purpose: To evaluate the multidetector computed tomography (MDCT) findings of acute knee trauma and to compare radiography with MDCT in patients referred ta level 1 trauma center. Material and Methods: During a 5-year period, a total of 415 MDCT examinations were performed on 409 patients with acute knee trauma to reveal complex fracture anatomy or rule out a fracture. MDCT and primary radiographs were re-evaluated with respect to fracture location and trauma mechanism. Tibial plateau fractures were further analyzed depending on anatomical location: anterior-medial, anterior-lateral, posterior-lateral, and posterior-medial regions. Maximal depression of the tibial articular surface was measured. Findings on the primary knee radiographs were compared with MDCT findings. Results: Of the 409 patients, 356 (87%) had a knee fracture. A total of 451 fractures were found in all anatomic regions: distal femur ( n = 49), proximal tibia ( n 307), patella ( n = 23), and proximal fibula ( n = 72). Primary radiographs were available in 316 (76%) cases. Of these, 225 (71%) had MDCT in order to reveal the fracture anatomy better, and 91 (29%) had a subsequent MDCT after negative plain radiographs. Overall sensitivity of radiography was 83%, while negative predictive value was 49%. On radiography, tibial plateau articular depression was underestimated in all regions except when the fracture consisted of the whole half of the anterior or posterior plateau. The three main injury mechanisms were traffic accident, a simple fall, and sport. In 49 cases (15%), primary radiographs were suboptimal due to positioning. Conclusion: In severely injured patients, diagnostically sufficient radiographs are difficult to obtain, and therefore a negative radiograph is not reliable in ruling out a fracture. In these patients, MDCT is a fast and accurate examination and is also recommended in patients with tibial plateau fractures or complex knee injuries in order to evaluate the fracture adequately.

  19. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    McKean, D.; Thomee, E.; Grant, D.; Teh, J.L.; Mansour, R. [Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Headington, Oxford (United Kingdom); Yoong, P. [Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading (United Kingdom); Yanny, S. [Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury (United Kingdom)

    2015-10-15

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

  20. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging.

    Science.gov (United States)

    McKean, D; Yoong, P; Yanny, S; Thomee, E; Grant, D; Teh, J L; Mansour, R

    2015-10-01

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2% (n = 130) patients were male. The PFL was injured in 36 cases (20%). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25%) were associated with further injuries of posterolateral corner structures and in 27 cases (75%) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner.

  1. Extensor mechanism injuries in tibiofemoral dislocations.

    Science.gov (United States)

    Wissman, Robert D; Verma, Sadhna; Kreeger, Michael; Robertson, Michael

    2009-01-01

    The purpose of this study is to evaluate the incidence, location, and associated findings of extensor mechanism injuries in the setting of tibiofemoral knee dislocations. A retrospective search for patients with previous knee dislocation and MRI of the knee was made during a 5-year period. Images were evaluated for abnormalities commonly seen in patellar instability. Patellar and quadriceps tendon integrity were also evaluated. A total of 14 patients were included in the study. Medial patellofemoral ligament injuries were identified in 10 patients (71%) with tibiofemoral dislocation. As in patients with previous patellar dislocation, medial patellofemoral ligament injuries commonly occurred at the femoral attachment of the ligament. Medial patellofemoral ligament injuries correlated well with vastus medialis oblique elevation. Patellar tendon injuries were less common identified in only 5 patients (36%). Medial patellofemoral ligament injuries can be associated with tibiofemoral knee dislocations. In addition, patellar tendon injuries can also occur, although these are usually partial tears.

  2. Modified hemihamate arthroplasty technique for treatment of acute proximal interphalangeal joint fracture-dislocations.

    Science.gov (United States)

    Yang, Dae Suk; Lee, Sang Ki; Kim, Kap Jung; Choy, Won Sik

    2014-04-01

    We retrospectively reviewed 11 patients who underwent modified hemihamate arthroplasty for the treatment of comminuted dorsal fracture-dislocation of the proximal interphalangeal (PIP) joint. This technique was used to minimize the potential risk of complications at the recipient site by volarly oblique osteotomy in the coronal plane at graft harvesting and anatomical repair of the detached flexor sheath. The average joint involvement of the fracture was 58.4%, and the mean duration of follow-up was 38 months. The active range of motion of the distal interphalangeal, PIP, and metacarpophalangeal joint was 80.4, 85.4, and 91.8 degrees, respectively. The mean disabilities of the arm, shoulder, and hand score was 4.8, and all patients achieved bony union at final follow-up. One patient showed radiographic signs of graft absorption, but this did not limit their daily activities. The modified hemihamate arthroplasty technique is safe and reliable and reduces the risk of iatrogenic damage when used to treat comminuted dorsal fracture-dislocations of the PIP joint.

  3. [Treatment of isolated and multiple ligament injuries of the knee: anatomy, biomechanics, diagnosis, indications for repair, surgery].

    Science.gov (United States)

    Yastrebov, O; Lobenhoffer, P

    2009-06-01

    Complex knee ligament injuries are characterized by simultaneous rupture of the anterior cruciate ligament (ACL) and/or the posterior cruciate ligament (PCL) and at least one collateral ligament. Isolated injury to the medial collateral ligament (MCL) and PCL have a high healing capacity and can be treated conservatively in many cases. Ruptures of the MCL can also be treated conservatively in complex injuries if the cruciate ligaments are reconstructed. Ruptures of the lateral structures usually need surgical reconstruction. Indications for acute surgical repair include meniscus dislocation, entrapment of collateral ligament portions in the joint, knee dislocation with severe knee instability, and displaced bony avulsions. The anatomy of the knee ligaments must be carefully respected in surgical reconstruction. Acute repair of collateral ligament injuries is possible only in the first 2 weeks after trauma. Acute arthroscopy is indicated only in combination with reconstructive surgery.

  4. Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods.

    Science.gov (United States)

    Kannus, P; Järvinen, M

    1990-04-01

    Nonoperative treatment has received little attention in the numerous scientific reports on knee ligament injuries. Great controversy still exists concerning the proper treatment of a knee with a ruptured ligament, especially the anterior cruciate ligament. However, according to the studies of the authors and an extensive review of the literature the indications for conservative management can be established to be all grade I and II sprains (partial tears) of knee ligaments as well as an isolated grade III sprain (complete tear) of the posterior cruciate ligament. In addition, an isolated complete rupture of an anterior cruciate, or medial or lateral collateral ligament may be treated nonoperatively in an older sedentary person. Other injuries obviously call for an operative approach at the acute stage. Nonoperative therapy protocols must be based on the knowledge of the biological phenomenon occurring during connective tissue healing process. In the first phase of ligament healing the injured knee needs 2 to 3 weeks immobilisation for undisturbed fibroblast invasion and proliferation of collagen fibres. This is achieved by immobilising the knee in a rehabilitative knee brace locked in 40 to 45 degrees of flexion. Thereafter, a gradually increasing controlled mobilisation is allowed in the brace to avoid the deleterious effects of immobilisation to cartilage, bone, muscles, tendons and ligaments, and to enhance the orientation of collagen fibres to the stress lines of the healing ligament. After 4 to 8 weeks the goal for rehabilitation is rapid and full recovery to work and sports. A functional knee brace may be used at this phase to give extra protection before final strengthening of the injured ligament. During the mobilisation and muscle training of the therapy protocol various specific techniques can be used for strengthening of the hamstring and quadriceps muscles, including isometric, isotonic, isokinetic and eccentric exercises with or without resistive

  5. Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance.

    Science.gov (United States)

    Balcarek, Peter; Ammon, Jan; Frosch, Stephan; Walde, Tim A; Schüttrumpf, Jan P; Ferlemann, Keno G; Lill, Helmut; Stürmer, Klaus M; Frosch, Karl-Heinz

    2010-07-01

    The objective of this study was to analyze the injury patterns of the medial patellofemoral ligament (MPFL) in acute lateral patellar dislocations (LPDs) considering the anatomically relevant factors of patellar instability. Knee magnetic resonance images were collected from 73 patients within 7 weeks after LPD, and the injury patterns of the MPFL were evaluated for trochlear dysplasia, for patellar height, and for the tibial tuberosity-trochlear groove (TT-TG) distance. Injury to the MPFL was found in 98.6% of the patients (72 of 73) after the acute LPD, with a complete tear in 51.4% (37 of 72), most frequently localized at the femoral attachment site, and a partial tear in 48.6% (35 of 72). Injury to the femoral origin (Fem), to the midsubstance (Mid), and to the patellar insertion (Pat) of the MPFL was found in 50.0% (36 of 72), 13.9% (10 of 72), and 13.9% (10 of 72), respectively. More than 1 site of injury was found in 22.2% (16 of 72), most frequently as a combined injury at the femoral origin and at the patellar insertion sites (Pat+Fem) (13 of 16). The study population, as well as the Pat, Fem, and Pat+Fem subgroups, showed significantly different values of trochlear dysplasia and patellar height when compared with the control group, whereas the data of the Mid group were not significantly different. In addition, injury at the patellar insertion (Pat) was accompanied by a significantly increased TT-TG distance when compared not only with the control group but also with the Fem, Mid, and Pat+Fem groups. The data from our study indicate that patterns of MPFL injury depend on trochlear dysplasia, patellar height, and TT-TG distance. They show a new aspect in the complex interplay between active, passive, and static stabilizers of the patellofemoral joint. Level IV, diagnostic case-control study. Crown Copyright (c) 2010. Published by Elsevier Inc. All rights reserved.

  6. Subtalar dislocations.

    Science.gov (United States)

    Rammelt, Stefan; Goronzy, Jens

    2015-06-01

    Subtalar dislocations make up 1-2% of all dislocations, about 75% of them being medial dislocations. Treatment consists of early reduction under adequate sedation. In cases of soft tissue interposition or locked dislocations, open reduction is warranted. More than 60% of subtalar dislocations are associated with additional fractures, therefore a postreduction CT is recommended. Complications include avascular necrosis of the talus, infection, posttraumatic arthritis, chronic subtalar instability, and complex regional pain syndrome with delayed reduction. The prognosis of purely ligamentous injuries is excellent after early reduction. Negative prognostic factors include lateral and open dislocations, total talar dislocations, and associated fractures. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Magnetic resonance imaging induced acute midfacial pain - incidental finding of a dislocated dental bur.

    Science.gov (United States)

    Voss, Jan Oliver; Raguse, Jan-Dirk; Hoffmeister, Bodo; Adolphs, Nicolai

    2015-01-01

    To describe the management of a patient with an initially unnoticed dislocated dental bur in the maxillary sinus that became symptomatic during a magnetic resonance imaging (MRI) scan. A MRI scan provoked strong midfacial pain in a 31-year-old male patient, who exhibited ambiguous neurologic impairment consistent with multiple sclerosis. Conventional radiography revealed an opaque foreign body in close proximity to the orbital floor that most likely caused the painful symptoms during the MRI. After additional X-ray computed tomography (X-ray CT) scans were performed, a metal dental bur was removed by a combined transconjunctival and transnasal approach under perioperative antibiotic treatment. The disappearance of instruments during surgical procedures requires diligent investigation and immediate retrieval.

  8. Does marathon running cause acute lesions of the knee? Evaluation with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, C.; Schueller, G.; Uffmann, M.; Bader, T.R. [Medical University of Vienna, Department of Radiology, Vienna (Austria)

    2006-10-15

    An investigation was conducted into whether running a marathon causes acute alterations in menisci, cartilage, bone marrow, ligaments, or joint effusions, which could be evaluated by magnetic resonance imaging (MRI). Twenty-two non-professional marathon runners underwent MRI of the knee before and immediately after running a marathon. Lesions of menisci and cartilage (five-point scale), bone marrow, ligaments (three-point scale), joint effusion, and additional findings were evaluated and a total score was assessed. Before the marathon, grade 1 lesions of the menisci were found in eight runners, and grade 2 lesions in five runners. After the marathon, an upgrading from a meniscal lesion grade 1 to grade 2 was observed in one runner. Before the marathon, grade 1 cartilage lesions were found in three runners, and grade 2 lesions in one runner, all of which remained unchanged after the marathon. Before and after the marathon, unchanged bone marrow edema was present in three runners and unchanged anterior cruciate ligament lesions (grade 1) were seen in two runners. Joint effusions were present in 13 runners in the pre-run scans, slightly increased in four runners after the marathon, and newly occurred in one runner after the marathon. A total score comprising all knee lesions in each runner showed an increase after the marathon in two runners, whereas no runner showed an improvement of the radiological findings (Wilcoxon signed-rank test, P>0.05). The evaluation of lesions of the knee with MRI shows that marathon running does not cause severe, acute lesions of cartilage, ligaments, or bone marrow of the knee in well-trained runners. Only subtle changes, such as joint effusions or increased intrameniscal signal alterations, were imaged after running a marathon. (orig.)

  9. Acute spontaneous atraumatic bilateral anterior dislocation of the shoulder joint with Hill-Sachs lesions: first reported case and review of literature.

    Science.gov (United States)

    Manoharan, Gopikanthan; Singh, Rohit; Ahmed, Bessam; Kathuria, Vinod

    2014-06-03

    The anatomy of the shoulder joint comprises a relatively large humeral head with a shallow glenoid cavity allowing a remarkable range of motion at the expense of inherent instability. Despite anterior shoulder dislocations being the most common type encountered, bilateral dislocations are rare and almost always posterior. The aetiology is usually direct or indirect trauma related to sports, seizures, electric shock or electroconvulsive therapy. We present the first reported case of atraumatic bilateral acute anterior shoulder dislocations with associated Hill-Sachs lesions in a young, fit and well patient with no comorbidities. MRI illustrated the Hill-Sachs lesions with superior labral tear from anterior to posterior, and confirmed the acute nature of the injury by demonstrating the bone marrow oedema. The patient was treated surgically with arthroscopic anterior stabilisation. At 6 months following surgery, the patient has a pain free full range of movement of both shoulders with no further dislocations and has returned to work. 2014 BMJ Publishing Group Ltd.

  10. Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma

    Energy Technology Data Exchange (ETDEWEB)

    Peltola, Erno K. [Helsinki University Hospital, Toeoeloe Trauma Center, Department of Radiology, Helsinki Medical Imaging Center, Helsinki (Finland); Koskinen, Seppo K. [Karolinska Universitetssjukhuset, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden)

    2015-09-15

    To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79 % and 100 %, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon. (orig.)

  11. Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Guang-Ying; Ding, Hong-Yu [Shandong University, Department of Ultrasonography, Qianfoshan Hospital, Jinan (China); Zheng, Lei; Sun, Bai-Sheng [Chinese People' s Armed Police Force, Department of Radiology, Shandong Provincial Corps Hospital, Jinan (China); Li, En-Miao [Jinan Third People' s Hospital, Department of Ultrasonography, Jinan (China); Shi, Hao [Shandong University, Department of Radiology, Qianfoshan Hospital, Jinan (China)

    2015-01-15

    The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8 %, 96.3 %, and 94.6 %, respectively, for partial MPFL tear and 86.3 %, 96.3 %, and 94 %, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6 %, 95.7 %, and 91.3 %, respectively, for partial MPFL tear and 80.4 %, 95.7 %, and 92.1 %, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. (orig.)

  12. The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study.

    Science.gov (United States)

    Moukarzel, Marcel; Di Rienzo, Franck; Lahoud, Jean-Claude; Hoyek, Fadi; Collet, Christian; Guillot, Aymeric; Hoyek, Nady

    2017-12-24

    The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty. Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries. Yet, whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study. Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test. The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed. Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future. Implications for rehabilitation    Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty:    • Enhances quadriceps strength.    • Alleviates pain.    • Enhances range of motion.    • Does not have any effect on basic functional mobility.    • Does not have any effect on knee girth.

  13. Stability of acute dorsal fracture dislocations of the proximal interphalangeal joint: a biomechanical study.

    Science.gov (United States)

    Tyser, Andrew R; Tsai, Michael A; Parks, Brent G; Means, Kenneth R

    2014-01-01

    We performed a cadaveric biomechanical study to characterize proximal interphalangeal joint stability after an injury to different amounts of the volar articular base of the middle phalanx (intact, 20%, 40%, 60%, and 80% volar defects). Eighteen digits on 6 hands were tested through full proximal interphalangeal joint range of motion using computer-controlled flexion and extension via the digital tendons. We collected proximal interphalangeal joint kinematic cine data in a true lateral projection with mini-fluoroscopy. We measured the amount of dorsal middle phalanx translation in full proximal interphalangeal joint extension. As we cycled the joint from full flexion into extension, we recorded the angle at which subluxation occurred. No specimens with 20% volar bony defect subluxated. All specimens in the 60% and 80% groups subluxated at an average flexion angle of 67° (range, 10° to 90°) in the 60% group and at all degrees of flexion in the 80% group. In the 40% group, 28% of specimens demonstrated subluxation at an average flexion angle of 14° (range, 4° to 40°). Mean dorsal translation of the middle phalanx in relation to the proximal phalanx at full digital extension was 0.2 mm in the 20% group, 0.8 mm in the 40% group, 3.2 mm in the 60% group, and 3.1 mm in the 80% group. Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. Stability in the 40% group was variable and appeared to be the threshold for stability. Knowledge of the typical amount of middle phalanx defect and degree of proximal interphalangeal joint extension that can lead to joint instability may improve management of mechanically important proximal interphalangeal joint fracture dislocations. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Magnetic resonance imaging of bone bruising in the acutely injured knee--short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Davies, N.H.; Niall, D.; King, L.J.; Lavelle, J.; Healy, J.C. E-mail: j.healy@ic.ac.uk

    2004-05-01

    AIM: To investigate the short-term outcome and associated injuries of bone bruising in the acutely injured knee. METHOD AND MATERIALS: Thirty patients (age range 17-39 years, mean 28 years) with bone bruising identified on magnetic resonance imaging (MRI) after an acute knee injury were rescanned 12-14 weeks post-injury. The volume of bone bruising was measured on coronal STIR (short TI inversion recovery) images and correlation made with the presence and type of ligamentous and osteochondral injuries. RESULTS: All bone bruises were present on repeat MRI. Twenty of the 30 patients (67%) had associated anterior cruciate ligament (ACL) injuries, seven of the 30 (23%) had collateral ligament injuries and three of the 30 (10%) had no associated ligamentous injuries. Greater than 50% reduction in bone bruise volume was demonstrated at repeat scanning in 24 of the 30 patients (80%) and less than 50% in five of the 30 patients (17%). One patient showed an increase in volume of bone bruising at follow-up. There was no correlation between initial size or size reduction of bone bruising and the presence/absence or type of associated injuries. In 21 patients the bone bruises resolved from the periphery, whilst eight patients showed bone bruises that resolved towards the joint margin, all of whom had associated osteochondral injuries. Of the 30 patients, 17 showed bone bruising that extended to the joint margin, 10 of whom had associated osteochondral injuries on MRI. On clinical review some degree of knee pain was still present in all but one of the patients reviewed. The single patient who reported complete resolution of symptoms was one of the three patients with isolated bone bruising CONCLUSION: Bone bruises persist for at least 12-14 weeks, which is longer than previously quoted. Two discrete patterns of bone bruise resolution have been demonstrated. The size and persistence of bone bruising is not related to the presence or absence or type of associated ligamentous

  15. The treatment of acute Rockwood type III acromio-clavicular joint dislocations by two different surgical techniques.

    Science.gov (United States)

    Biz, Carlo; Berizzi, Antonio; Cappellari, Alessandro; Crimì, Alberto; Tamburin, Stefano; Iacobellis, Claudio

    2015-12-14

    the treatment of acute type III acromio-clavicular Rockwood dislocations is still a matter of discussion in orthopaedic surgery. The purpose of this study, retrospective and comparative, is to evaluate the long-term results of two different surgical techniques of temporary stabilization using K-wires with and without tension band wiring. one hundred patients, treated from January 2007 and November 2010, were subdivided into two groups according to the surgical method used. They were clinically and radiographically assessed, and the results were compared with those present in the literature. the patients were clinically and radiologically evaluated with a mean follow-up of 44.7 months (range 25-60 months). According to the Constant Score, the positive results were 87.4% in group A and 90.2% in group B, without significant statistical difference (p>0.05). However, there were numerous complications, especially metal-work mobilization. the results that we have obtained, in part disappointing on the short-term, but positive overall and in line with the literature at long-term follow-up, do not clarify which of the two techniques is superior.

  16. Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study

    Directory of Open Access Journals (Sweden)

    Guerrero Patrick

    2009-07-01

    Full Text Available Abstract Background Lateral Patella dislocations are common injuries seen in the active and young adult populations. Our study focus was to evaluate medial patellofemoral ligament (MPFL injury patterns and associated knee pathology using Magnetic Resonance Imaging studies. Methods MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella dislocation were screened for this study. Of the 324 cases that were found, 195 patients with lateral patellar dislocation traumatic enough to cause bone bruises on the lateral femoral trochlea and the medial facet of the patella were selected for this study. The MRI images were reviewed by three independent observers for location and type of MPFL injury, osteochondral defects, loose bodies, MCL and meniscus tears. The data was analyzed as a single cohort and by gender. Results This study consisted of 127 males and 68 females; mean age of 23 yrs. Tear of the MPFL at the patellar attachment occurred in 93/195 knees (47%, at the femoral attachment in 50/195 knees (26%, and at both the femoral and patella attachment sites in 26/195 knees (13%. Attenuation of the MPFL without rupture occurred in 26/195 knees (13%. Associated findings included loose bodies in 23/195 (13%, meniscus tears 41/195 (21%, patella avulsion/fracture in 14/195 (7%, medial collateral ligament sprains/tears in 37/195 (19% and osteochondral lesions in 96/195 knees (49%. Statistical analysis showed females had significantly more associated meniscus tears than the males (27% vs. 17%, p = 0.04. Although not statistically significant, osteochondral lesions were seen more in male patients with acute patella dislocation (52% vs. 42%, p = 0.08. Conclusion Patients who present with lateral patella dislocation with the classic bone bruise pattern seen on MRI will likely rupture the MPFL at the patellar side. Females are more likely to have an associated meniscal tear than males; however, more males

  17. [Analysis of effects of arthroscopic treatment for recurrent patellar dislocation by lateral patellar retinacular release outside the synovial bursa of knee joint combined with reconstruction of medial patellofemoral ligament].

    Science.gov (United States)

    Li, Bei; Tan, Jian-yi; Zeng, Zhi-bin; Zhan, Tie-jun; Chen, Hai-qiang

    2015-07-01

    To introduce an arthroscopic technique in managing recurrent dislocation of the patella and its clinical results. Sixteen patients with recurrent patellar dislocation were reviewed, including 3 males and 13 females. The average age was 17.6 years old (ranged from 14 to 32 years). The patients suffering from patellar sub-luxation averaged 18.5 months (ranged from 6 to 23 months)before operation. These patients were treated with lateral patellar retinacular release outside the synovial bursa of knee joint and medial patellofemoral ligament reconstruction using the semitendinosus tendon free autograft. The Lyshohm scores before and after operation were used to evaluate outcomes at the final follow-up. All the patients were followed up, and the duration ranged from 6 to 48 months, with an average of 12 months. There was no recurrence. The Q angle decreased from (16.4 ± 3.7)° to (10.1 ± 1.4)°; insall index decreased from 1.37 ± 0.25 to 1.28 ± 0.23; congruence angle decreased from (21.3 ± 2.6)° to (5.86 ± 2.23)°; Lysholm score improved from 76.1 ± 5.2 to 89.8 ± 4.1 at 6 months after operation. Compared with conventional procedure, arthroscopic surgery for recurrent dislocation of the patella achieves excellent outcomes with minimum invasion.

  18. Ten-year follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocation in young patients.

    Science.gov (United States)

    Chapus, V; Rochcongar, G; Pineau, V; Salle de Chou, É; Hulet, C

    2015-12-01

    Early treatment of initial anterior glenohumeral dislocation in young patients is controversial and the interest of surgery, and notably arthroscopic stabilization, has not been demonstrated. A prospective study was therefore performed to assess (1) short-to-medium-term recurrence rate, (2) functional outcome, and (3) and medium-term osteoarthritis rate. Early arthroscopic stabilization by anterior capsule-labrum reinsertion after initial anterior shoulder dislocation is associated with low recurrence rate. Twenty-one patients with initial anterior dislocation were included between June 2002 and February 2004. All patients underwent arthroscopic Bankart repair within 30 days of dislocation. Patients were followed up prospectively, with clinical (Duplay and Constant scores) and radiological assessment (osteoarthritis). There were 5 recurrent dislocations (25%); 2 patients reported sensations of subluxation: i.e., 7 failures (35%). Mean Walch-Duplay score at 10 years was 88±1 (range, 30-100) and mean Rowe score 86±22 (range, 35-100). There was significant internal rotation deficit of one vertebral level between operated and contralateral shoulder (P shoulders (15%) showed Samilson grade 1 centered glenohumeral osteoarthritis. Early arthroscopic capsule-labrum reinsertion by the Bankart technique in the month following initial anterior dislocation of the shoulder in patients under 25 years of age provided a low recurrence rate (35%) compared to the literature, including dislocation (25%) and subluxation (10%). Functional outcome was satisfactory, and osteoarthritis rate was low (15% Samilson grade 1). IV, prospective non-comparative study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Broken or dislocated jaw

    Science.gov (United States)

    ... jaw; Fractured jaw; Fractured mandible; Broken jaw; TMJ dislocation; Mandibular dislocation ... needed to do this, particularly if repeated jaw dislocations occur. After dislocating your jaw, you should not ...

  20. Role of magnetic resonance imaging in the clinical management of the acutely locked knee

    Energy Technology Data Exchange (ETDEWEB)

    McNally, Eugene G.; Nasser, Khalid N.; Dawson, Stewart; Goh, Leslie A. [Department of Musculoskeletal Radiology, Nuffield Orthopaedic Centre and Oxford Radcliffe Hospital, Oxford, OX3 7LD (United Kingdom)

    2002-10-01

    To explore prospectively the hypothesis that MRI of the acutely locked knee can alter surgical decision-making.Design and patients. The study group comprised patients with a clinical diagnosis of knee locking requiring arthroscopy. The decision to carry out arthroscopy was made by an experienced consultant orthopaedic surgeon specialising in trauma and recorded in the patient's notes prior to MRI. Preoperative MRI was carried out using a 1.5 T system. The management was altered from surgical to conservative treatment in 20 (48%) patients on the basis of the MR findings. Arthroscopy was limited to patients with an MR diagnosis of a mechanical block, usually a displaced meniscal tear or loose body. Both patient groups were followed clinically until symptoms resolved.Results. Forty-two patients were entered into the study. MRI identified a mechanical cause for locking in 22 patients (21 avulsion meniscal tears and 1 loose body). All were confirmed at arthroscopy. Twenty patients were changed from operative to non-operative treatment on the basis of the MRI findings. One patient in this group required a delayed arthroscopy for an impinging anterior cruciate ligament stump. The sensitivity/specificity/accuracy of MRI in identifying patients who require arthroscopy was therefore 96%/100%/98% respectively.Conclusion. MRI can successfully segregate patients with a clinical diagnosis of mechanical locking into those who have a true mechanical block and those who can be treated conservatively. MRI should precede arthroscopy in this clinical setting. (orig.)

  1. Clinical and Arthroscopic Findings of Acute Anterior Cruciate Ligament Tears of the Knee

    Directory of Open Access Journals (Sweden)

    Kenji Shirakura

    1995-01-01

    Full Text Available Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty-three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond's fractures, 26 meniscus tears (8 medial and 18 lateral, 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05. Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations.

  2. [Acute myocardial infarction complicated pregnancy of patient after kindey transplantation and knee osteosarcoma].

    Science.gov (United States)

    Lehnertová, K; Huml, K; Pilka, R

    Case report describes a patient with acute ST elevation myocardial infarction with Q wave in 26 weeks gestation. Case report. Department of Obstetrics and Gynecology, University Hospital, Palacky University, Olomouc. Medical history is complicated with a cadaveric transplantation of kindey, osteosarcoma of the left knee with a joint extraction and chemotherapy, serious hypothyreosis after spontaneous discontinuation of medication and missing fetal nasal bone at the ultrasound examination. Myocardial infarction complicating pregnancy is an important cause of maternal morbidity and mortality. The coexistence of obesity, diabetes, chronic hypertension, and delayed age at pregnancy is expected to increase the prevalence of myocardial infarction during pregnancy. Timely treatment in the form of percutaneous coronary intervention has dramatically improved outcomes.

  3. Short-term outcomes of arthroscopic TightRope® fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations.

    Science.gov (United States)

    Bin Abd Razak, Hamid Rahmatullah; Yeo, Eng-Meng Nicholas; Yeo, William; Lie, Tijauw-Tjoen Denny

    2017-12-09

    The aim of this study was to compare the short-term outcomes of arthroscopic TightRope® fixation with that of hook plate fixation in patients with acute unstable acromioclavicular joint dislocations. We conducted a prospective case-control study of twenty-six patients with an acute ACJ dislocation who underwent surgical repair with either an arthroscopic TightRope® fixation or a hook plate from 2013 to 2016. Clinical and radiological data were collected prospectively. Clinical outcomes were evaluated using the Constant Score, the University of California at Los Angeles (UCLA) Shoulder Score, Oxford Shoulder Score as well as the visual analogue scale. Radiological outcomes were assessed with the coracoclavicular distance (CCD). Sixteen patients underwent arthroscopic TightRope® fixation, while 10 patients underwent hook plate fixation. There were no significant differences in the preoperative variables except for the mean UCLA 4b infraspinatus score (TightRope® 2.8 vs. hook plate 3.8; p = 0.030). Duration of surgery was significantly longer in the TightRope® group. At 1 year post-operatively, the TightRope® group had a significantly better Constant Score and CCD with no complications. All patients with hook plate fixation had to undergo a second procedure for removal of implant, and 3 patients had complications. Arthroscopic TightRope® fixation is a good option for the treatment of acute unstable ACJ dislocations. It has better short-term clinical and radiological outcomes as well as lesser complications when compared to hook plate fixation. Therapeutic, Level III.

  4. Effect of a Prophylactic Knee Brace on the Frequency and Severity of Acute Knee Injuries in Football.

    Science.gov (United States)

    1988-07-01

    knee injuries. The second highest incidence of injury was to the anterior cruciate ligament (ACL) which total 16 and accounted...grade II injuries. Sixty-four percent of the grade III sprains occurred to the anterior cruciate ligament (ACL). Within the MCL injury category, a...Posterior Cruciate Ligament MMX = Medial Meniscus LMX = Lateral Meniscus LCL = Lateral Collateral Ligament ACL = Anterior Cruciate Ligament

  5. Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults.

    LENUS (Irish Health Repository)

    Wakai, Abel

    2012-01-31

    BACKGROUND: There is conflicting evidence regarding the use of intra-articular lignocaine injection for the closed manual reduction of acute anterior shoulder dislocations. A systematic review may help cohere the conflicting evidence. OBJECTIVES: To compare the clinical efficacy and safety of intra-articular lignocaine and intravenous analgesia (with or without sedation) for reduction of acute anterior shoulder dislocation. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), and EMBASE (1980 to March 2010). We searched Current Controlled Trials metaRegister of Clinical Trials (compiled by Current Science) (March 2010). We imposed no language restriction. SELECTION CRITERIA: Randomized controlled trials comparing intra-articular lignocaine (IAL) with intravenous analgesia with or without sedation (IVAS) in adults aged 18 years and over for reduction of acute anterior shoulder dislocation. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Where possible, data were pooled and relative risks (RR) and mean differences (MD), each with 95% confidence intervals (CI), were computed using the Cochrane Review Manager statistical package (RevMan). MAIN RESULTS: Of 1041 publications obtained from the search strategy, we examined nine studies. Four studies were excluded, and five studies with 211 participants were eligible for inclusion. There was no difference in the immediate success rate of IAL when compared with IVAS in the closed manual reduction of acute anterior shoulder dislocation (RR 0.95; 95% CI 0.83 to 1.10). There were significantly fewer adverse effects associated with IAL compared with IVAS (RR 0.16; 95% CI 0.06 to 0.43). The mean time spent in the emergency department was significantly less with IAL compared with IVAS (MD 109.46 minutes; 95% CI 84.60 to 134.32). One trial reported significantly less time for

  6. Updated strategies to treat acute arterial complications associated with total knee and hip arthroplasty.

    Science.gov (United States)

    Troutman, Douglas A; Dougherty, Matthew J; Spivack, Adam I; Calligaro, Keith D

    2013-10-01

    Traditional treatment of acute arterial complications associated with total knee arthroplasty (TKA) and total hip arthroplasty (THA) has generally included arteriography followed by open surgery. The purpose of this study was to describe our evolution from open surgery to preferential endovascular treatment for acute arterial complications of TKA and THA. We analyzed our computerized database registry and patient charts for vascular interventions associated with TKA and THA at a hospital with a large volume of orthopedic surgery to determine changing trends in endovascular intervention for these complications. Between 1989 and 2012, 39,196 TKA (26,374 total: 23,205 primary; 3169 revisions) and THA (12,822 total: 10,293 primary; 2529 revisions) were performed. Vascular surgery consultation was provided for the treatment of acute ischemia, hemorrhage, ischemia with hemorrhage, and pseudoaneurysm formation. All interventions were performed within 30 days of joint replacement. A total of 49 (0.13%) acute arterial complications occurred over the 23-year period: 37 (76%) associated with TKA and 12 (24%) with THA. Arterial injury was detected on the same day as the orthopedic procedure in 28 patients, between postoperative days 1 and 5 in 18 patients, and between postoperative days 5 and 30 in three patients. The arterial complications caused ischemia in 28 patients (58%), hemorrhage in six (12%), ischemia with hemorrhage in six (12%), and pseudoaneurysm in nine (18%). Treatment included solely endovascular intervention in 12 (25%), failed endovascular treatment converted to open surgery in one (2%), and open surgery alone in 36 (73%) patients. Before 2002, only 6% (2/32; 2 TKA) of patients were successfully treated with endovascular intervention compared with 59% (10/17; 9 TKA, 1 THA) after June 2002 (P = .0004). There was no mortality, and limb salvage was achieved in all patients. Although the majority of acute arterial complications after TKA and THA are diagnosed on

  7. MR imaging in the evaluation of acute shoulder dislocations. Stellenwert der MR-Tomographie bei akuten Schulterluxationen

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, K.F.; Grebe, P.; Just, M. (Mainz Univ. (Germany). Inst. fuer Klinische Strahlenkunde); Runkel, M. (Mainz Univ. (Germany). Unfallchirurgische Klinik); Oberbillig, C. (St. Vincenz und Elisabeth Hospital, Mainz (Germany). Abt. fuer Unfallchirurgie)

    1992-09-01

    24 patients up to two weeks after primary traumatic shoulder dislocation were examined. A joint effusion allowing sufficient evaluation of the capsulolabral complex was present in 21/24 (87.5%) cases, 11/14 patients with combined dislocated detachments of the glenoid labrum and capsular lesions were subsequently operated upon. Marrow edema of the humeral head was found in 16/19 Hill-Sachs lesions and in 4/5 fractures of the greater tuberosity. Two patients presented with a lesion of the long biceps tendon associated with rotator cuff tears and were also subsequently operated upon. MRI performed shortly after primary traumatic shoulder dislocation allows a comprehensive evaluation of the intraarticular lesions and decisively influences further therapy. (orig./GDG).

  8. Perilunate Injuries, Not Dislocated (PLIND)

    Science.gov (United States)

    Herzberg, Guillaume

    2013-01-01

    Purpose We reviewed a series of equivalents of perilunate dislocations and fracture-dislocations (PLDs–PLFDs) in which there was no dislocation of the capitate from the lunate on the initial radiographs. We propose to include these injuries as a variant of perilunate dislocations that we have termed a perilunate injury, not dislocated (PLIND) lesion in a modified classification of perilunate injuries. Methods A review of the records of all acute perilunate injuries and displaced carpal fractures was done in a single-center university hospital wrist surgery unit over a 5-year period. All cases presenting at the acute stage with displaced fractures of scaphoid, lunate, triquetrum, or capitate along with scapholunate and/or lunotriquetral dissociation but no dislocation of the capitate from the lunate in the sagittal or coronal plane were reviewed and considered as PLIND lesions. Results We identified 11 patients with PLIND lesions. Three cases with clinical and radiological follow-up are presented. Discussion Equivalents of PLDs–PLFDs presenting without dislocation of the capitate from the lunate do exist. These injuries may be overlooked despite their severity. They require both osseous and ligamentous repair. Including them into an existing perilunate injuries classification highlights their recognition and enables a better understanding and treatment of both acute and chronic nondislocated perilunate injuries. Level of Evidence Level IV, retrospective case series. PMID:24436839

  9. Appendicular joint dislocations.

    Science.gov (United States)

    Hindle, Paul; Davidson, Eleanor K; Biant, Leela C; Court-Brown, Charles M

    2013-08-01

    This study defines the incidence and epidemiology of joint dislocations and subluxations of the appendicular skeleton. All patients presenting acutely to hospital with a dislocation or subluxation of the appendicular skeleton from a defined population were included in the study. There were 974 dislocations or subluxations over one year between the 1st November 2008 and the 31st October 2009. There was an overall joint dislocation incidence of 157/10(5)/year (188/10(5)/year in males and 128/10(5)/year in females). Males demonstrated a bimodal distribution with a peak incidence of 446/10(5)/year at 15-24 years old and another of 349/10(5)/year in those over 90 years. Females demonstrate an increasing incidence from the seventh decade with a maximum incidence of 520/10(5)/year in those over 90 years. The most commonly affected joints are the glenohumeral (51.2/10(5)/year), the small joints of the hand (29.9/10(5)/year), the patellofemoral joint (21.6/10(5)/year), the prosthetic hip (19.0/10(5)/year), the ankle (11.5/10(5)/year), the acromioclavicular joint (8.9/10(5)/year) and the elbow (5.5/10(5)/year). Unlike fractures, dislocations are more common in the both the most affluent and the most socially deprived sections of the population. Joint disruptions are more common than previously estimated. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Rocket launcher: A novel reduction technique for posterior hip dislocations and review of current literature.

    Science.gov (United States)

    Dan, Michael; Phillips, Alfred; Simonian, Marcus; Flannagan, Scott

    2015-06-01

    We provide a review of literature on reduction techniques for posterior hip dislocations and present our experience with a novel technique for the reduction of acute posterior hip dislocations in the ED, 'the rocket launcher' technique. We present our results with six patients with prosthetic posterior hip dislocation treated in our rural ED. We recorded patient demographics. The technique involves placing the patient's knee over the shoulder, and holding the lower leg like a 'Rocket Launcher' allow the physician's shoulder to work as a fulcrum, in an ergonomically friendly manner for the reducer. We used Fisher's t-test for cohort analysis between reduction techniques. Of our patients, the mean age was 74 years (range 66 to 85 years). We had a 83% success rate. The one patient who the 'rocket launcher' failed in, was a hemi-arthroplasty patient who also failed all other closed techniques and needed open reduction. When compared with Allis (62% success rate), Whistler (60% success rate) and Captain Morgan (92% success rate) techniques, there was no statistically significant difference in the successfulness of the reduction techniques. There were no neurovascular or periprosthetic complications. We have described a reduction technique for posterior hip dislocations. Placing the patient's knee over the shoulder, and holding the lower leg like a 'Rocket Launcher' allow the physician's shoulder to work as a fulcrum, thus mechanically and ergonomically superior to standard techniques. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  11. Atlantoaxial dislocation.

    Science.gov (United States)

    Jain, Vijendra K

    2012-01-01

    Atlanto-axial dislocations (AADs) may be classified into four varieties depending upon the direction and plane of the dislocation i.e. anteroposterior, rotatory, central, and mixed dislocations. However, from the surgical point of view these are divided into two categories i.e. reducible (RAADs) and irreducible (IAADs). Posterior fusion is the treatment of choice for RAAD. Transarticular screw fixation with sub-laminar wiring is the most stable& method of posterior fusion. Often, IAAD is due to inadequate extension in dynamic X-ray study which may also be due to spasm of muscles. If the anatomy at the occipito-atlanto-axial region {O-C1-C2; O: occiput, C1: atlas, C2: axis} is normal on X-ray, the dislocation should be reducible. In case congenital anomalies at O-C1-C2 and IAAD are seen on flexion/extension studies of the cervical spine, the C1-C2 joints should be seen in computerized tomography scan (CT). If the C1-C2 joint facet surfaces are normal, the AAD should be reducible by cervical traction or during surgery by mobilizing the joints. The entity termed "dolichoodontoid" does not exist. It is invariably C2-C3 (C3- third cervical vertebra) fusion which gives an appearance of dolichoodontoid on plain X-ray or on mid-saggital section of magnetic resonance imaging (MRI) or CT scan. The central dislocation and axial invagination should not be confused with basilar invagination. Transoral odontoidectomy alone is never sufficient in cases of congenital IAAD, adequate generous three-dimensional decompression while protecting the underlying neural structures should be achieved. Chronic post-traumatic IAAD are usually Type II odontoid fractures which get malunited or nonunited with pseudoarthrosis in dislocated position. All these dislocations can be reduced by transoral removal of the offending bone, callous and fibrous tissue.

  12. Perilunate Dislocation

    Directory of Open Access Journals (Sweden)

    John Jiao

    2016-09-01

    Full Text Available History of present illness: A 25-year-old female presented to the emergency department with left wrist pain following a fall off a skateboard. The patient fell on her outstretched left wrist with the wrist dorsiflexed and reported immediate sharp pain to her left wrist that was worse with movement. She denied other trauma. Significant findings: In the left lateral wrist x-ray, the lunate (outlined in blue is dislocated from the rest of the wrist bones (yellow line but still articulates with the radius (red line. The capitate (yellow line does not sit within the distal articulation of the lunate and is displaced dorsally. Additionally, a line drawn through the radius and lunate (green line fails to intersect with the capitate. This is consistent with a perilunate dislocation. This is compared to a lunate dislocation, where the lunate itself is displaced and turned ventrally (spilled teacup and the proximal aspect does not articulate with the radius. Discussion: A perilunate dislocation is a significant closed wrist injury that is easily missed on standard anterior-posterior imaging. These dislocations are relatively rare, involving only 7% of all carpal injuries and are associated with high-energy trauma onto a hyperextended wrist, such as falls from a height, motor vehicle accidents, and sports injuries.1 An untreated perilunate dislocation is associated with high risk of chronic carpal instability and post-traumatic arthritis. If the mechanism of injury is sufficient to suspect perilunate dislocation, multiple radiographic views of the wrist should be ordered. Patients should receive prompt orthopedic consultation for open reduction and ligamentous repair. Even after successful identification and subsequent surgical repair, median nerve neuropathy and post-traumatic arthritis are frequent.2-3

  13. Isolated Proximal Tibiofibular Dislocation during Soccer

    Directory of Open Access Journals (Sweden)

    Casey Chiu

    2015-01-01

    Full Text Available Proximal tibiofibular dislocations are rarely encountered in the Emergency Department (ED. We present a case involving a man presenting to the ED with left knee pain after making a sharp left turn on the soccer field. His physical exam was only remarkable for tenderness over the lateral fibular head. His X-rays showed subtle abnormalities of the tibiofibular joint. The dislocation was reduced and the patient was discharged from the ED with orthopedic follow-up.

