Medial and Lateral Rotatory Dislocations of the Ankle After Trivial Trauma—Pathomechanics and Management of Two Cases

Pure frontal plane rotatory dislocation of the ankle joint without an associated fracture is an extremely rare injury. We report one such case of an eversion rotatory dislocation and one case of an inversion rotatory dislocation. To our knowledge, this is the first report of an eversion injury resulting in dislocation of the ankle without fracture. Both patients had low energy trauma, predisposing ligamentous injuries, and recurrent sprains. In the patient with lateral rotatory dislocation, medial malleolar hypoplasia was also a contributing factor. Both patients healed the presenting index injury with nonoperative treatment, whereas the lateral rotatory dislocation had a lateral ankle stabilization to prevent subsequent injury.     

Isolated, Traumatic Anterior Dislocation of the Radial Head In An Adult A Case Study and Review of the Literature

Isolated radial head dislocation in adults is extremely rare and has been predominantly posterior. A case of isolated, acute anterior dislocation of the radial head an adult is reported.A 26-year-old male sustained an isolated radial head dislocation following a fall on the outstretched hand. The dislocation was treated by closed reduction and transcapitellar Kirschner wire fixation.     

Rotator cuff tear associated with a posterior dislocation of the shoulder in a young adult: a case report and literature review

Posterior glenohumeral dislocations are rare, and an accurate diagnosis is often difficult to make. Although rotator cuff tears are a known risk in the common traumatic anterior glenohumeral dislocation, they are an extremely rare event in association with posterior glenohumeral dislocation, regardless of patient age. There have only been 2 documented cases of rotator cuff tear following posterior shoulder dislocation previously reported in the literature.We report the case of a rotator cuff tear associated with a closed traumatic posterior dislocation of the shoulder in a 22-year-old male involved in a motorcycle accident. This is only the second report of an isolated rotator cuff tear occurring as a result of a posterior shoulder dislocation. Furthermore, this case concerns the youngest patient ever to sustain such an injury in the orthopaedic literature.     

Die Therapie der traumatischen vorderen Schulterluxation: Aktueller Stand der Therapie in Deutschland Gibt es wissenschaftlich gesicherte Therapiekonzepte?

There are no generally accepted concepts for the treatment of traumatic anterior shoulder dislocation. The objective of this study was to ascertain the current treatment for traumatic shoulder dislocations in German hospitals and to compare this with the data reported in the literature. A total of 210 orthopedic surgery departments were asked for their treatment strategy in an anonymous country-wide survey; 103 questionnaires (49%) were returned for evaluation. Additional imaging (ultrasound, CT, MRI) beyond the routine X-rays is performed in 82% of clinics for primary shoulder dislocation (94% in recurrent dislocation). A young, athletic patient (< 30 years old) would be operated on for a primary traumatic shoulder dislocation in 73% of hospitals (98% in recurrent dislocation). In contrast, a patient of the same age, with a moderate level of sporting activity would be treated conservatively in 67% of cases (14% in recurrent dislocation). Similarly, for an active, middle-aged patient with a demanding job, 74% of responses favored conservative treatment after a primary dislocation and 6% after a recurrent dislocation. Older patients (> 65 years old) are usually treated conservatively after a primary or recurrent shoulder dislocation (99%, 69%). For a primary shoulder dislocation the most popular surgical reconstruction is a Bankart repair (75%). For recurrent shoulder dislocation several different operative techniques are seen (Bankart 29%, T-shift 26%, Putti-Platt 8%, Eden-Lange-Hybbinette 22%, Weber osteotomy 13%). Based on our literature review, we found: (1) The clinical examination of both shoulders is important to diagnose hyperlaxity; (2) Routine CT or MRI is not necessary for primary traumatic shoulder dislocations; (3) A young, athletic patient should undergo surgical reconstruction after a primary shoulder dislocation; (4) The operation of choice for primary and recurrent dislocation is the Bankart repair; (5) There is no sufficient evidence that an arthroscopic Bankart repair is as good as an open procedure; (6) There are limited indications for other operative techniques, as they are associated with a higher recurrence and arthrosis rate.     

Hip dislocation revealing hip tuberculosis. A case report

Hip dislocation is an uncommon presentation of hip tuberculosis. We report a case in an 18-year-old woman with active hip tuberculosis. An attempt to reduce the dislocation 7 weeks into antituberculous therapy was followed by necrosis of the femoral head. Although severe forms of hip tuberculosis are common in endemic areas, dislocation is exceedingly rare. Capsule laxity and/or synovial hypertrophy probably contribute more to the occurrence of dislocation than does the accumulation of pus.     

Die bipolare Unterarmverrenkungsverletzung

Bipolar dislocation injury of the forearm is rarely documented. It is a combined forearm injury with trauma on the elbow side and on the side of the wrist joint. We describe two different cases of this complex dislocation. The first patient suffered from a Monteggia-like dislocation fracture with transscaphoid dislocation of the wrist. The second person had an acute longitudinal radioulnar membrane dissociation after elbow dislocation with an additional scapholunate tendon rupture. The difficult management of these injuries is illustrated by these cases.     

Prevention of dislocation after hip arthroplasty: lessons from long-term followup.