  14. A case of synovial lipomatosis with chronic synovitis presenting as acute knee pain

    Directory of Open Access Journals (Sweden)

    Sushma HM, Anoosha K, Vijay Shankar S, Amita K

    2014-07-01

    Full Text Available Background: Synovial lipomatosis is a rare, benign, intra-articular lipoma-like lesion characterized by villous proliferation of the synovium, most commonly affecting the knee joint. The usual presentation is long standing progressive swelling of the affected joint, with or without pain and restriction of movements. Histopathology is confirmatory. Case Report: We present the case of a 35- year old male patient with long standing history of swelling, short history of pain in the left knee joint. X-Ray and magnetic resonance imaging scans of the left knee showed the characteristic features of synovial lipomatosis with chronic synovitis. The patient underwent diagnostic arthroscopy with lavage of left knee joint. Histopathological study confirmed synovial lipomatosis with chronic synovitis. Conclusion: Synovial lipomatosis is a rare, benign, intra-articular lipoma-like lesion. Although rare, clinically it should be considered as an important differential in evaluating neoplastic and non- neoplastic conditions of the knee joint.

  15. Crystal Dislocations

    Directory of Open Access Journals (Sweden)

    Ronald W. Armstrong

    2016-01-01

    Full Text Available Crystal dislocations were invisible until the mid-20th century although their presence had been inferred; the atomic and molecular scale dimensions had prevented earlier discovery. Now they are normally known to be just about everywhere, for example, in the softest molecularly-bonded crystals as well as within the hardest covalently-bonded diamonds. The advent of advanced techniques of atomic-scale probing has facilitated modern observations of dislocations in every crystal structure-type, particularly by X-ray diffraction topography and transmission electron microscopy. The present Special Issue provides a flavor of their ubiquitous presences, their characterizations and, especially, their influence on mechanical and electrical properties.

  16. Three-dimensional MRI-based statistical shape model and application to a cohort of knees with acute ACL injury.

    Science.gov (United States)

    Pedoia, V; Lansdown, D A; Zaid, M; McCulloch, C E; Souza, R; Ma, C B; Li, X

    2015-10-01

    The aim of this study is to develop a novel 3D magnetic resonance imaging (MRI)-based Statistical Shape Modeling (SSM) and apply it in knee MRIs in order to extract and compare relevant shapes of the tibia and femur in patients with and without acute Anterior cruciate ligament (ACL) injuries. Bilateral MR images were acquired and analyzed for 50 patients with acute ACL injuries and for 19 control subjects. A shape model was extracted for the tibia and femur using an SSM algorithm based on a set of matched landmarks that are computed in a fully automatic manner. Shape differences were detected between the knees in the ACL-injury group and control group, suggesting a common shape feature that may predispose these knees to injury. Some of the detected shape features that discriminate between injured and control knees are related to intercondylar width and posterior tibia slope, features that have been suggested in previous studies as ACL morphological risk factors. However, shape modeling has the great potential to quantify these characteristics with a comprehensive description of the surfaces describing complex 3D deformation that cannot be represented with simple geometric indexes. 3D MRI-based bone shape quantification has the ability to identify specific anatomic risk factors for ACL injury. A better understanding of the role in bony shape on ligamentous injuries could help in the identification of subjects with an increased risk for an ACL tear and to develop targeted prevention strategies, including education and training. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  17. Acute changes in knee cartilage transverse relaxation time after running and bicycling.

    Science.gov (United States)

    Gatti, Anthony A; Noseworthy, Michael D; Stratford, Paul W; Brenneman, Elora C; Totterman, Saara; Tamez-Peña, José; Maly, Monica R

    2017-02-28

    To compare the acute effect of running and bicycling of an equivalent cumulative load on knee cartilage composition and morphometry in healthy young men. A secondary analysis investigated the relationship between activity history and the change in cartilage composition after activity. In fifteen men (25.8±4.2 years), the vertical ground reaction force was measured to determine the cumulative load exposure of a 15-min run. The vertical pedal reaction force was recorded during bicycling to define the bicycling duration of an equivalent cumulative load. On separate visits that were spaced on average 17 days apart, participants completed these running and bicycling bouts. Mean cartilage transverse relaxation times (T 2 ) were determined for cartilage on the tibia and weight-bearing femur before and after each exercise. T 2 was measured using a multi-echo spin-echo sequence and 3T MRI. Cartilage of the weight bearing femur and tibia was segmented using a highly-automated segmentation algorithm. Activity history was captured using the International Physical Activity Questionnaire. The response of T 2 to bicycling and running was different (p=0.019; mean T 2 : pre-running=34.27ms, pre-bicycling=32.93ms, post-running=31.82ms, post-bicycling=32.36ms). While bicycling produced no change (-1.7%, p=0.300), running shortened T 2 (-7.1%, prunning. Activity history was inversely related to tibial T 2 , suggesting cartilage conditioning. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Acute Improvement of Vertical Jump Performance After Isometric Squats Depends on Knee Angle and Vertical Jumping Ability.

    Science.gov (United States)

    Tsoukos, Athanasios; Bogdanis, Gregory C; Terzis, Gerasimos; Veligekas, Panagiotis

    2016-08-01

    Tsoukos, A, Bogdanis, GC, Terzis, G, and Veligekas, P. Acute improvement of vertical jump performance after isometric squats depends on knee angle and vertical jumping ability. J Strength Cond Res 30(8): 2250-2257, 2016-This study examined the acute effects of maximum isometric squats at 2 different knee angles (90 or 140°) on countermovement jump (CMJ) performance in power athletes. Fourteen national-level male track and field power athletes completed 3 main trials (2 experimental and 1 control) in a randomized and counterbalanced order 1 week apart. Countermovement jump performance was evaluated using a force-plate before and 15 seconds, 3, 6, 9, and 12 minutes after 3 sets of 3 seconds maximum isometric contractions with 1-minute rest in between, from a squat position with knee angle set at 90 or 140°. Countermovement jump performance was improved compared with baseline only in the 140° condition by 3.8 ± 1.2% on the 12th minute of recovery (p = 0.027), whereas there was no change in CMJ height in the 90° condition. In the control condition, there was a decrease in CMJ performance over time, reaching -3.6 ± 1.2% (p = 0.049) after 12 minutes of recovery. To determine the possible effects of baseline jump performance on subsequent CMJ performance, subjects were divided into 2 groups ("high jumpers" and "low jumpers"). The baseline CMJ values of "high jumpers" and "low jumpers" differed significantly (CMJ: 45.1 ± 2.2 vs. 37.1 ± 3.9 cm, respectively, p = 0.001). Countermovement jump was increased only in the "high jumpers" group by 5.4 ± 1.4% (p = 0.001) and 7.4 ± 1.2% (p = 0.001) at the knee angles of 90 and 140°, respectively. This improvement was larger at the 140° angle (p = 0.049). Knee angle during isometric squats and vertical jumping ability are important determinants of the acute CMJ performance increase observed after a conditioning activity.

  19. Conservative treatment of acute knee osteoarthritis: A review of the Cochrane Library

    Directory of Open Access Journals (Sweden)

    Emerito Carlos Rodriguez-Merchan

    2016-05-01

    Conclusions: Five main strategies for the conservative treatment of knee osteoarthritis exist that must be used before indicating surgical treatment: medical treatment, physical medicine and rehabilitation, intra-articular injections, acupuncture, and self-management education programs.

  20. Proximal tibiofibular dislocation: a case report and review of literature

    NARCIS (Netherlands)

    Nieuwe Weme, R. A.; Somford, M. P.; Schepers, T.

    2014-01-01

    An isolated dislocation of the proximal tibiofibular joint is uncommon. The mechanism of this injury is usually sports related. We present a case where initial X-rays did not show the tibiofibular joint dislocation conclusively. It was diagnosed after comparative bilateral AP X-rays of the knees

  1. Oxidative stress and inflammatory responses following an acute bout of isokinetic exercise in obese women with knee osteoarthritis.

    Science.gov (United States)

    Germanou, Evangelia I; Chatzinikolaou, Athanasios; Malliou, Paraskevi; Beneka, Anastasia; Jamurtas, Athanasios Z; Bikos, Christos; Tsoukas, Dimitrios; Theodorou, Apostolos; Katrabasas, Ioannis; Margonis, Konstantinos; Douroudos, Ioannis; Gioftsidou, Asimenia; Fatouros, Ioannis G

    2013-12-01

    Obesity is associated with osteoarthritis and it is accompanied by chronic inflammation and elevated oxidative stress. Strengthening-type exercise is used in knee osteoarthritis (KOA) rehabilitation. This study determined how acute isokinetic exercise influences inflammatory responses of obese middle-aged women with KOA. Ten obese women with KOA and 10 age/weight-matched controls performed an isokinetic exercise protocol. Assessment of performance (knee extensor/flexor torque), muscle soreness (DOMS), knee flexibility (KJRM), and pain, and blood collection were performed pre-exercise, post-exercise, and at 24h post-exercise. Blood was analyzed for creatine kinase activity (CK), lactate dehydrogenase activity (LDH), CRP, leukocytes, uric acid, IL-6, TBARS, lipid hydroperoxides (LPX), protein carbonyls (PC), oxidized (GSH) and reduced glutathione (GSSG), total antioxidant capacity (TAC), catalase activity, and glutathione peroxidase activity (GPX). Physical function remained unaltered by exercise (only torque at 90°/s decreased at 24h). Exercise increased DOMS throughout recovery but KJRM and pain remained unchanged. CK, LDH, and uric acid increased similarly in both groups. CRP remained unaffected by exercise while IL-6 increased only post-exercise. TBARS, PC, LPH, GSSG, and TAC increased only post-exercise in both groups. GSH and GSH/GSSG declined post-exercise and normalized thereafter. Catalase and GPX increased only in patients post-exercise. Isokinetic exercise induces only a mild inflammatory response of very short duration (exercise may be safe for this patient cohort. These results indicate that KOA patients may be able to receive another exercise stimulus after only 48h. Isokinetic exercise produces minimal inflammation and pain in knee osteoarthritis patients, could be performed every 48h during rehabilitation, and up-regulates patients' antioxidant system. Copyright © 2012 Elsevier B.V. All rights reserved.

  2. Talocrural dislocation with associated weber type C fibular fracture in a collegiate football player: a case report

    National Research Council Canada - National Science Library

    Ricci, R Daniel; Cerullo, James; Blanc, Robert O; McMahon, Patrick J; Buoncritiani, Anthony M; Stone, David A; Fu, Freddie H

    2008-01-01

    .... A below-knee, fiberglass splint was applied to stabilize the ankle joint complex. Subtalar dislocation, Maisonneuve fracture, malleolar fracture, deltoid ligament rupture, syndesmosis disruption...

  3. Acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery: a case report

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2012-03-01

    Full Text Available Abstract Introduction Spinal anesthesia is a widely used general purpose anesthesia. However, serious complications, such as intracranial subdural hemorrhage, can rarely occur. Case presentation We report the case of a 73-year-old Japanese woman who had acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery. Conclusion This case highlights the need to pay attention to acute intracranial subdural hemorrhage as a complication after spinal anesthesia. If the headache persists even in a supine position or nausea occurs abruptly, computed tomography or magnetic resonance imaging of the brain should be conducted. An intracranial subdural hematoma may have a serious outcome and is an important differential diagnosis for headache after spinal anesthesia.

  4. Acute Ankle Sprain in a Mouse Model: Changes in Knee-Joint Space.

    Science.gov (United States)

    Hubbard-Turner, Tricia; Wikstrom, Erik A; Guderian, Sophie; Turner, Michael J

    2017-06-02

      Ankle sprains remain the most common orthopaedic injury. Conducting long-term studies in humans is difficult and costly, so the long-term consequences of an ankle sprain are not entirely known.   To measure knee-joint space after a single surgically induced ankle sprain in mice.   Randomized controlled trial.   University research laboratory.   Thirty male mice (CBA/2J) were randomly placed into 1 of 3 surgical groups: the transected calcaneofibular ligament (CFL) group, the transected anterior talofibular ligament/CFL group, or a sham treatment group. The right ankle was operated on in all mice.   Three days after surgery, all of the mice were individually housed in cages containing a solid-surface running wheel, and daily running-wheel measurements were recorded. Before surgery and every 6 weeks after surgery, a diagnostic ultrasound was used to measure medial and lateral knee-joint space in both hind limbs.   Right medial (P = .003), right lateral (P = .002), left medial (P = .03), and left lateral (P = .002) knee-joint spaces decreased across the life span. The mice in the anterior talofibular ligament/CFL group had decreased right medial (P = .004) joint space compared with the sham and CFL groups starting at 24 weeks of age and continuing throughout the life span. No differences occurred in contralateral knee-joint degeneration among any of the groups.   Based on current data, mice that sustained a surgically induced severe ankle sprain developed greater joint degeneration in the ipsilateral knee. Knee degeneration could result from accommodation to the laxity of the ankle or biomechanical alterations secondary to ankle instability. A single surgically induced ankle sprain could significantly affect knee-joint function.

  5. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: Correlation analysis with anatomical variants and articular cartilage lesion of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Guang-ying; Ding, Hong-yu [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Ultrasonography, Jinan (China); Zheng, Lei; Ji, Bing-jun [Shandong Provincial Corps Hospital of Chinese People' s Armed Police Force, Department of Radiology, Jinan (China); Shi, Hao [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Radiology, Jinan (China); Feng, Yan [Affiliated Hospital of Binzhou Medical College, Department of Radiology, Binzhou (China)

    2017-03-15

    To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. (orig.)

  6. Association between traumatic bone marrow abnormalities of the knee, the trauma mechanism and associated soft-tissue knee injuries

    Energy Technology Data Exchange (ETDEWEB)

    Berger, Nicole [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Andreisek, Gustav; Karer, Anissja T.; Manoliu, Andrei; Ulbrich, Erika J. [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Bouaicha, Samy [University Hospital Zurich, Department of Trauma Surgery, Zurich (Switzerland); Naraghi, Ali [University of Toronto, Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto, ON (Canada); Seifert, Burkhardt [University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, Zurich (Switzerland)

    2017-01-15

    To determine the association between traumatic bone marrow abnormalities, the knee injury mechanism, and associated soft tissue injuries in a larger cohort than those in the published literature. Retrospective study including 220 patients with traumatic knee injuries. Knee MRIs were evaluated for trauma mechanism, soft tissue injury, and the location of bone marrow abnormalities. The locations of the abnormalities were correlated with trauma mechanisms and soft tissue injuries using the chi-square test with Bonferroni correction. One hundred and forty-four valgus injuries, 39 pivot shift injuries, 25 lateral patellar dislocations, 8 hyperextensions, and 4 dashboard injuries were included. Valgus and pivot shift injuries showed traumatic bone marrow abnormalities in the posterolateral regions of the tibia. Abnormalities after patellar dislocation were found in the anterolateral and centrolateral femur and patella. Hyperextension injuries were associated with abnormalities in almost all regions, and dashboard injuries were associated with changes in the anterior regions of the tibia and femur. Our study provides evidence of associations between traumatic bone marrow abnormality patterns and different trauma mechanisms in acute knee injury, and reveals some overlap, especially of the two most common trauma mechanisms (valgus and pivot shift), in a large patient cohort. (orig.)

  7. The effects of a functional knee brace during early treatment of patients with a nonoperated acute anterior cruciate ligament tear: a prospective randomized study.

    Science.gov (United States)

    Swirtun, Linda R; Jansson, Anna; Renström, Per

    2005-09-01

    To evaluate the effect of a functional knee brace on nonoperated acute anterior cruciate ligament (ACL)-deficient patients. : Prospective randomized clinical trial. University clinic. Ninety-five patients (18-50 years old) with an acute ACL tear were included in the present study. The subjects were randomized to either brace group, treated with functional bracing from the first testing session (partial rupture or articular cartilage injury shown on MRI or with arthroscopy, or other injuries that negatively affected rehabilitation, or dropped out due to surgery (n = 22), or personal reasons (n = 10). Forty-two patients remained in the study, 22 in the brace group and 20 in the control group. Visual analogue scale, Knee Osteoarthritis Outcome Score, Cincinnati knee score, a brace evaluation form, and muscle peak torque. When using the brace the subjects in the brace group experienced less (P = 0.047) sense of instability, evaluated with visual analogue scale, than the control group. However, bracing had no effect on any of the variables in Knee Osteoarthritis Outcome Score or Cincinnati knee score and no effect on quadriceps or hamstring muscle peak torque. Subjectively, the brace group experienced a positive effect of the brace on rehabilitation. Nonoperated acute ACL-deficient patients experienced a positive effect of the brace regarding sense of instability and rehabilitation. However, these findings were not supported by objective outcomes.

  8. Bilateral asymmetrical traumatic sternoclavicular joint dislocations.

    Science.gov (United States)

    Albarrag, Mohammed K

    2012-11-01

    Unilateral and bilateral sternoclavicular joint (SCJ) dislocations are rare injuries. The difficulty in assessing this condition often leads to delay in diagnosis and treatment. We report a rare case of bilateral asymmetrical traumatic SCJ dislocations in a 45-year-old male. The right anterior SCJ dislocation was reduced in the emergency room (ER) and resulted in residual instability. The left posterior SCJ dislocation was asymptomatic and unnoticed for six months. It is important for ER physicians and orthopaedic surgeons to be able identify and treat this condition. All suspected SCJ dislocations should be evaluated by computed tomography (CT) scan for confirmation of the diagnosis and evaluation of both SCJs. Posterior SCJ dislocation is a potentially fatal injury and should not be overlooked due to the presence of other injuries. Surgical intervention is often necessary in acute and old cases.

  9. Bilateral Asymmetrical Traumatic Sternoclavicular Joint Dislocations

    Science.gov (United States)

    Albarrag, Mohammed K.

    2012-01-01

    Unilateral and bilateral sternoclavicular joint (SCJ) dislocations are rare injuries. The difficulty in assessing this condition often leads to delay in diagnosis and treatment. We report a rare case of bilateral asymmetrical traumatic SCJ dislocations in a 45-year-old male. The right anterior SCJ dislocation was reduced in the emergency room (ER) and resulted in residual instability. The left posterior SCJ dislocation was asymptomatic and unnoticed for six months. It is important for ER physicians and orthopaedic surgeons to be able identify and treat this condition. All suspected SCJ dislocations should be evaluated by computed tomography (CT) scan for confirmation of the diagnosis and evaluation of both SCJs. Posterior SCJ dislocation is a potentially fatal injury and should not be overlooked due to the presence of other injuries. Surgical intervention is often necessary in acute and old cases. PMID:23275851

  10. Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Karantanas, Apostolos H. [Department of Radiology, University of Crete, Heraklion 711 10 Greece (Greece)], E-mail: apolsen@yahoo.com; Drakonaki, Elena [Department of Radiology, University of Crete, Heraklion 711 10 Greece (Greece); Karachalios, Theophilos [Department of Orthopaedic Surgery, University of Thessaly, Larissa 411 10 Greece (Greece); Korompilias, Anastasios V. [Department of Orthopaedic Surgery, University of Ioannina, Ioannina 451 10 (Greece); Malizos, Konstantinos [Department of Orthopaedic Surgery, University of Thessaly, Larissa 411 10 Greece (Greece)

    2008-07-15

    Purpose: The aim of the study was to present the MRI findings of non-traumatic edema-like lesions presented acutely in the adult knee and to correlate them with the 3-year outcome and the bone mineral density (BMD) in the spine. Materials and methods: Ninety-eight patients (40 men, 58 women, mean age 60.1 {+-} 11 years, age range 27-82 years), were followed up clinically as well as with MR imaging, when indicated, for at least 3 years. Patients were classified according to presentation in 3 groups (A: bone marrow edema (BME), B: BME and subchondral fracture, C: BME and articular collapse) and according to outcome in 2 groups (A: reversible BME, B: articular collapse). BMD measurements of the spine were carried out in males over 70 and females over 60 years old using DEXA. Results: The isolated BME pattern was observed in 64.3% (Group A), subchondral fractures without articular collapse in 11.2% (Group B) and articular collapse in 24.5% (Group C). Significant differences were found among the 3 groups at presentation, regarding the age, sex, BMD, affected area and duration of symptoms prior to imaging (p < 0.05). Localization of the lesions in the weight-bearing areas of the knee was shown in 100% of C, in 90.9% of B and in 50.8% of A. The duration of symptoms prior to imaging was longer in C (7.6 {+-} 2.8 m) than in A (2.5 {+-} 1.7 m) and B (4.0 {+-} 3.2 m) (p < 0.05). Group B progressed to articular collapse in 45.5%, the rest demonstrating a favourable outcome. Group C showed clinical improvement in 75% and persistent symptoms that required knee arthroplasty in 25% of cases. Articular collapse was the final outcome in 29.6% and transient BME in 70.4% of patients. These two groups showed significant differences regarding the age (p {approx} 0), sex (p = 0.002), low BMD (p = 0.004), affected area (p {approx} 0), presence of subchondral sparing (p {approx} 0), duration of symptoms prior to imaging (p {approx} 0), time from onset of symptoms to the final outcome (p

  11. Sonography on injury of the medial patellofemoral ligament after acute traumatic lateral patellar dislocation: Injury patterns and correlation analysis with injury of articular cartilage of the inferomedial patella.

    Science.gov (United States)

    Zhang, Guang-Ying; Zheng, Lei; Shi, Hao; Qu, Su-Hui; Ding, Hong-Yu

    2013-12-01

    The purpose of this study was to investigate the accuracy of high-frequency ultrasonography in the diagnosis of injuries of medial patellofemoral ligaments (MPFLs), analyse the characteristics of MPFL injury and correlations between injury of the MPFL and articular cartilage of the inferomedial patella in patients with acute traumatic lateral patellar dislocation. High-frequency sonographic images of 49 patients with acute traumatic lateral patellar dislocations treated surgically were reviewed. The χ(2) tests were performed for statistical analysis. Twenty-eight cases of complete MPFL tear and 21 cases of partial MPFL tear were identified in operation, with 27 cases of MPFL tear located at their femoral attachment, 21 cases of tear at the patellar attachment and one case of midsubstance tear. The diagnostic accuracy of sonography regarding partial MPFL tear and complete MPFL tear was 89.8% and 89.8%. Among the patients with MPFL tear at the patellar attachment, eight and six cases were concomitant with chondral and osteochondral lesions in the inferomedial patella, respectively, in contrast to nine and six cases in patients with MPFL tear at the femoral attachment, respectively. There was no significant difference between the two locations described above regarding the prevalence rates of chondral or osteochondral lesions of the inferomedial patella (P=0.732, P=0.614). Among the patients with complete MPFL tear, 12 and 10 cases were concomitant with chondral and osteochondral lesions in the inferomedial patella, respectively, while six and two cases were concomitant with partial MPFL tear. There was no significant difference between the two types of injuries discussed above on the prevalence rates of chondral lesions of the inferomedial patella (P=0.305), but the prevalence rate of osteochondral lesions between the two types of injuries discussed above was statistically different (P=0.035). The MPFL is most easily injured at the femoral attachment, secondly at

  12. A national survey of the physiotherapy management of patients following first-time patellar dislocation.

    Science.gov (United States)

    Smith, Toby O; Chester, Rachel; Clark, Allan; Donell, Simon T; Stephenson, Richard

    2011-12-01

    The purpose of this study was to determine how musculoskeletal physiotherapists in acute National Health Service (NHS) hospitals manage patients following a first time patellar dislocation. National survey study. All NHS acute hospitals with an accident and emergency and/or an orthopaedic department were surveyed. 306 institutions were surveyed. Each institution was sent a 14 question self-administered questionnaire pertaining to the assessment, treatment, evaluation and outcome of patients following a first time patellar dislocation. After 3 weeks, all non-respondents were sent a reminder letter. After a further 3 weeks, those who had not responded by this time were sent a final reminder and copy of the questionnaire. The survey response rate was 59%. The respondents indicated that first-time patellar dislocation was not a common musculoskeletal disorder managed by NHS physiotherapists, constituting an average of 2% of caseloads. The results suggested that physiotherapists most commonly assess for reduced quadriceps or VMO capacity, gait, patellar tracking and glide, and knee effusion when examining patients following a first-time patellar dislocation. The most common treatments adopted are reassurance, behaviour modification followed by proprioceptive, knee mobility, quadriceps and specific VMO exercises. Generic lower limb assessment and treatment strategies are widely used to manage this patient group. Given the previous paucity in this literature, further study is now recommended to assess the efficacy of these interventions to provide UK physiotherapists with an evidence-base to justify their management strategies. Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  13. Acute Effects of Kinesio Taping on Knee Extensor Peak Torque and Stretch Reflex in Healthy Adults

    Science.gov (United States)

    Yeung, Simon S.; Yeung, Ella W.

    2016-01-01

    Abstract Kinesio Tex tape (KT) is used to prevent and treat sports-related injuries and to enhance muscle performance. It has been proposed that the direction of taping may either facilitate or inhibit the muscle by having different effects on cutaneous receptors that modulate excitability of the motor neurons. This study had 2 goals. First, we wished to determine if KT application affects muscle performance and if the method of application facilitates or inhibits muscle performance. This was assessed by measuring isokinetic knee extension peak torque in the knee extensor. Second, we assessed neurological effects of taping on the excitability of the motor neurons by measuring the reflex latency and action potential by electromyography (EMG) in the patellar reflex. The study was a single-blind, placebo-controlled crossover trial with 28 healthy volunteers with no history of knee injuries. Participants received facilitative KT treatment, inhibitory KT treatment, or Hypafix taping of the knee extensor. There were significant differences in the peak torque between 3 treatments (F(2,54) = 4.873, P < 0.01). Post hoc analysis revealed that facilitative KT treatment resulted in higher knee extensor peak torque performance than inhibitory KT treatment (P = 0.036, effect size 0.26). There were, however, no significant differences in the reflex latency (F(2,54) = 2.84, P = 0.067) nor in the EMG values (F(2,54) = 0.18, P = 0.837) in the patellar reflex between the 3 taping applications. The findings suggest that the direction of KT application over the muscle has specific effects on muscle performance. Given the magnitude of effect is small, interpretation of clinical significance should be considered with caution. The underlying mechanism warrants further investigation. PMID:26825916

  14. Truly anatomic coracoclavicular ligament reconstruction with 2 Endobutton devices for acute Rockwood type V acromioclavicular joint dislocations.

    Science.gov (United States)

    Xue, Cheng; Song, Li-Jun; Zhang, Hao; Tang, Guo-Long; Li, Xiang; Fang, Jia-Hu

    2018-01-15

    Truly anatomic coracoclavicular ligament reconstruction (TACCR) according to the original insertions is a creative new method for the treatment of severe acromioclavicular separation. This research analyzed the clinical and radiologic results of TACCR in 25 patients with at least 2-year follow-up. The study enrolled 25 patients with Rockwood type V acromioclavicular joint dislocations who underwent TACCR using 2 Endobutton (Smith & Nephew Inc., Andover, MA, USA) devices from May 2013 to October 2015. Patients were assessed with clinical and radiologic follow-up at 3, 6, 12, 18, and 24 months postoperatively. The clinical assessments consisted of the visual analog scale and the Constant score. The radiographic evaluations were performed by measurements of the coracoclavicular distance. The mean follow-up was 34 ± 6.8 months (range, 24-48 months). The visual analog scale and Constant scores revealed significant advancements from 5 ± 0.9 (range, 4-7) and 45 ± 5.6 (range, 30-54) scores preoperatively to 0 ± 0.5 (range, 0-2) and 95 ± 2.9 (range, 91-98) scores at 24 months postoperatively, respectively. The coracoclavicular distance significantly decreased from 23 ± 5.4 mm (range, 16-34 mm) preoperatively to 8 ± 0.9 mm (range, 7-10 mm) at the final follow-up. TACCR represents a safe, reliable and creative surgical technique that yields good to excellent clinical and radiologic outcomes in the treatment of severe acromioclavicular separation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

    Science.gov (United States)

    Izadpanah, Kaywan; Jaeger, Martin; Ogon, Peter; Südkamp, Norbert P.; Maier, Dirk

    2015-01-01

    An arthroscopically assisted technique for the treatment of acute acromioclavicular joint dislocations is presented. This pathology-based procedure aims to achieve anatomic healing of both the acromioclavicular ligament complex (ACLC) and the coracoclavicular ligaments. First, the acromioclavicular joint is reduced anatomically under macroscopic and radiologic control and temporarily transfixed with a K-wire. A single-channel technique using 2 suture tapes provides secure coracoclavicular stabilization. The key step of the procedure consists of the anatomic repair of the ACLC (“AC-Reco”). Basically, we have observed 4 patterns of injury: clavicular-sided, acromial-sided, oblique, and midportion tears. Direct and/or transosseous ACLC repair is performed accordingly. Then, an X-configured acromioclavicular suture tape cerclage (“AC-Bridge”) is applied under arthroscopic assistance to limit horizontal clavicular translation to a physiological extent. The AC-Bridge follows the principle of internal bracing and protects healing of the ACLC repair. The AC-Bridge is tightened on top of the repair, creating an additional suture-bridge effect and promoting anatomic ACLC healing. We refer to this combined technique of anatomic ACLC repair and protective internal bracing as the “AC-RecoBridge.” A detailed stepwise description of the surgical technique, including indications, technical pearls and pitfalls, and potential complications, is given. PMID:26052493

  16. Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test.

    Science.gov (United States)

    Vigotsky, Andrew D; Lehman, Gregory J; Contreras, Bret; Beardsley, Chris; Chung, Bryan; Feser, Erin H

    2015-01-01

    Background. Foam rolling has been shown to acutely increase range of motion (ROM) during knee flexion and hip flexion with the experimenter applying an external force, yet no study to date has measured hip extensibility as a result of foam rolling with controlled knee flexion and hip extension moments. The purpose of this study was to investigate the acute effects of foam rolling on hip extension, knee flexion, and rectus femoris length during the modified Thomas test. Methods. Twenty-three healthy participants (male = 7; female = 16; age = 22 ± 3.3 years; height = 170 ± 9.18 cm; mass = 67.7 ± 14.9 kg) performed two, one-minute bouts of foam rolling applied to the anterior thigh. Hip extension and knee flexion were measured via motion capture before and after the foam rolling intervention, from which rectus femoris length was calculated. Results. Although the increase in hip extension (change = +1.86° (+0.11, +3.61); z(22) = 2.08; p = 0.0372; Pearson's r = 0.43 (0.02, 0.72)) was not due to chance alone, it cannot be said that the observed changes in knee flexion (change = -1.39° (-5.53, +2.75); t(22) = -0.70; p = 0.4933; Cohen's d = - 0.15 (-0.58, 0.29)) or rectus femoris length (change = -0.005 (-0.013, +0.003); t(22) = -1.30; p = 0.2070; Cohen's d = - 0.27 (-0.70, 0.16)) were not due to chance alone. Conclusions. Although a small change in hip extension was observed, no changes in knee flexion or rectus femoris length were observed. From these data, it appears unlikely that foam rolling applied to the anterior thigh will improve passive hip extension and knee flexion ROM, especially if performed in combination with a dynamic stretching protocol.

  17. Acute effects of cold therapy on knee skin surface temperature: gel pack versus ice bag

    OpenAIRE

    Breslin, Matthew; Lam, Patrick; Murrell, George A C

    2015-01-01

    Background To our knowledge there has been no research that has compared the effectiveness of two popular cold therapy modalities applied to healthy human knees, with a surgical dressing, over a 4?h period. Hypothesis To determine whether gel packs are more effective than ice bags at reducing skin surface temperature in humans. Study design This was a randomised, repeated measures crossover study, which included nine healthy participants. Level of evidence Level 2. Methods Two cold therapy mo...

  18. Acute effects of cold therapy on knee skin surface temperature: gel pack versus ice bag.

    Science.gov (United States)

    Breslin, Matthew; Lam, Patrick; Murrell, George A C

    2015-01-01

    To our knowledge there has been no research that has compared the effectiveness of two popular cold therapy modalities applied to healthy human knees, with a surgical dressing, over a 4 h period. To determine whether gel packs are more effective than ice bags at reducing skin surface temperature in humans. This was a randomised, repeated measures crossover study, which included nine healthy participants. Level 2. Two cold therapy modalities-a gel pack (DonJoy-Orthopaedic Pty Ltd, Normanhurst, New South Wales, Australia) and an ice bag (ICE'N'EASY, Bokarina, Queensland, Australia)-were applied on top of a surgical dressing, covering the knee. Each participant randomly received two cold therapy treatments, in separate sessions, at least 4 days apart. Each session utilised the time protocol of 20 min application on the hour, for 4 h. Skin surface temperature was recorded throughout the session at 1 min intervals. In the first application, the ice bag (5°C±1.7°C) was more effective at reducing skin surface temperature (pice bag initially was more effective than the gel pack at reducing skin surface temperature of healthy knees, with a surgical dressing. Over a 4 h period both gel packs and ice bags were just as effective at reducing skin surface temperature and at maintaining these lower temperatures.

  19. Recurrent Dislocation of the Patella

    Science.gov (United States)

    Benítez, Gustavo

    2015-01-01

    Purpose: To evaluate results of medial patellofemoral ligament (MPFL) reconstruction associated with lateral release and advancement of vastus medialis in recurrent dislocation of the patella. Methods: We retrospectively evaluated 11 patients with a mean follow-up of 19 months. Mean age was 23, mainly women. We did MPFL reconstruction with semitendinosus or gracilis tendon depending on BMI, associated with advancement of vastus medialis and lateral release. Results: Mean Kujala score improved from 46,54 pts. preoperative to 88,36 postoperative. Our main complication was 1 patient with rigid knee, who required movilization under anesthesia and arthroscopic arthrolisis to improve her outcome. Conclusion: The combination of this techniques are a good alternative to treat patients with recurrent patella disclocation, with good short and mid-term results. Biomechanic intra and postop complications of MPFL reconstruction are related to patellar fixation, anatomic positioning of femoral tunnel and knee position of the graft fixation.

  20. Dislocation: First Aid

    Science.gov (United States)

    First aid Dislocation: First aid Dislocation: First aid By Mayo Clinic Staff A dislocation is an injury in which the ends of your bones are forced from ... a collision during contact or high-speed sports. Dislocation usually involves the body's larger joints. In adults, ...

  1. Knee pain among workers and associated occupational factors: a systematic

    OpenAIRE

    Silva,Marcelo Cozzensa da

    2006-01-01

    Com o objetivo de reunir informações sobre dor nos joelhos entre trabalhadores e fatores ocupacionais associados, foi realizada uma revisão sistemática nas bases de dados Medline, Lilacs, Scielo, Free Medical Journals, entre outros, referentes ao período 1990-2006, usando os descritores knee, knee pain, knee joint, knee dislocation, knee injuries, work, workplace, workload, employment, occupations, industry, occupational, workers, arthrosis, osteoarthritis e seus equivalentes em portugu...

  2. Bilateral anterior shoulder dislocation

    Science.gov (United States)

    Meena, Sanjay; Saini, Pramod; Singh, Vivek; Kumar, Ramakant; Trikha, Vivek

    2013-01-01

    Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side. Prompt closed reduction followed by immobilization in arm sling and subsequent rehabilitation ensured a good outcome. PMID:24082765

  3. Knee MRI

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Knee Magnetic resonance imaging (MRI) of the knee ... of a knee MRI? What is a Knee MRI? MRI of the knee provides detailed images of ...

  4. Runner's Knee

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Runner's Knee KidsHealth / For Teens / Runner's Knee What's in this ... told he had runner's knee. What Is Runner's Knee? Runner's knee is the term doctors use for ...

  5. Traumatic knee extension deficit (the locked knee)

    DEFF Research Database (Denmark)

    Helmark, I C; Neergaard, K; Krogsgaard, M R

    2007-01-01

    In the present study we investigated the validity of magnetic resonance imaging (MRI) and arthroscopy in knees with acute, traumatic extension deficit (the "locked knee"), and evaluated whether arthroscopy of knees with no mechanical pathology could be avoided by MRI evaluation. The study consisted...... of 50 patients who had an acute, traumatic extension deficit of the knee. All patients were submitted to MRI prior to arthroscopy. Following MRI and surgery, standardized forms were filled out, attempting to objectify the findings. The orthopaedic surgeon was not aware of the MRI result prior to surgery......, the following results were calculated for the overall appearance of a lesion able to cause locking: Positive predictive value = 0.85, negative predictive value = 0.77, sensitivity = 0.95, specificity = 0.53. Two knees were erroneously evaluated with no mechanical locking at MRI (one bucket-handle lesion and one...

  6. Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging in Acute Injuries of the Anterior Cruciate Ligament.

    Science.gov (United States)

    Helito, Camilo Partezani; Helito, Paulo Victor Partezani; Costa, Hugo Pereira; Demange, Marco Kawamura; Bordalo-Rodrigues, Marcelo

    2017-01-01

    To evaluate the epidemiology of injuries and abnormalities of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in cases of acute anterior cruciate ligament (ACL) injury. MRIs of patients with acute ACL injury were evaluated. Acute injuries of the ACL were considered in cases in which the patient reported knee trauma occurring less than 3 weeks prior and when bone bruise in the femoral condyles and tibial plateau was identified. ALL abnormality was considered when it showed proximal or distal bone detachment, discontinuity of fibers, or irregular contour associated with periligamentous edema. The ALL was divided into femoral, tibial, and meniscal portions, and the lesions and/or abnormalities of each portion were characterized. The correlation of ALL injury with injuries of the lateral meniscus was evaluated. A total of 101 MRIs were initially evaluated. The ALL was not characterized in 13 (12.8%) examinations, resulting in 88 (87.1%) cases of injury evaluation. Of these, 55 (54.4%) patients had a normal ALL, and 33 (32.6%) showed signs of injury. Among the cases with injury, 24 (72%) patients showed proximal lesions, 7 (21%) showed distal lesions, and 2 (6.0%) patients presented both proximal and distal lesions. The meniscal portion of the ALL appeared abnormal in 16 (48%) patients. No relationship was found between ALL injury and lateral meniscus injury. Based on MRI analysis of acute ACL injuries with bone bruising of the lateral femoral condyle and lateral tibial plateau, approximately a third demonstrated ALL injuries of which the majority was proximal. Level IV, case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  7. Medial subtalar dislocation: Case report

    Directory of Open Access Journals (Sweden)

    Manojlović Radovan

    2010-01-01

    Full Text Available Introduction. Subtalar dislocation (SI is a term that refers to an injury in which there is dislocation of the talonavicular and talocalcanear joint, although the tibiotalar joint is intact. Case Outline. A case of medial subtalar dislocation as a result of basketball injury, so-called 'basketball foot', is presented. Closed reposition in i.v. anaesthesia was performed with the patient in supine position and a knee flexed at 90 degrees. Longitudinal manual traction in line of deformity was carried out in plantar flexion. The reposition continued with abduction and eversion simultaneously increasing dorsiflexion. It was made in the first attempt and completed instantly. Rehabilitation was initiated after 5 weeks of immobilization. One year after the injury, the functional outcome was excellent with full range of motion and the patient was symptom-free. For better interpretation of roentgenogram, bone model of subtalar dislocation was made using the cadaver bone. Conclusion. Although the treatment of such injury is usually successful, diagnosis can be difficult because it is a rare injury, and moreover, X-ray of the injury can be confusing due to superposition of bones. Radiograms revealed superposition of the calcaneus, tarsal and metatarsal bones which was radiographically visualized in the anterior-posterior projection as one osseous block inward from the talus, and on the lateral view as in an osteal block below the tibial bone. Prompt recognition of these injuries followed by proper, delicately closed reduction under anaesthesia is crucial for achieving a good functional result in case of medial subtalar dislocation.

  8. Sonographic appearances of medial retinacular complex injury in transient patellar dislocation

    Energy Technology Data Exchange (ETDEWEB)

    O' Reilly, M.A.R.; O' Reilly, P.M.R.; Bell, J

    2003-08-01

    AIM: To describe the sonographic appearances of the medial retinacular (MPFR) complex of the knee in patients with acute and recurrent patellar dislocation. MATERIALS AND METHODS: Thirty patients were scanned within 2-4 weeks of an acute episode of lateral patellar dislocation. Eleven gave a history of recurrent patellar dislocation. Ten patients had examination under anaesthesia with arthroscopy and repair of the injury. The sonographic and operative results were compared. RESULTS: The normal sonographic appearance of the MPFR is described. Of the 10 patients who underwent examination under anaesthesia, four patients had complete avulsion of the MPFR from the patella, two patients had avulsion of the MPFR from the adductor tubercle and four patients had avulsion of the MPFR from both the patella and adductor tubercle. There was complete correlation between the sonographic and operative findings for injuries of the MPFR. Other findings included partial retinacular tears, injury to the medial collateral ligament, haematoma within vastus medialis obliquus (VMO) and bony avulsions from the patella and adductor tubercle. CONCLUSION: Sonography gives reliable information regarding the site of the injury and its extent thus helping to decide whether conservative or operative treatment is the most appropriate approach to management of the injury.

  9. Acute effects of kinesio taping on knee extensor peak torque and electromyographic activity after exhaustive isometric knee extension in healthy young adults.

    Science.gov (United States)

    Yeung, Simon S; Yeung, Ella W; Sakunkaruna, Yosawin; Mingsoongnern, Sutida; Hung, Wing Y; Fan, Yun L; Iao, Heng C

    2015-05-01

    To evaluate the effect of Kinesio Tex tape and its method of application, Kinesio Taping (KT) on knee extensor performance before and after an exhaustive isometric knee extension exercise. Single-blinded, randomized control trial. Centre for Sports Training and Rehabilitation at The Hong Kong Polytechnic University. Twenty-six healthy volunteers with no history of knee injuries. Subjects were randomized to either the KT or sham taping group. The effects of KT on the neuromuscular performance of the knee extensors were measured before and after KT application, and immediately and 5 and 10 minutes after an exhaustive isometric knee extension exercise. Within-group analyses revealed a significant effect of time on the peak torque in isometric knee extension (F2.73,65.44 = 24.5, P Kinesio taping is commonly seen in the sports arena. The popularity is presumably due to the general belief in its injury prevention and enhancement of muscle performance. The results of the present findings suggested that KT shortens the time to reach peak torque generation. Aside from this, there is no other significant positive effect on muscle performance. Further investigation on the effects of KT on muscle performance is warranted.

  10. Irreducible Traumatic Posterior Shoulder Dislocation

    Directory of Open Access Journals (Sweden)

    Blake Collier

    2017-01-01

    Full Text Available History of present illness: A 22-year-old male presented to the Emergency Department complaining of right shoulder pain after a motocross accident. He was traveling at approximately 10 mph around a turn when he lost control and was thrown over the handlebars, landing directly on his right shoulder. On arrival, he was holding his arm in adduction and internal rotation. An area of swelling was noted over his anterior shoulder. He was unable to abduct his shoulder. No humeral gapping was noted. He had normal neuro-vascular status distal to the injury. Significant findings: Radiographs demonstrated posterior displacement of the humeral head on the “Y” view (see white arrow and widening of the glenohumeral joint space on anterior-posterior view (see red arrow. The findings were consistent with posterior dislocation and a Hill-Sachs type deformity. Sedation was performed and reduction was attempted using external rotation, traction counter-traction. An immediate “pop” was felt during the procedure. Post-procedure radiographs revealed a persistent posterior subluxation with interlocking at posterior glenoid. CT revealed posterior dislocation with acute depressed impaction deformity medial to the biceps groove with the humeral head perched on the posterior glenoid, interlocked at reverse Hill-Sachs deformity (see blue arrow. Discussion: Posterior shoulder dislocations are rare and represent only 2% of all shoulder dislocations. Posterior shoulder dislocations are missed on initial diagnosis in more than 60% of cases.1 Posterior shoulder dislocations result from axial loading of the adducted and internally rotated shoulder, violent muscle contractions (resulting from seizures or electrocution, a direct posterior force applied to the anterior shoulder.1 Physical findings include decreased anterior prominence of the humeral head, increased palpable posterior prominence of the humeral head below the acromion, increased palpable prominence of the

  11. Changes in MR Relaxation Times of the Meniscus With Acute Loading: An In Vivo Pilot Study in Knee Osteoarthritis

    Science.gov (United States)

    Subburaj, Karupppasamy; Souza, Richard B.; Wyman, Bradley T.; Le Graverand-Gastineau, Marie-Pierre Hellio; Li, Xiaojuan; Link, Thomas M.; Majumdar, Sharmila

    2014-01-01

    Purpose To prospectively evaluate changes in T1ρ and T2 relaxation times in the meniscal body with acute loading using MRI in osteoarthritic knees and to compare these findings with those of age-matched healthy controls. Materials and Methods Female subjects above 40 years of age with (N1 = 20) and without osteoarthritis (OA) (N2 = 10) were imaged on a 3 Tesla MR scanner using a custom made loading device. MR images were acquired, with the knee flexed at 20°, with and without a compressive load of 50% of the subject's bodyweight. The subjects were categorized based on the radiographic evidence of OA. Three different zones (outer, middle, and inner) of meniscus body were defined (each occupying 1/3rd the width). After adjusting for age and body mass index in the general linear regression model, repeated measures analysis of variance was used to detect significant differences in T1ρ and T2 with and without loading. Results In the unloaded condition, the average T1ρ and T2 times were elevated in the outer and middle zones of the medial meniscus in OA subjects compared with the controls. In the loaded condition, T1ρ and T2 times of the outer zone of the medial meniscus was significantly elevated in OA subjects compared with controls. Finally the change (from unloaded to loaded) was significantly higher in controls than OA subjects (15.1% versus 8.3%; P = 0.039 for ΔT1ρ, and 11.5% versus 6.9%, P = 0.049 for ΔT2). Conclusion These findings suggest that while the OA process appears to affect the relaxation times of all regions within the meniscus, it may affect some regions sooner or to a greater degree. Furthermore, the differences in the change in relaxation times between unloaded and loaded conditions may reveal evidence about load transmission failure of the outer zone of the medial meniscus in subjects with knee OA. It is possible that these metrics (ΔT1ρ and ΔT2) may be valuable as an early biomechanical biomarker, which could be used to predict load

  12. A conservative programme for treatment of anterior knee pain in ...

    African Journals Online (AJOL)

    earlier studies, as to the exact definition of anterior knee pain. Anterior knee pain ... sport participation. Exclusion criteria were: previously diagnosed ligamentous, meniscal, tendon, fat pad or bursae involvement; previous surgery; history of patella dislocation or subluxation; ..... Sports-related knee injuries in female athletes.

  13. Vertical atlantoaxial dislocation

    OpenAIRE

    Ramaré, S.; Lazennec, J. Y.; Camelot, C.; Saillant, G.; Hansen, S.; Trabelsi, R.

    1999-01-01

    An unusual case of vertical atlantoaxial dislocation without medulla oblongata or spinal cord injury is reported. The pathogenic process suggested occipito-axial dislocation. The case was treated surgically with excellent results on mobility and pain.

  14. [Ligament bracing--augmented primary suture repair in multiligamentous knee injuries].

    Science.gov (United States)

    Heitmann, M; Gerau, M; Hötzel, J; Giannakos, A; Frosch, K-H; Preiss, A

    2014-02-01

    Reconstruction of knee stability by primary ligament sutures and additional augmentation after knee dislocation. Acute knee dislocation Schenck type III and IV. Operative treatment should be performed within 7 days after injury. Chronic instability after knee dislocation, refixable bony avulsions, critical soft tissue, infection, lack of compliance. Supine position with electric leg holder. Short arthroscopic assessment of concomitant injuries. Schenck type III medial injuries and Schenck IV injuries: anteromedial parapatellar arthrotomy. Injuries type Schenck III lateral: anteromedian arthrotomy. Armoring of ligament stumps for transosseus sutures. Placement of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) drill tunnels. Extracortical diversion of the suture armorings and insertion of augmentation systems. Fixation of the PCL augmentation in 70-90° flexion. Fixation of the ACL augmentation in 20-30° flexion. Knotting of the transosseus ligament sutures. If necessary (postero-)lateral and/or medial stabilization. Limited weight bearing with 20 kg for 6 weeks. Stabilizing brace (e.g., Hypex-Lite®, Albrecht) generally for 12 weeks. Mobilization under tension of the quadriceps muscle for 6 weeks. In total, 20 patients have been treated using the principle of "ligament bracing". So far 8 patients (aged 18-60 years, median 33 years) have been assessed with a follow-up of 10-15 months (median 12 months) postoperatively. In all, 6 patients showed stable knees with good results. Recurrent instability of the ACL was observed in 2 patients; the collateral ligaments and PCL were stable. For the evaluation the following scores were used: IKDC score, Tegner score, and Lysholm score. To objectify the data, stress radiography and physical examination were performed. Using the operative technique mentioned above, no complications occurred. During follow-up 2 patients reported a deficiency of flexion.

  15. Acute effects of lateral shoe wedges on joint biomechanics of patients with medial compartment knee osteoarthritis during stationary cycling.

    Science.gov (United States)

    Gardner, Jacob K; Klipple, Gary; Stewart, Candice; Asif, Irfan; Zhang, Songning

    2016-09-06

    Cycling is commonly prescribed for individuals with knee osteoarthritis (OA) but very little biomechanical research exists on the topic. Individuals with OA may be at greater risk of OA progression or other knee injuries because of their altered knee kinematics. This study investigated the effects of lateral wedges on knee joint biomechanics and pain in patients with medial compartment knee OA during stationary cycling. Thirteen participants with OA and 11 paired healthy participants volunteered for this study. A motion analysis system and a customized instrumented pedal were used to collect 5 pedal cycles of kinematics and kinetics, respectively, during 2 minutes of cycling in 1 neutral and 2 lateral wedge (5° and 10°) conditions. Participants pedaled at 60 RPM and an 80W workrate and rated their knee pain on a visual analog scale during each minute of each condition. There was a 22% decrease in the internal knee abduction moment with the 10° wedge. However, this finding was not accompanied by a decrease in knee adduction angle or subjective pain. Additionally, there was an increase in vertical and horizontal pedal reaction force which may negate the advantages of the decreased internal knee abduction moment. For people with medial knee OA, cycling with 10° lateral wedges may not be sufficient to slow the progression of OA beyond the neutral riding condition. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Knee Replacement

    Science.gov (United States)

    Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to ... Your doctor may recommend it if you have knee pain and medicine and other treatments are not ...

  17. Knee Injuries

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Knee Injuries KidsHealth / For Teens / Knee Injuries What's in ... can do to protect them. What's in a Knee? The knee is a joint , actually the largest ...

  18. Superior dislocation of the patella: a case report.

    Science.gov (United States)

    Cusco, Xavier; Seijas, Roberto; Ares, Oscar; Cugat, Jose R; Garcia-Balletbo, Montserrat; Cugat, Ramon

    2009-07-30

    Superior dislocation of the patella is an uncommon condition that mainly occurs in knees with a high patella and medial femorotibial degenerative arthritis. There are no previous reports of this condition occurring in association with tibial valgus osteotomy. We report the case of a patient in whom vertical dislocation recurred twice at 4 months after tibial valgus osteotomy. To avert additional recurrence or new dislocations, the patient was treated surgically to remove the existing osteophytes. An arthroscopic approach was decided because of the lower associated morbidity and good results with this technique compared to open surgery.

  19. Superior dislocation of the patella: a case report

    Directory of Open Access Journals (Sweden)

    Garcia-Balletbo Montserrat

    2009-07-01

    Full Text Available Abstract Background Superior dislocation of the patella is an uncommon condition that mainly occurs in knees with a high patella and medial femorotibial degenerative arthritis. There are no previous reports of this condition occurring in association with tibial valgus osteotomy. Case report: We report the case of a patient in whom vertical dislocation recurred twice at 4 months after tibial valgus osteotomy. To avert additional recurrence or new dislocations, the patient was treated surgically to remove the existing osteophytes. Conclusions: An arthroscopic approach was decided because of the lower associated morbidity and good results with this technique compared to open surgery.

  20. Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test

    Directory of Open Access Journals (Sweden)

    Andrew D. Vigotsky

    2015-09-01

    Full Text Available Background. Foam rolling has been shown to acutely increase range of motion (ROM during knee flexion and hip flexion with the experimenter applying an external force, yet no study to date has measured hip extensibility as a result of foam rolling with controlled knee flexion and hip extension moments. The purpose of this study was to investigate the acute effects of foam rolling on hip extension, knee flexion, and rectus femoris length during the modified Thomas test.Methods. Twenty-three healthy participants (male = 7; female = 16; age = 22 ± 3.3 years; height = 170 ± 9.18 cm; mass = 67.7 ± 14.9 kg performed two, one-minute bouts of foam rolling applied to the anterior thigh. Hip extension and knee flexion were measured via motion capture before and after the foam rolling intervention, from which rectus femoris length was calculated.Results. Although the increase in hip extension (change = +1.86° (+0.11, +3.61; z(22 = 2.08; p = 0.0372; Pearson’s r = 0.43 (0.02, 0.72 was not due to chance alone, it cannot be said that the observed changes in knee flexion (change = −1.39° (−5.53, +2.75; t(22 = −0.70; p = 0.4933; Cohen’s d = − 0.15 (−0.58, 0.29 or rectus femoris length (change = −0.005 (−0.013, +0.003; t(22 = −1.30; p = 0.2070; Cohen’s d = − 0.27 (−0.70, 0.16 were not due to chance alone.Conclusions. Although a small change in hip extension was observed, no changes in knee flexion or rectus femoris length were observed. From these data, it appears unlikely that foam rolling applied to the anterior thigh will improve passive hip extension and knee flexion ROM, especially if performed in combination with a dynamic stretching protocol.

  1. Temporomandibular joint dislocation in an 18-month-old child

    Directory of Open Access Journals (Sweden)

    Jaeson Mohanan Painatt

    2017-01-01

    Full Text Available Temporomandibular joint (TMJ dislocation in children is extremely rare. In our case, an 18-month-old child presented with a history of inability to close her mouth. To confirm the clinical diagnosis, a computed tomogram was taken. Clinical examination and X-ray of the TMJ revealed bilateral TMJ dislocation. Bilateral TMJ reduction was achieved manually after giving analgesia and procedural sedation. This is one of the few case reports of an acute dislocation in a toddler.

  2. In vivo study of acute effects of hip and knee positions on blood flow in canine sciatic nerve

    OpenAIRE

    Koga, Kei; Naito, Masatoshi; Akiyoshi, Yuichiro; Asayama, Isao; Shiramizu, Kei; Abe, Tatunobu; Kanbe, Taichi

    2002-01-01

    We studied blood flow in the canine sciatic nerve using a laser Doppler flowmeter. Blood flow was measured in 20 hind limbs of ten adult dogs at varying angles of hip flexion, hip rotation and knee flexion. Blood flow decreased as flexion and internal rotation of the hip increased and also with only slight flexion of the knee. With 90° knee flexion, the mean blood flow did not change significantly when the hip was internally rotated from 0° to 30°. When the knee was straight, the blood flow c...

  3. Arthroscopic treatment of acromioclavicular dislocation

    Directory of Open Access Journals (Sweden)

    Mihai T. Gavrilă

    2017-11-01

    Full Text Available A thorough understanding of biomechanical function of both acromioclavicular (AC and coracoclavicular (CC ligaments, stimulated surgeons to repair high-grade AC dislocation using arthroscopic technique. This technique necessitates a clear understanding of shoulder anatomy, especially of the structures in proximity to the clavicle and coracoid process and experiences in arthroscopic surgery. The follow case describes an arthroscopic technique used to treat AC dislocation in young man 30 years old, who suffered an injury at right shoulder. Results were similar to those obtained using open surgery and this encouraged us to continue utilization of this method. As a conclusion, arthroscopic treatment of AC separation is one of the best options as surgical treatment. Early results suggested that immediate anatomic reduction of an acute AC separation usually provides satisfactory clinical results at intermediate-term follow-up.

  4. Minimally invasive total knee arthroplasty.

    Science.gov (United States)

    Bonutti, Peter M; Mont, Michael A; McMahon, Margo; Ragland, Phillip S; Kester, Mark

    2004-01-01

    Currently, minimally invasive total knee arthroplasty is defined as an incision length of definition are: 1. The amount of soft-tissue dissection (including muscle, ligament, and capsular damage). 2. Patellar retraction or eversion. 3. Tibiofemoral dislocation. Minimally invasive surgery should not be considered to be a cosmetic procedure but rather one that addresses patients' concerns with regard to postoperative pain and slow rehabilitation. Standard total knee arthroplasties provide pain relief, but returning to activities of daily living remains a challenge for some individuals, who may take several weeks to recover. Several studies have demonstrated long-term success (at more than ten years) of standard total knee arthroplasties. However, many patients remain unsatisfied with the results of the surgery. In a study of functional limitations of patients with a Knee Society score of > or = 90 points after total knee arthroplasty, only 35% of patients stated that they had no limitations. This finding was highlighted in a study by Dickstein et al., in which one-third of the elderly patients who underwent knee replacement were unhappy with the outcome at six and twelve months postoperatively. Although many surgeons utilize objective functional scoring systems to evaluate outcome, it is likely that the criteria for a successful result of total knee arthroplasty differ between the patient and the surgeon. This was evident in a report by Bullens et al., who concluded that surgeons are more satisfied with the results of total knee arthroplasty than are their patients. Trousdale et al. showed that, in addition to concerns about long-term functional outcome, patients' major concerns were postoperative pain and the time required for recovery. Patients undergoing total knee arthroplasty have specific functional goals, such as climbing stairs, squatting, kneeling, and returning to some level of low-impact sports after surgery. Our clinical investigations demonstrated that

  5. In vivo study of acute effects of hip and knee positions on blood flow in canine sciatic nerve.

    Science.gov (United States)

    Koga, Kei; Naito, Masatoshi; Akiyoshi, Yuichiro; Asayama, Isao; Shiramizu, Kei; Abe, Tatunobu; Kanbe, Taichi

    2002-01-01

    We studied blood flow in the canine sciatic nerve using a laser Doppler flowmeter. Blood flow was measured in 20 hind limbs of ten adult dogs at varying angles of hip flexion, hip rotation and knee flexion. Blood flow decreased as flexion and internal rotation of the hip increased and also with only slight flexion of the knee. With 90 degrees knee flexion, the mean blood flow did not change significantly when the hip was internally rotated from 0 degrees to 30 degrees. When the knee was straight, the blood flow changed significantly during the same procedure. To prevent sciatic nerve palsy, attention should be paid to the positioning of the hip and knee during total hip arthroplasty.

  6. Can the Ottawa and Pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics?

    Science.gov (United States)

    Konan, S; Zang, T T; Tamimi, N; Haddad, F S

    2013-04-01

    Our aim was to study the role of the Ottawa and Pittsburgh rules to reduce the unnecessary use of radiographs following knee injury. We prospectively reviewed 106 patients who were referred to our clinic over a 3-month period. The Ottawa and Pittsburgh rules were applied to individual patients to evaluate the need for radiography. One hundred and one patients (95%) had radiography of their knee. Five patients (5%) had a fracture of their knee and in all cases, the Ottawa and Pittsburgh knee rules were fulfilled. Using the Ottawa rules, 27 radiographs (25%) could have been avoided without missing a fracture. Using the Pittsburgh rules, 32 radiographs (30%) could have been avoided. The Ottawa and Pittsburgh rules have a high sensitivity for the detection of knee fractures. Their use can aid efficient clinical evaluation without adverse clinical outcome and may reduce healthcare costs.

  7. Are radiographs needed when MR imaging is performed for non-acute knee symptoms in patients younger than 45 years of age?

    Energy Technology Data Exchange (ETDEWEB)

    Braak, Bert P.M. ter; Vincken, Patrice W.J.; Erkel, Arian R. van; Bloem, Johan L. [Leiden University Medical Center, Department of Radiology, P.O. Box 9600, Leiden (Netherlands); Bloem, Rolf M. [Leiden University Medical Center, Department of Orthopaedic Surgery, Leiden (Netherlands); Napoleon, L.J.; Coene, M.N. [HAGA Hospital, Department of Orthopaedic Surgery, The Hague (Netherlands); Luijt, Peter A. van [Leiden University Medical Center, Department of Traumatology, Leiden (Netherlands); Lange, Sam de [Medical Center Haaglanden, Department of Orthopaedic Surgery, The Hague (Netherlands); Department of Orthopaedic Surgery, Delft (Netherlands)

    2007-12-15

    The objective was to determine the value of radiographs in young adults with non-acute knee symptoms who are scheduled for magnetic resonance imaging (MRI). Nine hundred and sixty-one consecutive patients aged between 16 and 45 years with knee symptoms of at least 4 weeks' duration were prospectively included in three participating hospitals. After applying exclusion criteria, 798 patients remained. Exclusion criteria were previous knee surgery (including arthroscopy) or MRI, history of rheumatoid arthritis, clinical diagnosis of retropatellar chondromalacia, contra-indication for MRI and recent trauma. We identified two groups: group A with no history of trauma (n = 332), and group B with an old (>4 weeks) history of trauma (n = 466). Patients had a standardized history taken, and underwent a physical exam, antero-posterior (AP) and lateral radiographs and MRI. We evaluated the radiographs and MRI for osseous lesions, articular surface lesions, fractures, osteoarthritis, loose bodies, bone marrow edema and incidental findings. Subsequently, patients with osseous abnormalities (Kellgren grade 1 and 2 excluded) on radiographs and a matched control group was evaluated again using MRI without radiographs. Median duration of symptoms was 20 weeks. In group A, radiographs showed 36 osseous abnormalities in 332 patients (10.8%). Only 13 of these, all Kellgren grade 1 osteoarthritis, were not confirmed on MRI. MRI showed 72 (21.7%) additional abnormalities not confirmed on radiographs. In group B, radiographs showed 40 osseous abnormalities (8.6%) in 466 patients. Only 15 of these, all Kellgren grade 1 osteoarthritis, were not confirmed on MRI. MRI showed 194 (41.6%) additional abnormalities not confirmed on radiographs. The second evaluation of MRI without radiographs in 34 patients was identical to the first MRI evaluation. Common lesions were significantly more often diagnosed with MRI than with radiographs. Radiographs should not be obtained routinely when MRI is

  8. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty.

    Directory of Open Access Journals (Sweden)

    Maren Falch Lindberg

    Full Text Available Unrelieved postoperative pain after total knee arthroplasty (TKA is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA.Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD 0 to 4. Clinical data were extracted from medical records.Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery.Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients' perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.

  9. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty.

    Science.gov (United States)

    Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M; Lerdal, Anners

    2016-01-01

    Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients' perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.

  10. Effectiveness of acute in-hospital physiotherapy with knee-extension strength training in reducing strength deficits in patients with a hip fracture: A randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Lise Kronborg

    Full Text Available Is acute in-hospital physiotherapy with additional progressive knee-extension strength training (ST of the fractured limb more effective in reducing knee-extension strength deficit at follow-up compared to physiotherapy without strength training in patients with a hip fracture?Assessor blinded, randomised controlled trial with intention-to-treat analysis.90 patients with a hip fracture admitted to an acute orthopaedic Hip Fracture Unit at a university hospital between October 2013 and May 2015.Daily physiotherapy with or without progressive knee-extension strength training (10RM, 3 x 10 repetitions, of the fractured limb using ankle weight cuffs conducted by ward physical therapists during hospital stay.Primary outcome was the change in maximal isometric knee-extension strength in the fractured limb in percentage of the non-fractured limb from inclusion to postoperative day 10 or discharge (follow-up. Secondary outcome was Timed Up and Go test measured early after surgery and at follow-up.In the intention-to-treat analysis of between-group differences, the primary outcome improved 8.1% (95% CI -2.3; 18.4 by additional strength training from baseline to follow-up. In the per-protocol analysis of non-missing data, significant between-group improvements by 10.5% (95% CI 0.3; 20.7 were found in favour of additional ST. No significant between-group differences were found in any secondary outcome.Physiotherapy with addition of 5 sessions of ST yielded no additional improvements compared to physiotherapy without strength training in reducing the knee-extension strength deficit at follow-up in patients with a hip fracture. It is debatable whether larger improvements than the observed 8-10% can be expected given that only five exercise sessions, on average, were completed. In fragile patients with a hip fracture in the acute phase, where the ability to participate in functional exercise is compromised, we still consider early strength training a

  11. Tratamento artroscópico da luxação acromioclavicular aguda com âncoras Arthroscopic treatment of acute acromioclavicular joint dislocation using suture anchors

    Directory of Open Access Journals (Sweden)

    Leonardo Muntada Cavinatto

    2011-01-01

    Full Text Available OBJETIVO: Apresentar os resultados clínicos e radiográficos de uma série de casos com diagnóstico de Luxação Acromioclavicular (LAC Aguda, tratados através da fixação coracoclavicular com âncoras por via artroscópica. MÉTODO: Vinte pacientes apresentando LAC com menos de 30 dias de evolução foram operados pela técnica da estabilização coracoclavicular com âncoras por via artroscópica. Duas âncoras metálicas com dois fios cada, foram inseridas no coracóide. Os fios foram amarrados sobre a clavícula passando por túneis transósseos claviculares. Para a avaliação radiográfica, foi utilizada a medida comparativa da distância coracoclavicular com o lado contralateral e a avaliação funcional através dos escores de Constant e UCLA o seguimento foi de seis meses. RESULTADO: Dos vinte casos inicialmente selecionados, seis necessitaram de novo procedimento cirúrgico e foram excluídos do estudo. Dos quatorze pacientes restantes, apenas dois mantiveram redução da articulação acromioclavicular, enquanto os demais apresentaram algum grau de desvio no decorrer da evolução. Desconsiderando os pacientes excluídos, os escores de Constant e UCLA tiveram média 94,79 (82-100 e, 32,64 (26-35, respectivamente. CONCLUSÃO: A técnica apresentou um alto índice de perda da redução ao longo da evolução de seis meses. A avaliação funcional apresentou resultado satisfatório com escore médio elevado de Evidência: Nível de Evidência: Nível III, estudo retrospectivo.OBJECTIVE: To present the clinical and radiographic results of a case series of patients with acute acromioclavicular dislocation (AAD treated by arthroscopic coracoclavicular fixation with suture anchors. METHOD: Twenty patients with AAD with less than 30 days since the injury were submitted to a coracoclavicular stabilization procedure using 2 suture anchors placed at the base of the coracoid process. Each suture anchor was connected to 2 strands of No.2

  12. Avulsion fracture of an ossified pes anserinus tendon post-lateral patellar dislocation.

    Science.gov (United States)

    Albtoush, Omar M; Taib, Abtehag A; Horger, Marius; Springer, Fabian

    2017-11-23

    The pes anserinus is a common tendon comprising the tendinous insertions of the sartorius, gracilis, and semitendinosus muscles. It inserts at the anteromedial aspect of the tibia and plays a significant role in stabilization of the medial side of the knee joint. The current article presents a case with recurrent lateral patellar dislocations causing chronic stress along the medial knee stabilizers and consecutive enthesophyte formation at the insertion of the pes anserinus tendon that showed a transverse fracture upon a subsequent incident of traumatic lateral patellar dislocation. Avulsion injuries of the pes anserinus tendon are rarely encountered, and to our knowledge, association with recurrent lateral patellar dislocations has not been described before.

  13. Homogenization of dislocation dynamics

    Energy Technology Data Exchange (ETDEWEB)

    El Hajj, Ahmad; Ibrahim, Hassan; Monneau, Regis, E-mail: elhajj@cermics.enpc.fr, E-mail: ibrahim@cermics.enpc.fr, E-mail: monneau@cermics.enpc.fr [CERMICS, ENPC, 6 and 8 avenue Blaise Pascal, Cite Descartes, Champs sur Marne, 77455 Marne-la-Valle Cedex 2 (France)

    2009-07-15

    In this paper we consider the dynamics of dislocations with the same Burgers vector, contained in the same glide plane, and moving in a material with periodic obstacles. We study two cases: i) the particular case of parallel straight dislocations and ii) the general case of curved dislocations. In each case, we perform rigorously the homogenization of the dynamics and predict the corresponding effective macroscopic elasto-visco-plastic flow rule.

  14. Effectiveness of acute in-hospital physiotherapy with knee-extension strength training in reducing strength deficits in patients with a hip fracture

    DEFF Research Database (Denmark)

    Kronborg, Lise; Bandholm, Thomas; Palm, Henrik

    2017-01-01

    -extension strength training (10RM), 3 x 10 repetitions, of the fractured limb using ankle weight cuffs conducted by ward physical therapists during hospital stay. OUTCOME MEASURES: Primary outcome was the change in maximal isometric knee-extension strength in the fractured limb in percentage of the non...... that only five exercise sessions, on average, were completed. In fragile patients with a hip fracture in the acute phase, where the ability to participate in functional exercise is compromised, we still consider early strength training a possibility to improve outcomes of clinical importance, given...

  15. Acromioclavicular joint dislocations.

    Science.gov (United States)

    Babhulkar, Ashish; Pawaskar, Aditya

    2014-03-01

    Acromioclavicular (AC) dislocation is a common injury especially among sportsmen. There is still a lack of consensus on whether to conserve or operate type III AC joint dislocations. Even among surgeons inclined to operate AC joint dislocations there is no unanimity on which surgical technique. There are a plethora of choices between mechanical fixation or synthetic materials or biologic anatomic reconstructions. Even among surgeons, there is a choice between open repairs and the latest-arthroscopic reconstructions. This review of AC joint dislocations intends to analyze the available surgical options, a critical analysis of existing literature, actual technique of anatomic repair, and also accompanying complications.

  16. Anterior glenohumeral joint dislocations.

    Science.gov (United States)

    Dodson, Christopher C; Cordasco, Frank A

    2008-10-01

    The glenohumeral joint is the most mobile articulation in the body and the most commonly dislocated diarthroidal joint. Anterior dislocation is by far the most common direction and can lead to instability of the glenohumeral joint, which ranges from subtle increased laxity to recurrent dislocation. Overtime, understanding of anterior shoulder dislocations and the resulting instability has improved. Likewise, significant advances in arthroscopic equipment have allowed use of the arthroscope to address anatomically the various lesions that cause instability. This article reviews the anatomy, pathophysiology, clinical evaluation, and treatment of anterior shoulder instability.

  17. Effect of knee joint icing on knee extension strength and knee pain early after total knee arthroplasty: a randomized cross-over study.

    Science.gov (United States)

    Holm, Bente; Husted, Henrik; Kehlet, Henrik; Bandholm, Thomas

    2012-08-01

    To investigate the acute effect of knee joint icing on knee extension strength and knee pain in patients shortly after total knee arthroplasty. A prospective, single-blinded, randomized, cross-over study. A fast-track orthopaedic arthroplasty unit at a university hospital. Twenty patients (mean age 66 years; 10 women) scheduled for primary unilateral total knee arthroplasty. The patients were treated on two days (day 7 and day 10) postoperatively. On one day they received 30 minutes of knee icing (active treatment) and on the other day they received 30 minutes of elbow icing (control treatment). The order of treatments was randomized. Maximal knee extension strength (primary outcome), knee pain at rest and knee pain during the maximal knee extensions were measured 2-5 minutes before and 2-5 minutes after both treatments by an assessor blinded for active or control treatment. The change in knee extension strength associated with knee icing was not significantly different from that of elbow icing (knee icing change (mean (1 SD)) -0.01 (0.07) Nm/kg, elbow icing change -0.02 (0.07) Nm/kg, P = 0.493). Likewise, the changes in knee pain at rest (P = 0.475), or knee pain during the knee extension strength measurements (P = 0.422) were not different between treatments. In contrast to observations in experimental knee effusion models and inflamed knee joints, knee joint icing for 30 minutes shortly after total knee arthroplasty had no acute effect on knee extension strength or knee pain.

  18. Stabilisation of Posterior Sternoclavicular Joint Dislocation using ...

    African Journals Online (AJOL)

    Posterior sternoclavicular joint dislocation is a rare injury. It is usually sustained acutely in activities such as contact sports eg. rugby and motorcycle accidents. Plain radiography of the chest will often miss the diagnosis and confirmation is by CT scans. However CT scans are often reported to miss epiphyseal injuries.

  19. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players.

    Science.gov (United States)

    Markovic, Goran

    2015-10-01

    The aim of the present investigation was to evaluate the acute effects of foam rolling (FR) and a new form of instrument-assisted soft tissue mobilization (IASTM), Fascial Abrasion Technique ™ (FAT) on hip and knee range of motion in soccer players. Twenty male soccer players randomly allocated into FR and FAT group (n = 10 each). Passive knee flexion and straight leg raise tests were measured before, immediately after and 24 h after intervention (FR or FAT). The FR group applied a 2-min quadriceps and hamstrings rolling, while FAT group received a 2-min application of FAT to the quadriceps and hamstrings muscles. Both groups significantly improved knee and hip ROM (p < 0.05), with higher gains observed in FAT group (10-19% vs. 5-9%). At 24 h post-treatment, only FAT group preserved most of the gains in ROM (7-13%; p < 0.05). These results support the use of the newly developed IASMT, Fascial Abrasion Technique ™ and FR for increasing lower extremity ROM of athletes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Tratamento da luxação femoro-patelar aguda pelo reparo do ligamento femoro-patelar medial Treatment of acute patellofemoral dislocation through medial patellofomoral ligament repair

    Directory of Open Access Journals (Sweden)

    Gilberto Luis Camanho

    2005-01-01

    Full Text Available Os autores avaliaram a evolução de 17 pacientes que tiveram luxação femoropatelar aguda e foram tratados pela sutura do ligamento femoropatelar medial. A sutura do ligamento foi feita por via artroscópica em 9 pacientes que apresentaram a lesão do ligamento próxima à patela. Nos oito pacientes restantes a lesão do ligamento femoropatelar ocorreu próxima ao epicôndilo femoral e foi tratada pela reinserção no epicôndilo femoral com âncoras. Os pacientes foram acompanhados por um tempo médio de 40 meses e não houve nenhuma recidiva da luxação femoropatelar durante este período.The authors evaluated the evolution of seventeen patients with acute patellofemoral dislocation. Patients were treated through medial patellar ligament suture. The suture of the ligament was performed by arthroscopy in nine patients with ligament lesion near to the patella. The other eight patients, with patellofemoral ligament lesion occurring near to the femoral epicondyle, were treated by reinsertion at the femoral epicondyle with anchors. The patients had a mean follow-up period of forty months and there was no femoropatellar dislocation recurrence.

  1. Dislocation in Spoken French.

    Science.gov (United States)

    Calve, Pierre

    1985-01-01

    Discusses dislocation, a construction in which one element, usually a noun, is isolated either at the beginning or at the end of a sentence while being represented in the body of the sentence by a pronoun. Discusses the place of dislocation in linguistic studies and its pedagogical implications. (SED)

  2. Traumatic Elbow Dislocations

    NARCIS (Netherlands)

    G.I.T. Iordens (Gijs)

    2014-01-01

    markdownabstractThe elbow is the second most common major joint to dislocate after the shoulder in the adult population. Its stability is highly dependent on a complex interaction between bony articulations, capsuloligamentous structures and dynamic muscle restraints. Dislocations are traditionally

  3. Irreducible, incarcerated vertical dislocation of patella into a Hoffa fracture

    Directory of Open Access Journals (Sweden)

    Prasad C Soraganvi

    2014-01-01

    Full Text Available Rotational dislocations of patella, which involve rotation of the patella around a horizontal or vertical axis are rare. These rotational dislocations of patella are difficult to reduce by close methods. These dislocations can have associated osteochondral and retinacular injury. We report a case of a 20-year-old male who presented with swelling and pain in the right knee following a motor cycle accident. Radiological evaluation using the computed tomography revealed a patellar dislocation with a concomitant Hoffa fracture. Patella was rotated around the vertical axis and was incarcerated into the Hoffa fracture. This is a very rare injury and first of its kind to be reported. The difficulties in diagnosis, mechanism of injury and management have been discussed. We feel closed reduction of such an injury is likely to fail and open reduction is recommended.

  4. Traumatic Posterior Dislocation of Hip in Child: A Case Report

    Directory of Open Access Journals (Sweden)

    Dinesh Dhar

    2017-07-01

    Full Text Available Traumatic hip dislocation in children is uncommon, but like in adults, it is an orthopedic emergency. We report a rare case of traumatic posterior dislocation left hip in a 9 year old boy following a motor vehicle accident. The dislocation was promptly reduced by closed manipulation in Accident and Emergency Department with the application of above knee skin traction which was maintained for 3 weeks  followed by non-weight bearing crutch walking for another 6 weeks. On follow up, the patient had a good outcome without any evidence of avascular necrosis (AVN. In this rare case report a literature review of pediatric hip dislocation with treatment recommendations have been highlighted.

  5. In-game Management of Common Joint Dislocations.

    Science.gov (United States)

    Skelley, Nathan W; McCormick, Jeremy J; Smith, Matthew V

    2014-05-01

    Sideline management of sports-related joint dislocations often places the treating medical professional in a challenging position. These injuries frequently require prompt evaluation, diagnosis, reduction, and postreduction management before they can be evaluated at a medical facility. Our objective is to review the mechanism, evaluation, reduction, and postreduction management of sports-related dislocations to the shoulder, elbow, finger, knee, patella, and ankle joints. A literature review was performed using the PubMed database to evaluate previous and current publications focused on joint dislocations. This review focused on articles published between 1980 and 2013. Clinical review. Level 4. The clinician should weigh the benefits and risks of on-field reduction based on their knowledge of the injury and the presence of associated injuries. When properly evaluated and diagnosed, most sports-related dislocations can be reduced and initially managed at the game.

  6. The contribution of daily experiences and acute exercise to fluctuations in daily feeling states among older, obese adults with knee osteoarthritis.

    Science.gov (United States)

    Focht, Brian C; Gauvin, Lise; Rejeski, W Jack

    2004-04-01

    This study examined the contribution of daily experiences and acute exercise to fluctuations in feeling states of older, obese adults with knee osteoarthritis and explored the role of perceived physical function and general health perceptions as moderator variables. Using an experience sampling procedure, a total of 964 feeling state assessments were recorded and coded into samplings that occurred either on a nonexercise day or prior to or following scheduled activity on an exercise day. Multilevel modeling analyses controlling for the influence of subjective stress, contemporaneous pain reports, and diurnal variations revealed that physical exhaustion was higher immediately following exercise. Analyses of the moderator variables demonstrated that general health perceptions and perceived physical function accounted for significant portions of between-subject variance with more positive perceptions of each variable being related to higher levels of pleasant feeling states and lower feelings of physical exhaustion. However, perceived physical function and general health perceptions did not influence feeling states that emerged in conjunction with physical activity. The present findings suggest that whereas daily fluctuations in feeling states are influenced by perceived physical function and general health perceptions, older adults with knee OA do not exhibit the improvements in feeling states that have often been observed following acute exercise in younger, more physically active populations.

  7. Effect of knee joint icing on knee extension strength and knee pain early after total knee arthroplasty: a randomized cross-over study

    DEFF Research Database (Denmark)

    Holm, Bente; Husted, Henrik; Kehlet, Henrik

    2012-01-01

    Objective: To investigate the acute effect of knee joint icing on knee extension strength and knee pain in patients shortly after total knee arthroplasty.Design: A prospective, single-blinded, randomized, cross-over study.Setting: A fast-track orthopaedic arthroplasty unit at a university hospital.......Participants: Twenty patients (mean age 66 years; 10 women) scheduled for primary unilateral total knee arthroplasty.Interventions: The patients were treated on two days (day 7 and day 10) postoperatively. On one day they received 30 minutes of knee icing (active treatment) and on the other day they received 30...... minutes of elbow icing (control treatment). The order of treatments was randomized.Main outcome measures: Maximal knee extension strength (primary outcome), knee pain at rest and knee pain during the maximal knee extensions were measured 2-5 minutes before and 2-5 minutes after both treatments...

  8. Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon.

    Science.gov (United States)

    Bitar, Alexandre Carneiro; Demange, Marco Kawamura; D'Elia, Caio Oliveira; Camanho, Gilberto Luis

    2012-01-01

    Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment. To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation. Randomized controlled trial; Level of evidence, 1. Thirty-nine patients (41 knees) (mean age, 24.2 years; range, 12-38 years) with acute patellar dislocation were randomized into 2 groups. One group was treated nonoperatively with immobilization and physiotherapy, the other was treated surgically with MPFL reconstruction; both groups were evaluated with minimum follow-up of 2 years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrence was evaluated. Pearson χ(2) or Fisher exact test was used in the statistical evaluation. The statistical analysis showed that the mean Kujala score was significantly lower in the nonoperative group (70.8), when compared with the mean value of the surgical group (88.9; P = .001). The surgical group presented a higher percentage of "good/excellent" results (71.43%) on the Kujala score when compared with the nonoperative group (25.0%; P = .003). The nonoperative group presented a large number of recurrences and subluxations (7 patients; 35% of cases), whereas there were no reports of recurrences or subluxations in the surgical group. Treatment with MPFL reconstruction using the patellar tendon produced better results, based on the analyses of posttreatment recurrences and the better final results of the Kujala questionnaire after a minimum follow-up period of 2 years.

  9. Dislocation climb in two-dimensional discrete dislocation dynamics

    NARCIS (Netherlands)

    Davoudi, K.M.; Nicola, L.; Vlassak, J.J.

    2012-01-01

    In this paper, dislocation climb is incorporated in a two-dimensional discrete dislocation dynamics model. Calculations are carried out for polycrystalline thin films, passivated on one or both surfaces. Climb allows dislocations to escape from dislocation pile-ups and reduces the strain-hardening

  10. [Acute total knee replacement infection after a cat bite and scratch: a clinical case and review of the literature].

    Science.gov (United States)

    Miranda, I; Angulo, M; Amaya, J V

    2013-01-01

    In the last 15 years only few cases of Pasteurella multocida (P. multocida) total knee arthroplasty infection have been published, mostly related to cat or dog bites or scratches. We report a case of P. multocida total knee arthroplasty infection in a 64-year- old patient, 10 days after being scratched and bitten by his cat. The patient was successfully treated with debridement and tibial interspacer exchange and antibiotic treatment for 6 weeks. Antimicrobial prophylaxis should be considered in cat or dog bites or scratches victims with prosthetic joints. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  11. Bilateral traumatic hip dislocation associated with sacro-iliac dislocation.

    Science.gov (United States)

    Galois, L; Meuley, E; Pfeffer, F; Mainard, D; Delagoutte, J P

    We report a rare injury in an 18-year-old woman who sustained posterior bilateral hip dislocation with sacro-iliac dislocation after a high energy motor vehicle accident. She was treated by closed reduction and skeletal traction. Bilateral traumatic hip dislocation is an uncommon occurrence. Rarer still is bilateral traumatic hip dislocation associated with sacro-iliac dislocation because it combines two different mechanisms of trauma. (Hip International 2002; 1: 47-9).

  12. Finger Proximal Interphalangeal Joint Dislocation.

    Science.gov (United States)

    Ramponi, Denise; Cerepani, Mary Jo

    2015-01-01

    Finger dislocations are common injuries that are often managed by emergency nurse practitioners. A systematic physical examination following these injuries is imperative to avoid complications. Radiographic views, including the anteroposterior, lateral, and oblique views, are imperative to evaluate these finger dislocations. A dorsal dislocation of the proximal interphalangeal (PIP) joint is the most common finger dislocation type often easily reduced. A volar PIP dislocation can often be difficult to reduce and may result in finger deformity. Finger dislocations should be reduced promptly. Referral to an orthopedic hand specialist is required if the dislocation is unable to be reduced or if the finger joint is unstable following reduction attempts.

  13. Dislocation of the fibular head in an unusual sports injury: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Riaz

    2008-05-01

    Full Text Available Abstract Introduction One of the primary functions of the proximal tibiofibular joint is slight rotation to accommodate rotational stress at the ankle. Proximal tibiofibular joint dislocation is a rare injury and accounts for less than 1% of all knee injuries. This dislocation has been reported in patients who had been engaged in football, ballet dancing, equestrian jumping, parachuting and snowboarding. Case presentation A 20-year-old man was injured whilst playing football. He felt a pop in the right knee and was subsequently unable to bear weight on it. The range of movement in his knee joint was limited. Anterior-posterior and lateral X-rays of the knee revealed anterolateral dislocation of the proximal tibiofibular joint. Comparison views confirmed the anterolateral dislocation. He had a failed manipulation under anaesthesia and the joint needed an open reduction in which the fibular head was levered back into place. Operative findings revealed a horizontal type of joint. Conclusion An exceedingly rare dislocation of a horizontal type of proximal tibiofibular joint was presented following a football injury. This dislocation was irreducible by a closed method.

  14. Knee Injuries and Disability Among Enlisted Males in the U.S. Navy.

    Science.gov (United States)

    1985-05-01

    Loose body in knee 1 0.5 6 729.6 Chondromalacia 96 49.5 1 729.7 Other knee diseases 28 14.4 3 729.9 Fractured patella 5 2.6 5 822.0. 822.1 Dislocated...derangements (30.8%), and Chondromalacia (19.9%) were the most common knee diagnoses among the 1974 cohort. Estimated annual age- (length-of-service- and pay...ICDA-8 Code Description 724.5 Other knee derangement 729.6 Loose body in knee 729.7 Chondromalacia of knee 729.9 other diseases of knee 822.0, 822.1

  15. Dislocation of the proximal tibiofibular joint, do not miss it

    Science.gov (United States)

    van Wulfften Palthe, Alexander FY; Musters, Linda; Sonnega, Remko JA; van der Sluijs, Hans A

    2015-01-01

    We present a case of a 45-year-old woman with a right proximal tibiofibular dislocation she sustained after a fall during roller skating. Anteroposterior and lateral radiographs confirmed the diagnosis; there were no other injuries. The dislocation was reduced by direct manipulation after intra-articular infiltration, in our emergency department. The patient was treated with a long, non-weight bearing leg cast for 1 week. After 4 weeks, she had no pain and a full range of motion of the knee. PMID:26628303

  16. A distinct form of spondyloepimetaphyseal dysplasia with multiple dislocations.

    Science.gov (United States)

    Hall, C M; Elçioglu, N H; Shaw, D G

    1998-01-01

    Three unrelated patients with identical radiological features are presented. Hypotonia was noted at birth and one patient was diagnosed as having congenital fibre type disproportion in the neonatal period. Later muscle biopsies, however, were entirely normal. All patients, now in their teens and twenties, are of normal intelligence, show striking epiphyseal and metaphyseal changes of the long bones, and have joint laxity and multiple dislocations of large joints, which are particularly incapacitating at the knees. These three cases represent a sporadic, previously unreported skeletal dysplasia with spondyloepimetaphyseal distribution and multiple large joint dislocations. Images PMID:9678701

  17. A distinct form of spondyloepimetaphyseal dysplasia with multiple dislocations.

    Science.gov (United States)

    Hall, C M; Elçioglu, N H; Shaw, D G

    1998-07-01

    Three unrelated patients with identical radiological features are presented. Hypotonia was noted at birth and one patient was diagnosed as having congenital fibre type disproportion in the neonatal period. Later muscle biopsies, however, were entirely normal. All patients, now in their teens and twenties, are of normal intelligence, show striking epiphyseal and metaphyseal changes of the long bones, and have joint laxity and multiple dislocations of large joints, which are particularly incapacitating at the knees. These three cases represent a sporadic, previously unreported skeletal dysplasia with spondyloepimetaphyseal distribution and multiple large joint dislocations.

  18. The most common knee injury in volleyball

    OpenAIRE

    Přádová, Kateřina

    2012-01-01

    A knee is the most complicated joint in our body. It is commonly injured during volleyball, mainly resulting as a knee pain syndrome or an acute rupture of an anterior cruciate ligament. In its theoretical part this bachelor thesis gives an overview of basic anatomy and biomechanics of the knee joint, it deals with the gender differences in morfology and neurophysiology and it contains a chapter dealing with biomechanics of the knee joint in volleyball. The second part of this bachelor thesis...

  19. Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Pankaj Jogi

    2015-02-01

    Full Text Available Objectives: To determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty. Methods: Patients who had total hip arthroplasty (n = 30 or total knee arthroplasty (n = 33 were seen in their residence 1–2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33 or typical plus balance (TE + B, n = 30 exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1 the Berg Balance Scale, (2 the Timed Up and Go test, (3 the Western Ontario McMaster Universities Osteoarthritis Index, and (4 the Activities-specific Balance Confidence Scale. Results: Post-intervention scores for all four outcome measures were significantly improved (p < 0.01 over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01. Conclusion: Balance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone.

  20. The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year

    DEFF Research Database (Denmark)

    Frobell, R B; Le Graverand, M-P; Buck, R

    2008-01-01

    OBJECTIVES: To investigate changes in the knee during the first year after acute rupture of the anterior cruciate ligament (ACL) of volumes of joint fluid (JF), bone marrow lesions (BMLs), and cartilage volume (VC), and cartilage thickness (ThCcAB) and cartilage surface area (AC). To identify...... treated with ACL reconstruction followed by a structured rehabilitation program and 24 subjects were treated with structured rehabilitation only. Morphometric data were acquired from computer-assisted segmentation of MR images. Morphometric cartilage change was reported as mean change divided...... (TrF), while an increase of VC and ThCcAB was found in the central medial femur (cMF) (SRM greater than 0.477). ACL reconstruction was directly and significantly related to increased JF volume at 3 and 6 months (P

  1. The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons.

    Science.gov (United States)

    Sommerfeldt, Mark; Bouliane, Martin; Otto, David; Rowe, Brian H; Beaupre, Lauren

    2015-02-01

    Evidence-based guidelines on the use of immobilization in the management of common acute soft-tissue knee injuries do not exist. Our objective was to explore the practice patterns of emergency physicians (EPs), sports medicine physicians (SMPs) and orthopedic surgeons (OS) regarding the use of early immobilization in the management of these injuries. We developed a web-based survey and sent it to all EPs, SMPs and OS in a Canadian urban centre. The survey was designed to assess the likelihood of prescribing immobilization and to evaluate factors associated with physicians from these 3 disciplines making this decision. The overall response rate was 44 of 112 (39%): 17 of 58 (29%) EPs, 7 of 15 (47%) SMPs and 20 of 39 (51%) OS. In cases of suspected meniscus injuries, 9 (50%) EPs indicated they would prescribe immobilization, whereas no SMPs and 1 (5%) OS would immobilize (p = 0.002). For suspected anterior cruciate ligament injuries, 13 (77%) EPs, 2 (29%) SMPs and 5 (25%) OS said they would immobilize (p = 0.005). For lateral collateral ligament injuries, 9 (53%) EPs, no SMPs and 6 (32%) OS would immobilize (p = 0.04). All respondents would prescribe immobilization for a grossly unstable knee. We found that EPs were are more likely to prescribe immobilization for certain acute soft-tissue knee injuries than SMPs and OS. The development of an evidenced- based guideline for the use of knee immobilization after acute soft-tissue injury may reduce practice variability.

  2. Dislocation Dynamics During Plastic Deformation

    CERN Document Server

    Messerschmidt, Ulrich

    2010-01-01

    The book gives an overview of the dynamic behavior of dislocations and its relation to plastic deformation. It introduces the general properties of dislocations and treats the dislocation dynamics in some detail. Finally, examples are described of the processes in different classes of materials, i.e. semiconductors, ceramics, metals, intermetallic materials, and quasicrystals. The processes are illustrated by many electron micrographs of dislocations under stress and by video clips taken during in situ straining experiments in a high-voltage electron microscope showing moving dislocations. Thus, the users of the book also obtain an immediate impression and understanding of dislocation dynamics.

  3. Knee arthroscopy

    Science.gov (United States)

    ... be able to walk without crutches or a knee brace for several weeks. Full recovery may take several months to a year. If you also have arthritis in your knee, you will still have arthritis symptoms after surgery ...

  4. Knee Bursitis

    Science.gov (United States)

    ... volleyball — can increase your risk of knee bursitis. Runners can develop pain and inflammation in the pes anserine bursa, situated on the inner side of your knee below the joint. Obesity and osteoarthritis. Pes anserine bursitis, affecting the inner ...

  5. Dor lateral no joelho do atleta: um raro caso de luxação do tendão do bíceps femoral Lateral pain in an athlete's knee: a rare case of dislocation of the femoral biceps tendon

    Directory of Open Access Journals (Sweden)

    Aires Duarte Junior

    2012-01-01

    Full Text Available A luxação do tendão do bíceps femoral é uma condição rara, descrita na literatura clinicamente com uma dor lateral do joelho e inicialmente relatada como uma inserção anômala da cabeça longa do bíceps femoral. Depois se verificou que a causa é uma mobilidade anormal do tendão sobre a proeminência da cabeça da fíbula em determinados ângulos de flexão do joelho. O objetivo deste relato de caso raro é descrever e discutir sobre o quadro de dor lateral no joelho num atleta de natação que iniciou a subluxação do bíceps femoral durante a prática esportiva, que o incapacitava de realizar provas e torneios. O caso é discutido frente à literatura levantada, à provável etiologia traumática de repetição que levou a essa condição, além do tratamento cirúrgico que foi realizado, obtendo excelente resultado e retorno a prática esportiva habitual.Dislocation of the femoral biceps tendon is rare and is described clinically in the literature as a lateral pain in the knee. It was initially reported as an anomalous insertion of the long head of the femoral biceps. Subsequently, it was found to be caused by abnormal mobility of the tendon over the prominence of the fibu lar head at certain angles of knee flexion. The objective of the present report was to describe and discuss a condition of lateral knee pain in a swimmer who started to present subluxation of the femoral biceps during sports practice, which incapacitated him from taking part in trials and competitions. The case is dis cussed in the light of the literature surveyed; the likelihood that the etiology for the trauma leading to this condition was repeti tion; and the surgical treatment instituted, which led to excellent results and the patient's return to his habitual sports practice.

  6. Spontaneous dislocation of a transparent lens to the anterior chamber: A case report

    Directory of Open Access Journals (Sweden)

    Jovanović Miloš

    2010-01-01

    Full Text Available Introduction. The causes leading to dislocation of the natural lenses are different involving injuries, hereditary diseases and spontaneous dislocation. Spontaneous dislocation of a transparent natural lens is extremely rare, especially dislocation of the anterior eye chamber. We report a case of spontaneous dislocation of the transparent natural lens to the anterior eye chamber in a patient who had no history of eye injuries. Case Outline. The patient was a 17-year old boy. Lens dislocation was spontaneous, and the patient presented for ophthalmological consultation due to a sudden vision impairment of the left eye. Biomicroscopic examination verified that the transparent lens was in the anterior chamber, and it was spherophakia of lesser diameter; there were no signs of increased intraocular pressure, as typically expected in lens dislocation to the anterior chamber. The patient was operated on in general anaesthesia. Surgery involved intracapsular extraction of the dislocated lens through a corneoscleral incision. Conclusion. This case report shows that a spontaneous dislocation of the natural lens may occur in younger people. The dislocated spherophakic lens to the anterior eye chamber did not contribute to the rise of the intraocular pressure and development of acute glaucoma. The acute glaucoma resulted from the pilocarpine narrowing of the pupil due to pupillary block. The intracapsular instrumental extraction of the dislocated transparent lens from the anterior chamber was successfully completed through a corneoscleral incision.

  7. Orthopedic management of spina bifida. Part I: hip, knee, and rotational deformities

    OpenAIRE

    Swaroop, Vineeta T.; Dias, Luciano

    2009-01-01

    Children with spina bifida develop a wide variety of congenital and acquired orthopedic deformities. Among these are hip deformities such as contracture, subluxation, or dislocation. Patients may also have problems with the knee joint, such as knee flexion or extension contracture, knee valgus deformity, or late knee instability and pain. In addition, rotational deformities of the lower extremities, either internal or external torsion, are common as well. This paper will review both the overa...

  8. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K

    2012-01-01

    It is unknown whether the bone bruise that occurs in connection with acute anterior cruciate ligament (ACL) rupture is causing pain and dysfunction. We followed prospectively 17 patients [10 men, seven women, mean age 28 years (range 23-34)] with acute ACL rupture for 2 months. A magnetic resonance...

  9. Anterior knee pain.

    Science.gov (United States)

    LLopis, Eva; Padrón, Mario

    2007-04-01

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  10. Anterior knee pain

    Energy Technology Data Exchange (ETDEWEB)

    LLopis, Eva [Hospital de la Ribera, Alzira, Valencia (Spain) and Carretera de Corbera km 1, 46600 Alzira Valencia (Spain)]. E-mail: ellopis@hospital-ribera.com; Padron, Mario [Clinica Cemtro, Ventisquero de la Condesa no. 42, 28035 Madrid (Spain)]. E-mail: mario.padron@clinicacemtro.com

    2007-04-15

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  11. Anterior knee pain

    Science.gov (United States)

    Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee ... kneecap (patella) sits over the front of your knee joint. As you bend or straighten your knee, ...

  12. Posterior Elbow Dislocation

    Directory of Open Access Journals (Sweden)

    Victoria Oppenheim

    2016-09-01

    Full Text Available History of present illness: A 15-year old female presented with left elbow pain. While competing in a high school wrestling match, she extended her left arm to brace a fall and had immediate onset of sharp pain. She denied weakness or numbness of her left arm. She had no past medical history. Significant findings: Elbow dislocations are classified by the position of the radio-ulnar joint relative to the humerus.1 Images 1, 2, and 3 show a left posterior elbow dislocation; the radius and ulna are displaced posteriorly with respect to the distal humerus. The lateral view of the elbow most clearly shows this: trochlear notch of the ulna is empty and displaced posteriorly relative to the trochlea. There is no associated fracture. Images 4 and 5 show the elbow status-post reduction, demonstrating proper alignment of the distal humerus with the radius and ulna. Discussion: Traumatic dislocations of the elbow are relatively uncommon in pediatric patients, with a peak incidence at 13 to 14 years.1 Dislocations are usually posterior and occur after forced abduction and extension of the elbow.1 It is important to evaluate for an associated fracture or avulsion, which occurs in over 50% of pediatric elbow dislocations. Fractures most commonly involve the medial epicondyle, radial head and neck, or coronoid process.1 One should also consider a neurovascular injury to the ulnar or median nerve or to the brachial artery or its branches.1 Posterior elbow dislocations should be reduced as soon as possible.1 Patients should receive adequate sedation and/or analgesia. One method of reduction is the “puller” technique, during which a practitioner stabilizes the humerus, while a second practitioner applies force against the anterior forearm, with gentle traction distally.1 Post-reduction neurovascular reassessment is important. After successful reduction, patients can be immobilized in a posterior long arm splint.

  13. Dislocation of the hip (image)

    Science.gov (United States)

    A dislocation is an injury in which a bone is displaced from its proper position. Unless there are accompanying fractures or tissue damage, a simple dislocation may be manipulated back into place. Recovery may ...

  14. Traumatic thumb carpometacarpal joint dislocations.

    Science.gov (United States)

    Bosmans, B; Verhofstad, M H J; Gosens, T

    2008-03-01

    Isolated traumatic dislocation of the thumb carpometacarpal joint, also called the trapeziometacarpal joint, is a rare injury. Controversy still exists concerning which ligaments are the true key stabilizers for the joint and therefore need to be damaged to result in dislocation, and optimal treatment strategies for thumb carpometacarpal joint dislocations are the subject of continuing debate. We give a review of the literature concerning traumatic dislocations of the carpometacarpal joint of the thumb and propose a treatment algorithm.

  15. Design rules for dislocation filters

    OpenAIRE

    Ward, Tom; Sánchez, Ana M; Tang, Mingchu; Wu, Jiang; Liu, Huiyun; Dunstan, David J.; Beanland, Richard

    2014-01-01

    The efficacy of strained layer threading dislocation filter structures in single crystal epitaxial layers is evaluated using numerical modeling for (001) face-centred cubic materials, such as GaAs or Si(1-x)Ge(x), and (0001) hexagonal materials such as GaN. We find that threading dislocation densities decay exponentially as a function of the strain relieved, irrespective of the fraction of threading dislocations that are mobile. Reactions between threading dislocations tend to produce a popul...

  16. Possible effects of mobilisation on acute post-operative pain and nociceptive function after total knee arthroplasty

    DEFF Research Database (Denmark)

    Lunn, T H; Kristensen, B B; Gaarn-Larsen, L

    2012-01-01

    BACKGROUND: Experimental studies in animals, healthy volunteers, and patients with chronic pain suggest exercise to provide analgesia in several types of pain conditions and after various nociceptive stimuli. To our knowledge, there is no data on the effects of exercise on pain and nociceptive fu...... function (pain threshold and tolerance) was assessed with pressure algometry and an electrical stimulus. RESULTS: Pain at rest (supine) and during hip and knee flexion was significantly reduced 5 min (P ......BACKGROUND: Experimental studies in animals, healthy volunteers, and patients with chronic pain suggest exercise to provide analgesia in several types of pain conditions and after various nociceptive stimuli. To our knowledge, there is no data on the effects of exercise on pain and nociceptive...... function in surgical patients despite early mobilisation being an important factor to enhance recovery. We therefore investigated possible effects of mobilisation on post-operative pain and nociceptive function after total knee arthroplasty (TKA). METHODS: Thirty patients undergoing TKA under standardised...

  17. Behavior of dislocations in silicon

    Energy Technology Data Exchange (ETDEWEB)

    Sumino, Koji [Nippon Steel Corp., Chiba Prefecture (Japan)

    1995-08-01

    A review is given of dynamic behavior of dislocations in silicon on the basis of works of the author`s group. Topics taken up are generation, motion and multiplication of dislocations as affected by oxygen impurities and immobilization of dislocations due to impurity reaction.

  18. Congenital hip dislocation (image)

    Science.gov (United States)

    ... by a blow, fall, or other trauma, a dislocation can also occur from birth. The cause is unknown but genetic factors may play a role. Problems resulting from very mild developmental dysplasia of the hip may not become apparent until the person is ...

  19. Dislocated Worker Project.

    Science.gov (United States)

    1988

    Due to the severe economic decline in the automobile manufacturing industry in southeastern Michigan, a Dislocated Workers Program has been developed through the partnership of the Flint Area Chamber of Commerce, three community colleges, the National Center for Research in Vocational Education, the Michigan State Department of Education, the…

  20. Multiple joint dislocations: an additional skeletal finding in Lowry-Wood syndrome?

    Science.gov (United States)

    Magnani, Cinzia; Tedesco, Salvatore Antonio; Dallaglio, Sara; Sommi, Marcello; Bacchini, Ermanno; Vetro, Annalisa; Zuffardi, Orsetta; Bevilacqua, Giulio

    2009-02-15

    We report on the case of a 17-year-old boy with clinical features compatible with Lowry-Wood syndrome: microcephaly, short stature, multiple epiphyseal dysplasia, tapetoretinal degeneration, and mental retardation. Bilateral restricted elbow extension, knock knees and hip dislocation were also present. Radiographs showed evidence of radial dislocation due to the absence of the radial heads, lateral dislocation of both patellae, multiple epiphyseal dysplasia that was more severe at the proximal femoral epiphyses, and dislocation of both hips with severe hip dysplasia. The patient developed a behavioral disorder at age 15. Conventional karyotyping was normal (46,XY). Molecular karyotyping, performed through array-based competitive genomic hybridization, showed copy number variants that were probably benign. We suggest that multiple joint dislocations, including the patellae, may be a sign of Lowry-Wood syndrome.

  1. POSTERIOR STERNOCLAVICULAR JOINT DISLOCATION IN A DIVISION I FOOTBALL PLAYER: A CASE REPORT

    OpenAIRE

    Cruz, Mario F.; Erdeljac, Joe; Williams, Richard; Brown, Mike; Bolgla, Lori

    2015-01-01

    Posterior dislocation of the sterno‐clavicular (SC) joint is a rare injury in athletes. It normally occurs in high collision sports such as American football or rugby. Acute posterior dislocations of the SC joint can be life‐threatening as the posteriorly displaced clavicle can cause damage to vital vascular and respiratory structures such as the aortic arch, the carotid and subclavian arteries, and the trachea. The potential severity of a posterior SC joint dislocation provides multiple chal...

  2. Lens dislocation has a possible relationship with laser iridotomy

    Directory of Open Access Journals (Sweden)

    Mutoh T

    2012-12-01

    Full Text Available Tetsuya Mutoh,1,2 Kevin F Barrette,2 Yukihiro Matsumoto,1 Makoto Chikuda11Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan; 2Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USAAbstract: We report our recent experience of four eyes with spontaneous lens dislocation in four patients with no history of trauma or any systemic disease associated with zonular dialysis. Lens dislocation developed with 0.5 to 6 months following laser iridotomy. All patients were male and two eyes were complicated with acute primary angle closure glaucoma preoperatively. Case 1 showed bilateral lens dislocation, while cases 2 and 3 involved unilateral lens dislocation. Cases 2 and 3 showed lenses completely dislocated into the vitreous cavity. All cases needed lens removal and scleral fixation of intraocular lenses. Final visual acuity was 1.2 in all cases. We suspect that laser iridotomy may induce localized zonular dialysis that results in progressive zonular weakness, leading to lens dislocation.Keywords: lens dislocation, laser iridotomy, primary angle closure glaucoma

  3. [Subtalar dislocation of the foot].

    Science.gov (United States)

    Lacko, M; Cellár, R; Vaško, G

    2012-01-01

    Based on a retrospective analysis, the authors present their experience with treatment of subtalar dislocation of the foot. Between 1999 and 2011 six patients, all of them men, with the average age of 31 years were treated for subtalar fractures. Five patients were diagnosed with medial dislocation and one with lateral dislocation. In one patient with medial subtalar dislocation it was an open injury. The clinical and radiographic results of the patients followed up for 1 to 12 years (average, 7.8 years) were retrospectively evaluated. The achieved average score, based on the AOFAS ankle and hindfoot scale, was 91.3 points (± 9.77; minimum, 73; maximum, 100). Excellent results were recorded in four patients, good in one and satisfactory in the patient with lateral dislocation. Radiographic signs of subtalar joint osteoarthritis were found in one patient. No neurological or circulation dis - orders, skin necrosis, signs of reflex sympathetic dystrophy, aseptic bone necrosis of the talus, infection or joint instability were recorded. A subtalar dislocation of the foot involves simultaneous dislocation of the talocalcaneal and talonavicular joints. It is a rare injury accounting for about 1 to 2% of all traumatic dislocations. It may occur as medial, lateral, anterior or posterior subtalar dislocation. The results of treatment depend on several factors, such as the type of dislocation (medial and open dislocations are at higher risk), associated injuries, or damage to deep skin layers, and also on an exact diagnosis, early and accurate reduction and sufficiently long foot immobilisation.

  4. [Diagnostic and therapeutic management of primary and recurrent patellar dislocations - analysis of a nationwide survey and the current literature].

    Science.gov (United States)

    Hohlweck, J; Quack, V; Arbab, D; Spreckelsen, C; Tingart, M; Lüring, C; Rath, B

    2013-08-01

    Patellar dislocations are a common injury of the knee joint. During patella dislocations injuries of soft-tissue structures can occur that can destabilise the patella and lead to recurrent dislocations. There are also congenital pathologies that predispose to patella dislocations. In the current literature, diagnostics and treatment of patellar dislocations are frequently discussed. Therefore the aim of our survey was to analyse and summarise actual diagnostic and therapeutic strategies regarding primary and recurrent patella dislocations. An online questionnaire form was sent to 735 orthopaedic and/or trauma departments in Germany. The departments were invited to participate in an anonymous survey concerning diagnostics and treatment of primary and recurrent patellar dislocations. The questionnaire consisted of multiple choice questions and was divided into three sections. The first section included questions concerning the department structure. The second part contained questions regarding diagnostics and treatment of primary patella dislocations. The third part involved diagnostic and treatment strategies for recurrent patella dislocations. A systematic review of outcome after treatment of patellar dislocation was performed and discussed with the results of the survey. 245 hospitals (33.3 %) returned the questionnaire. Among the participants were 23 % orthopaedic surgery departments, 32 % trauma surgery departments and 45 % combined departments. 12 % were university hospitals and 53 % academic teaching hospitals. Clinical examination was performed by nearly all participants after primary and recurrent patella dislocations. MRI was used as diagnostic tool in 81 % after primary patella dislocation and in 85 % after recurrent patella dislocation. Conventional X-rays were performed in 58 % (primary) and 51 % (recurrent patella dislocations). Computed tomography scans for measurement of the tuberositas tibiae-trochlea groove distance were used in 35 % after recurrent

  5. Patella Dislocation with Vertical Axis Rotation: The “Dorsal Fin” Patella

    Directory of Open Access Journals (Sweden)

    David Gamble

    2015-01-01

    Full Text Available A 44-year-old woman presented following minor trauma to her right knee. While dancing she externally rotated around a planted foot and felt sudden pain in her right knee. She presented with her knee locked in extension with a “dorsal fin” appearance of the soft tissues tented over the patella. This was diagnosed as a rare case of an intraarticular patella dislocation, which was rotated 90 degrees about the vertical axis. Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation. Postreduction arthroscopy demonstrated that no osteochondral or soft tissue damage to the knee had been sustained. In patients presenting with a knee locked in extension with tenting of skin over the patella (the “dorsal fin” appearance, intra-articular patella dislocation should be suspected. Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint. In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture.

  6. Jumper's Knee (Patellar Tendonitis)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Jumper's Knee KidsHealth / For Teens / Jumper's Knee What's in this ... continued damage to the knee. How Does the Knee Work? To understand how jumper's knee happens, it ...

  7. Five-year follow-up of knee joint cartilage thickness changes after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Eckstein, F; Wirth, W; Lohmander, Stefan

    2015-01-01

    Objective: Anterior cruciate ligament (ACL) rupture involves increased risk of osteoarthritis. We explored cartilage thickness changes over five years after ACL rupture. Methods: 121 young active adults (26% women, age 18-35 years) with acute traumatic ACL rupture were studied (the KANON...

  8. Neglected isolated scaphoid dislocation

    Directory of Open Access Journals (Sweden)

    Jong-Ryoon Baek

    2016-01-01

    Full Text Available The authors present a case of isolated scaphoid dislocation in a 40-year-old male that was undiagnosed for 2 months. The patient was treated by open reduction, Kirschner wire fixation, interosseous ligament repair using a suture anchor and Blatt's dorsal capsulodesis. At 6 years followup, his radiographs of wrist showed a normal carpal alignment with a scapholunate gap of 3 mm and no evidence of avascular necrosis (AVN of the scaphoid.

  9. Open Dislocation of Fifth Digit

    Directory of Open Access Journals (Sweden)

    Robert Rowe

    2016-09-01

    Full Text Available History of present illness: A 17-year-old female presented with a chief complaint of right fifth finger pain. The patient reported that she was playing volleyball when she blocked an opponent’s shot and sustained an injury to her right fifth finger. Significant findings: Physical exam revealed an open dislocation of the proximal interphalangeal joint (PIP of the right fifth digit. X-ray confirmed dislocation and revealed no fractures. The patient received a tetanus booster, Cefazolin, and the dislocation was then washed out and reduced. Multiple reduction attempts were made and were only successful once the metacarpophalangeal joints were held in 90 degree flexion, which relaxed the lateral bands and enabled the finger to be reduced. Discussion: PIP dislocations result in more complications than those of distal interphalangeal joints (DIP.1 Dorsal dislocations of the PIP are more common than volar dislocations and usually cause injury to the volar plate and the collateral ligaments.2 Dislocations are typically reduced with hyper-extension of the middle phalanx followed by longitudinal traction of the distal portion of the finger, and then gentle flexion or palmar force.1,2 The finger is then splinted in 20-30 degrees of flexion. Open dislocations and fracture dislocations should be evaluated for hand surgery.1 If left untreated or incompletely reduced, dorsal dislocations of the PIP may lead to swan neck deformities.2

  10. Acute effects of whole-body vibration on peak isometric torque, muscle twitch torque and voluntary muscle activation of the knee extensors.

    Science.gov (United States)

    Jordan, M; Norris, S; Smith, D; Herzog, W

    2010-06-01

    The purpose of this investigation was to compare the acute effects of whole-body vibration (WBV) with a static squat on resting muscle twitch torque, peak isometric torque and voluntary muscle activation of the knee extensors during an isometric maximal voluntary contraction (MVC). Twenty-four healthy, strength-trained males were recruited for this randomized, cross-over design investigation. The WBV treatment consisted of three sets of 60 s of vibration (30 Hz, +/-4 mm) while standing in a semi-squat position. Voluntary muscle activation, peak isometric torque during MVC and resting muscle twitch torque (RTT) through percutaneous femoral nerve stimulation were obtained before and following the treatment. Change in peak isometric torque, voluntary muscle activation and the RTT were calculated as the difference between pre- and post-treatment values. There was no observable post-activation potentiation of muscle twitch torque or enhancement in voluntary muscle activation or peak isometric torque. However, decreases in the peak isometric torque (P=0.0094) and voluntary muscle activation (P=0.0252) were significantly smaller post WBV interventions compared with the control treatment. Based on the current data, it is unclear whether or not this was attributable to the effects of WBV but further research into this possibility is warranted.

  11. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  12. The Classic: Dislocation and Fracture-Dislocation of the Pelvis

    OpenAIRE

    Holdsworth, F W

    2012-01-01

    This Classic Article is a reprint of the original work by F.W. Holdsworth, Dislocation and fracture-dislocation of the pelvis. An accompanying biographical sketch of F.W. Holdsworth is available at DOI 10.1007/s11999-012-2422-4. Reproduced and adapted with permission and copyright © of the British Editorial Society of Bone and Joint Surgery. Holdsworth FW. Dislocation and fracture-dislocation of the pelvis. J Bone Joint Surg Br. 1948;30:461–466.

  13. Management of Unusual Atlantoaxial Dislocation.

    Science.gov (United States)

    Song, Ruipeng; Fan, Daoyang; Wu, Han; Zhang, Zhen; Zhao, Liang; Liu, Yilin; Liao, Wensheng; Tan, Hongyu; Wang, Limin; Wang, Weidong

    2017-04-15

    A case report and review of the literature. The aim of this study was to describe the successful treatment of one posterior atlantoaxial dislocation without fracture and to review the relevant literature. Posterior atlantoaxial dislocation without fracture of the odontoid process is extremely rare. Management of these patients is still unknown. A posterior atlantoaxial dislocation without fracture in a 58-year-old man with incomplete quadriplegia was treated surgically with posterior atlantoaxial pedicle screws internal fixation and fusion after closed reduction. The images, treatment, and related literature are reviewed. The patient had complete recovery of neurologic deficit and bony fusion of the atlantoaxial joint was identified on the follow-up computed tomography taken 3 months after posterior fixation. To our knowledge, no case of posterior atlantoaxial dislocation with neurologic deficit has been previously reported in English medical literature. We described a rare case of posterior atlantoaxial dislocation with neurologic deficit. Treatment procedure of posterior atlantoaxial dislocation was presented. 5.

  14. Force-plate analyses of balance following a balance exercise program during acute post-operative phase in individuals with total hip and knee arthroplasty: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Pankaj Jogi

    2016-11-01

    Full Text Available Objectives: Typical rehabilitation programs following total hip arthroplasty and total knee arthroplasty include joint range of motion and muscle-strengthening exercises. Balance and balance exercises following total hip arthroplasty and total knee arthroplasty have not received much attention. The purpose of this study was to determine whether an intervention of balance exercises added to a typical rehabilitation program positively affects patients’ balance. Methods: A total of 63 patients were provided with outpatient physical therapy at their home. Patients were randomly assigned to either typical (n = 33 or balance (n = 30 exercise group. The typical group completed seven typical surgery-specific joint range of motion and muscle-strengthening exercises, while the balance group completed the typical exercises plus three balance exercises. After 5 weeks of administering the rehabilitation program, patients’ balance was assessed on a force plate using 95% ellipse area of the center of pressure amplitude. Results: Patients in the balance group demonstrated significant reduction in the 95% ellipse area for the anterior and posterior lean standing conditions (p < 0.01. Conclusion: Balance exercises added to the typical outpatient physical therapy program resulted in significantly greater improvements in balance for participants with total hip arthroplasty or total knee arthroplasty, compared to the typical exercise program alone. Physical therapists might consider the use of balance exercises to improve balance in individuals in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty.

  15. Chronic Irreducible Anterior Dislocation of the Shoulder without Significant Functional Deficit.

    Science.gov (United States)

    Chung, Hoejeong; Yoon, Yeo-Seung; Shin, Ji-Soo; Shin, John Junghun; Kim, Doosup

    2016-09-01

    Shoulder dislocation is frequently encountered by orthopedists, and closed manipulation is often sufficient to treat the injury in an acute setting. Although most dislocations are diagnosed and managed promptly, there are rare cases that are missed or neglected, leading to a chronically dislocated state of the joint. They are usually irreducible and cause considerable pain and functional disability in most affected patients, prompting the need to find a surgical method to reverse the worsening conditions caused by the dislocated joint. However, there are cases of even greater rarity in which chronic shoulder dislocations are asymptomatic with minimal functional or structural degeneration in the joint. These patients are usually left untreated, and most show good tolerance to their condition without developing disabling symptoms or significant functional loss over time. We report on one such patient who had a chronic shoulder dislocation for more than 2 years without receiving treatment.

  16. Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture.

    Science.gov (United States)

    Tarasevicius, Sarunas; Busevicius, Mantas; Robertsson, Otto; Wingstrand, Hans

    2010-08-06

    Hip dislocation after arthroplasty for femoral neck fractures remains a serious complication. The aim of our study was to investigate the dislocation rate in acute femoral neck fracture patients operated with a posterior approach with cemented conventional or dual articulation acetabular components. We compared the dislocation rate in 56 consecutive patients operated with conventional (single mobility) cemented acetabular components to that in 42 consecutive patients operated with dual articulation acetabular components. All the patients were operated via posterior approach and were followed up to one year postoperatively. There were 8 dislocations in the 56 patients having conventional components as compared to no dislocations in those 42 having dual articulation components (p = 0.01). The groups were similar with respect to age and gender distribution. We conclude that the use of a cemented dual articulation acetabular component significantly reduces the dislocation rates in femoral neck fracture patients operated via posterior approach.

  17. Design rules for dislocation filters

    Science.gov (United States)

    Ward, T.; Sánchez, A. M.; Tang, M.; Wu, J.; Liu, H.; Dunstan, D. J.; Beanland, R.

    2014-08-01

    The efficacy of strained layer threading dislocation filter structures in single crystal epitaxial layers is evaluated using numerical modeling for (001) face-centred cubic materials, such as GaAs or Si1-xGex, and (0001) hexagonal materials such as GaN. We find that threading dislocation densities decay exponentially as a function of the strain relieved, irrespective of the fraction of threading dislocations that are mobile. Reactions between threading dislocations tend to produce a population that is a balanced mixture of mobile and sessile in (001) cubic materials. In contrast, mobile threading dislocations tend to be lost very rapidly in (0001) GaN, often with little or no reduction in the immobile dislocation density. The capture radius for threading dislocation interactions is estimated to be approximately 40 nm using cross section transmission electron microscopy of dislocation filtering structures in GaAs monolithically grown on Si. We find that the minimum threading dislocation density that can be obtained in any given structure is likely to be limited by kinetic effects to approximately 104-105 cm-2.

  18. Inferior hip dislocation after falling from height: A case report.

    Science.gov (United States)

    Tekin, Ali Çağrı; Çabuk, Haluk; Büyükkurt, Cem Dinçay; Dedeoğlu, Süleyman Semih; İmren, Yunus; Gürbüz, Hakan

    2016-01-01

    Traumatic inferior hip dislocation is the least common of all hip dislocations. Adult inferior hip dislocations usually occur after high-energy trauma, very few cases are reported without fracture. A 26-year-old female was brought to the emergency department with severe pain in the left hip, impaired posture and restricted movement following a fall from 15m height. The hip joint was fixed in 90° flexion, 15° abduction, and 20° external rotation. No neurovascular impairment was determined. On radiologic examination, a left ischial type inferior hip dislocation was detected. Hemorrhagic shock which developed due to acute blood loss to thoracic and abdominal cavity and patient died at third hour after she was brought to the hospital. Traumatic hip dislocations have high morbidity and mortality rates due to multiple organ damage, primarily of the extremities, chest and abdomen. In the treatment of traumatic hip dislocation, closed reduction is recommended through muscle relaxation under general anesthesia or sedation. This procedure should be applied before any intervention for concomitant extremity injuries. A detailed evaluation on emergency presentation, a multi-disciplinary approach and early diagnosis with the rapid application of imaging methods could be life-saving for such patients. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Acute Septic Arthritis of the Knee Caused by Kingella kingae in a 5-Year-Old Cameroonian Boy

    Directory of Open Access Journals (Sweden)

    Nawal El Houmami

    2017-11-01

    Full Text Available Kingella kingae is an important cause of invasive infections in young children from Western countries. Although increasing reports indicate that this organism is the leading agent of bone and joint infections in early childhood, data on K. kingae infections from resource-limited settings are scarce, and none has yet been reported in Africa. We herein report the diagnostic and epidemiological investigations of the first case of K. kingae arthritis identified in a child from sub-Saharan Africa. A 5-year-old Cameroonian boy presented with a sudden painful limp which appeared in the course of a mild rhinopharyngitis. He lived in Cameroon where he had been vaccinated with BCG at birth and moved to France for holidays 4 days before consultation. There was no history of trauma and he did not have any underlying medical condition. Upon admission, he had a temperature of 36.7°C, and clinical examination revealed right-sided knee tenderness and effusion that was confirmed by ultrasound imaging. Laboratory results showed a white blood cell count of 5,700 cells/mm3, C-reactive protein level of 174 mg/L, and platelet count of 495,000 cells/mm3. He underwent an arthrocentesis and was immediately given intravenous amoxicillin-clavulanate. Conventional cultures from blood samples and synovial fluids were negative. Polymerase chain reaction (PCR assay targeting the broad-range 16S rRNA gene and real-time quantitative PCR assays targeting Mycobacterium species were negative. Surprisingly, real-time PCR assays targeting the cpn60, rtxA, and rtxB genes of K. kingae were positive. Multicolor fluorescence in situ hybridization specific for K. kingae identified the presence of numerous coccobacilli located within the synovial fluid. Finally, multilocus sequence typing analysis performed on deoxyribonucleic acid directly extracted from joint fluid disclosed a novel K. kingae sequence-type complex. This case report demonstrates that K. kingae may be considered

  20. BILATERAL PATHOLOGICAL HIP DISLOCATION IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Yuriy E. Garkavenko

    2017-03-01

    Full Text Available Introduction. Pathological dislocation of the hip is one of the most severe complications of acute hematogenous osteomyelitis. The program of treatment for children with pathological hip dislocation is complex, but it has been sufficiently developed and implemented very successfully. At the same time, the available literature provides no cases of treating children with bilateral pathological hip dislocations after hematogenous osteomyelitis. There is no information on the incidence of such cases or in regards to remote functional results. Materials and methods. The results of the treatment of 18 children with bilateral pathological dislocation of the hip after hematogenous osteomyelitis are presented, which constituted 23.1% of the total number of patients (78 who underwent surgery in 2000–2016 for the diagnosis of pathological hip dislocation. Both hip joints were surgically operated on in 12 patients, while one hip joint was operated on in 6 patients. To assess the anatomical and functional state of hip joints, the clinical and roentgenological diagnostic techniques were used. Results and discussion. To stabilize and restore the function of the hip joints, 18 children underwent 30 surgical interventions: simple open hip reduction (19 and open hip reduction with hip arthroplasty with one (6 or two (5 demineralized osteochondral allogeneic grafts. The decision regarding the possibility of performing surgical intervention on the second hip joint was made only after a child's check-up examination was complete and after positive information about the anatomical and functional state of the operated hip joint was obtained. According to these criteria, 14 (77.8% children underwent surgical treatment of the second hip joint 1–1.5 years after the course of conservative measures to restore the range of motion in the previously operated hip joint. Over a period of 1–12 years, 17 patients were examined, 10 of which underwent an operation on both

  1. UCI total knee replacement. A follow-up study.

    Science.gov (United States)

    Hamilton, L R

    1982-06-01

    Using the UCI (University of California at Irvine) total knee prosthesis, an arthroplasty was performed in ninety-seven patients (121 knees) from 1972 through 1977. I examined eighty of these patients (100 knees) at three to eight years after the operation and it was necessary to either perform or recommend further surgery in twenty-five of them (twenty-seven knees). These results were designated as failures. The knees in valgus angulation that failed typically did so within the first year because of medical instability and patellar dislocation. The knees in varus angulation that failed typically did so one to six years after operation because of loosening of the tibial component. When failure became established, each knee was found to have reverted to its preoperative angular deformity, indicating that deforming factors were still operative. I suspect that ligament imbalance may have contributed to many of these failures. The surface area and stiffness of the 5.0 and 7.5-millimeter-thick tibial components of the original UCI prosthesis were not sufficient to prevent loosening and subsidence. Constraint between the tibial and femoral components was not sufficient to prevent subluxation or dislocation if soft-tissue release was needed for correction of deformity. Prompted by this experience, total knee arthroplasty using the UCI device has been discontinued at the Ochsner Medical Institutions.

  2. Management of joint dislocations of the lower limb in Larsen syndrome: practical approach.

    Science.gov (United States)

    Matar, H E; Garg, N K

    2017-01-01

    INTRODUCTION Larsen syndrome is an autosomal-dominant osteochondrodysplasia characterised by large joint dislocations and craniofacial anomalies. CASE HISTORY We present a rare case of Larsen syndrome with bilateral dislocated hips and knees and severe clubfeet at 7-year follow-up. We undertook bilateral open reduction of both hips at age 8 months. This procedure was preceded by open reduction and left-knee V-Y quadricepsplasty at age 4 months following a failed trial of closed reduction of the left knee. Both feet had a severe deformity (Pirani score of 5.5 and 6.0) and were treated using the Ponseti method, but the left foot relapsed at 24 months and required posteromedial release. CONCLUSIONS We tried to address the difficult questions on the timing and sequence of surgical interventions by treating clubfeet and dislocated knees early using Ponseti casts which included the knees. Open reduction of hips was done later, and further interventions were guided by functional needs.

  3. The SIGN nail for knee fusion: technique and clinical results

    Directory of Open Access Journals (Sweden)

    Anderson Duane Ray

    2016-01-01

    Full Text Available Purpose: Evaluate the efficacy of using the SIGN nail for instrumented knee fusion. Methods: Six consecutive patients (seven knees, three males with an average age of 30.5 years (range, 18–50 years underwent a knee arthrodesis with SIGN nail (mean follow-up 10.7 months; range, 8–14 months. Diagnoses included tuberculosis (two knees, congenital knee dislocation in two knees (one patient, bacterial septic arthritis (one knee, malunited spontaneous fusion (one knee, and severe gout with 90° flexion contracture (one knee. The nail was inserted through an anteromedial entry point on the femur and full weightbearing was permitted immediately. Results: All knees had clinical and radiographic evidence of fusion at final follow-up and none required further surgery. Four of six patients ambulated without assistive device, and all patients reported improved overall physical function. There were no post-operative complications. Conclusion: The technique described utilizing the SIGN nail is both safe and effective for knee arthrodesis and useful for austere environments with limited fluoroscopy and implant options.

  4. Surgical Treatment of Congenital and Obligatory Dislocation of the Patella in Children.

    Science.gov (United States)

    Sever, Ronen; Fishkin, Michael; Hemo, Yoram; Wientroub, Shlomo; Yaniv, Moshe

    2017-03-21

    Congenital (fixed) dislocations and obligatory (habitual) patellar dislocations represent a complex clinical and surgical challenge. Numerous treatment options, offering different perspectives, and surgical solutions are reported in the literature.We implemented the surgical technique principles, originally described by Stanisavljevic, for congenital (fixed) and obligatory (habitual) patellar dislocations, with slight modifications. We retrospectively evaluated the results of group of 12 patients (15 knees), operated between the years 2002 and 2013. The procedure includes extensive subperiosteal quadriceps realignment and soft tissue medial plication, followed by distal realignment through patellar tendon splitting. The outcome measures were patellar stability, knee range of motion, Pedi-IKDC knee function score, and the PODCI global function score. The study group included 12 patients, 9 females and 3 males (15 knees) whose mean age was 5 years 2 months at diagnosis and 7 years 5 months at surgery. Nine patients had an underlying diagnosed genetic background [Down syndrome (n=6), Larsen syndrome (n=2), nail-patella syndrome (n=1)]. The mean follow-up was 46.2 months. Eleven patients, gained stable patella with no recurrence of dislocation. Postoperative knee active extension was improved significantly (P<0.0001) for all patients. The average postoperative Pedi-IKDC and PODCI scores were significantly higher (P<0.001) among the idiopathic group. These results suggest that the Stanisavljevic procedure principles with modifications, provides an efficient method for treatment of fixed and obligatory patellar dislocation. In our opinion, young age at surgery played an important role in the surgical outcome. Level IV-therapeutic.

  5. Bilateral recurrent discloation of the patella associated with below knee amputation: A case report

    Directory of Open Access Journals (Sweden)

    Lenka Prasanna

    2005-02-01

    Full Text Available Abstract Background Recurrent dislocation of the patella in patients with below knee amputation is a known entity. Abnormally high-riding patella (patella alta and medial patellofemoral ligament insufficiency in these patients predisposes them to patellar instability. The established treatment of this problem is surgical realignment. Case presentation A 25 year old male patient with bilateral below knee amputation presented with bilateral recurrent dislocation of the patella while walking on knees on uneven ground. Clinical and radiographic studies showed patella alta. A simple shoe modification was used to treat this patient. Conclusions A simple shoe modification can be used to treat such a condition which is otherwise treated surgically.

  6. A rare case of Hoffa fracture combined with lateral patellar dislocation

    Directory of Open Access Journals (Sweden)

    Martin C. Jordan

    2017-06-01

    Full Text Available The coronal unicondylar fracture of the distal femur (AO 33-B3 is a rare intraarticular injury within the weight bearing area of the knee, initially described by Albert Hoffa in 1904. We report an unusual combination of a Hoffa fracture with lateral patellar dislocation in a young adult. Our patient sustained the injury by a sudden twist of his leg during sports. He presented clinically with knee swelling, dislocation of the patella, and localized tenderness; unable to bare weight. After plane radiograph confirmed the injury, manual reduction of the patella was done by hyperextension of the knee and medialward pressure. Afterwards, a CT scan and MRI were conducted. The injury was surgically treated with lag-screws, locking-plate and MPFL-reconstruction.

  7. Energies of dissociated dislocations in ice

    OpenAIRE

    福田, 明治

    1988-01-01

    Elastic energies of dissociated dislocations on the basal plane were calculated using anisotropic elasticity. Energies of stacking faults and dislocation cores were supposed to get total energies of the dislocations. It is proposed that a dislocation with [0001] Burgers vectors dissociated two partial dislocations with 1/2 [0001] Burgers vector not with 1/6 Burgers vector, and that a combination of dislocations with [0001] Burgers vector and with 1/3 Burgers vector is stable.

  8. Left Dislocation: a typological overview

    African Journals Online (AJOL)

    Andrason, A, Dr

    [Peter,]i I've known himi for a long time. b. .... or dislocating the leftmost NP This movie outside of the semantic and syntactic dependency relations licensed by the predicate. In other words, the critical difference between these constructions, is that the dislocated NP This movie can be omitted in (2c) without causing any.

  9. Nature of Dislocations in Silicon

    DEFF Research Database (Denmark)

    Hansen, Lars Bruno; Stokbro, Kurt; Lundqvist, Bengt

    1995-01-01

    Interaction between two partial 90 degrees edge dislocations is studied with atomic-scale simulations using the effective-medium tight-binding method. A large separation between the two dislocations (up to 30 Angstrom), comparable to experimental values, is achieved with a solution of the tight-b...

  10. Knee disarticulation

    Directory of Open Access Journals (Sweden)

    Antun Muljačić

    2009-08-01

    Full Text Available In this paper we presented three patients withknee disarticulation performed according toBaumgartner. The Baumgartner tehnique and theapplication of knee disarticulation prosthesis appearedto be superior in comparisson with othermethods.

  11. Dislocation Velocities and Dislocation Structure in Cubic Zirconia and Sapphire

    Science.gov (United States)

    Farber, Boris Yarovlevick

    The dislocation structure around elevated temperature indentations in 9.4 and 21 mol% rm Y_2O _3 fully-stabilized cubic ZrO_2 (c-ZrO_2) was investigated using selective etching and transmission electron microscopy (TEM). Cracking arising from interaction between slip bands was observed in the 21 mol% rm Y_2O _3 material, and direct evidence of the formation of Lomer type dislocation pile-ups leading to crack nucleation was obtained by TEM. Stress and temperature dependencies of the edge and screw dislocation velocities in c-ZrO_2 were measured. The activation energy for motion of the edge dislocations (5.0 +/- 0.4 eV) is slightly lower than that for screw dislocations (5.6 +/- 0.6 eV). The stress exponent (m) is close to 1 at low temperatures (stress relaxation in the vicinity of room temperature Knoop indents in c-ZrO_2 was investigated using photoelasticity method. A rapid low temperature stress relaxation was observed, and a mechanism was proposed. The temperature dependence of the Vickers hardness was measured on the basal (0001} and pyramidal {11|23} planes of single crystal alpha -Al_2O_3 (sapphire) from room temperature to 1273 K. The plastic zone surrounding the indents was investigated using selective etching and TEM. Indentation was accompanied by three competitive damage processes: fracture, twinning and dislocation plasticity. At room temperature, cracking predominated. At intermediate temperatures, extensive rhombohedral twinning was observed, while at higher temperatures, prismatic slip bands on {11|20} dominated the microstructure. The dislocation substructure at the vicinity of the indents consists of fairly straight dislocations lying on basal and/or prism planes and aligned along crystallographic directions. The details of the glide dissociation of perfect screw dislocations into three collinear partials, the mechanism of the microplasticity of sapphire single crystals, and details of the Peierls potential are discussed. An anomalously high low

  12. Knee Injuries and Disorders

    Science.gov (United States)

    Your knee joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the knee joint move. When any of these structures is hurt or diseased, you have knee problems. Knee problems can cause pain and difficulty ...

  13. Dyspnea in a case of shoulder dislocation – to beware of this rare life-threatening symptom

    Directory of Open Access Journals (Sweden)

    Joshi Satyen Praful

    2016-01-01

    Full Text Available Shoulder dislocation is a common injury in orthopedic practice. In an acute presentation, closed reduction of the shoulder joint leads to an uneventful recovery. However, in the developing world neglected shoulder dislocation and treatments from quacks are not uncommon. Improper treatment and neglect can rarely become life threatening. We present one such case, emphasizing the need to investigate the symptom of dyspnea in a patient with history of shoulder dislocation.

  14. Knee Pain and Patellofemoral Symptoms in Patients With Cerebral Palsy.

    Science.gov (United States)

    Rethlefsen, Susan A; Nguyen, Danny T; Wren, Tishya A L; Milewski, Matthew D; Kay, Robert M

    2015-01-01

    Knee pain in cerebral palsy (CP) is associated with increased patellofemoral forces present when walking with flexed knees. In typically developing children, knee pain and patellofemoral dysfunction are associated with obesity, genu valgum, femoral anteversion, and external tibial torsion. These problems are also common in CP, and may contribute to knee problems in this population. The purposes of this study were to define the prevalence of knee pain and patellofemoral dysfunction in children with CP, and to identify physical and gait characteristics (using 3-dimensional gait analysis data) that predispose them to such problems. Retrospective review of 121 children with CP, Gross Motor Function Classification System level I to IV, who underwent computerized gait analysis testing. Demographics, range of motion, body mass index and hip, knee, and ankle kinematics were compared between subjects with and without knee pain. Twenty-five of 121 subjects (21%) reported knee pain at the time of testing. Three of 121 subjects (2%) had a history of patellar subluxation/dislocation. Age and sex were significantly related to presence of knee pain. The likelihood of knee pain was almost 5 times higher in females (odds ratio=4.9, [95% confidence interval, 1.8-13.3], P=0.002), with a prevalence of 40% (17/42) in females versus 10% (8/79) in males. The likelihood of knee pain increased with age by approximately 13% per year (odds ratio=1.13, [95% confidence interval, 1.00-1.28], P=0.058). Malignant malalignment syndrome showed a potential relationship to more severe knee pain (P=0.05), which warrants further investigation. Body mass index, pes valgus, and degree of stance knee flexion showed no statistically significant relationships to knee pain (P>0.16). The prevalence of knee pain in ambulatory patients with CP is approximately 21%. Patellar subluxation (2%) and dislocation are rare in these patients. Knee pain is not always related to crouch, femoral anteversion, external

  15. Swollen Knee (Water on the Knee)

    Science.gov (United States)

    ... buildup in and around the knee joint include: Osteoarthritis Rheumatoid arthritis Infection Gout Pseudogout Bursitis Cysts Tumors Risk factors Age. Your likelihood of developing a swollen knee ...

  16. Patellofemoral Arthritis After Lateral Patellar Dislocation: A Matched Population-Based Analysis.

    Science.gov (United States)

    Sanders, Thomas L; Pareek, Ayoosh; Johnson, Nicholas R; Stuart, Michael J; Dahm, Diane L; Krych, Aaron J

    2017-04-01

    The rate of patellofemoral arthritis after lateral patellar dislocation is unknown. Purpose/Hypothesis: The purpose of this study was to compare the risk of patellofemoral arthritis and knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not. Cohort study; Level of evidence, 3. In this study, 609 patients who had a first-time lateral patellar dislocation between 1990 and 2010 were compared with an age- and sex-matched cohort of patients who did not have a patellar dislocation. Medical records were reviewed to collect information related to the initial injury, recurrent dislocation, treatment, and progression to clinically significant patellofemoral arthritis (defined as symptoms with degenerative changes on patellar sunrise radiographs). Factors associated with arthritis (age, sex, recurrence, osteochondral injury, trochlear dysplasia) were examined. At a mean follow-up of 12.3 ± 6.5 years from initial dislocation, 58 patients (9.5%) in the dislocation cohort were diagnosed with patellofemoral arthritis, corresponding to a cumulative incidence of arthritis of 1.2% at 5 years, 2.7% at 10 years, 8.1% at 15 years, 14.8% at 20 years, and 48.9% at 25 years. In the control cohort, 8 patients (1.3%) were diagnosed with arthritis, corresponding to a cumulative incidence of arthritis of 0% at 5 years, 0% at 10 years, 1.3% at 15 years, 2.9% at 20 years, and 8.3% at 25 years. Therefore, patients who experienced a lateral patellar dislocation had a significantly higher risk of developing arthritis (hazard ratio [HR], 7.8; 95% CI, 3.9-17.6; P arthritis after patellar dislocation. Patellar dislocation is a significant risk factor for patellofemoral arthritis, as

  17. Discrete dislocation modelling of submicron indentation

    NARCIS (Netherlands)

    Widjaja, A; Van der Giessen, E; Needleman, A

    2005-01-01

    Indentation of a planar single crystal by a circular rigid indenter is analyzed using discrete dislocation plasticity. The crystal has three slip systems and is initially dislocation-free, but edge dislocations can nucleate from point sources inside the crystal. The lattice resistance to dislocation

  18. Repair of sternoclavicular joint dislocations with FiberWire®.

    Science.gov (United States)

    Adamcik, Stefan; Ahler, Markus; Gioutsos, Konstantinos; Schmid, Ralph A; Kocher, Gregor J

    2017-03-01

    Up to 50% of traumatic sternoclavicular joint (SCJ) dislocations need open reduction and fixation to prevent long-term complications and complaints. We present our preferred surgical approach for acute as well as chronic SCJ dislocations, including their outcome. Five consecutive male patients with a median age of 27 (range 20-49) were treated for traumatic anterior (n = 2) or posterior (n = 3) SCJ dislocation. Open reduction and surgical fixation were achieved by a modified figure-of-eight sutures using Fiberwire®. In anterior dislocations, an additional reconstruction of the costoclavicular ligament was performed. Median follow-up was 11 months (range 9-48) and included clinical evaluation and the use of the DASH questionnaire. Open surgical reduction and SCJ repair were successfully achieved in all patients without complications. Repair resulted in very good functional outcomes in all five patients with DASH scores of 0, 8 (n = 3) and 5, 8 (n = 2), respectively. The presented technique allowed simple, effective, and durable repair of the SCJ joint in patients with SCJ dislocations with excellent functional outcomes.

  19. Anatomical considerations in multiligament knee injury and surgery.

    Science.gov (United States)

    Dwyer, Tim; Whelan, Danny

    2012-09-01

    The management of multiligament knee injury mandates a comprehensive understanding of the anatomy on all sides of the joint. Imperative to repair or reconstructive procedures is an intimate knowledge of the structure of the cruciate and collateral ligaments, as well as the complex confluence of structures that comprise the posteromedial and posterolateral corners. Beyond the ligamentous anatomy, the surgeon must also be aware of the potential for neurologic and vascular compromise-both from injury and from treatment-that can often complicate multiligament knee injuries. In this article, we outline the basic anatomy and biomechanical function of the ligamentous structures of the knee, structures at risk, and the patterns of injury seen with knee dislocations and multiple ligament knee injuries in general.

  20. Dynamical correlations near dislocation jamming.

    Science.gov (United States)

    Laurson, Lasse; Miguel, M-Carmen; Alava, Mikko J

    2010-07-02

    Dislocation assemblies exhibit a jamming or yielding transition at a critical external shear stress value σ=σ{c}. Here we study the heterogeneous and collective nature of dislocation dynamics within a crystal plasticity model close to σ{c}, by considering the first-passage properties of the dislocation dynamics. As the transition is approached in the moving phase, the first-passage time distribution exhibits scaling, and a related peak dynamical susceptibility χ{4}{*} diverges as χ{4}{*}∼(σ-σ{c}){-α}, with α≈1.1. We relate this scaling to an avalanche description of the dynamics. While the static structural correlations are found to be independent of the external stress, we identify a diverging dynamical correlation length ξ{y} in the direction perpendicular to the dislocation glide motion.

  1. Prediction of dislocation boundary characteristics

    DEFF Research Database (Denmark)

    Winther, Grethe

    Plastic deformation of both fcc and bcc metals of medium to high stacking fault energy is known to result in dislocation patterning in the form of cells and extended planar dislocation boundaries. The latter align with specific crystallographic planes, which depend on the crystallographic....... Crystal plasticity calculations combined with the hypothesis that these boundaries separate domains with local differences in the slip system activity are introduced to address precise prediction of the experimentally observed boundaries. The presentation will focus on two cases from fcc metals...... orientation of the grain [1]. For selected boundaries it has been experimentally verified that the boundaries consist of fairly regular networks of dislocations, which come from the active slip systems [2]. The networks have been analyzed within the framework of Low-Energy-Dislocation-Structures (LEDS...

  2. An unusual knee dislocation: A case report | Musa | Nigerian Journal ...

    African Journals Online (AJOL)

    No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 6 (1) 2007: pp. 28-29. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/njotra.v6i1.29288 · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  3. Arthroscopic treatment of acromioclavicular dislocation

    OpenAIRE

    Mihai T. Gavrilă; Ștefan Cristea

    2017-01-01

    A thorough understanding of biomechanical function of both acromioclavicular (AC) and coracoclavicular (CC) ligaments, stimulated surgeons to repair high-grade AC dislocation using arthroscopic technique. This technique necessitates a clear understanding of shoulder anatomy, especially of the structures in proximity to the clavicle and coracoid process and experiences in arthroscopic surgery. The follow case describes an arthroscopic technique used to treat AC dislocation in young man 30 year...

  4. Anterior hip dislocation in conjunction with a stroke: a diagnosis not to miss.

    Science.gov (United States)

    Furness, Nicholas; Da Costa, Thomas Mendes; Bishay, Michael

    2013-06-18

    Anterior dislocation of the native hip joint is an uncommon presentation accounting for around 15% of all hip dislocations. It is usually the result of a high-energy impact in circumstances such as a motor vehicle accident or a fall from a significant height. A delay in relocation of more than 6 h has been associated with a high risk of avascular necrosis of the femoral head. We report the case of a 75-year-old man who suffered an anterior dislocation of his native hip following a fall from a standing height, associated with an acute cerebrovascular stroke. There was significant delay in the recognition of the dislocation due to the coexistent signs of the stroke. This case illustrates that hip dislocation can occur following a low-energy mechanism of injury with the possibility of serious long-term consequences if it is not promptly recognised and treated.

  5. Early dislocation after reverse total shoulder arthroplasty.

    Science.gov (United States)

    Chalmers, Peter N; Rahman, Zain; Romeo, Anthony A; Nicholson, Gregory P

    2014-05-01

    Although instability can occur after reverse total shoulder arthroplasty (RTSA), the risk factors, the treatment, and ultimate fate of the implant in these patients remains poorly understood. Demographics, acute treatment, and the need for revision were evaluated in all patients with RTSAs who sustained a subsequent dislocation within the first 3 months. Standardized outcome scores were collected preoperatively and at the final follow-up. Atraumatic instability occurred in 11 patients (incidence, 2.9%) treated with RTSA early (before 3 months postsurgery). The mean time to dislocation was 3.4 weeks. These patients tended to be previously operated-on (64%), male (82%), overweight (mean body mass index (BMI) of 32.2 kg/m(2), with 82% having a BMI ≥30 kg/m(2)), and without a satisfactory subscapularis repair at initial RTSA (64%). Initial treatment included closed reduction in 9 patients, open reduction in 1, and open reduction with a thicker polyethylene insert in 1. Four experienced recurrent instability requiring a thicker polyethylene insert. Two additional patients were converted to hemiarthroplasty due to persistent instability. Visual analog pain scores (P = .014) and American Shoulder and Elbow Surgeons scores (P = .018) were significantly improved. Simple Shoulder Test scores trended towards improvement (P = .073). Early dislocations of the RTSA prosthesis were uncommon. The most common associated factors were a BMI >30 kg/m(2), male gender, subscapularis deficiency, and previous surgery; in these patients, we now use an abduction orthosis. Closed reduction alone was successful in 4 of the 9 closed reductions (44%). Five of 11 RTSAs (45%) required polyethylene exchange. The RTSA was retained in 82%, 36% with the original implant. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing?

    Science.gov (United States)

    Magnussen, Robert A; Verlage, Megan; Stock, Elizabeth; Zurek, Lauren; Flanigan, David C; Tompkins, Marc; Agel, Julie; Arendt, Elizabeth A

    2017-08-01

    While a significant research has gone into identifying patients at highest risk of recurrence following primary patellar dislocation, there has been little work exploring the outcomes of patients who do not have a recurrent patellar dislocation. We hypothesize that patients without recurrent dislocation episodes will exhibit significantly higher KOOSs than those who suffer recurrent dislocations, but lower scores than published age-matched normative data. A retrospective review of patients with nonoperatively treated primary lateral patellar dislocations was carried out, and patients were contacted at a mean of 3.4 years (range 1.3-5.5 years) post-injury. Information regarding subsequent treatment and recurrent dislocations along with patient-reported outcome scores and activity level was collected. One hundred and eleven patients (29.8 %) of 373 eligible patients agreed to study participation, seven of whom were excluded because they underwent subsequent patellar stabilization surgery on the index knee. Seventy-six patients (73.1 %) reported no further dislocation events, and the mean KOOS subscales at follow-up were: symptoms-80.2 ± 18.8, pain-81.8 ± 16.2, ADL-88.7 ± 15.9, sport/recreation-72.1 ± 24.4, and QOL-63.9 ± 23.8 at a mean follow-up of 3.3 years (range 1.3-5.5 years). No significant differences in any of the KOOS subscales were noted between these patients and the group that reported recurrent patellar dislocations. Only 26.4 % of the patients without further dislocations reported they were able to return to desired sport activities without limitations following their dislocation. Patients who do not report recurrent patellar dislocations following nonoperative treatment of primary patellar dislocations are in many cases limited by this injury 3 years following the initial dislocation event. Retrospective cohort study, Level III.

  7. Knee Problems

    Science.gov (United States)

    ... Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath in Infants and Children Shoulder Problems Skin Rashes & Other Skin Problems Throat Problems Tooth Problems Urination Problems Back to Symptoms Step 2 Answering Questions Did your knee pain ...

  8. Treatment and results in pediatric traumatic hip dislocation: case series and review of the literature.

    Science.gov (United States)

    Başaran, Serdar Hakan; Bilgili, Mustafa Gökhan; Erçin, Ersin; Bayrak, Alkan; Öneş, Halil Nadir; Avkan, Mustafa Cevdet

    2014-11-01

    Six acute traumatic hip dislocations in pediatric patients were retrospectively analyzed. Types of dislocations, associated lesions, treatment methods, complications, and clinical and radiological outcomes were reviewed. Six child patients treated due to traumatic hip dislocation between 2007 and 2011 in our clinic were included in the study. While five of the patients were male, one was female; the average age was 8 years and 8 months. The mean follow-up was 25.2±10 months. There were posterior dislocations in five cases and transepiphyseal fractured dislocation in one case. Four cases were treated by closed reduction while two cases were treated with open reduction method. In the last control of the patients, asymmetric widening in the hip joint was found due to osteochondral fracture in one patient and coxa magna occurred in one patient. Avascular necrosis developed in one case with transepiphyseal fractured dislocation. Harris hip score evaluation was found excellent in five cases and bad in the case with fractured dislocation. Traumatic hip dislocation is a rare condition. It should be treated with preferably closed method as soon as possible. Repetitive reduction trials should be avoided. Open reduction should be performed to recognize accompanying lesions after advanced radiologic examinations such as computerized tomography and magnetic resonance imaging.

  9. Neglected anterior dislocation of shoulder with large Hillsach's lesion & deficient glenoid: Treated by autogenous bone graft & modified Latarjet procedure.

    Science.gov (United States)

    Peshin, Chetan; Jangira, Vivek; Gupta, Ravi Kumar; Jindal, Rohit

    2015-12-01

    Neglected anterior dislocation of shoulder is rare in spite of the fact that the anterior dislocation of the shoulder is seen in around 90% of the acute cases. Most of the series of neglected dislocation describe posterior dislocation to be far more common.(1) (,2) We hereby report a case of the neglected anterior shoulder dislocation in a 15 year old boy who had a history of epilepsy. There was a large Hill Sachs lesion in humeral head which was impacted in glenoid inferiorly and glenoid was eburnated at that margin. The humeral head was reconstructed with a tricortical iliac graft. Glenoid was reconstructed by transfer of coracoids process of scapula to antero-inferior glenoid (modified Latarjet procedure). This case is unique because management of humeral head defect with bone graft is not mentioned in anterior dislocation.

  10. Neglected anterior dislocation of shoulder with large Hillsach's lesion & deficient glenoid: Treated by autogenous bone graft & modified Latarjet procedure☆

    Science.gov (United States)

    Peshin, Chetan; Jangira, Vivek; Gupta, Ravi Kumar; Jindal, Rohit

    2015-01-01

    Neglected anterior dislocation of shoulder is rare in spite of the fact that the anterior dislocation of the shoulder is seen in around 90% of the acute cases. Most of the series of neglected dislocation describe posterior dislocation to be far more common.1,2 We hereby report a case of the neglected anterior shoulder dislocation in a 15 year old boy who had a history of epilepsy. There was a large Hill Sachs lesion in humeral head which was impacted in glenoid inferiorly and glenoid was eburnated at that margin. The humeral head was reconstructed with a tricortical iliac graft. Glenoid was reconstructed by transfer of coracoids process of scapula to antero-inferior glenoid (modified Latarjet procedure). This case is unique because management of humeral head defect with bone graft is not mentioned in anterior dislocation. PMID:26566343

  11. A continuum theory of edge dislocations

    Science.gov (United States)

    Berdichevsky, V. L.

    2017-09-01

    Continuum theory of dislocation aims to describe the behavior of large ensembles of dislocations. This task is far from completion, and, most likely, does not have a ;universal solution;, which is applicable to any dislocation ensemble. In this regards it is important to have guiding lines set by benchmark cases, where the transition from a discrete set of dislocations to a continuum description is made rigorously. Two such cases have been considered recently: equilibrium of dislocation walls and screw dislocations in beams. In this paper one more case is studied, equilibrium of a large set of 2D edge dislocations placed randomly in a 2D bounded region. The major characteristic of interest is energy of dislocation ensemble, because it determines the structure of continuum equations. The homogenized energy functional is obtained for the periodic dislocation ensembles with a random contents of the periodic cell. Parameters of the periodic structure can change slowly on distances of order of the size of periodic cells. The energy functional is obtained by the variational-asymptotic method. Equilibrium positions are local minima of energy. It is confirmed the earlier assertion that energy density of the system is the sum of elastic energy of averaged elastic strains and microstructure energy, which is elastic energy of the neutralized dislocation system, i.e. the dislocation system placed in a constant dislocation density field making the averaged dislocation density zero. The computation of energy is reduced to solution of a variational cell problem. This problem is solved analytically. The solution is used to investigate stability of simple dislocation arrays, i.e. arrays with one dislocation in the periodic cell. The relations obtained yield two outcomes: First, there is a state parameter of the system, dislocation polarization; averaged stresses affect only dislocation polarization and cannot change other characteristics of the system. Second, the structure of

  12. Knee pain (image)

    Science.gov (United States)

    ... front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as ... knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the ...

  13. Total Knee Replacement

    Science.gov (United States)

    ... activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and ... Total Knee Replacement cont. Preparing for Surgery Medical Evaluation If you decide to have total knee replacement ...

  14. Water on the Knee

    Science.gov (United States)

    ... your knee joint. Some people call this condition "water on the knee." A swollen knee may be ... Choose low-impact exercise. Certain activities, such as water aerobics and swimming, don't place continuous weight- ...

  15. Preventing Knee Injuries

    Science.gov (United States)

    ... Our Newsletter Donate Blog Skip breadcrumb navigation Preventing Knee Injuries Knee injuries in children and adolescent athletes ... this PDF Share this page: WHAT ARE COMMON KNEE INJURIES? Pain Syndromes One of the most common ...

  16. Knee microfracture surgery

    Science.gov (United States)

    Cartilage regeneration - knee ... Three types of anesthesia may be used for knee arthroscopy surgery: Medicine to relax you, and shots of painkillers to numb the knee Spinal (regional) anesthesia General anesthesia (you will be ...

  17. Surgical treatment of recurrent patellar dislocation in children associated with patello-femoral dysplasia

    OpenAIRE

    vergara- amador, Enrique; Universidad nacional de colombia; castro, Ricardo; Universidad nacional de colombia

    2014-01-01

    The aim of this paper is to show the results in a small series of patients withpatellofemoral instability or recurrent patellar dislocation in children operated with theproximal realignment technique. Materials and methods: It is a series of 10 knees in7 children, with proximal patela realignment patela using the Insall technique. The mostimportant role of the patela is to increase the quadriceps efficiency. The patelo -femoralinstability is defined as a condition in which there is insufficie...

  18. Supracondylar correction osteotomy to prevent repetitive posterior dislocation of a hip prosthesis.

    Science.gov (United States)

    Haverkamp, D; Marti, R K

    2008-02-01

    Recurrent dislocation of a total hip prosthesis can be a challenging and often disappointing problem. This case report describes a 78-year-old woman who had recurrent posterior dislocations of a revision total hip replacement (THR) that occurred on flexion and internal rotation of the hip. The initial THR for posttraumatic osteonecrosis and extensive revision THA were performed through an anterolateral approach. Conservative treatment was not successful in preventing posterior re-dislocation, neither was open surgery in which offset was improved. Investigation under anesthesia by means of an image-intensifier showed that the prosthesis was easily dislocated posteriorly on flexion and internal rotation. On external rotation the hip was completely stable. Flexion-internal rotation is a rare motion which, if the patient is clearly instructed should be avoidable. The mechanism of an anterior dislocation caused by external rotation, extension and adduction is more common, especially since an anterolateral approach was used in all procedures. We describe the surgical technique of performing an supracondylar external rotating osteotomy of the femur to avoid further dislocation. Fixation was performed with a condylar plate fixation of which the proximal part is fixated above the distal point of the femur component to avoid a stress riser. Since the foot and knee of the patient are now internally rotated, the patient is forced to produce an external rotation in the hip to have a normal leg alignment, therefore preventing the internal rotation on which the dislocation occurred. In the prevention of a re-dislocation, solutions other than performing a revision of the THA can successfully solve the problem and should therefore be considered.

  19. Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation.

    Science.gov (United States)

    Akinbami, Babatunde O

    2011-06-15

    Virtually all the articles in literature addressed only a specific type of dislocation. The aim of this review was to project a comprehensive understanding of the pathologic processes and management of all types of dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa. In addition, a new classification of temporomandibular joint dislocation was also proposed. A thorough computer literature search was done using the Medline, Cochrane library and Embase database. Key words like temporo-mandibular joint dislocation were used for the search. Additional manual search was done by going through published home-based and foreign articles. Case reports/series, and original articles that documented the type of dislocation, number of cases treated in the series and original articles. Treatment done and outcome of treatment were included in the study. A total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations. Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. Various treatment modalities are outlined in this report as indicated for each type of dislocation. The more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques.

  20. Sideline Management of Joint Dislocations.

    Science.gov (United States)

    Schupp, Christian M; Rand, Scott E; Hanson, Travis W; Lee, Bryan M; Jafarnia, Korsh; Jia, Yuhang; Moseley, J Bruce; Seaberg, John P; Seelhoefer, Gregory M

    2016-01-01

    Athletes can sustain a large variety of injuries from simple soft tissue sprains to complex fractures and joint dislocations. This article reviews and provides the most recent information for sports medicine professionals on the management of simple and complex joint dislocations, i.e., irreducible and/or associated with a fracture, from the sidelines without the benefit of imaging. For each joint, the relevant anatomy, common mechanisms, sideline assessment, reduction techniques, initial treatment, and potential complications will be discussed, which allow for the safe and prompt return of athletes to the field of play.

  1. [Traumatic hip dislocations in children].

    Science.gov (United States)

    Ayadi, K; Trigui, M; Gdoura, F; Elleuch, B; Zribi, M; Keskes, H

    2008-02-01

    Traumatic hip dislocation is a rare event in children. Appropriate management remains a subject of debate. The purpose of this study was to investigate the epidemiological, therapeutic features of this situation and the long-term outcome after treatment. This was a retrospective analysis of 15 traumatic hip dislocations collected over a period of 20 years in pediatric patients with at least two years follow-up. We searched for predisposing factors and factors affecting prognosis. The series included 11 boys and three girls, mean age eight years. Dislocation was posterior in 13 hips and anterior in two. Time to reduction was less than 3h in eight cases, 3-6h in five and greater than 6h in two. After reduction, traction was performed in nine children, for 20 days on average, followed in five cases by immobilization for 40 days on average. Five hips were immobilized directly after reduction. We identified two groups by age: group 1 with dislocations in children aged less than six years (seven children) were characterized by low-energy trauma. Dislocation was not associated with other lesions. Predisposing factors (overt ligament hyperlaxity, insufficient superolateral head cover, coax valga) were noted in six children. Reduction was simple. Later treatment consisted in immobilization with a pelvispedious cast for 30-45 days. Group 2 were dislocations in children aged over six years (seven children) victims of high-energy trauma. Associated injuries were frequent. Predisposing factors were not present. At mean 11 years follow-up, all hips are considered normal clinically. The radiograph was normal for 14 hips. In one case, there was a slight coax magna. In three patients, defective femoral head cover persisted. Coxa valga persisted in two patients. Traumatic dislocation of the hip joint is rare in very young children, but results from a minimally traumatic event. This suggests the presence of predisposing factors in this category of patients, particularly

  2. Total carpometacarpal joint dislocation combined with trapezium fracture, trapezoid dislocation and hamate fracture

    DEFF Research Database (Denmark)

    Gvozdenovic, R; Vadstrup, Lars Soelberg

    2015-01-01

    Multiple metacarpal dislocations combined with carpal fracture - dislocations are rare injuries. We report a new combination of these injuries where fracture-dislocation of the base of the 1st metacarpal bone occurred simultaneously with a comminuted fracture of the trapezium, dislocation of the ...

  3. Combined proximal and distal realignment procedures to treat the habitual dislocation of the patella in adults.

    Science.gov (United States)

    Shen, Hsain-Chung; Chao, Kuo-Hua; Huang, Guo-Shu; Pan, Ru-Yu; Lee, Chian-Her

    2007-12-01

    Habitual dislocation of the patella (HDP) is a rare condition. Many surgical procedures using proximal realignment have been reported to treat HDP in children, with around 80% satisfactory results. However, few articles have addressed the treatment of HDP associated with high-grade patellofemoral chondromalacia in adults. A combination of proximal and distal realignment procedures of the patella will reduce pain and increase function in adult patients with HDP. Case series; Level of evidence, 4. Twelve patients with 13 symptomatic cases of HDP of the knee underwent surgical treatment that included lateral release, medial retinaculum advancement, and the anteromedial tibial tubercle transfer procedure. The average period between dislocation and surgery was 10.8 years. One patient had an additional procedure, an open-wedge varus corrective osteotomy of the distal femur, because of a 20 degrees valgus deformity of the knee. The patellofemoral morphology study included routine and Merchant views of the knee and a computed tomography scan at full extension and at 30 degrees flexion of the knee, before the operation and at follow-up. Any associated intra-articular pathologic findings during the surgical procedure were addressed. Patellofemoral function was evaluated with the Kujala functional score before surgery and at the time of the final follow-up. Chondromalacia of the patella over the medial facet and central ridge was grade III in 8 knees and grade IV in 5 knees. Corresponding chondral erosion of the lateral femoral condyle was noted in every knee. All patients were followed for an average period of 67.3 months (range, 25-103 months). The average preoperative Kujala functional score was 43.9 and the average postoperative score was 88.9 (Ppatella effectively treat HDP in adults with associated high-grade patellofemoral chondromalacia.

  4. Acute patellofemoral instability in children and adolescents.

    Science.gov (United States)

    Antinolfi, Pierluigi; Bartoli, Matteo; Placella, Giacomo; Speziali, Andrea; Pace, Valerio; Delcogliano, Marco; Mazzola, Claudio

    2016-01-01

    Patellofemoral problems are considered to be among the most frequent causes of knee pain in children and adolescents. Correcting bone abnormalities through specific and targeted interventions is mandatory in skeletally immature patients. Medial patellofemoral ligament (MPFL) reconstruction is the preferred procedure, but there are several important precautionary considerations that the surgeon must take into account. It must always be remembered that MPFL rupture is the result, not the cause, of an altered extensor mechanism; therefore, patellar stabilization with MPFL reconstruction is only the first step to be accomplished in the management of an MPFL rupture. If other anatomical alterations are encountered, alternative/additional surgical procedures should be considered. If MPFL rupture occurs without associated anatomical or functional knee alterations, an appropriate rehabilitation program after MPFL reconstruction should be sufficient to achieve a good outcome. In conclusion, an acute patellar dislocation should be managed conservatively unless there is evidence of osteochondral damage or medial retinaculum lesions. Osseous procedures are contraindicated in children, while MPFL anatomical reconstruction with "physeal sparing" is the primary surgical option.

  5. ARTHROSCOPIC TREATMENT OF ACROMIOCLAVICULAR JOINT DISLOCATION BY TIGHT ROPE TECHNIQUE (ARTHREX®)

    Science.gov (United States)

    GÓmez Vieira, Luis Alfredo; Visco, Adalberto; Daneu Fernandes, Luis Filipe; GÓmez Cordero, Nicolas Gerardo

    2015-01-01

    Presenting the arthroscopic treatment by Tight Rope - Arthrex® system for acute acromioclavicular dislocation and to evaluate results obtained with this procedure. Methods: Between August 2006 and May 2007, 10 shoulders of 10 patients with acute acromioclavicular dislocation were submitted to arthroscopic repair using the Tight Rope - Arthrex® system. Minimum follow-up was 12 months, with a mean of 15 months. Age ranged from 26 to 42, mean 34 years. All patients were male. Radiology evaluation was made by trauma series x-ray. The patients were assisted in the first month weekly and after three months after the procedure. Clinical evaluation was based on the University of California at Los Angeles (UCLA) criteria. Results: All patients were satisfied after the arthroscopic procedure and the mean UCLA score was 32,5. Conclusion: The arthroscopic treatment by Tight Rope – Arthrex® system for acute acromioclavicular dislocation showed to be an efficient technique. PMID:26998453

  6. 14 CFR 314.6 - Qualifying dislocation.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Qualifying dislocation. 314.6 Section 314.6 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) PROCEDURAL REGULATIONS EMPLOYEE PROTECTION PROGRAM General § 314.6 Qualifying dislocation. A qualifying dislocation is a...

  7. Non-invasive interactive neurostimulation (InterX ™) reduces acute pain in patients following total knee replacement surgery: a randomised, controlled trial

    OpenAIRE

    Nigam, Ashok K; Taylor, Drena M; Valeyeva, Zulia

    2011-01-01

    Abstract Background Adequate post-operative pain relief following total knee replacement (TKR) is very important to optimal post-operative recovery. Faster mobilisation and rehabilitation ultimately results in optimum recovery outcomes, but pain is often the limiting factor. This study evaluates the potential clinical benefit of the InterX neurostimulation device on pain reduction and rehabilitative outcome. Methods A clinical trial under the Hywel Dda Clinical Audit Committee to validate the...

  8. Metal working and dislocation structures

    DEFF Research Database (Denmark)

    Hansen, Niels

    2007-01-01

    Microstructural observations are presented for different metals deformed from low to high strain by both traditional and new metal working processes. It is shown that deformation induced dislocation structures can be interpreted and analyzed within a common framework of grain subdivision on a finer...

  9. Data Collection and Analysis Using Wearable Sensors for Monitoring Knee Range of Motion after Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Chih-Yen Chiang

    2017-02-01

    Full Text Available Total knee arthroplasty (TKA is the most common treatment for degenerative osteoarthritis of that articulation. However, either in rehabilitation clinics or in hospital wards, the knee range of motion (ROM can currently only be assessed using a goniometer. In order to provide continuous and objective measurements of knee ROM, we propose the use of wearable inertial sensors to record the knee ROM during the recovery progress. Digitalized and objective data can assist the surgeons to control the recovery status and flexibly adjust rehabilitation programs during the early acute inpatient stage. The more knee flexion ROM regained during the early inpatient period, the better the long-term knee recovery will be and the sooner early discharge can be achieved. The results of this work show that the proposed wearable sensor approach can provide an alternative for continuous monitoring and objective assessment of knee ROM recovery progress for TKA patients compared to the traditional goniometer measurements.

  10. Should All Shoulder Dislocations be Closed Reduced? Assessment of Risk of Iatrogenic Injury in 150 Patients

    Science.gov (United States)

    Solovyova, Olga; Shakked, Rachel

    2017-01-01

    Abstract Aims The purpose of this study was to determine if there was an association between iatrogenic fractures and closed reduction of shoulder dislocations. Patients and Methods In a retrospective case series, 150 consecutive patients with acute first time shoulder dislocations were evaluated. Patient demographics, direction of dislocation, associated injuries, reduction methods, number of attempts, and type of anesthesia/analgesia were determined. Pre- and post-reduction radiographs and medical record were reviewed to identify the presence of proximal humerus fractures. Results There were thirty nine fracture-dislocations (26%) of the proximal humerus. Eight patients (5%) failed reduction on initial attempt. Four of these (3%) were unable to be reduced in the emergency room and were taken to OR for reduction. There was no statistically significant difference in reduction maneuver or type of anesthesia/analgesia used when comparing fracture-dislocations to dislocations only (pdislocation are extremely rare. None were identified in this review of 150 patients. We believe that closed reduction is safe even in the setting of fracture dislocations. PMID:28852334

  11. Slip systems, lattice rotations and dislocation boundaries

    DEFF Research Database (Denmark)

    Winther, Grethe

    2008-01-01

    Plastic deformation by slip induces rotations of the crystallographic lattice and evolution of dislocation structures. Both lattice rotations and dislocation structures exhibit a dependence on the grain orientation, which reflects underlying relations to the slip pattern. Relations between the type...... of dislocation structure formed, in particular the crystallographic alignment of dislocation boundaries, and the slip pattern are demonstrated. These relations are applied to polycrystals deformed in tension and rolling, producing good agreement with experiment for rolling but less good agreement for tension...... of these discrepancies is discussed. Finally, the implications of the relations between slip and dislocation structures for the modelling of mechanical properties are discussed....

  12. The pediatric knee: current concepts in sports medicine.

    Science.gov (United States)

    Beck, Nicholas A; Patel, Neeraj M; Ganley, Theodore J

    2014-01-01

    As the popularity and intensity of children's athletics have increased, so has the risk for knee injuries. Fractures of the tibial eminence may be treated operatively or nonoperatively depending on fracture classification, but arthrofibrosis is a potentially significant complication. Anterior cruciate ligament rupture presents treatment challenges as regards the optimal timing and method of reconstruction. A number of novel reconstructive techniques have been developed to minimize risks to the physes in this population. Recent studies have focused on the prognosis, surgical indications, and operative techniques for osteochondritis dissecans in children. A number of authors have also sought to better-define the optimal diagnostic testing and management of patellar dislocation. In this review, we provide an update on current concepts for tibial eminence fractures, anterior cruciate ligament injuries, osteochondritis dissecans of the knee, and patellar dislocation in young athletes.

  13. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been s...... speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)....

  14. Simultaneous shoulder and elbow dislocation.

    Science.gov (United States)

    Cobanoğlu, Mutlu; Yumrukcal, Feridun; Karataş, Cengiz; Duygun, Fatih

    2014-05-23

    Ipsilateral shoulder and elbow dislocation is very rare and only six articles are present in the literature mentioning this kind of a complex injury. With this presentation we aim to emphasise the importance of assessing the adjacent joints in patients with trauma in order not to miss any accompanying pathologies. We report a case of a 43-year-old female patient with ipsilateral right shoulder and elbow dislocation treated conservatively. The patient reported elbow pain when first admitted to emergency service but she was diagnosed with simultaneous ipsilateral shoulder and elbow injury and treated conservatively. As a more painful pathology may mask the additional ones, one should hasten to help before performing a complete evaluation. Any harm caused to the patient due to this reason would not be a complication but a malpractice. 2014 BMJ Publishing Group Ltd.

  15. Bilateral sternoclavicular joint dislocation due to sternal fracture: Is it a dislocation or a separation?

    Science.gov (United States)

    Yi, Jin Woong; Kim, Doo Hyun; Heo, Youn Moo; Jun, June Bum

    2016-05-01

    Traumatic bilateral sternoclavicular joint dislocation is very rare injury. In shoulder girdle injuries, anterior dislocation of the sternoclavicular joint accounts for 3 % and posterior sternoclavicular joint dislocation is lesser. Previous reported cases about bilateral sternoclavicular joint dislocation were result from proximal clavicle fracture with intact connection between sternum and ribs. But, the sternoclavicular joint dislocation secondary to fracture and angulation of the sternum with intact relationship between ribs and clavicle has not been reported. Authors experienced patient who has a bilateral anterior sternoclavicular joint dislocation caused by sternum fracture and anterior angulation, but intact relationship between ribs and clavicle. We report this case with satisfactory result.

  16. Recurrent Dislocation of the Patella

    OpenAIRE

    Ben?tez, Gustavo

    2015-01-01

    Purpose: To evaluate results of medial patellofemoral ligament (MPFL) reconstruction associated with lateral release and advancement of vastus medialis in recurrent dislocation of the patella. Methods: We retrospectively evaluated 11 patients with a mean follow-up of 19 months. Mean age was 23, mainly women. We did MPFL reconstruction with semitendinosus or gracilis tendon depending on BMI, associated with advancement of vastus medialis and lateral release. Results: Mean Kujala score improved...

  17. Septic hip dislocations in children in a developing country

    Directory of Open Access Journals (Sweden)

    Gabriel Ngom

    2011-01-01

    Full Text Available Purpose: To report on a radiological issue and therapeutic aspects encountered in septic hip dislocations in a developing country. Patients and Methods: Nineteen children among whom 11 boys and 8 girls aged on average 5.3-years old presented 7 recent and 12 late hip dislocations. Those dislocations were distributed into in category 1: dislocations without associated lesion; category 2: dislocations associated with minor lesions; category 3: dislocations associated with major lesion. Ten children who presented an elevated erythrocyte sedimentation rate (ESR received antibiotics. An arthrotomy was performed in children with a recent dislocation. Traction was performed in all children with an average duration of 5 weeks. The results were considered good, intermediate or bad using two parameters: ESR and reduction of dislocation. Results: 2 category 1 dislocations, 6 category 2 dislocations and 11 category 3 dislocations were noted. As concerns the recent dislocations, there were 2 category 1 dislocations and 5 category 2 dislocations. For late dislocations, 1 category 2 and 11 category 3 dislocations were recorded. There were 8 good results and 11 bad results. The good results concerned 7 recent dislocations and one late dislocation. The bad results concerned exclusively late dislocations. Conclusion: In children with septic hip dislocations, the good results concern almost exclusively recent dislocations but arthrotomy and immobilization must be done early.

  18. [CLINICAL APPLICATION OF OXFORD MOBILE-BEARING BIPOLAR PROSTHESIS UNICOMPARTMENTAL KNEE ARTHROPLASTY FOR SINGLE COMPARTMENTAL KNEE OSTEOARTHRITIS].

    Science.gov (United States)

    Wang, Shangzeng; Cheng, Shao; Wang, Yisheng

    2016-01-01

    To evaluate the effectiveness of Oxford mobile-bearing bipolar prosthesis unicompartmental knee arthroplasty (UKA) in the treatment of single compartmental knee osteoarthritis. Between June 2011 and July 2013, 22 cases of single compartmental knee osteoarthritis were treated by Oxford mobile-bearing bipolar prosthesis UKA. Of 22 cases, 8 were male and 14 were female with an average age of 65 years (range, 45-80 years); the left knee was involved in 12 cases, and the right knee in 10 cases, with a mean disease duration of 32.5 months (range, 8-90 months). The mean weight was 55.2 kg (range, 50-65 kg), and the mean body mass index was 20.8 kg/m2 (range, 17-25 kg/m2). Osteoarthritis involved in the single knee medial compartment in all patients. Knee society score (KSS) and range of motion (ROM) were measured to evaluate the knee joint function. Primary healing of incision was obtained in all patients, and there was no complication of infection, bedsore, or deep venous thrombosis. Postoperative follow-up was 2-4 years (mean, 3.2 years). The X-ray films showed good position of prosthesis, no prosthesis dislocation, or periprosthetic infection during follow-up. Knee ROM, KSS function score, and KSS clinical score were significantly improved at 1 week after operation and at last follow-up when compared with preoperative ones (P 0.05). Oxford mobile-bearing bipolar prosthesis UKA is an effective method to treat single compartmental knee osteoarthritis, with the advantages of less trauma, earlier rehabilitation exercise, near physiological state in joint function, and less risk of complications.

  19. Associated lesions requiring additional surgical treatment in grade 3 acromioclavicular joint dislocations.

    Science.gov (United States)

    Arrigoni, Paolo; Brady, Paul C; Zottarelli, Leonardo; Barth, Johannes; Narbona, Pablo; Huberty, David; Koo, Samuel S; Adams, Christopher R; Parten, Peter; Denard, Patrick J; Denard, Patrick; Burkhart, Stephen S

    2014-01-01

    To evaluate the incidence of associated pathologic shoulder lesions that were addressed surgically in grade 3 acromioclavicular joint (ACJ) dislocations, as well as to compare this incidence between younger and older patients and between acute and chronic cases. In this multicenter nonrandomized retrospective study, 98 patients operated on for grade 3 ACJ dislocation underwent concomitant arthroscopic evaluation for the identification and treatment of any associated lesions. The type and treatment of associated lesions were collected in a central database and analyzed. We classified patients according to age (dislocation was 29.5%. Patients aged 45 years or older had a greater risk of presenting with associated lesions that needed to be surgically addressed (odds ratio, 3.01). The overall rates of associated surgical lesions in acute versus chronic cases were not shown to be significantly different. Level IV, prognostic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  20. Atraumatic Anterior Dislocation of the Hip Joint

    Directory of Open Access Journals (Sweden)

    Tadahiko Ohtsuru

    2015-01-01

    Full Text Available Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case.

  1. Management of proximal interphalangeal joint dislocations in athletes.

    Science.gov (United States)

    Bindra, Randy R; Foster, Brian J

    2009-08-01

    Proximal interphalangeal joint dislocations are common athletic injuries. In dislocations and fracture dislocations, the most important treatment principle is congruent joint reduction and maintenance of stability. This article reviews the relevant anatomy, injury characteristics, and treatment options for proximal interphalangeal joint dislocations and fracture dislocations. Treatment methods discussed include closed reduction, percutaneous fixation, and open reduction.

  2. Spectrum of carpal dislocations and fracture-dislocations: imaging and management.

    Science.gov (United States)

    Scalcione, Luke R; Gimber, Lana H; Ho, Annette M; Johnston, Stephen S; Sheppard, Joseph E; Taljanovic, Mihra S

    2014-09-01

    The objectives of this article are to discuss the imaging of carpal dislocations and fracture-dislocations and to review the ligamentous anatomy of the wrist, mechanisms of injury, and routine management of these injuries. Perilunate dislocations, perilunate fracture-dislocations (PLFDs), and lunate dislocations are high-energy wrist injuries that can and should be recognized on radio-graphs. These injuries are a result of important sequential osseous and ligamentous injuries or failures. Prompt and accurate radiographic diagnosis aids in the management of patients with perilunate dislocations, PLFDs, and lunate dislocations while assisting orthopedic surgeons with subsequent surgical planning. CT may better show the extent of the injury and help in treatment planning particularly in cases of delayed treatment or chronic perilunate dislocation. A CT examination with coronal, sagittal, and 3D reformatted images is ordered at our institution in cases in which the extent of the carpal injuries is poorly shown on radiographic examination.

  3. Misfit dislocations in composites with nanowires

    CERN Document Server

    Gutkin, M Y; Sheinerman, A G

    2003-01-01

    A theoretical model is suggested which describes the generation and evolution of misfit dislocations in composite solids containing nanowires with rectangular cross-section. In the framework of the model, the ranges of the geometric parameters (nanowire sizes, misfit parameter, interspacing between the nanowire and the free surface of the composite) are calculated at which the generation of various misfit dislocation configurations (loops, semi-loops and dipoles) is energetically favourable. Transformations of these dislocation configurations and their specific features are discussed.

  4. Dislocation and dissociation of bipolar hip hemiarthroplasty.

    Science.gov (United States)

    Moriarity, Andrew; Ellanti, Prasad; Talha, Samir; McKenna, John

    2015-07-15

    Hemiarthroplasty of the hip is a commonly performed procedure for subcapital neck of femur fractures. Dislocation of the hemiarthroplasty is a recognised but uncommon complication. Dislocations can be complicated by the uncoupling or dissociation of the femoral head component from the femoral stem. Dissociations are rare and require open reduction. We present a case of a patient with a hip hemiarthroplasty dislocation and dissociation subsequent to a fall. 2015 BMJ Publishing Group Ltd.

  5. Imaging findings of anterior hip dislocations.

    Science.gov (United States)

    Pfeifer, Kyle; Leslie, Michael; Menn, Kirsten; Haims, Andrew

    2017-06-01

    Anterior hip dislocations are rare orthopedic emergencies resulting from high-energy trauma and have unique imaging characteristics on radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Imaging findings on CT and MRI allow for the prompt recognition and classification of anterior hip dislocations, which guides patient management and reduces complications. The purpose of this article is to review imaging findings of anterior hip dislocations, specifically focusing on CT and MRI.

  6. Imaging findings of anterior hip dislocations

    Energy Technology Data Exchange (ETDEWEB)

    Pfeifer, Kyle [Mallinckrodt Institute of Radiology, Department of Radiology, St. Louis, MO (United States); Leslie, Michael [Yale School of Medicine, Department of Orthopedics and Rehabilitation, New Haven, CT (United States); Menn, Kirsten; Haims, Andrew [Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT (United States)

    2017-06-15

    Anterior hip dislocations are rare orthopedic emergencies resulting from high-energy trauma and have unique imaging characteristics on radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Imaging findings on CT and MRI allow for the prompt recognition and classification of anterior hip dislocations, which guides patient management and reduces complications. The purpose of this article is to review imaging findings of anterior hip dislocations, specifically focusing on CT and MRI. (orig.)

  7. Reconstruction of displaced acromio-clavicular joint dislocations using a triple suture-cerclage: description of a safe and efficient surgical technique

    National Research Council Canada - National Science Library

    Sandmann, Gunther H; Martetschläger, Frank; Mey, Lisa; Kraus, Tobias M; Buchholz, Arne; Ahrens, Philipp; Stöckle, Ulrich; Freude, Thomas; Siebenlist, Sebastian

    2012-01-01

    ...) cerclages and one coracoclavicular (CC) cerclage with resorbable sutures. Between 2007 and 2009 a total of 39 patients fit the inclusion criteria after operative treatment of acute AC joint dislocation...

  8. [Traumatic lumbosacral dislocation - an underrated injury].

    Science.gov (United States)

    Schroeter, S; Weise, K; Badke, A

    2009-01-01

    Traumatic lumbosacral dislocations are rare. We report two cases with initially missed posttraumatic lumbosacral dislocations. The reported cases and the review of the literature show that, especially, accident victims with multiple fractures of the lumbar transverses processes may require a CT scan to confirm fractures or dislocations of L5/S1. Follow-up examinations due to persisting pain after physiotherapy should include lateral X-rays of the lumbar spine of the patient standing. According to the literature and our experience, the treatment of traumatic lumbosacral dislocation usually consists of open reduction and postero-lateral or dorso-ventral fusion of the unstable segments.

  9. Epidemiology of Isolated Acromioclavicular Joint Dislocation

    Directory of Open Access Journals (Sweden)

    Claudio Chillemi

    2013-01-01

    Full Text Available Background. Acromioclavicular (AC joint dislocation is a common shoulder problem. However, information about the basic epidemiological features of this condition is scarce. The aim of this study is to analyze the epidemiology of isolated AC dislocation in an urban population. Materials and Methods. A retrospective database search was performed to identify all patients with an AC dislocation over a 5-year period. Gender, age, affected side and traumatic mechanism were taken into account. X-rays were reviewed by two of the authors and dislocations were classified according to the Rockwood’s criteria. Results. A total of 108 patients, with a mean age of 37.5 years were diagnosed with AC dislocation. 105 (97.2% had an isolated AC dislocation, and 3 (2.8% were associated with a clavicle fracture. The estimated incidence was 1.8 per 10000 inhabitants per year and the male-female ratio was 8.5 : 1. 50.5% of all dislocations occurred in individuals between the ages of 20 and 39 years. The most common traumatic mechanism was sport injury and the most common type of dislocation was Rockwood type III. Conclusions. Age between 20 and 39 years and male sex represent significant demographic risk factors for AC dislocation.

  10. Arthroscopic Treatment of Traumatic Hip Dislocation.

    Science.gov (United States)

    Begly, John P; Robins, Bryan; Youm, Thomas

    2016-05-01

    Traumatic hip dislocations are high-energy injuries that often result in considerable morbidity. Although appropriate management improves outcomes, associated hip pathology may complicate the recovery and lead to future disability and pain. Historically, open reduction has been the standard of care for treating hip dislocations that require surgical intervention. The use of hip arthroscopy to treat the sequelae and symptoms resulting from traumatic hip dislocations recently has increased, however. When used appropriately, hip arthroscopy is a safe, effective, and minimally invasive treatment option for intra-articular pathology secondary to traumatic hip dislocation.

  11. Treatment of neglected elbow dislocations with the help of hinged external fixator: Report of two cases

    Directory of Open Access Journals (Sweden)

    Özgür Karakoyun

    2014-06-01

    Full Text Available Elbow dislocations are cases that have to be treated in emergency conditions. Neglected elbow dislocations are seen very rarely and the treatment of such cases are more complicated than acute cases. We present two cases of neglected elbow dislocations treated with open reduction and hinged external fixators. Case 1: 23 year old female patient had a neglected posterior dislocation of left elbow with ipsilateral humeral shaft fracture caused by car accident. The patient was treated after 3 months of initial trauma. We have performed open reduction for the joint. After that we fixed the joint whit a hinged external fixator. The humeral shaft fracture was also fixed with the components of the external fixator. Case 2: 33 year male patient had a large bone and soft tissue defect around the left elbow accompanying with neglected medial elbow dislocation. He presented to our clinic with a delay of 2 months. The patient was treated with open reduction and hinged external fixator after reconstruction of bone defect of distal humerus. Conclusion: The treatment of neglected cases is quite challenging. Open reduction and external fixation has satisfactory results in treatment of late cases of elbow dislocation with the possibility of early rehabilitation. This method can be considered as an option for such cases. J Clin Exp Invest 2014; 5 (2: 443-446

  12. Knee joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100088.htm Knee joint replacement - series—Normal anatomy To use the ... to slide 4 out of 4 Overview The knee is a complex joint. It contains the distal ...

  13. Knee arthroscopy - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100117.htm Knee arthroscopy - series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The knee is a complex joint made up of the ...

  14. Partial knee replacement - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  15. Knee braces - unloading

    Science.gov (United States)

    ... most people talk about the arthritis in their knees, they are referring to a type of arthritis ... is caused by wear and tear inside your knee joints. Cartilage, the firm, rubbery tissue that cushions ...

  16. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten T; Bencke, Jesper

    2010-01-01

    To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA).......To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA)....

  17. Magnetic resonance imaging evaluation of capsulolabral tears after traumatic primary anterior shoulder dislocation. A prospective comparison with arthroscopy of 25 cases

    DEFF Research Database (Denmark)

    Suder, P.A.; Frich, Lars Henrik; Hougaard, K.

    1995-01-01

    joint side rotator cuff tear, 1 partial rupture of the biceps tendon, and 1 osseous Bankart lesion. Anterior capsulolabral tears and Hill-Sachs lesions appeared with a high incidence after acute anterior primary shoulder dislocation. Conventional MRI was only moderately reliable in the preoperative......The purpose of our study was to evaluate the use of static magnetic resonance imaging (MRI) as a preoperative diagnostic tool in young patients with a traumatic primary anterior shoulder dislocation. Twenty-five patients who had acute primary traumatic anterior shoulder dislocation were examined...... with MRI and arthroscopy. The patients (18 male and 7 female) were between 16 and 39 years old (mean age, 27 years). They had no previous shoulder dislocations. The dislocations were confirmed radiographically. Examination with MRI and arthroscopy was performed within 10 days after the trauma. The MRI...

  18. Arthroscopic findings after shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Medenica Ivica

    2009-01-01

    Full Text Available Background/Aim. Recurrent instability of the shoulder joint is frequently difficult to differentiate from diseased or injured rotator cuff or tendon of the forearm flexor (m. biceps brachii. Shoulder joint arthroscopy has been only recently introduced into instable shoulder joint lesion examination. The aim of this study was to present and analyze an arthroscopic finding on instable shoulder joint in order to determine causes and mechanisms of instability, as well as principles of surgical treatment. Methods. Arthroscopy of the shoulder joint was performed in 158 patients with at least one documented shoulder joint dislocation. These patients were divided into two groups. The group I included the patients with one to three dislocations, while the group II those with more than three dislocations. Preoperative diagnosis was based on anamnestic data and clinical examination using specific tests, and on the diagnosis of shoulder joint using radiography or computed tomography. Results. Out of the total number of the patients 138 (87.34% had injury of the anterior patellar brim, 119 (75.32% had failure of the anterior capsule, 126 (79.75% had compressive cartilage injury of the posterior part of the head of the upper arm bone (Hill-Sachs lesion, 102 (64.56% had insufficiency of glenohumeral tendon, 11 (6.96 had complete cut of the rotator cuff, 23 (14.56% had injury of the posterior patellar brim, 12 (7.59% had injury of the upper anterior-posterior patellar brim (SLAP. Conclusion. According to the obtained results it could be concluded that there is no a unique injury that leads to shoulder joint instability. It is necessary to point out to the significance of anamnesis and clinical examination in making diagnosis. Arthroscopic diagnostics is indicated in clinically unreliable findings as an additional method for determining operative treatment.

  19. Simple medial elbow dislocations: a rare injury at risk for early instability.

    Science.gov (United States)

    Jockel, Christopher R; Katolik, Leonid I; Zelouf, David S

    2013-09-01

    To report the presentation, treatment, and outcomes of a series of simple medial elbow dislocations and to identify features distinguishing this injury from the more common dislocation patterns. From 2000 to 2011, 4 cases of simple medial elbow dislocations were treated at a single referral center. Retrospective review was conducted to evaluate presentation, treatment, and outcomes. The mean patient age was 56 years (range, 49-61 y). All dislocations were in the nondominant arm of women after a fall from standing height. Two elbows had immediate closed reduction, and 2 elbows could not be reduced acutely. All elbows presented within 2.5 weeks of injury with recurrent instability or dislocation. Two patients also had acute symptoms of ulnar neuropathy. All patients had surgical repair of the lateral collateral ligament complex and extensor tendon origin. Three patients had ulnar nerve decompressions. All elbows were stable to valgus, varus, and rotatory stress testing, with no subjective instability at a minimum follow-up of 8 months (range, 8-144 mo). Three patients reported no pain. Symptoms of ulnar neuropathy resolved in all patients. Mean elbow range of motion was from 13° to 135° of extension/flexion, with full pronation and supination. Simple medial elbow dislocations may be at risk for early instability and may represent a more noteworthy soft tissue injury than typical dislocation patterns. Surgical treatment of early instability in these injuries led to acceptable patient outcomes. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. Late dislocation is associated with recurrence after total hip arthroplasty.

    Science.gov (United States)

    Itokawa, Takashi; Nakashima, Yasuharu; Yamamoto, Takuaki; Motomura, Goro; Ohishi, Masanobu; Hamai, Satoshi; Akiyama, Mio; Hirata, Masanobu; Hara, Daisuke; Iwamoto, Yukihide

    2013-08-01

    This study was conducted to examine the risk factors for recurrent dislocation after total hip arthroplasty (THA) and test the hypothesis that late dislocations are associated with recurrence. A total of 1,250 hips in 1,017 patients were retrospectively reviewed. All operations were performed through the posterolateral approach with posterior soft tissue repair. An early or late dislocation was defined as a dislocation occurring before or after one year postoperatively, respectively. Dislocation occurred in 36 hips (2.9 %) and 20 of them experienced recurrence. Recurrent dislocations were observed in ten out of 25 hips (40.0 %) with early dislocation; however, ten out of 11 hips (90.9 %) with late dislocation experienced recurrence (p = 0.0046). Multivariate analysis revealed that late dislocation was significantly associated with recurrence with odds ratio of 5.94 per year. Seven in 20 hips with recurrent dislocation required surgical treatment. Late dislocation significantly contributed to the development of recurrent dislocations.

  1. Dislocation/separation injuries among US high school athletes in 9 selected sports: 2005-2009.

    Science.gov (United States)

    Kerr, Zachary Y; Collins, Christy L; Pommering, Thomas L; Fields, Sarah K; Comstock, R Dawn

    2011-03-01

    To investigate the epidemiology of dislocations/separations in a nationally representative sample of high school student-athletes participating in 9 sports. Descriptive epidemiologic study. Sports injury data for the 2005-2009 academic years were collected using an Internet-based injury surveillance system, Reporting Information Online (RIO). A nationally representative sample of 100 US high schools. Injuries sustained as a function of sport and gender. Dislocation/separation rates, body site, outcome, surgery, and mechanism. Dislocations/separations represented 3.6% (n = 755) of all injuries. The most commonly injured body sites were the shoulder (54.9%), wrist/hand (16.5%), and knee (16.0%); 18.4% of dislocations/separations were recurrences of previous injuries at the same body site; 32.3% of injuries were severe (ie, student-athletes unable to return to play within 3 weeks of the injury date), and 11.8% required surgical repair. The most common mechanisms of injury were contact with another player (52.4%) and contact with the playing surface (26.4%). Injury rates varied by sport. In gender-comparable sports, few variations in patterns of injury existed. Rates were highest in football (2.10 per 10 000 athletic exposures) and wrestling (1.99) and lowest in baseball (0.24) and girls' soccer (0.27). Although dislocation/separation injuries represent a relatively small proportion of all injuries sustained by high school student-athletes, the severity of these injuries indicates a need for enhanced injury prevention efforts. Developing effective targeted preventive measures depends on increasing our knowledge of dislocation/separation rates, patterns, and risk factors among high school athletes.

  2. What Are Knee Problems?

    Science.gov (United States)

    ... Health Topics English Español 한국어 繁體中文 tiếng Việt Knee Problems Basics In-Depth Download Download EPUB Download PDF What are they? Points To Remember About Knee Problems Knee problems may be caused by injury, ...

  3. Hybrid dislocated control and general hybrid projective dislocated synchronization for the modified Lue chaotic system

    Energy Technology Data Exchange (ETDEWEB)

    Xu Yuhua [College of Information Science and Technology, Donghua University, Shanghai 201620 (China) and Department of Maths, Yunyang Teacher' s College, Hubei 442000 (China)], E-mail: yuhuaxu2004@163.com; Zhou Wuneng [College of Information Science and Technology, Donghua University, Shanghai 201620 (China)], E-mail: wnzhou@163.com; Fang Jianan [College of Information Science and Technology, Donghua University, Shanghai 201620 (China)

    2009-11-15

    This paper introduces a modified Lue chaotic system, and some basic dynamical properties are studied. Based on these properties, we present hybrid dislocated control method for stabilizing chaos to unstable equilibrium and limit cycle. In addition, based on the Lyapunov stability theorem, general hybrid projective dislocated synchronization (GHPDS) is proposed, which includes complete dislocated synchronization, dislocated anti-synchronization and projective dislocated synchronization as its special item. The drive and response systems discussed in this paper can be strictly different dynamical systems (including different dimensional systems). As examples, the modified Lue chaotic system, Chen chaotic system and hyperchaotic Chen system are discussed. Numerical simulations are given to show the effectiveness of these methods.

  4. [Bipolar forearm dislocation or floating forearm (a case report)].

    Science.gov (United States)

    Daoudi, A; Elibrahimi, A; Loudiyi, W D; Elmrini, A; Chakour, K; Boutayeb, F

    2009-02-01

    Bipolar dislocation of the forearm or floating forearm is a rare injury. It combines concomitant elbow and wrist dislocation. Only six cases have been reported in the literature. The diagnosis of wrist dislocation may initially be missed and therefore the prognosis will be worse. The authors report a case of a bipolar dislocation with a posterior dislocation of the elbow and a perilunate dislocation of the wrist.

  5. Formation of disorientations in dislocation structures during plastic deformation

    DEFF Research Database (Denmark)

    Pantleon, W.

    2002-01-01

    Disorientations developing during plastic deformation in dislocation structures are investigated. Based on expected mechanisms for the formation of different types of dislocation boundaries (statistical trapping of dislocations or differently activated slip systems) the formation of the disorient......Disorientations developing during plastic deformation in dislocation structures are investigated. Based on expected mechanisms for the formation of different types of dislocation boundaries (statistical trapping of dislocations or differently activated slip systems) the formation...

  6. Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Wellsandt, Elizabeth; Gardinier, Emily S; Manal, Kurt; Axe, Michael J; Buchanan, Thomas S; Snyder-Mackler, Lynn

    2016-01-01

    Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Case-control study; Level of evidence, 3. Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs -0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: -0.001 ± 0.032 N·m·s/kg·m [nonOA] vs -0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs -0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb

  7. The Effect of Timing on the Treatment and Outcome of Combined Fourth and Fifth Carpometacarpal Fracture Dislocations.

    Science.gov (United States)

    Zhang, Chi; Wang, Hua; Liang, Chizhang; Yu, Weizhong; Li, Yunfeng; Shang, Ruguo; Huang, Chongbo; Huang, Chongxia

    2015-11-01

    In this study, we designed a prospective project to test the hypothesis that acute fourth and fifth carpometacarpal (CMC) fracture dislocations can be treated conservatively with good restoration of strength, range of motion (ROM), and function, whereas patients with delayed treatment of fourth and fifth CMC fracture dislocations should be treated with open reduction and internal fixation (ORIF). We evaluated the results of 20 patients with acute and 6 patients with subacute fourth and fifth CMC fracture dislocations. All 20 acute CMC fracture dislocations were treated conservatively, whereas 3 of the 6 patients with subacute injuries underwent operative intervention. The sensibility, ROM, and grip strength of the hands were tested during 1-year follow-up. The Michigan Hand Outcomes Questionnaire and control radiographs were also taken. All 20 patients with acute CMC fracture dislocations showed good restoration of grip strength, ROM, and function, with an average Michigan Hand Outcomes Questionnaire score of 98 ± 2 at 1-year follow-up. Patients with delayed diagnosis who underwent conservative treatment had noticeable deformity of their injured hands, pain complaints, limited ROM at the fourth and fifth CMC joints, and decreased grip strength. The 3 patients with delayed diagnosis treated with ORIF showed good restoration of grip strength, ROM, and function. Patients with acute CMC fracture dislocations can be treated by closed reduction with good restoration of grip strength, ROM, and function. In patients with delayed presentation of CMC fracture dislocations, we recommend ORIF. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. Knee Arthrodesis After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. A total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified by linking the data using....... Differences in cumulative incidence were compared with the Gray test. RESULTS: A total of 164 of the 165 arthrodeses were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of arthrodesis was 0.26% (95% confidence interval, 0.21% to 0.31%). The 5-year cumulative...

  9. Double Dislocation of Interphalangeal Joints Accompanied with Contralateral Shoulder Dislocation: A Case Report.

    Science.gov (United States)

    Raval, Pradyumna Ramchandra; Jariwala, Arpit

    2016-02-01

    Dislocation of any joint is an orthopaedic emergency and needs immediate attention by the attending physician. A delay in reducing a dislocated joint can lead to disastrous complications both immediately as well as in the long run. Although anterior dislocation of a shoulder joint is by far the commonest dislocation encountered by any emergency care physician, other joints may also get dislocated. In certain cases two joints may get dislocated simultaneously. Such dislocation is known as a double dislocation. Double dislocation of the proximal interphalangeal joint and the distal interphalangeal joint in the same finger is a rare injury. High impact loading at the fingertip is the primary cause in most cases and it is often associated with younger individuals playing contact sports. The right little finger is the digit commonly involved and this injury is evident in football players more often than not. Although closed reduction is a preferred treatment, it may not be always successful. Time of presentation, tendon interposition, associated swelling and co-existent phalangeal fractures are certain key impediments to a successful closed reduction manoeuvre. In patients with an open injury, a thorough wash out and appropriate antibiotic cover is mandatory. We report a rare case of double dislocation of the interphalangeal joints accompanied with contralateral shoulder dislocation in an elderly man sustained after a fall which was treated successfully with closed reduction and early mobilization. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  10. Dislocation generation during early stage sintering.

    Science.gov (United States)

    Sheehan, J. E.; Lenel, F. V.; Ansell, G. S.

    1973-01-01

    Discussion of the effects of capillarity-induced stresses on dislocations during early stage sintering. A special version of Hirth's (1963) theoretical calculation procedures modified to describe dislocation nucleation on planes meeting the sintering body's neck surface obliquely is shown to predict plastic flow at stress levels know to exist between micron size metal particles in the early stages of sintering.

  11. On establishing coreference in Left Dislocation constructions ...

    African Journals Online (AJOL)

    The phenomenon of left dislocation (LD) has received relatively little attention in the generative literature. In Government & Binding theory and early versions of Minimalist Syntax, the left-dislocated expression is conventionally taken to be base-generated in its sentence-initial surface position and the resumptive pronoun in ...

  12. Superior dislocation hip with anterior column acetabular

    African Journals Online (AJOL)

    abp

    2012-06-21

    Jun 21, 2012 ... Abstract. Superior variety of anterior dislocation of the hip is a rare injury. Its occurrence with acetabular fractures has been documented infrequently. We report a case of superior dislocation of the hip with anterior column acetabular fracture. Open reduction of the hip and internal fixation of the fracture was ...

  13. Interactions between Dislocations and Grain Boundaries

    NARCIS (Netherlands)

    Soer, Wouter Anthon

    2006-01-01

    Dislocations (line defects) and grain boundaries (planar defects) are two types of lattice defects that are crucial to the deformation behavior of metals. Permanent deformation of a crystalline material is microscopically associated with the nucleation and propagation of dislocations, and extensive

  14. Moving dislocations studied by nuclear magnetic resonance

    NARCIS (Netherlands)

    Hut, Gezinus

    1976-01-01

    In this thesis a new approach to the study of moving dislocations in crystalline solids during plastic deformation will be presented. Since the process of dislocation motion is made up of atomic movements nuclear magnetic resonance techniques should offer a possibility to determine the manner in

  15. On establishing coreference in Left Dislocation constructions

    African Journals Online (AJOL)

    user

    The phenomenon of left dislocation (LD) has received relatively little attention in the generative literature. In Government & Binding theory and early versions of Minimalist Syntax, the left- dislocated expression is conventionally taken to be base-generated in its sentence-initial surface position and the resumptive pronoun in ...

  16. stabilisation of posterior sternoclavicular joint dislocation using

    African Journals Online (AJOL)

    JOINT DISLOCATION USING PALMARIS LONGUS TENDON. AUTOGRAFT: A CASE REPORT. V. M. Mutiso* .... Post operative follow up was uneventful. The skin healed well and she was commenced on physiotherapy with good ... The treatment of posterior sternoclavicular joint dislocation is varied owing to the rarity of the.

  17. Chronic Protracted Dislocation of the Temporomandibular Joint ...

    African Journals Online (AJOL)

    Background: Chronic protracted dislocation worsens with time due to continuing spasms and progressive fibrosis and consolidation. The aim of this report was to document our experience in the management of two different cases of longstanding dislocation in our centre. Method: First case was treated with traction method ...

  18. Anterior bilateral temporomandibular joint dislocation: an ...

    African Journals Online (AJOL)

    Anterior dislocation of the temporomandibular joint (TMJ) though an infrequent presentation at the emergency department; often demands an immediate reduction to relieve discomfort and prevent adverse long-term sequelae. A simple and effective technique to reduce the dislocation is successfully demonstrated by putting ...

  19. [A man with a dislocated hip

    NARCIS (Netherlands)

    Valke, L.L.; Leeuwesteijn, A.E.; Poelhekke, L.M.S.J.

    2015-01-01

    A 95-year-old male presented with a dislocated hip hemiarthroplasty after falling off his chair. After closed reposition, symptoms of dislocation remained. A control X-ray showed a disassociation of the prosthesis at the head-neck interface. Therefore, open reposition was performed. X-ray control is

  20. Developmental Dislocation (Dysplasia) of the Hip (DDH)

    Science.gov (United States)

    ... bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. ... the American Academy of Orthopaedic Surgeons. .org Developmental Dislocation (Dysplasia) of the Hip cont. • Family history of DDH (parents or siblings) • ...

  1. Frozen shoulder or missed posterior dislocation?

    African Journals Online (AJOL)

    posterior shoulder dislocation or adhesive capsulitis. Discussion. PSD is a rare entity. Incidence is approximately 2 - 5% of all shoulder dislocations.[1] Most often PSD is the result of an epileptic seizure. Less frequent causes are seizures due to alcoholic withdrawal or other metabolic disorders, electrocution or during a ...

  2. Mg doping affects dislocation core structures in GaN.

    Science.gov (United States)

    Rhode, S K; Horton, M K; Kappers, M J; Zhang, S; Humphreys, C J; Dusane, R O; Sahonta, S -L; Moram, M A

    2013-07-12

    Aberration-corrected scanning transmission electron microscopy was used to investigate the core structures of threading dislocations in undoped GaN films with both high and low dislocation densities, and in a comparable high dislocation density Mg-doped GaN film. All a-type dislocations in all samples have a 5/7-atom core structure. In contrast, most (a+c)-type dislocations in undoped GaN dissociate due to local strain variations from nearby dislocations. In contrast, Mg doping prevents (a+c)-type dislocation dissociation. Our data indicate that Mg affects dislocation cores in GaN significantly.

  3. Quality differences between private for-profit, private non-profit and public hospitals in Norway: a retrospective national register-based study of acute readmission rates following total hip and knee arthroplasties.

    Science.gov (United States)

    Holom, Geir Hiller; Hagen, Terje P

    2017-08-18

    To compare the quality of care-using unplanned acute hospital readmissions as a quality measure-among patients treated at private for-profit hospitals (PFPs), private non-profit hospitals (PNPs) and public hospitals (PUBs) in Norway. A retrospective comparative study using the Norwegian Patient Register. Readmissions were evaluated by logistic regressions both using adjustment for various patient-level and other covariates, and a two-stage model using distance as an instrumental variable. The Norwegian healthcare system. All publicly financed patients having primary total hip (37 897 patients) or primary total knee arthroplasty (25 802 patients) at one of the three hospital types from 2009 to 2014. 30-day unplanned acute hospital readmission rate. We found highest readmission rates among PUBs and lowest among PFPs, for both procedures. However, the patients were on average more than 2 years younger at PFPs. PFPs also treated the least severe patients, while PUBs treated the most severe. Using adjustment for various patient-level and other covariates, compared to PUBs, both PFPs and PNPs had lower odds of readmission following both procedures. However, using the instrumental variable method, the only significant difference found was a lower odds of readmission at PNPs among hip patients when compared with PUBs. No patients in our data set were readmitted to PFPs, those originally treated at PFPs were readmitted to either PNPs or PUBs, and PUBs received most of the readmitted patients across hospital types. Quality differences between hospital types were small; however, PNPs had significantly lower readmission rates compared with PUBs among patients having total hip arthroplasty. PUBs received the larger part of the readmitted patients across hospital types and thus play an essential role in the care of more complex patients and for readmissions, regardless of any quality differences. © Article author(s) (or their employer(s) unless otherwise stated in the

  4. Modeling of Dislocation Structures in Materials

    CERN Document Server

    Rickman, J M; Vinals, Jorge

    1996-01-01

    A phenomenological model of the evolution of an ensemble of interacting dislocations in an isotropic elastic medium is formulated. The line-defect microstructure is described in terms of a spatially coarse-grained order parameter, the dislocation density tensor. The tensor field satisfies a conservation law that derives from the conservation of Burgers vector. Dislocation motion is entirely dissipative and is assumed to be locally driven by the minimization of plastic free energy. We first outline the method and resulting equations of motion to linear order in the dislocation density tensor, obtain various stationary solutions, and give their geometric interpretation. The coupling of the dislocation density to an externally imposed stress field is also addressed, as well as the impact of the field on the stationary solutions.

  5. Absent congenital cervical pedicle nearly misdiagnosed as a facet dislocation: A case report

    Directory of Open Access Journals (Sweden)

    Scott Safir

    2017-09-01

    Conclusion: In the acute trauma setting, congenital absent cervical pedicle can be difficult to differentiate from unilateral facet dislocation and may require the use of advanced imaging and close communication between the neurosurgery and radiology departments. Given the high morbidity and mortality involved in the repair of facet dislocation in a child, it is crucial to maintain high degree of clinical suspicion for absent spinal pedicle. In this case, the patient nearly underwent surgical intervention, but was ultimately able to be discharged home with no symptoms or deficits after correct diagnosis.

  6. Glenohumeral dislocations in snowboarding and skiing.

    Science.gov (United States)

    Ogawa, Hiroyasu; Sumi, Hiroshi; Sumi, Yasuhiko; Shimizu, Katsuji

    2011-11-01

    Glenohumeral dislocations occurring during snowboarding and skiing are severe and often leave after effects. However, little is known about their aetiology and injury pattern. The purpose of this study was to elucidate the feature of glenohumeral dislocations in these winter sports. The injuries sustained by snowboarders and skiers, who were admitted to our hospital during five ski seasons from 2004 to 2009, were analysed using questionnaires and patients' records. A retrospective cohort study and a multivariate regression analysis were performed to reveal the epidemiology and injury pattern of glenohumeral dislocations. The overall rate of glenohumeral dislocation was 0.0583 per 1000 participant days (0.0676 per 1000 participant days in snowboarders and 0.0295 per 1000 participant days in skiers). Glenohumeral dislocations in snowboarding were significantly more common in higher age, male gender, injuries resulting more from falls, wet snow conditions, injuries of the leading-side joint and engaging the toe-side edge of the snowboard. Similarly, in skiers, glenohumeral dislocations were significantly more common in higher age, male gender, higher skill level, injuries resulting more from falls and injuries occurring on steep slopes. Nearly all (95.8%) of the glenohumeral dislocations were of the anterior type, and the prevalence of fracture-dislocations of the glenohumeral joint was higher in skiing (33.9%) than in snowboarding (12.4%). The variables strongly associated with glenohumeral dislocations in snowboarding and skiing were age, gender, snow condition and skiing speed. Snowboarding and skiing are sports with increased risk of glenohumeral dislocation compared with the general population, and the injury pattern differs between them. In snowboarding, injury patterns seem to be influenced by performance style. Copyright © 2010 Elsevier Ltd. All rights reserved.

  7. Dynamic control of knee axial deformities

    Directory of Open Access Journals (Sweden)

    E. E. Malyshev

    2013-01-01

    Full Text Available The authors have evaluated the clinical examination of the patients with axial malalignments in the knee by the original method and device which was named varovalgometer. The measurements were conducted by tension of the cord through the spina iliaca anterior superior and the middle of the lower pole of patella. The deviation of the center of the ankle estimated by metal ruler which was positioned perpendicular to the lower leg axis on the level of the ankle joint line. The results of comparison of our method and computer navigation in 53 patients during the TKA show no statistically significant varieties but they differ by average 5° of valgus in clinical examination in comparison with mechanical axis which was identified by computer navigation. The dynamic control of axial malalignment can be used in clinical practice for estimation of the results of treatment of pathology with axial deformities in the knee; for the control of reduction and secondary displacement of the fractures around the knee; for assessment of instability; in planning of correctional osteotomies and intraoperative control of deformity correction; for estimation of Q angle in subluxation and recurrent dislocation of patella; in planning of TKA; during the growth of child it allows to assess the progression of deformity.

  8. Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study.

    Science.gov (United States)

    Gamulin, Axel; Lübbeke, Anne; Belinga, Patrick; Hoffmeyer, Pierre; Perneger, Thomas V; Zingg, Matthieu; Cunningham, Gregory

    2017-07-18

    The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

  9. Diagnosis and Treatment of Anterior Tibial Plateau Fracture-Dislocation: A Case Series and Literature Review.

    Science.gov (United States)

    Wu, Kai; Huang, Jianhua; Lin, Jian; Wang, Qiugen

    2017-02-01

    Anterior tibial plateau fracture is fairly common. This study was aimed at introducing a type of severe anterior tibial plateau fracture (anterior tibial plateau fracture-dislocation) and evaluating its clinical characteristics and treatment strategies. In this study, 18 patients with severe anterior tibial plateau fracture (study group) were enrolled between November 2006 and August 2014, and their data were compared with those of 21 patients treated for normal Schatzker type VI tibial plateau fracture (control group) between January 2010 and August 2014. At the last follow-up, bony union had been achieved in both groups. The incidence of ligament injury was higher in the case of anterior tibial plateau fracture than control group. The average range of motion in the study group was 0.56 to 109 degrees, while that in the control group was 1.81 to 117 degrees. The average Hospital for Special Surgery scores and Lysholm scores in the study group were significantly lower than those in the control group. Further, the incidence of postoperative complications and reduction loss were higher for anterior tibial plateau fracture cases than for normal Schatzker type VI fracture. Our findings also showed a significantly higher rate (22.2%) of popliteal artery injury in the study group than in the control group. Anterior tibial plateau fracture-dislocation is a special type of Schatzker type VI fracture with very low incidence and most commonly characterized by the anterior subsidence of the tibial component, irreducible dislocation of the knee joint, and varying degrees of neurovascular and knee-joint peripheral ligaments injuries, as well as high incidence of complications during fixation surgery. The treatment of anterior tibial plateau fracture-dislocation is challenging even for experienced surgeons. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Knee Arthrodesis After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... of 34 patients (21%) underwent repeat arthrodesis, and 23 patients (14%) eventually underwent transfemoral amputation. CONCLUSIONS: The cumulative incidence of arthrodesis within 15 years after primary knee arthroplasty was 0.26%. There was a significant decrease in the 5-year cumulative incidence...

  11. Evolution, Interaction, and Intrinsic Properties of Dislocations in Intermetallics: Anisotropic 3D Dislocation Dynamics Approach

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Qian [Iowa State Univ., Ames, IA (United States)

    2008-01-01

    The generation, motion, and interaction of dislocations play key roles during the plastic deformation process of crystalline solids. 3D Dislocation Dynamics has been employed as a mesoscale simulation algorithm to investigate the collective and cooperative behavior of dislocations. Most current research on 3D Dislocation Dynamics is based on the solutions available in the framework of classical isotropic elasticity. However, due to some degree of elastic anisotropy in almost all crystalline solids, it is very necessary to extend 3D Dislocation Dynamics into anisotropic elasticity. In this study, first, the details of efficient and accurate incorporation of the fully anisotropic elasticity into 3D discrete Dislocation Dynamics by numerically evaluating the derivatives of Green's functions are described. Then the intrinsic properties of perfect dislocations, including their stability, their core properties and disassociation characteristics, in newly discovered rare earth-based intermetallics and in conventional intermetallics are investigated, within the framework of fully anisotropic elasticity supplemented with the atomistic information obtained from the ab initio calculations. Moreover, the evolution and interaction of dislocations in these intermetallics as well as the role of solute segregation are presented by utilizing fully anisotropic 3D dislocation dynamics. The results from this work clearly indicate the role and the importance of elastic anisotropy on the evolution of dislocation microstructures, the overall ductility and the hardening behavior in these systems.

  12. PHYSICAL THERAPY INTERVENTION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION AFTER REPEATED LATERAL PATELLAR SUBLUXATION/DISLOCATION.

    Science.gov (United States)

    Vitale, Teresa Errigo; Mooney, Brianne; Vitale, Ashley; Apergis, Demitra; Wirth, Stephen; Grossman, Mark G

    2016-06-01

    The incidence of patellar subluxation or dislocation has been documented up to 43/100,000 with females more prevalent then males. There are many contributing factors involving the hip, knee, and ankle that lead to patellar subluxation. A patellar position of lateral tilt with lateral glide may indicate weakness of the vastus medialis oblique (VMO) and adductors, increased tightness in the iliotibial band, and overpowering of the vastus lateralis. Patella alta can predispose an individual to lateral dislocation due to the patella placement outside of the femoral trochlear groove with a disadvantage of boney stability. Other factors that may cause the patella to laterally sublux or dislocate during a functional activity or sporting activity include a position of femoral external rotation, tibial internal rotation, and excessive contraction of the vastus lateralis. The medial patellofemoral ligament (MPFL) aids in the prevention of a lateral patellar subluxation or dislocation. In cases where there is recurrent subluxation/dislocation and Magnetic Resonance Imaging confirms a MPFL tear, a reconstruction may be the treatment of choice. The purpose of this case series is to describe the post-surgical physical therapy management of MPFL reconstructions, outcomes using the Modified Cincinnati Knee Outcome Measure (MCKOM) and to propose staged physical therapy interventions for this pathology in the form of a treatment progression. Post-operative management data and outcomes were retrospectively collected using a detailed chart review methodology from seven subjects who underwent MPFL reconstruction. The Modified Cincinnati Knee Outcome Measure (MCKOM) was analyzed for each participant in four sections that were most important to the return and maintenance of participation in sport. At follow-up the mean scores for the seven subjects in Section 3 (instability) was 19.3/20, Section 4 (overall activity level) was 17.3/20, Section 7 (running activity) was 4.5/5, and Section 8

  13. Atlantoaxial dislocation and Down's syndrome.

    Science.gov (United States)

    Whaley, W J; Gray, W D

    1980-01-01

    The phenotypic features of Down's syndrome are easily recognized and include characteristic facial features, hypotonia, ligament laxity, transverse palmar creases and mental subnormality. Associated manifestations and complications are also familiar and involve almost every organ system. Congenital heart defects, bowel malformations and a tendency to leukemia are common attendant problems. Less common, however, are defects of the skeletal system; in fact, the most recent edition of a standard pediatric textbook makes no mention of anomalies of the vertebral column. The purpose of this paper is to call attention to the association between Down's syndrome and atlantoaxial dislocation, which in our patient resulted in quadriplegia and eventually death. Images FIG. 1 FIG. 2 PMID:6448087

  14. Traumatic Anterior Dislocation of the Shoulder: Factors Affecting the Progress of the Traumatic Anterior Dislocation

    Science.gov (United States)

    Cho, Nam Su; Cho, Seung Hyun

    2009-01-01

    Background The aim of this study was to identify the factors that affect the progress of a traumatic anterior dislocation of the shoulder. Methods Two hundred and thirty-eight patients (246 shoulders) with a traumatic anterior dislocation were enrolled in this study. The mean age at the time of surgery was 25 years (range, 14 to 47 years). There were 214 men and 24 women. Results One hundred and sixty-four shoulders (67%) were younger than 20 years at the time of the first dislocation. Patients younger than 20 years showed a shorter interval of redislocation (p = 0.001) and a higher frequency of dislocation (p = 0.001). Athletic patients experienced their first dislocation at a younger age (p = 0.023) and showed a shorter interval of redislocation (p = 0.001) than their non-athetic counterparts. The incidence of classic and non-classic Bankart lesions was unaffected by age at the time of the first dislocation, interval between the first and second dislocation or the frequency of dislocation. Patients with bony Bankart lesions had a higher frequency of dislocation (p = 0.043). Conclusions The age at the time of the first dislocation and athletic activity were related to early redislocation and a high frequency of dislocation. Bony Bankart lesions were observed more often in patients with a higher frequency of dislocation. Early surgical treatment is a good option for young athletic patients with a bony Bankart lesion and a short interval between the first and second dislocation. PMID:19956475

  15. Increasing preoperative dislocations and total time of dislocation affect surgical management of anterior shoulder instability

    Science.gov (United States)

    Denard, Patrick J.; Dai, Xuesong; Burkhart, Stephen S.

    2015-01-01

    Purpose: Our purpose was to determine the relationship between number of preoperative shoulder dislocations and total dislocation time and the need to perform bone deficiency procedures at the time of primary anterior instability surgery. Our hypothesis was that need for bone deficiency procedures would increase with the total number and hours of dislocation. Materials and Methods: A retrospective review was performed of primary instability surgeries performed by a single surgeon. Patients with 25% glenoid bone loss were treated with Latarjet reconstruction. Number of dislocations and total dislocation time were examined for their relationship with the treatment method. Results: Ten arthroscopic Bankart repairs, 13 arthroscopic Bankart plus remplissage procedures, and 9 Latarjet reconstructions were available for review. Total dislocations (P = 0.012) and total hours of dislocation (P = 0.019) increased from the Bankart, to the remplissage, to the Latarjet groups. Patients with a total dislocation time of 5 h or more were more likely to require a Latarjet reconstruction (P = 0.039). Patients with only 1 preoperative dislocation were treated with an isolated Bankart repair in 64% (7 of 11) of cases, whereas those with 2 or more dislocations required a bone loss procedure in 86% (18 of 21) of cases (P = 0.013). Conclusion: Increasing number of dislocations and total dislocation time are associated with the development of glenoid and humeral head bony lesions that alter surgical management of anterior shoulder instability. The necessity for the addition of a remplissage to an arthroscopic Bankart repair or the use of a Latarjet reconstruction increases with only 1 recurrent dislocation. Level of evidence: Level III, retrospective comparative study. PMID:25709237

  16. Simultaneous MPFL and LPFL reconstruction for recurrent lateral patellar dislocation with medial patellofemoral instability

    Directory of Open Access Journals (Sweden)

    Masashi Kusano

    2014-01-01

    Full Text Available We report an extremely rare case of both recurrent lateral patella dislocation and medial patellofemoral instability, following prior operations to correct patella maltracking. Manual translation of the patella revealed medial and lateral instability with a positive apprehension sign. 3-D computer modelling of kinematics based on MRI data demonstrated that the patella deviated laterally at full extension and translated medially with knee flexion. The medial and lateral patellofemoral ligaments were reconstructed simultaneously with hamstring tendons, alleviating peripatellar pain and patellar instability in both directions.

  17. Search for Dislocation Free Helium 4 Crystals.

    Science.gov (United States)

    Souris, F; Fefferman, A D; Haziot, A; Garroum, N; Beamish, J R; Balibar, S

    The giant plasticity of [Formula: see text]He crystals has been explained as a consequence of the large mobility of their dislocations. Thus, the mechanical properties of dislocation free crystals should be quite different from those of usual ones. In 1996-1998, Ruutu et al. published crystal growth studies showing that, in their helium 4 crystals, the density of screw dislocations along the c-axis was less than 100 per cm[Formula: see text], sometimes zero. We have grown helium 4 crystals using similar growth speeds and temperatures, and extracted their dislocation density from their mechanical properties. We found dislocation densities that are in the range of 10[Formula: see text]-10[Formula: see text] per cm[Formula: see text], that is several orders of magnitude larger than Ruutu et al. Our tentative interpretation of this apparent contradiction is that the two types of measurements are somewhat indirect and concern different types of dislocations. As for the dislocation nucleation mechanism, it remains to be understood.

  18. UCI knee replacement.

    Science.gov (United States)

    Evanski, P M; Waugh, T R; Orofino, C F; Anzel, S H

    1976-10-01

    Between March 9, 1972 and December 31, 1973, a total of 103 UCI knee replacements were performed. Follow-up data are available on 83 knees with an average follow-up of 33 months. Patient evaluation of the end results indicates that 78.3 per cent were better, 9.6 per cent unchanged, and 12.1 per cent worse. Patient evaluation of their own knee function averaged 55 per cent preoperatively and 79 per cent postoperatively. Patients were also evaluated on a 100 point Modified Larson Analysis Form. The average preoperative score was 46, and the average postoperative score was 70. There were six (5.8%) biological complications in the 103 knee replacement. Biological complications included infections, wound healing problems and unexplained pain. Mechanical complications were seen in 18 (17.4%) knees, and included knee instability, tibial component loosening or deformation, and patellar problems. Additional surgery was required in 18 (17.4%) knees. Failure of the procedure eventually requiring removal of the prosthesis and fusion or amputation occurred in 4 (3.9%) knees. The intermediate-term results of UCI knee replacement have been clinically satisfactory. We currently recommend consideration of this procedure for patients with disabling arthritis of the knee.

  19. The "lateral gutter drive-through" sign: an arthroscopic indicator of acute femoral avulsion of the popliteus tendon in knee joints.

    Science.gov (United States)

    Feng, Hua; Zhang, Hui; Hong, Lei; Wang, Xue-Song; Zhang, Jin

    2009-12-01

    Acute avulsions of the popliteus tendon and the lateral collateral ligament of the femur (peel-off lesion) are common and can both be missed during preoperative assessment and later overlooked during surgery if not specifically sought out. Arthroscopic observation of the direct avulsion sign of the torn end of the popliteus tendon occurs less frequently in patients with acute and subacute injuries. This study describes an arthroscopic sign that detects these tears when they either involve only the popliteal tendon or include the lateral collateral ligament assessed from the lateral gutter of the joint. The "lateral gutter drive-through," visualized during diagnostic arthroscopy, is described as entering of the arthroscope into the posterolateral compartment through the interval between the popliteal tendon and the lateral femoral condyle. A positive sign indicates (1) the presence of femoral avulsion tears of the popliteal tendon or concomitant lateral collateral ligament, (2) the presence of repairable posterolateral corner tears, and (3) the enablement of mini-open surgery for the repair of these avulsion tears with a recess or reattachment procedure. In addition, arthroscopic evaluation of the lateral compartment and preoperative magnetic resonance imaging assessment are used to eliminate the multiple-level injuries of the popliteus tendon and lateral collateral ligament.

  20. Transient medial patellar dislocation: injury patterns at US and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Le Corroller, Thomas; Champsaur, Pierre [Hopital Sainte-Marguerite, Radiology Department, Marseille (France); Faculte de Medecine de Marseille, Anatomy Department, Marseille (France); Dediu, Melania [Hopital Sainte-Marguerite, Radiology Department, Marseille (France)

    2009-05-15

    Medial dislocation of the patella is an unusual entity. It is usually an iatrogenic complication of surgical lateral retinacular release. We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. US showed acute injury to the lateral patellar retinaculum with complete avulsion at its patellar insertion. MR imaging confirmed the complete tear of the lateral patellar retinaculum and disclosed contusion of the anteromedial portion of the medial femoral condyle and lateral patella. This case is noteworthy because the injury patterns of patellar soft tissue restraints differ markedly from the classical features of lateral patellar dislocation. (orig.)

  1. Older Adults without Radiographic Knee Osteoarthritis: Knee Alignment and Knee Range of Motion

    Directory of Open Access Journals (Sweden)

    Lissa Fahlman

    2014-01-01

    Full Text Available This study describes knee alignment and active knee range of motion (ROM in a community-based group of 78-year old adults (n = 143 who did not have radiographic evidence of knee osteoarthritis in either knee (KL 0.001 than women with varus or straight knees. Men and women with valgus or varus knee alignments had generally lower ROM than individuals with both knees straight. In summary, this study highlights the complex relationships among knee alignment, ROM, body mass index, and gender in elderly adults without radiographic knee osteoarthritis.

  2. Non-invasive interactive neurostimulation (InterX ™ reduces acute pain in patients following total knee replacement surgery: a randomised, controlled trial

    Directory of Open Access Journals (Sweden)

    Taylor Drena M

    2011-08-01

    Full Text Available Abstract Background Adequate post-operative pain relief following total knee replacement (TKR is very important to optimal post-operative recovery. Faster mobilisation and rehabilitation ultimately results in optimum recovery outcomes, but pain is often the limiting factor. This study evaluates the potential clinical benefit of the InterX neurostimulation device on pain reduction and rehabilitative outcome. Methods A clinical trial under the Hywel Dda Clinical Audit Committee to validate the clinical benefit of Non-invasive Interactive Neurostimulation (NIN therapy using the InterX device was performed in patients undergoing TKR. 61 patients were randomised to treatment groups in blocks of two from the Theatre Operation List. The control group received the standard hospital course of pain medication and rehabilitation twice daily for 3 post-op days. The experimental group received 8 sessions of NIN therapy over 3 post-op days in addition to the standard course received by the Control group. Pain and range of motion were collected as the primary study measures. Results Sixty one subjects were enrolled and randomised, but 2 subjects (one/group were excluded due to missing data at Baseline/Final; one subject in the InterX group was excluded due to pre-existing rheumatoid pain conditions confounding the analysis. The experimental group pre- to post-session Verbal Rating Scale for pain (VRS showed that NIN therapy consistently reduced the pain scores by a mean of 2.3 points (SE 0.11. The NIN pre-treatment score at Final was used for the primary ANCOVA comparison, demonstrating a significantly greater cumulative treatment effect of a mean 2.2 (SE 0.49 points pain reduction (p = 0.002. Control subjects only experienced a mean 0.34 (SE 0.49 point decrease in pain. Ninety degrees ROM was required to discharge the patient and this was attained as an average despite the greater Baseline deficit in the InterX group. Eight control patients and three

  3. Non-invasive interactive neurostimulation (InterX™) reduces acute pain in patients following total knee replacement surgery: a randomised, controlled trial.

    Science.gov (United States)

    Nigam, Ashok K; Taylor, Drena M; Valeyeva, Zulia

    2011-08-24

    Adequate post-operative pain relief following total knee replacement (TKR) is very important to optimal post-operative recovery. Faster mobilisation and rehabilitation ultimately results in optimum recovery outcomes, but pain is often the limiting factor. This study evaluates the potential clinical benefit of the InterX neurostimulation device on pain reduction and rehabilitative outcome. A clinical trial under the Hywel Dda Clinical Audit Committee to validate the clinical benefit of Non-invasive Interactive Neurostimulation (NIN) therapy using the InterX device was performed in patients undergoing TKR. 61 patients were randomised to treatment groups in blocks of two from the Theatre Operation List. The control group received the standard hospital course of pain medication and rehabilitation twice daily for 3 post-op days. The experimental group received 8 sessions of NIN therapy over 3 post-op days in addition to the standard course received by the Control group. Pain and range of motion were collected as the primary study measures. Sixty one subjects were enrolled and randomised, but 2 subjects (one/group) were excluded due to missing data at Baseline/Final; one subject in the InterX group was excluded due to pre-existing rheumatoid pain conditions confounding the analysis. The experimental group pre- to post-session Verbal Rating Scale for pain (VRS) showed that NIN therapy consistently reduced the pain scores by a mean of 2.3 points (SE 0.11). The NIN pre-treatment score at Final was used for the primary ANCOVA comparison, demonstrating a significantly greater cumulative treatment effect of a mean 2.2 (SE 0.49) points pain reduction (p = 0.002). Control subjects only experienced a mean 0.34 (SE 0.49) point decrease in pain. Ninety degrees ROM was required to discharge the patient and this was attained as an average despite the greater Baseline deficit in the InterX group. Eight control patients and three experimental patients did not achieve this ROM. The

  4. Traumatic dislocation of the first carpometacarpal joint.

    Science.gov (United States)

    Kraus, Chadd K; Weaver, Kevin R

    2014-12-01

    We present a case report and review of the literature of traumatic dislocation of the carpometacarpal joint of the left thumb without associated fracture. The injury was sustained while skiing, and after emergency department diagnosis, the dislocation was reduced and the joint stabilized with a splint. The patient was discharged with close follow-up with a hand surgeon for definitive surgical fixation. Carpometacarpal joint dislocations of the thumb are exceedingly rare injuries and require appropriate diagnosis and treatment to minimize the morbidity and loss of function that can occur with these injuries.

  5. Bilateral carpometacarpal joint dislocations of the thumb.

    Science.gov (United States)

    Jeong, Changhoon; Kim, Hyoung-Min; Lee, Sang-Uk; Park, Il-Jung

    2012-09-01

    A traumatic carpometacarpal joint dislocation of the thumb accounts for less than 1% of all hand injuries. Optimal treatment strategies for this injury are still a subject of debate. In this article, we report a case of bilateral thumb carpometacarpal joint dislocations: a unique combination of injuries. We believe our case is the second report of bilateral carpometacarpal joint dislocation regarding the thumb in English literature. It was successfully treated with closed reduction and percutaneous K-wires fixation on one side, and an open reduction and reconstruction of the ligament on the other side.

  6. Early Intraprosthetic Dislocation of a Dual Mobility Acetabular Construct after Total Hip Arthroplasty.

    Science.gov (United States)

    Tyagi, Vineet; Akinbo, Oluwaseun

    2017-01-01

    The concept of a dual mobility (DM) cup has been in existence for more than 40 years and was initially popularized in Europe. Only recently has it started to garner attention in the United States. Its design, consisting of a small femoral head articulating within a larger polyethylene (PE) insert, which articulates with an outer shell, has found increasing use in patients that are at risk for post-operative dislocations. This case report describes a case of recurrent total hip arthroplasty (THA) dislocation managed with the implantation of a DM cup with an acute intraprosthetic dislocation of the DM construct. A 52-year-old woman underwent an uneventful left THA through a posterior approach. Within 6 weeks of her surgery, she had four dislocations, managed with closed reductions. She then underwent an open revision of her acetabular component with conversion to a DM construct. 5 weeks after her revision, she had another dislocation treated with closed reduction in the operating room, with the resultant eccentric location of the femoral head in the acetabular component. Computed tomography (CT) confirmed intraprosthetic dislocation with the PE liner lodged in the gluteal tissue. She was taken to the operating room with a plan to revise her acetabular component to another DM construct, but with an increase in the anteversion despite initial anteversion being "appropriate" on CT imaging. Intraoperatively, the PE liner was embedded in gluteal tissue as depicted on the CT. The abductors were intact. There was no impingement in extension and maximal external rotation when trialed with a conventional head/liner construct. A new DM construct was then implanted. Intraprosthetic dislocation is a rare occurrence and unique complication to DM constructs. It is not common in the short-term setting postoperatively to our knowledge, and this case report represents an early report of intraprosthetic dislocation in the literature. Care should be taken during reduction of dislocated

  7. Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis.

    Science.gov (United States)

    Zheng, Xiaozuo; Kang, Kai; Li, Tong; Lu, Bo; Dong, Jiangtao; Gao, Shijun

    2014-12-01

    The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials.

  8. Traumatic hip dislocation; a South East Nigeria hospital experience ...

    African Journals Online (AJOL)

    Background: Hip dislocation is a relatively common orthopaedic emergency. The hip is an inherently stable joint and substantial force is required for dislocation to occur. Thus hip dislocation is said to follow motor vehicle accidents with more than 90% of hip dislocations being posterior. Thompson and Epstein grade I and II ...

  9. Monteggia fracture-dislocation: a case report, its' initial management ...

    African Journals Online (AJOL)

    Fracture of proximal ulna and dislocation of the proximal radio-ulna joint in the same arm is called Monteggia fracture- dislocation. Four clinical variants of this fracture- dislocation have been described in literature. This is a report and description of initial management of a fracture- dislocation, which was consequent to a ...

  10. Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Marcel Jun Sugawara Tamaoki

    Full Text Available CONTEXT AND OBJECTIVE: Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. DESIGN AND SETTING: Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp. METHODS: From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. RESULTS: Forty-two patients were included: 20 in the group without analgesia (control group and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0, standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001 and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001. There was one failure in the control group. There were no other complications in either group. CONCLUSION: Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. CLINICAL TRIAL REGISTRATION: ISRCTN27127703.

  11. Mechanisms for decoration of dislocations by small dislocation loops under cascade damage conditions

    DEFF Research Database (Denmark)

    Trinkaus, H.; Singh, B.N.; Foreman, A.J.E.

    1997-01-01

    In metals under cascade damage conditions, dislocations are frequently found to be decorated with a high density of small clusters of self-interstitial atoms (SIAs) in the form of dislocation loops, particularly during the early stages of the microstructural evolution in well annealed pure metals....... This effect may arise as a result of either (a) migration and enhanced agglomeration of single SIAs in the form of loops in the strain field of the dislocation or (b) glide and trapping of SIA loops (produced directly in the cascades) in the strain field of the dislocation, In the present paper, both...... of these possibilities are examined. It is shown that the strain field of the dislocation causes a SIA depletion in the compressive as well as in the dilatational region resulting in a reduced rather than enhanced agglomeration of SIAs. (SIA depletion may, however, induce enhanced vacancy agglomeration near dislocations...

  12. Ipsilateral open anterior hip dislocation and open posterior elbow dislocation in an adult.

    Science.gov (United States)

    Kumar, Sunil; Rathi, Akhilesh; Sehrawat, Sunil; Gupta, Vikas; Talwar, Jatin; Arora, Sumit

    2014-01-01

    Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.

  13. RECURRENT SHOULDER DISLOCATION: ASPECTS BETWEEN THE FIRST EPISODE AND SURGICAL TREATMENT.

    Science.gov (United States)

    Ikemoto, Roberto Yukio; Murachovsky, Joel; Strose, Eric; Nascimento, Luís Gustavo Prata; Bueno, Rogério Serpone; Almeida, Luís Henrique Oliveira

    2009-01-01

    To determine: 1) whether the patients had been oriented to use immobilization for at least four weeks and which type of immobilization was prescribed, 2) how many dislocations occurred until the patient received information about the need of surgery, 3) How long it takes for patients to have an appointment with a shoulder surgeon, 4) How many dislocations the patient had at the time of surgery. Of the 100 patients surgically treated or waiting for surgery at outpatient facilities, we interviewed 61 patients with questions related to the mechanism of dislocation, emergency service sites, guidelines for acute event treatment and follow-up, time elapsed until surgery and follow-up. Collected data were submitted to analysis. Only 13 patients (22%) had received correct information about their lesion, prognosis concerning recurrence, and about the need of surgery and expert follow-up in recurrent cases. None of our patients received proper information about type and duration of immobilization. None of our patients had received proper orientation to remain immobilized for four weeks, and the types of immobilization vary from a handmade sling to a manufactured Velpeau. Most of our patients (78%) did not receive proper orientation about specialized follow-up and surgery after their second episode of dislocation. The time for a specialized appointment with shoulder surgeon ranges from four to six months, with 1-100 dislocation episodes at the moment of surgery.

  14. Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature

    Directory of Open Access Journals (Sweden)

    Francisco J. Ascaso

    2015-01-01

    Full Text Available Posterior chamber intraocular lens (PC-IOL subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.

  15. POSTERIOR STERNOCLAVICULAR JOINT DISLOCATION IN A DIVISION I FOOTBALL PLAYER: A CASE REPORT.

    Science.gov (United States)

    Cruz, Mario F; Erdeljac, Joe; Williams, Richard; Brown, Mike; Bolgla, Lori

    2015-10-01

    Posterior dislocation of the sterno-clavicular (SC) joint is a rare injury in athletes. It normally occurs in high collision sports such as American football or rugby. Acute posterior dislocations of the SC joint can be life-threatening as the posteriorly displaced clavicle can cause damage to vital vascular and respiratory structures such as the aortic arch, the carotid and subclavian arteries, and the trachea. The potential severity of a posterior SC joint dislocation provides multiple challenges for clinicians involved in the emergency care and treatment of this condition. Integration of clinical examination observations, rapid critical thinking, and appropriate diagnostic imaging are often required to provide the best management and outcome for the injured athlete. The criterion for return-to-play and participation in collision sports after suffering a posterior dislocation of the SC joint are unclear due to the rarity of this injury. The purpose of this case report is to describe the management, from the initial on-field evaluation through the return-to-sport, of a collegiate Division I football player following a traumatic sports-related posterior SC joint dislocation. The rehabilitation process and the progression to return to participation are also presented and briefly discussed. 4-Single case report.

  16. Atlas shrugged: cervical myelopathy caused by congenital atlantoaxial dislocation aggravated by child labor.

    Science.gov (United States)

    Parikh, Roneil N; Muranjan, Mamta; Karande, Sunil; Sankhe, Shilpa

    2014-04-01

    Symptomatic atlantoaxial dislocation is common in predisposing genetic or acquired disorders. However, an isolated atlantoaxial dislocation frequently is congenital and silent unless discovered during course of evaluation for neurological symptoms of cervical spinal cord injury attributed to minor or chronic, repetitive trauma. A 12-year-old girl working as a farm laborer developed calf pain provoked by walking, which increased in severity and progressed to involve the upper limbs. It was followed by progressive ascending quadriplegia. The illness resembled acute inflammatory demyelinating polyneuropathy with respiratory involvement. Presence of "claw" hands bilaterally and wasting of intrinsic muscles of the hands led to the suspicion of a cervical myelopathy. Neuroimaging confirmed a congenital atlantoaxial dislocation with basilar invagination. The absence of abnormal signals in the cervical spinal cord was unusual. The symptomatic congenital atlantoaxial dislocation was postulated to be precipitated by chronic trauma suffered while habitually carrying heavy loads on the head and leading to spinal cord injury without radiographic abnormalities. Correction via surgery was successful. Congenital atlantoaxial dislocation should be suspected in a clinical setting of neurological symptoms of cervical spinal cord injury without obvious trauma or predisposing primary diseases. Prompt cervical spine imaging reveals the correct diagnosis. Physicians in countries in which child labor is rampant should be aware of the potential complications of cervical cord injuries from child labor. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Surgical versus nonsurgical treatment in first traumatic anterior dislocation of the shoulder in athletes

    Directory of Open Access Journals (Sweden)

    Gustavo Gonçalves Arliani

    2011-03-01

    Full Text Available Gustavo Gonçalves Arliani, Diego da Costa Astur, Carina Cohen, Benno Ejnisman, Carlos Vicente Andreoli, Alberto Castro Pochini, Moises CohenCentro de Traumatologia do Esporte (CETE, Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo, São Paulo, BrazilAbstract: Anterior traumatic dislocation is a common problem faced by orthopedic surgeons. After the first episode of shoulder dislocation, a combination of lesions can lead to chronic instability. The management in treatment of young athletes after the first acute anterior shoulder dislocation is controversial. The available literature supports early surgical treatment for young male athletes engaged in highly demanding physical activities after the first episode of traumatic dislocation of the shoulder. This is because of the best functional results and lower recurrence rates obtained with this treatment in this population. However, further clinical trials of good quality comparing surgical versus nonsurgical treatment for well-defined lesions are needed, especially for categories of patients who have a lower risk of recurrence.Keywords: athlete, conservative treatment, surgical treatment, immobilization, stabilization, primary treatment, shoulder dislocation

  18. Jumper's Knee (Patellar Tendonitis) (For Parents)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Jumper's Knee (Patellar Tendonitis) KidsHealth / For Parents / Jumper's Knee (Patellar ... prevent continued damage to the knee. How the Knee Works To understand how jumper's knee happens, it ...

  19. Wear in human knees

    Directory of Open Access Journals (Sweden)

    M.L. Wang

    2015-06-01

    Full Text Available Wear occurs in natural knee joints and plays a pivotal factor in causing articular cartilage degradation in osteoarthritis (OA processes. Wear particles are produced in the wear process and get involved in inflammation of human knees. This review presents progresses in the mechanical and surface morphological studies of articular cartilages, wear particles analysis techniques for wear studies and investigations of human knee synovial fluid in wear of human knees. Future work is also included for further understanding of OA symptoms and their relations which may shed light on OA causes.

  20. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...... surgeon seems to positively influence the rate of surgical complications and implant survival. The painful TKA knee should be thoroughly evaluated, but not revised except if a relevant indication can be established. The most frequent indications for revision are: aseptic loosening, instability, infection...

  1. Dislocation nucleation facilitated by atomic segregation

    Science.gov (United States)

    Zou, Lianfeng; Yang, Chaoming; Lei, Yinkai; Zakharov, Dmitri; Wiezorek, Jörg M. K.; Su, Dong; Yin, Qiyue; Li, Jonathan; Liu, Zhenyu; Stach, Eric A.; Yang, Judith C.; Qi, Liang; Wang, Guofeng; Zhou, Guangwen

    2018-01-01

    Surface segregation--the enrichment of one element at the surface, relative to the bulk--is ubiquitous to multi-component materials. Using the example of a Cu-Au solid solution, we demonstrate that compositional variations induced by surface segregation are accompanied by misfit strain and the formation of dislocations in the subsurface region via a surface diffusion and trapping process. The resulting chemically ordered surface regions acts as an effective barrier that inhibits subsequent dislocation annihilation at free surfaces. Using dynamic, atomic-scale resolution electron microscopy observations and theory modelling, we show that the dislocations are highly active, and we delineate the specific atomic-scale mechanisms associated with their nucleation, glide, climb, and annihilation at elevated temperatures. These observations provide mechanistic detail of how dislocations nucleate and migrate at heterointerfaces in dissimilar-material systems.

  2. Evaluation and treatment of prosthetic hip dislocation

    National Research Council Canada - National Science Library

    Dabaghi, A; Saleme, J; Ochoa, L

    2014-01-01

    Hip dislocation is the second most common complication of total hip arthroplasty followed by aseptic loosening, is the second most common complication of THA presenting with an incidence of 2.4-3.9...

  3. Strain rate sensitivity analysis in phase-field dislocation dynamics

    OpenAIRE

    Cao, Lei; Koslowski, Marisol

    2014-01-01

    We present dislocation simulations involving the collective behavior of partials and extended full dislocations in nanocrystalline (nc) materials. Although atomistic simulations have shown the importance of including partial dislocations in high strain rate simulations, the behavior of partial dislocations in complex geometries with low strain rates has not been explored. To account for the dissociation of dislocations into partials we include the full representation of the gamma surface for ...

  4. The Character of Dislocations in LiCoO2

    OpenAIRE

    Gabrisch, H.; Yazami, R.; Fultz, B.

    2002-01-01

    Dislocations in LiCoO2 were observed by transmission electron microscopy, and their Burgers vectors were determined by analysis of diffraction contrast in tilting experiments. The configuration of all dislocations indicates that they are glissile, and dislocation configurations were found that are indicative of active slip planes. Perfect dislocations of a/3 type Burgers vectors were observed on {0001} habit planes. These perfect dislocations sometimes dissociate into Shockley partial disloca...

  5. Posterior sternoclavicular dislocation: an American football injury

    DEFF Research Database (Denmark)

    Marker, L B; Klareskov, B

    1996-01-01

    Posterior dislocation of the sternoclavicular joint is uncommon, accounting for less than 0.1% of all dislocations. Since 1824 a little more than 100 cases have been reported, and the majority in the past 20 years. A review of published reports suggests that this injury is seen particularly in co...... in connection with American football. A typical case is described. The importance of this injury is that there is often a delay in diagnosis with potentially serious complications....

  6. Posterior sternoclavicular dislocation: an American football injury

    DEFF Research Database (Denmark)

    Marker, L B; Klareskov, B

    1996-01-01

    Posterior dislocation of the sternoclavicular joint is uncommon, accounting for less than 0.1% of all dislocations. Since 1824 a little more than 100 cases have been reported, and the majority in the past 20 years. A review of published reports suggests that this injury is seen particularly...... in connection with American football. A typical case is described. The importance of this injury is that there is often a delay in diagnosis with potentially serious complications....

  7. Dislocation dynamics of web type silicon ribbon

    Science.gov (United States)

    Dillon, O. W., Jr.; Tsai, C. T.; De Angelis, R. J.

    1987-01-01

    Silicon ribbon grown by the dendritic web process passes through a rapidly changing thermal profile in the growth direction. This rapidly changing profile induces stresses which produce changes in the dislocation density in the ribbon. A viscoplastic material response function (Haasen-Sumino model) is used herein to calculate the stresses and the dislocation density at each point in the silicon ribbon. The residual stresses are also calculated.

  8. Slip patterns and preferred dislocation boundary planes

    DEFF Research Database (Denmark)

    Winther, G.

    2003-01-01

    The planes of deformation induced extended planar dislocation boundaries are analysed in two different co-ordinate systems, namely the macroscopic system defined by the deformation axes and the crystallographic system given by the crystallographic lattice. The analysis covers single and polycryst......The planes of deformation induced extended planar dislocation boundaries are analysed in two different co-ordinate systems, namely the macroscopic system defined by the deformation axes and the crystallographic system given by the crystallographic lattice. The analysis covers single...

  9. Compound transstyloid, transscaphoid, perilunate fracture dislocation

    Directory of Open Access Journals (Sweden)

    Nadeem Ali

    2013-01-01

    Full Text Available Compound fracture dislocations of proximal carpal bones are very rare. We report a 26-year-old male, Defense personnel by profession, who sustained a compound Gustilo Anderson type IIIA transstyloid, transscaphoid, perilunate dislocation. The patient underwent primary proximal row carpectomy and stabilization with uni-planar, uni-lateral external fixator, and K-Wires. On follow-up after a year, the patient had almost negligible range of motion around wrist without any significant discomfort.

  10. Incidence of Posttraumatic Shoulder Dislocation in Poland.

    Science.gov (United States)

    Szyluk, Karol J; Jasiński, Andrzej; Mielnik, Michał; Koczy, Bogdan

    2016-10-25

    BACKGROUND The incidence of shoulder joint dislocation has been estimated at 11-26 per 100 000 population per year. In our opinion, basic epidemiological data need to be continually updated in studies of large populations. To study the incidence of posttraumatic dislocation of the shoulder joint in the Polish population. MATERIAL AND METHODS We retrospectively investigated the entire Polish population between 1 January 2010 and 1 January 2015. To identify the study group, data collected in the electronic database of the National Health Fund were used. The study group was divided into subgroups to detect possible differences in the incidence of shoulder dislocation with regard to age, sex, and season of the year (month) when the dislocation occurred. RESULTS The cumulative size of the study sample was 192.72 million over the 5 years of the study. We identified 51 409 patients with first posttraumatic shoulder dislocation, at a mean age of 50.83 years (SD 21.12), from 0 to 104 years. The incidence of traumatic shoulder dislocations for the entire study group ranged from 24.75/100 000/year (number of posttraumatic shoulder dislocations per 100 000 persons per year) to 29.09/100 000/year, for a mean of 26.69/100 000/year. CONCLUSIONS In this study, the overall incidence of first-time posttraumatic shoulder dislocations in the Polish general population was 26.69 per 100 000 persons per year. These results are higher than estimates presented by other authors. It is necessary to study, regularly update, and monitor this problem in the general population.

  11. Posterior atlantoaxial dislocation without odontoid fracture

    Energy Technology Data Exchange (ETDEWEB)

    Chaudhary, Reema; Raut, Abhijit [King Edward VII Memorial Hospital, Department of Radiology, Parel, Mumbai (India); Chaudhary, Kshitij; Metkar, Umesh; Rathod, Ashok [King Edward VII Memorial Hospital, Department of Orthopaedics, Parel, Mumbai (India); Sanghvi, Darshana [King Edward VII Memorial Hospital, Department of Radiology, Parel, Mumbai (India); DMRD, DNB, Dadar, Mumbai (India)

    2008-04-15

    We report a case of posterior atlantoaxial dislocation without a fracture of the odontoid in a 35-year-old woman. There have been nine reported cases of similar injury in the English literature. The integrity of the transverse ligament following posterior atlantoaxial dislocations has not been well documented in these reports. In the present case, MRI revealed an intact transverse ligament, which probably contributed to the stability of the C1-C2 complex following closed reduction. (orig.)

  12. New clinical classification system for atlantoaxial dislocation.

    Science.gov (United States)

    Xu, JunJie; Yin, QingShui; Xia, Hong; Wu, ZengHui; Ma, XiangYang; Zhang, Kai; Wang, ZhiYun; Yang, JinCheng; Ai, FuZhi; Wang, JianHua; Liu, JingFa; Mai, XiaoHong

    2013-01-01

    The purpose of this study was to define a new clinical classification of atlantoaxial dislocation based on its clinical manifestations, namely reducible atlantoaxial dislocation (RAAD), irreducible atlantoaxial dislocation (IAAD), and fixed atlantoaxial dislocation (FAAD). A total of 107 patients with atlantoaxial dislocation were respectively treated based on this clinical classification, including 66 patients with RAAD, 39 patients with IAAD, and 2 patients with FAAD. Six of the 66 patients with RAAD with rotatory atlantoaxial dislocation were treated with traction and a cervical collar, 9 with fresh type II dens fracture were treated with cannulated screw fixation, and 51 were treated with posterior atlantoaxial or occipitocervical arthrodesis. Thirty-eight patients with IAAD received a transoral atlantoaxial reduction plate system, and 1 with a giant cell tumor was treated with lesion resection and vertebral reconstruction by a shaped titanium mesh system followed by posterior occipitocervical screw-rod fixation. The 2 patients with FAAD underwent anterior decompression and received a transoral atlantoaxial reduction plate system. Follow-up data were obtained for a minimum of 6 months. All patients' neurological symptoms improved postoperatively. Bony union was accomplished by 3-month follow-up. Donor-site infection was found in 1 patient, with no occurrence of other complications. This article proposes a new classification of atlantoaxial dislocation indicating the severity and difficulty in reduction of the atlantoaxial joint. The classification system assists with decision making regarding therapeutic options. Transoral atlantoaxial reduction plate fixation and posterior atlantoaxial screw-rod fixation are commonly performed for atlantoaxial dislocation. Copyright 2013, SLACK Incorporated.

  13. Dislocation of the talonavicular joint: case report.

    Science.gov (United States)

    Ross, P M; Mitchell, D C

    1976-05-01

    Dislocation of the talonavicular joint is rare, caused by severe abduction or adduction of the forefoot. Proper reduction is necessary to avoid equinovarus deformity, ankylosis, or degenerative arthritis. A case of talonavicular dislocation with fracture of the head of the talus in a 52-year old woman is reported, with delayed treatment by open reduction using Kirschner wires and casting for 7 weeks. This patient is successfully employed as a waitress 2 years postinjury.

  14. Extended Dislocations in Plastically Deformed Metallic Nanoparticles

    OpenAIRE

    Bin Zheng; Yi-Nong Wang; Min Qi; Huiling Du

    2016-01-01

    In the present study, the sawtooth nature of compressive loading of metallic nanoparticles is observed using a molecular dynamics simulation. The atomic structure evolution confirmed that extended dislocations are the main defects split into two asynchronous partial disloca‐ tions, along with stored and released fault energy. This is considered the essence of sawtooth loading. The size of the nanoparticles relative to the equilibrium width of the extended dislocation is discussed to explain t...

  15. [Surgical treatment for open dislocation of talus].

    Science.gov (United States)

    Han, Qing-lin; Wang, You-hua; Liu, Fan

    2011-07-01

    To evaluate the clinical effects of surgical treatment for open dislocation of talus. From June 2001 to July 2008,the complete data of 11 patients with open dislocations of talus were retrospectively analyzed, including 8 males and 3 females with an average age of 39.5 years (ranged 19 to 52). According to Gustilo typing, type I was in 2 cases, type II in 6 cases, type III A in 2 cases, type III B in 1 case. Five cases were tibial astragaloid joint dislocation in which 3 cases associated with subtalar joint dislocation, 4 cases were subtalar joint dislocation and 2 cases were total dislocation of talus. Among them, 8 dislocations associated with talus fractures. All patients were treated with debridement, open reduction, internal fixation with K-wires or screws and external fixation with plaster or external fixator within 8 hours after injury. External fixations were removed at 6 weeks after operation. Partial weight bearing was permitted only when X-rays indicated bony healing. Clinical effects were evaluated according to AOFAS system and X-ray films during follow-up. The mean time of follow-up was 13.8 months(ranged 10 to 15 months). Eight patients with fractures obtained bone healing in 4-7 months with an average of 4.3 months. No infection of wound or deep tissue was found. At final follow-up, talus necrosis was in 2 cases and traumatic arthritis was in 2 cases. The AOFAS score was 71.3 +/- 8.6, among the total, the pain, function, alignment was respectively (32.4 +/- 7.1), (31.0 +/- 15.7), (7.6 +/- 2.3) scores. Complete debridement may avoid infection in treating open dislocation of talus, early reduction and fixation is a key point during treatment.

  16. Extended Dislocations in Plastically Deformed Metallic Nanoparticles

    Directory of Open Access Journals (Sweden)

    Bin Zheng

    2016-05-01

    Full Text Available In the present study, the sawtooth nature of compressive loading of metallic nanoparticles is observed using a molecular dynamics simulation. The atomic structure evolution confirmed that extended dislocations are the main defects split into two asynchronous partial disloca‐ tions, along with stored and released fault energy. This is considered the essence of sawtooth loading. The size of the nanoparticles relative to the equilibrium width of the extended dislocation is discussed to explain the simulation results.

  17. Creep Deformation by Dislocation Movement in Waspaloy.

    Science.gov (United States)

    Whittaker, Mark; Harrison, Will; Deen, Christopher; Rae, Cathie; Williams, Steve

    2017-01-12

    Creep tests of the polycrystalline nickel alloy Waspaloy have been conducted at Swansea University, for varying stress conditions at 700 °C. Investigation through use of Transmission Electron Microscopy at Cambridge University has examined the dislocation networks formed under these conditions, with particular attention paid to comparing tests performed above and below the yield stress. This paper highlights how the dislocation structures vary throughout creep and proposes a dislocation mechanism theory for creep in Waspaloy. Activation energies are calculated through approaches developed in the use of the recently formulated Wilshire Equations, and are found to differ above and below the yield stress. Low activation energies are found to be related to dislocation interaction with γ' precipitates below the yield stress. However, significantly increased dislocation densities at stresses above yield cause an increase in the activation energy values as forest hardening becomes the primary mechanism controlling dislocation movement. It is proposed that the activation energy change is related to the stress increment provided by work hardening, as can be observed from Ti, Ni and steel results.

  18. Effect of dislocations on gallium arsenide FETs

    Science.gov (United States)

    Barrett, D. L.; McGuigan, S.; Eldridge, G. W.; Swanson, B. W.; Thomas, R. N.

    1985-02-01

    Indium doping at 5 x 10 to the 19th power/cc was found to be optimum for the growth of low-dislocation GaAs crystals, and to avoid constitutional supercooling effects. Dislocation etch pit densities of near 200/cc were measured in the central region of In-doped crystals, increasing to above 1000/sq cm in the peripheral regions. Based on the concept that dislocations are generated to relieve excess thermoelastic stress, a preliminary thermal model was used to design a hot zone shield to reduce thermal gradients during growth. An optimum combination of indium-doping, reduced thermal gradient growth, and appropriate growth parameters are expected to yield completely dislocation-free GaAs crystals. A FET metrology mask has been fabricated and preliminary FET device Fabrication begun, for evaluation of the effects of dislocations on FET device parameters. Twenty state-of-the-art, low dislocation, indium-doped GaAs wafers were delivered to the contractor for DARPA-related program evaluation.

  19. Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors

    Directory of Open Access Journals (Sweden)

    Zhang Jingwei

    2014-07-01

    Full Text Available 【Abstract】Objective: To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation. Methods: Twenty-eight patients with acute traumatic Rockwood III, IV and V dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited. All patients underwent open reduction combined with suture anchors. Function was evaluated using the ConstantMurley shoulder score. Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3, 6 and 12 months. Results:Two cases with fixation loosening were not included in final statistical analysis. Other patients obtained full joint reposition on immediate postoperative radiographs. Follow-up was performed with an average of 15.6 months (range, 12-19. After early range of motion exercises, 96.2% of the patients (25/26 could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months. There was no infection. Average Constant-Murley score was 96.3 points (range, 94-100 and mean Taft shoulder rating was 10.7 points (range, 8-12 at 12 months. Conclusion: The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation. Key words: Acromioclavicular joint; Dislocations; Surgery; Suture anchors

  20. Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture

    Science.gov (United States)

    2013-01-01

    Background This study aims to explore the technique of soft tissue balance and joint tension maintenance in total knee arthroplasty (TKA) for the rheumatoid arthritis (RA) patients with flexion contracture of the knee. Methods This retrospective study reviewed flexion contracture deformity of RA patients who underwent primary TKA and ligament and soft tissue balancing. Based on the flexion contracture deformity, the remaining 76 patients available for analysis were divided into two groups, i.e., severe flexion group (SF) and moderate flexion group (MF). Results There were no intraoperative complications in this study. All patients had improved Knee Society Rating System scores and range of motion. The flexion contracture was completely corrected in MF and SF patients. There were no cases of patellar dislocation, but three cases had mild mediolateral instability in severe flexion group. Four knees (two knees in SF versus two knees in MF) had transient peroneal nerve palsy but recovered after conservative therapy. Conclusions TKA can be performed successfully in the RA knees with severe flexion contracture. It is very important in TKA to maintain the joint stability in the condition of severe flexion contracture deformity of the RA knee. PMID:24229435

  1. [Dislocation of the atlantoaxial joint].

    Science.gov (United States)

    Koppe, D; Markart, M; Ertel, W

    2014-06-01

    Injuries of the cervical spine in adolescents only occur in 0.2 % of cases. Due to the mismatch of size of the head in comparison to the relatively weakly developed neck muscles at this age, the cranial section is more vulnerable to injuries of any kind compared to the lower sections of the cervical spine. In children isolated ligament trauma is more common than fractures due to the relatively good bone structure combined with a lower bone density but the risk for fractures increases with the age of the patient. Atlantoaxial dislocation (AAD) in children is a very rare mostly ligamentous injury. A differentiation is made between traumatic AAD and the much more common non-traumatic AAD described in the literature. Although the cause is still unknown different risk factors have been isolated that seem to increase the risk for non-traumatic AAD. The following article presents guidelines for the diagnosis and treatment of this rare type of injury and also describes the case of a 19-year-old female who presented at the emergency department with an AAD without a history of trauma. After successful closed repositioning the neck was stabilized in a semi-rigid cervical collar for 6 weeks.

  2. Surgical treatment of Rockwood grade-V acromioclavicular joint dislocations

    Science.gov (United States)

    2013-01-01

    Background and purpose Long-term outcome after surgery for grade-V acromioclavicular joint dislocation has not been reported. We performed a retrospective analysis of functional and radiographic outcome 15–22 years after surgery. Patients and methods We examined 50 patients who were treated at our hospital between April 1985 and December 1993. Various methods of stabilization were used: K-wires (n = 36), 4.5-mm screw (n = 12), or biodegradable screw (n = 2). Osteosynthesis material was removed after 6–8 weeks. Mean follow-up time was 18 (15–22) years. Outcomes were assessed with the Constant shoulder (CS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, the simple shoulder test (SST), the Copeland shoulder impingement test, the cross-arm test, pain, stability of the AC joint, and complications. From radiographs, we evaluated AC and glenohumeral (GH) arthrosis, osteolysis of the lateral clavicle, and alignment of the clavicle with the acromion. Results Mean values were 90 (75–100) in CS score, 5.1 (0–41) in DASH score, and 11 (2–12) in SST. There was no statistically significant difference in CS score between the injured shoulder and the uninjured shoulder. The AC joint was clinically stable in 42 patients. In 38 patients, the clavicle alignment with the acromion was normal in radiographs. Lateral clavicle osteolysis (10 patients) appeared to be associated with permanent AC joint dislocation. Interpretation Surgery with a temporary fixation for acute grade-V AC joint dislocation leads to successful long-term functional results. Only minor disability occurred in some patients. PMID:23409813

  3. Radiologic findings in cases involving complications arising from total knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Deok Ho; Ryu, Kyung Nam; Bae, Dae Kyung [Kyunghee Univ. Hospital, Seoul (Korea, Republic of)

    1999-09-01

    Total knee arthroplasty(TKA) has been used for the treatment of knee joint pain, deformity, and instability caused by osteoarthritis, rheumatoid arthritis, or tuberculous arthritis, and by virtue of good results and rapid development, the procedure has been increasingly employed. With the development of total knee prosthesis, complications have also increased, however, and due to complications occurring up to six years after surgery, fusion occurs in about 2% of all replaced knees. The most common complication of TKA is loosening, followed by infection. Others are thrombosis, subluxation, dislocation and fracture, and complications may be divided into four groups: biologic, technical, specific to type of components, and associated with certain diagnosis. Where these complications occur, a patient must undergo a second procedure, but the success rate is lower than for the initial procedure. Exact etiological evaluation important clinically and radiologically. We illustrate the etiologies and radiologic characteristics of TKA complications according to classification.

  4. Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis.

    Science.gov (United States)

    Gardner, Jacob K; Zhang, Songning; Liu, Hairui; Klipple, Gary; Stewart, Candice; Milner, Clare E; Asif, Irfan M

    2015-03-01

    Cycling is commonly prescribed for knee osteoarthritis, but previous literature on biomechanics during cycling and the effects of acute intervention on osteoarthritis patients does not exist. Due to their altered knee kinematics, osteoarthritis patients may be at greater risk of osteoarthritis progression or other knee injuries during cycling. This study investigated the effects of reduced foot progression (toe-in) angles on knee joint biomechanics in subjects with medial compartment knee osteoarthritis. Thirteen osteoarthritis and 11 healthy subjects participated in this study. A motion analysis system and custom instrumented pedal was used to collect 5 pedal cycles of kinematic and kinetic data in 1 neutral and 2 toe-in conditions (5° and 10°) at 60 RPM and 80W. For peak knee adduction angle, there was a 61% (2.7°) and a 73% (3.2°) decrease in the 5° and 10° toe-in conditions compared to neutral in the osteoarthritis group and a 77% (1.7°) and 109% (2.4°) decrease in the healthy group for the 5° and 10° conditions, respectively. This finding was not accompanied by a decrease in pain or peak knee abduction moment. A simple linear regression showed a positive correlation between Kelgren-Lawrence score and both peak knee adduction angle and abduction moment. For individuals who cycle with increased knee adduction angles, decreasing the foot progression angle may be beneficial for reducing the risk of overuse knee injuries during cycling by resulting in a frontal plane knee alignment closer to a neutral position. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Medial Patellofemoral Ligament Injuries in Children With First-Time Lateral Patellar Dislocations: A Magnetic Resonance Imaging and Arthroscopic Study.

    Science.gov (United States)

    Askenberger, Marie; Arendt, Elizabeth A; Ekström, Wilhelmina; Voss, Ulrika; Finnbogason, Throstur; Janarv, Per-Mats

    2016-01-01

    A lateral patellar dislocation (LPD) is the most common knee injury in children with traumatic knee hemarthrosis. The medial patellofemoral ligament (MPFL), the important passive stabilizer against LPDs, is injured in more than 90% of cases. The MPFL injury pattern is most often defined in adults or in mixed-age populations. The injury pattern in the skeletally immature patient may be different. To describe MPFL injuries in the skeletally immature patient by magnetic resonance imaging (MRI), and to compare the results with the injury pattern found at arthroscopic surgery. Case series; Level of evidence, 4. This was a prospective series of patients aged 9 to 14 years with acute, first-time traumatic LPDs in whom clinical examinations, radiographs, MRI, and arthroscopic surgery were performed within 2 weeks from the index injury. The MPFL injury was divided into 3 different groups according to the location: patellar site, femoral site, or multifocal. The MPFL injury site was confirmed on MRI by soft tissue edema. The length of the MPFL injury at the patellar site was measured at arthroscopic surgery, and those ≥2 cm were defined as total ruptures. A total of 74 patients (40 girls and 34 boys; mean age, 13.1 years) were included; 73 patients (99%) had an MPFL injury according to MRI and arthroscopic surgery. The MRI scans showed an isolated MPFL injury at the patellar attachment site in 44 of 74 patients (60%), a multifocal injury in 26 patients (35%), an injury at the femoral site in 3 patients (4%), and no injury in 1 patient (1%). Arthroscopic surgery disclosed an isolated MPFL injury at the patellar site in 60 of 74 patients (81%) and a multifocal injury in 13 patients (18%); the MPFL injury at the patellar site was a total rupture in 49 patients (66%). Edema at the patellar attachment site on MRI was proven to be an MPFL rupture at the same site at arthroscopic surgery in 99% of the patients. A patellar-based injury, isolated or as part of a multifocal injury

  6. Un trait du francais parle authentique: La dislocation. (A Trait of Authentic Spoken French: Dislocation.)

    Science.gov (United States)

    Calve, Pierre

    1983-01-01

    The dislocation of sentence elements in spoken French is seen as allowing the speaker to free himself from certain constraints imposed on word order, position of accents, and grammar. Dislocation is described, its various functions are enumerated, and implications for second language instruction are outlined. (MSE)

  7. Pneumatic osteoarthritis knee brace.

    Science.gov (United States)

    Stamenović, Dimitrije; Kojić, Milos; Stojanović, Boban; Hunter, David

    2009-04-01

    Knee osteoarthritis is a chronic disease that necessitates long term therapeutic intervention. Biomechanical studies have demonstrated an improvement in the external adduction moment with application of a valgus knee brace. Despite being both efficacious and safe, due to their rigid frame and bulkiness, current designs of knee braces create discomfort and difficulties to patients during prolonged periods of application. Here we propose a novel design of a light osteoarthritis knee brace, which is made of soft conforming materials. Our design relies on a pneumatic leverage system, which, when pressurized, reduces the excessive loads predominantly affecting the medial compartment of the knee and eventually reverses the malalignment. Using a finite-element analysis, we show that with a moderate level of applied pressure, this pneumatic brace can, in theory, counterbalance a greater fraction of external adduction moment than the currently existing braces.

  8. Musculoskeletal MR: knee

    Energy Technology Data Exchange (ETDEWEB)

    Staebler, A.; Glaser, C.; Reiser, M. [Dept. of Diagnostic Radiology, Klinikum Grosshadern, Ludwig-Maximilian Universitaet Muenchen (Germany)

    2000-02-01

    Magnetic resonance imaging is the most sensitive, specific, and accurate noninvasive method for diagnosing internal derangement of the knee. During the past 15 years knowledge of pathologic conditions of the knee had evolved significantly. Beyond the basic principles of imaging knee injuries great impact was made on the understanding of indirect or collateral findings, even in rare diseases. In this article the spectrum of disorders of the knee are reviewed and an overview of the current literature is given. This includes considerations about how to achieve a high-standard MR imaging study of the knee, and principles of imaging anterior cruciate ligament and meniscal tears. A focus is put on distinct diseases including intra-articular and intraosseous ganglion cysts, iliotibial band friction syndrome, transient osteoporosis, osteonecrosis, osteochondritis dissecans, and imaging of the articular cartilage. (orig.)

  9. Hybrid Dislocated Control and General Hybrid Projective Dislocated Synchronization for Memristor Chaotic Oscillator System

    Directory of Open Access Journals (Sweden)

    Junwei Sun

    2014-01-01

    Full Text Available Some important dynamical properties of the memristor chaotic oscillator system have been studied in the paper. A novel hybrid dislocated control method and a general hybrid projective dislocated synchronization scheme have been realized for memristor chaotic oscillator system. The paper firstly presents hybrid dislocated control method for stabilizing chaos to the unstable equilibrium point. Based on the Lyapunov stability theorem, general hybrid projective dislocated synchronization has been studied for the drive memristor chaotic oscillator system and the same response memristor chaotic oscillator system. For the different dimensions, the memristor chaotic oscillator system and the other chaotic system have realized general hybrid projective dislocated synchronization. Numerical simulations are given to show the effectiveness of these methods.

  10. Screw dislocation-driven epitaxial solution growth of ZnO nanowires seeded by dislocations in GaN substrates.

    Science.gov (United States)

    Morin, Stephen A; Jin, Song

    2010-09-08

    In the current examples of dislocation-driven nanowire growth, the screw dislocations that propagate one-dimensional growth originate from spontaneously formed highly defective "seed" crystals. Here we intentionally utilize screw dislocations from defect-rich gallium nitride (GaN) thin films to propagate dislocation-driven growth, demonstrating epitaxial growth of zinc oxide (ZnO) nanowires directly from aqueous solution. Atomic force microscopy confirms screw dislocations are present on the native GaN surface and ZnO nanowires grow directly from dislocation etch pits of heavily etched GaN surfaces. Furthermore, transmission electron microscopy confirms the existence of axial dislocations. Eshelby twist in the resulting ZnO nanowires was confirmed using bright-/dark-field imaging and twist contour analysis. These results further confirm the connection between dislocation source and nanowire growth. This may eventually lead to defect engineering strategies for rationally designed catalyst-free dislocation-driven nanowire growth for specific applications.

  11. Isolated Radiopalmar Dislocation of Fifth Carpometacarpal Joint: A Rare Presentation.

    Science.gov (United States)

    Hegde, Atmananda S; Shenoy, R M; Arif, Salauddin; Shetty, Abhishek; Babu, Rajan

    2015-09-01

    Carpometacarpal (CMC) joint dislocations are uncommon injuries that account for less than 1% of hand injuries. Dorsal dislocations of the CMC joints are more frequent than volar dislocations. Palmar dislocations can be either ulnopalmar or radiopalmar. There are very few reports of isolated radiopalmar dislocations of the fifth CMC joint in the English-language literature. In our case of radiopalmar dislocation, diagnosis was delayed, and attempts at closed reduction were unsuccessful. Therefore, it was treated by open reduction and Kirschner-wire fixation. This article reports a rare type of injury and discusses its management.

  12. Salam: Of Dislocation, Marginality and Flexibility

    Directory of Open Access Journals (Sweden)

    Efenita M. Taqueban

    2012-12-01

    Full Text Available This paper reconstructs the life stories of residents of SalamCompound. The compound serves as entry point for many Muslim migrants who leave the southern Philippines. Salam is both a refuge and a halfway point. A sense of dislocation permeates the stories. Dislocation begins with the movement away from a homeland that is familiar and defining of identity. The dislocation is, in a sense, an escape, a desperate project to avoid armed conflict in the southern Philippines or a desperate enterprise in search of work.Salam is a halfway point for transients prospecting for overseas work, the staging area for a global labor exodus. The sense of dislocation is not unlike locating oneself in the margins, portrayed in the residents’ negotiated identitiesand spaces, constantly challenged, implicitly regulated. Dislocation is also depicted as flexibility, portrayed by the residents making do and their everyday creative resistance and struggle in new locations in the city. Gathered throughethnographic method, the stories offer a glimpse into the lives of the residents of the compound, how they negotiate around social constructions of identities — resisting and accommodating internal and external forces that impinge ontheir lives, revealing a rich and poignant tapestry of family relations, community ironies and an ever-impinging world beyond its walls.

  13. Isolated dorsal dislocation of the tarsal naviculum.

    Science.gov (United States)

    Hamdi, Kaziz; Hazem, Ben Ghozlen; Yadh, Zitoun; Faouzi, Abid

    2015-01-01

    Isolated dislocation of the tarsal naviculum is an unusual injury, scarcely reported in the literature. The naviculum is surrounded by the rigid bony and ligamentous support hence fracture dislocation is more common than isolated dislocation. The mechanism and treatment options remain unclear. In this case report, we describe a 31 year old man who sustained an isolated dorsal dislocation of the left tarsal naviculum, without fracture, when he was involved in a motor vehicle collision. The reported mechanism of the dislocation is a hyper plantar flexion force applied to the midfoot, resulting in a transient disruption of the ligamentous support of the naviculum bone, with dorsal displacement of the bone. The patient was treated with open reduction and Krischner-wire fixation of the navicular after the failure of closed reduction. The wires were removed after 6 weeks postoperatively. Physiotherapy for stiffness and midfoot pain was recommended for 2 months. At 6 months postoperatively, limping, midfoot pain and weakness were reported, no X-ray abnormalities were found. The patient returned to his obvious activities with a normal range of motion.

  14. Isolated dorsal dislocation of the tarsal naviculum

    Directory of Open Access Journals (Sweden)

    Kaziz Hamdi

    2015-01-01

    Full Text Available Isolated dislocation of the tarsal naviculum is an unusual injury, scarcely reported in the literature. The naviculum is surrounded by the rigid bony and ligamentous support hence fracture dislocation is more common than isolated dislocation. The mechanism and treatment options remain unclear. In this case report, we describe a 31 year old man who sustained an isolated dorsal dislocation of the left tarsal naviculum, without fracture, when he was involved in a motor vehicle collision. The reported mechanism of the dislocation is a hyper plantar flexion force applied to the midfoot, resulting in a transient disruption of the ligamentous support of the naviculum bone, with dorsal displacement of the bone. The patient was treated with open reduction and Krischner-wire fixation of the navicular after the failure of closed reduction. The wires were removed after 6 weeks postoperatively. Physiotherapy for stiffness and midfoot pain was recommended for 2 months. At 6 months postoperatively, limping, midfoot pain and weakness were reported, no X-ray abnormalities were found. The patient returned to his obvious activities with a normal range of motion.

  15. Structure of the Dislocation in Sapphire

    DEFF Research Database (Denmark)

    Bilde-Sørensen, Jørgen; Thölen, A. R.; Gooch, D. J.

    1976-01-01

    Experimental evidence of the existence of 01 0 dislocations in the {2 0} prism planes in sapphire has been obtained by transmission electron microscopy. By the weak-beam technique it has been shown that the 01 0 dislocations may dissociate into three partials. The partials all have a Burgers vector...... of ⅓ 01 0 and are separated by two identical faults. The distance between two partials is in the range 75-135 Å, corresponding to a fault energy of 320±60 mJ/m2. Perfect 01 0 dislocations have also been observed. These dislocations exhibited either one or two peaks when imaged in the (03 0) reflection...... by the weak-beam technique. The interpretation of the electron micrographs has been supported by computer simulation of the dislocation images. A faulted dipole has been observed, indicating that some of the prismatic loops often seen to lie in rows along [0001] are faulted with a ⅓ 01 0 Burgers vector...

  16. [Intra-articular knee stabilization with synthetic material. A practice-oriented stabilization technic].

    Science.gov (United States)

    Lieben, N H

    1986-12-01

    An intra-articular method designed to stabilise the knee joint using synthetic material after rupture of the anterior cruciate ligament is described. The results obtained in forty dogs and two cats treated by this method during the period from 1980 to 1985, are reported. The morbid-anatomical findings within fourteen months after surgery are referred to in one case. Rejection of the ligament was not observed in a single case. When habitual or stationary medial dislocation of the patella was present in addition to a lesion of the anterior cruciate ligament, the patella was no longer found to be subject to dislocation following stabilisation of the knee joint. Clinical results ranged from moderate to satisfactory, varying with the degree of arthrosis and the lesions of the meniscus which were present. This technique does not take up much time and consequently saves expenses.

  17. Gonalgia entre trabalhadores e fatores ocupacionais associados: uma revisão sistemática Knee pain and associated occupational factors: a systematic review

    Directory of Open Access Journals (Sweden)

    Marcelo Cozzensa da Silva

    2007-08-01

    Full Text Available Com o objetivo de reunir informações sobre gonalgia entre trabalhadores e fatores ocupacionais associados, foi realizada uma revisão sistemática nas bases de dados MEDLINE, LILACS, SciELO, Free Medical Journals, entre outros, referentes ao período 1990-2006, usando-se os descritores gonalgia, knee, knee pain, knee joint, knee dislocation, knee injuries, work, workplace, workload, employment, occupations, industry, occupational, workers, arthrosis, osteoarthritis e seus equivalentes em português e espanhol. Dos 2.263 estudos inicialmente encontrados, somente 26 cumpriram os critérios necessários para permanecer na revisão. As prevalências de gonalgia nos últimos 12 meses variaram entre 11,2% e 60,9%, e os principais fatores associados foram: sexo feminino, idade avançada, índice de massa corporal elevado, trabalhar ajoelhado e carregar peso no trabalho.In order to collect information on knee pain and associated occupational factors, a systematic review was conducted using the MEDLINE, LILACS, SciELO, and Free Medical Journals databases, from 1990 to 2006. Key words were: gonalgia, knee, knee pain, knee joint, knee dislocation, knee injuries, work, workplace, workload, employment, occupations, industry, occupational, workers, arthrosis, and osteoarthritis. Equivalent terms in Portuguese and Spanish were also used. From the initial 2,263 studies gathered, only 26 met the review's inclusion criteria. Knee pain prevalence in the previous 12 months ranged from 11.2% to 60.9%. The main associated factors were: female gender, older age, high body mass index, kneeling working position, and lifting at work.

  18. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise......, and - at least in the younger patients - more cementless implants. Trends related to organization are implementation of the fast track concept, which has reduced morbidity and length of stay, and concentration in larger units, which will also decrease morbidity and mortality. An annual volume of >25 TKAs per...

  19. Femoral head fracture without hip dislocation

    Directory of Open Access Journals (Sweden)

    Aggarwal Aditya K

    2013-10-01

    Full Text Available 【Abstract】Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries. Key words: Femur head; Hip dislocation; Classification; Arthroplasty, replacement, hip

  20. Suture rupture in acromioclavicular joint dislocations treated with flip buttons.

    Science.gov (United States)

    Motta, Pierorazio; Maderni, Alberto; Bruno, Laura; Mariotti, Umberto

    2011-02-01

    Acute acromioclavicular joint dislocations (ACDs) may be treated arthroscopically with flip buttons. This extra-articular fixation is easy to implant and is well tolerated. Between 2007 and 2009, 20 ACD patients (2 women and 18 men; mean age, 32 years) had surgery by the arthroscopic TightRope technique (Arthrex, Naples, FL). The main complication of this technique that has been reported is the partial loss of reduction at follow-up due to clavicular osteolysis under the superior flip button. We describe 4 cases with loss of reduction due to rupture of the sutures running across the buttons: 2 women with joint hyperlaxity and acute Rockwood grade IV ACD and 2 men, heavy manual workers, with joint hyperlaxity and acute Rockwood grade IV ACD. The use of flip buttons might not be indicated in patients with joint hyperlaxity because they are able to obtain immediate stability only on the vertical plane and not on the horizontal plane. Anteroposterior movements of the acromioclavicular joint might rub the suture against the bone tunnels leading to wear and cutting. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  1. Dislocation microstructure evolution in cyclically twisted microsamples: a discrete dislocation dynamics simulation

    Science.gov (United States)

    Senger, J.; Weygand, D.; Kraft, O.; Gumbsch, P.

    2011-10-01

    Miniaturization in technical devices has increased interest in the investigation of the deformation and fatigue behaviour of metals in the micrometre regime. Due to the small dimensions of these devices, mechanical properties depend on the motion of a marginal number of dislocations. In this paper, the evolution of dislocation microstructure in torsion loaded single crystalline aluminium wires is analysed by three-dimensional discrete dislocation dynamics simulations. It is shown that the size of pile-ups and the number of the active slip systems is significantly influenced by cross-slip events independent of the crystallographic orientation. Dislocations are driven by the stress gradient from the applied loading to move into the centre of the sample. These dislocations cannot escape through the surface because of the reversal of the sign of the stress in the centre of the sample. If the micrometre-sized specimens are untwisted, the remaining dislocation microstructure in these samples depends on the maximum torsion angle reached before unloading. The larger the torsion angle, the higher is the remaining dislocation density in the unloaded specimens. These results are discussed with respect to cyclic deformation mechanisms at small scale.

  2. Functional treatment versus plaster for simple elbow dislocations (FuncSiE): A randomized trial

    NARCIS (Netherlands)

    J. de Haan (Jeroen); D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); G.I.T. Iordens (Gijs); R.S. Breederveld (Roelf S.); M.W.G.A. Bronkhorst (Maarten); M.M.M. Bruijninckx (Milko); M.R. de Vries (Mark); B.J. Dwars (Boudewijn); D. Eygendaal (Denise); R. Haverlag (Robert); S.A.G. Meylaerts (Sven); J.W. Mulder (Jan-Willem); K.J. Ponsen (Kees-jan); W.H. Roerdink (Herbert); G.R. Roukema (Gert); I.B. Schipper (Inger); M.A. Schouten (Michel); J.B. Sintenie (Jan Bernard); S. Sivro (Senail); J.G.H. van den Brand (Johan); H.G.W.M. Meulen (Hub); T.P.H. Thiel (Tom); A.B. van Vugt (Arie); E.J.M.M. Verleisdonk (Egbert); J.P.A.M. Vroemen (Jos); M. Waleboer (Marco); W.J. Willems (Jaap); S. Polinder (Suzanne); P. Patka (Peter); E.M.M. van Lieshout (Esther); N.W.L. Schep (Niels)

    2010-01-01

    textabstractBackground. Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures. After reduction of a simple dislocation, treatment options include immobilization in a

  3. Rare cause of knee pain after martial arts demonstration: a case report.

    Science.gov (United States)

    Armstrong, Marc B; Thurber, Jalil

    2013-04-01

    Patellar dislocations are a commonly treated injury in the Emergency Department (ED), with a majority of cases involving lateral subluxation of the patella outside of the joint space. Intra-condylar dislocations of the patella are rare. Of the two types of axis rotation, vertical and horizontal, the vertical occurs five times less frequently. These injuries most often undergo open reduction or, at best, closed reduction under general anesthesia. To remind Emergency Physicians to consider this injury in any patient with severe knee pain and limited mobility, even with a history that is lacking significant trauma. We present a case of intra-condylar patellar dislocation with vertical axis rotation. This injury is no longer primarily attributed to the young and, barring fracture, closed reduction in the ED should be considered. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Dislocation filtering in GaN nanostructures.

    Science.gov (United States)

    Colby, Robert; Liang, Zhiwen; Wildeson, Isaac H; Ewoldt, David A; Sands, Timothy D; García, R Edwin; Stach, Eric A

    2010-05-12

    Dislocation filtering in GaN by selective area growth through a nanoporous template is examined both by transmission electron microscopy and numerical modeling. These nanorods grow epitaxially from the (0001)-oriented GaN underlayer through the approximately 100 nm thick template and naturally terminate with hexagonal pyramid-shaped caps. It is demonstrated that for a certain window of geometric parameters a threading dislocation growing within a GaN nanorod is likely to be excluded by the strong image forces of the nearby free surfaces. Approximately 3000 nanorods were examined in cross-section, including growth through 50 and 80 nm diameter pores. The very few threading dislocations not filtered by the template turn toward a free surface within the nanorod, exiting less than 50 nm past the base of the template. The potential active region for light-emitting diode devices based on these nanorods would have been entirely free of threading dislocations for all samples examined. A greater than 2 orders of magnitude reduction in threading dislocation density can be surmised from a data set of this size. A finite element-based implementation of the eigenstrain model was employed to corroborate the experimentally observed data and examine a larger range of potential nanorod geometries, providing a simple map of the different regimes of dislocation filtering for this class of GaN nanorods. These results indicate that nanostructured semiconductor materials are effective at eliminating deleterious extended defects, as necessary to enhance the optoelectronic performance and device lifetimes compared to conventional planar heterostructures.

  5. Epidemiology of Joint Dislocations and Ligamentous/Tendinous Injuries among 2,700 Patients: Five-year Trend of a Tertiary Center in Iran.

    Science.gov (United States)

    Nabian, Mohammad H; Zadegan, Shayan Abdollah; Zanjani, Leila Oryadi; Mehrpour, Saeed R

    2017-11-01

    The epidemiology of traumatic dislocations and ligamentous/tendinous injuries is poorly understood. In this study, we aimed to evaluate the prevalence and distribution of various dislocations and ligamentous/tendinous injuries in a tertiary orthopedic hospital in Iran. Musculoskeletal injuries in an academic tertiary health care center in Tehran February 2005 to October 2010 were recorded. The demographic details of patients with pure dislocations and ligamentous/tendinous injuries were extracted and the type and site of injuries were classified according to their specific age/gender groups. Among 18,890 admitted patients, 628 (3.3%) were diagnosed with dislocations and 2.081 (11%) with ligamentous/tendinous injuries. The total male/female ratio was 4.2:1 in patients with dislocations and 1.7:1 in patients with ligamentous/tendinous injuries. Shoulder was the most prevalent site of dislocation (50.6%), followed by fingers (10.1%), toes (7.6%), hip (7.3%), and elbow (6.5%). Ankle was the most common site of ligamentous/tendinous injury (53.5%), followed by midfoot (12.3%), knee (8.3%), hand (7%), and shoulder (5%). The mean ages of the patients in dislocations and ligamentous/tendinous injuries were 35.0±18.2 and 31.3± 15.1, respectively. There was no seasonal variation. Shoulder dislocation and ankle ligamentous injury are the most frequent injuries especially in younger population and have different distribution patterns in specific age and sex groups. Epidemiologic studies can help develop and evaluate the injury prevention strategies, resource allocation, and training priorities.

  6. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty.

    Science.gov (United States)

    Holm, Bente; Kristensen, Morten T; Bencke, Jesper; Husted, Henrik; Kehlet, Henrik; Bandholm, Thomas

    2010-11-01

    To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA). Prospective, descriptive, hypothesis-generating study. A fast-track orthopedic arthroplasty unit at a university hospital. Patients (N=24; mean age, 66y; 13 women) scheduled for primary unilateral TKA were investigated 1 week before surgery and on the day of hospital discharge 2.4 days postsurgery. Not applicable. We assessed all patients for knee-joint circumference, knee-extension strength, and functional performance using the Timed Up & Go, 30-second Chair Stand, and 10-m fast speed walking tests, together with knee pain during all active test procedures. All investigated variables changed significantly from pre- to postsurgery independent of knee pain. Importantly, knee circumference increased (knee swelling) and correlated significantly with the decrease in knee-extension strength (r=-.51; P=.01). Reduced fast-speed walking correlated significantly with decreased knee-extension strength (r=.59; P=.003) and decreased knee flexion (r=.52; P=.011). Multiple linear regression showed that knee swelling (P=.023), adjusted for age and sex, could explain 27% of the decrease in knee-extension strength. Another model showed that changes in knee-extension strength (P=.009) and knee flexion (P=.018) were associated independently with decreased performance in fast-speed walking, explaining 57% of the variation in fast-speed walking. Our results indicate that the well-known finding of decreased knee-extension strength, which decreases functional performance shortly after TKA, is caused in part by postoperative knee swelling. Future studies may look at specific interventions aimed at decreasing knee swelling postsurgery to preserve knee-extension strength and facilitate physical rehabilitation after TKA. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Atomistic simulations of dislocation processes in copper

    DEFF Research Database (Denmark)

    Vegge, T.; Jacobsen, K.W.

    2002-01-01

    We discuss atomistic simulations of dislocation processes in copper based on effective medium theory interatomic potentials. Results on screw dislocation structures and processes are reviewed with particular focus on point defect mobilities and processes involving cross slip. For example, the sta...... of vacancy controlled climb show the jogs to climb easily in their extended form. The stability of small vacancy dipoles is discussed and it is seen that the introduction of jogs may lead to the formation of Z-type faulted vacancy dipoles....

  8. Exploring the Limit of Dislocation Based Plasticity in Nanostructured Metals

    DEFF Research Database (Denmark)

    Hughes, D. A.; Hansen, Niels

    2014-01-01

    microscopy reveal that dislocation processes still dominate. Dislocation based plasticity continues far below the transition suggested by experiment and molecular dynamics simulations, with a limit below 5 nm. Very high strength metals may emerge based on this enhanced structural refinement....

  9. Ipsilateral open anterior hip dislocation and open posterior elbow dislocation in an adult

    Directory of Open Access Journals (Sweden)

    Kumar Sunil

    2014-02-01

    Full Text Available 【Abstract】Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.

  10. Radiographic and computed tomographic analysis of the position of the tibial tubercle in recurrent dislocation and subluxation of the patella.

    Science.gov (United States)

    Tsujimoto, K; Kurosaka, M; Yoshiya, S; Mizuno, K

    2000-01-01

    Among the factors that influence the patellofemoral alignment and stability, the position of the tibial tubercle was evaluated using plain radiographs and computed tomography (CT). Radiographs of the Q-angle with the knee in full extension and quadriceps muscle relaxed showed that mean Q-angles in the dislocation or subluxation group and control group were 13.8 degrees and 14.3 degrees, respectively. The major reason for this deceptive measurement was a patella positioned laterally in the dislocation or subluxation group. Better estimation was made with the modified Q-angle measurement by using the most concave point of the intercondylar notch as a reference point instead of the center of the patella. By overshadowing CT images of the levels of the patellofemoral joint and the tibial tubercle, it was possible to evaluate the location of the tibial tubercle in relation to the femoral trochlea. Both the angular measurement (lateral deviation angle [LDA]) and the distance measurement (lateral deviation index [LDI]) showed that the tibial tubercle in the dislocation or subluxation group was rotated externally and shifted laterally (LDA, 36.3+/-7.0 degrees and LDI, 30.1+/-5.6) compared with the control group (LDA, 20.2+/-7.1 degrees and LDI, 15.1+/-5.6). Further study is warranted to elucidate the exact mechanism of recurrent patellar dislocation and subluxation.

  11. Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis?

    Directory of Open Access Journals (Sweden)

    Takacs J

    2013-07-01

    Full Text Available Judit Takacs,1 Judy E Anderson,1,3 Jeff RS Leiter,1,2,4 Peter B MacDonald,2,4 Jason D Peeler1,4 1Department of Human Anatomy and Cell Science, 2Department of Surgery, 3Department of Biological Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; 4Pan Am Clinic, Winnipeg, Manitoba, Canada Background: Knee osteoarthritis (OA is the most prevalent medical condition in individuals over the age of 65 years, and is a progressive joint degenerative condition with no known cure. Research suggests that there is a strong relationship between knee pain and loss of physical function. The resulting lifestyle modifications negatively impact not only disease onset and progression but also overall health, work productivity, and quality of life of the affected individual. Purpose: The goal of this investigation was to examine the feasibility of using an emerging technology called lower body positive pressure (LBPP to simulate weight loss and reduce acute knee pain during treadmill walking exercise in overweight individuals with radiographically confirmed symptomatic knee OA. Design: Prospective case series. Methods: Twenty-two overweight individuals with knee OA completed two 20-minute treadmill walking sessions (one full weight bearing and one LBPP supported at a speed of 3.1 mph, 0% incline. Acute knee pain was assessed using a visual analog scale, and the percentage of LBPP support required to minimize knee pain was evaluated every 5 minutes. Knee Osteoarthritis Outcome Scores were used to quantify knee pain and functional status between walking sessions. The order of testing was randomized, with sessions occurring a minimum of 1 week apart. Results: A mean LBPP of 12.4% of body weight provided participants with significant pain relief during walking, and prevented exacerbation of acute knee pain over the duration of the 20-minute exercise session. Patients felt safe and confident walking with LBPP support on the treadmill, and demonstrated no change

  12. Runners knee (image)

    Science.gov (United States)

    ... forces on the knee, such as a misaligned patella. Chondromalacia is treated with rest or immobilization and nonsteroidal anti-inflammatory drugs for pain. Physical therapy, especially ... alignment of the patella that cannot be corrected with therapy.

  13. Knee MRI scan

    Science.gov (United States)

    ... pain that does not get better with treatment Instability of the knee You may also have this ... Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  14. Knee arthroscopy - discharge

    Science.gov (United States)

    ... your leg propped up on 1 or 2 pillows. Place the pillows under your foot or calf muscle. This helps ... Getting your home ready - knee or hip surgery Surgical wound care - open Review Date 11/27/2016 ...

  15. An unusual case of traumatic bilateral hip dislocation without fracture

    Science.gov (United States)

    Cobar, Andrés; Bregni, María; Altamirano, Marco

    2017-01-01

    Abstract Bilateral traumatic hip dislocations are extremely rare. Most of these are related to acetabular or proximal femoral fractures, consisting of complex lesions, and are rarely pure ligamentous injuries. Posterior dislocation is the most frequent. Some dislocations are accompanied by sciatic nerve palsy. The present case is a posterior bilateral hip dislocation with no other associated lesions, there are very few reports published with this clinical setting. The patient had good functional outcome. PMID:28560017

  16. Prevalent knee pain and sport

    DEFF Research Database (Denmark)

    Hahn, Thomas; Foldspang, Anders

    1998-01-01

    STUDY OBJECTIVE: To estimate the prevalence of knee pain in active athletes and to investigate potential associations to type, amount and duration of sports participation. MEASUREMENTS: 339 athletes gave information about occupation, sports activity and different features of knee pain, based...... on a self-filled questionnaire. MAIN RESULTS: The prevalence of knee pain within the preceding 12 months, constant or recurrent knee pain, absence from sport and absence from work due to knee pain, was 54%, 34%, 19% and 4%, respectively. Knee pain was positively associated with years of jogging...... and with weekly hours of participation in competitive gymnastics but negatively with weekly hours of tennis. Constant or recurrent knee pain was positively associated with years of swimming. Absence from sport due to knee pain was positively associated with weekly hours of soccer participation. CONCLUSIONS: Knee...

  17. An Irreducible Ankle Fracture Dislocation: The Bosworth Injury

    NARCIS (Netherlands)

    T. Schepers (Tim); T. Hagenaars (Tjebbe); D. den Hartog (Dennis)

    2012-01-01

    textabstractIrreducible fracture dislocations of the ankle are rare and represent true orthopedic emergencies. We present a case of a fracture dislocation that was irreducible owing to a fixed dislocation of the proximal fibular fragment posterior to the lateral ridge of the tibia. This particular

  18. 21 CFR 890.3665 - Congenital hip dislocation abduction splint.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Congenital hip dislocation abduction splint. 890.3665 Section 890.3665 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN....3665 Congenital hip dislocation abduction splint. (a) Identification. A congenital hip dislocation...

  19. Septic hip dislocations in children in a developing country | Ngom ...

    African Journals Online (AJOL)

    Purpose: To report on a radiological issue and therapeutic aspects encountered in septic hip dislocations in a developing country. Patients and Methods: Nineteen children among whom 11 boys and 8 girls aged on average 5.3-years old presented 7 recent and 12 late hip dislocations. Those dislocations were distributed ...

  20. Ipsilateral dislocation of the shoulder and elbow: A case report

    African Journals Online (AJOL)

    Pr KODO

    Abstract. Ipsilateral dislocation of the shoulder and elbow is uncommon. Shoulder dislocation is often misdiagnosed on admission. We report the case of an 31-year old male whose dislocations were both recognised at the initial examination. Diagnosis pitfalls, mechanism, and management of this rare injury are reviewed.