Regarding dislocation after total hip arthroplasty, prevention is worth an ounce of cure. The current authors evaluated dislocation after total hip arthroplasty during the 26-year practice of one surgeon to identify potential variables that can contribute to the prevention of dislocation. Between 1970 and 1996, dislocation after total hip replacement occurred after 7.2% of primary hip arthroplasty procedures (298 of 4164 primary hip replacements) and 11.2% of revision hip arthroplasty procedures (90 of 803 revision hip replacements). Significant findings included an increase in dislocation when 22-mm modular femoral heads were used and a decrease in dislocation after revision for dislocation when constrained liners were used. An additional finding was that 26% of first time dislocations occurred more than 2 years after surgery. Concerning prevention of dislocation, small head modular femoral components should be used cautiously, and constrained liners should be considered in complex revision cases. Patients should be counseled concerning the potential for dislocation many years after their arthroplasty.     

Traumatic posterior hip dislocation in a 16-month-old child: a case report and review of literature

Traumatic posterior hip dislocation is an uncommon injury in children, constituting less than 5% of paediatric dislocations. In a younger child (<5 years), minor trauma such as a slip or fall from a low height may cause a hip dislocation, whereas in an adolescent a dislocation is usually caused by a major trauma such as motor vehicle accident. In this case report we present a rare case of traumatic hip dislocation in a 16-month-old girl. Early detection and closed reduction ensured good outcome in our case. A high index of suspicion is necessary to achieve satisfactory reduction within six hours of dislocation because reduction after this period will greatly increase the risk of complications.     

Superolateral dislocation of the intact mandibular condyle into the temporal fossa: review of the literature and report of a case.

Anterior dislocation of the mandibular condyle is common, but superolateral dislocation is quite rare. Because of its rarity, this type of dislocation is often misdiagnosed or completely overlooked. We describe an additional case of superolateral dislocation of the intact condyle into the temporal fossa. We review all of the available English literature on superolateral dislocation and discuss a causative mechanism, the diagnostic features, and clinical management.     

Double-level spinal injury resulting in "en bloc" dislocation of the lumbar spine. A case report.

We report the case of a 21-year-old man with a unilateral lumbosacral dislocation together with a fracture of L1 resulting in "en bloc" dislocation, which is difficult to classify from an anatomopathological and biomechanical point of view. Unilateral lumbosacral dislocation is likewise an infrequent injury with less than 10 cases previously reported. Its association results in an anterior displacement to the left of the whole lumbar spine. To our knowledge, this displacement "en bloc" of the lumbar spine represents a rotatory dislocation of the same, an injury which we have not seen described until now in the literature.     

Traumatic and spontaneous dislocation of extensor tendon of the long finger

Extensor tendon dislocation is an unusual problem in patients unaffected by rheumatoid arthritis. Sixteen cases of ulnar dislocation of the long extensor tendon of the long finger are reported. Five of these cases were classified as traumatic dislocation and 11 as spontaneous dislocation. All cases were treated by surgery. Differences in anatomic and clinical features between traumatic and spontaneous dislocation of the long extensor tendon are described.     

Traumatic lateral lumbosacral dislocation: one case and review of literature

OBJECTIVE: Lateral traumatic lumbosacral dislocation is a rare and severe lesion of the lumbosacral junction. Only one case has been reported in the literature. We report a new case of pure lateral lumbosacral dislocation. METHODS: A 27-year-old man had an isolated pure lateral traumatic dislocation of the lumbosacral junction after a motorcycle accident. The diagnosis and the therapeutic course are analyzed and discussed. RESULTS: Traumatic lumbosacral dislocation usually occurs in patient with multiple traumas. Generally, in the case of complete fracture-dislocation, on lateral radiographs one can observe the L5 vertebra slippage over the sacrum, resulting from an associated severe disc disruption. This feature was not seen in our patient. Surgical treatment consisted of an open reduction of the dislocation, stabilization with posterior instrumentation, and a lumbosacral arthrodesis by posterolateral grafting. In cases of pure lateral dislocation, short instrumentation can be recommended, extending from L5 to S1. Addition of an interbody fusion should be considered when the L5-S1 disc is disrupted, which is responsible for the anterior slippage of L5 over S1. Disc disruption can be evoked on preoperative magnetic resonance imaging (MRI) and intraoperatively by exploring the spinal canal. CONCLUSIONS: Pure lumbosacral dislocation with a lateral translation seemed to have no disc disruption as observed in complete fracture dislocation. Nevertheless, we recommend looking for an L5-S1 disc disruption either on preoperative MRI or during surgical exploration.     

Luxation coxo-fémorale révélatrice d'une tuberculose de la hanche. À propos d'une observation

A case report. Hip dislocation is an uncommon presentation of hip tuberculosis. We report a case in an 18-year-old woman with active hip tuberculosis. An attempt to reduce the dislocation 7 weeks into antituberculous therapy was followed by necrosis of the femoral head. Although severe forms of hip tuberculosis are common in endemic areas, dislocation is exceedingly rare. Capsule laxity and/or synovial hypertrophy probably contribute more to the occurrence of dislocation than does the accumulation of pus.     

Stabilization of traumatic atlanto-occipital dislocation. Case report

Traumatic atlanto-occipital dislocation is most often fatal. Consequently, there are only scattered case reports of patients surviving this injury, and treatment modalities are anecdotal and varied. The case of an 18-year-old woman who suffered an anterior atlanto-occipital dislocation as the result of a motor-vehicle accident is presented. Rigid posterior fixation and complete reduction of the dislocation were achieved using an anatomically contoured steel loop secured to the occiput and cervical vertebrae. The addition of cancellous bone to the graft afforded long-term stability. This operative treatment provided anatomical realignment of the dislocation and allowed early mobilization of the patient with the use of aggressive rehabilitation. Previously reported cases of patients surviving anterior atlanto-occipital dislocation are reviewed. The use of cervical traction, halo bracing, and operative stabilization is discussed.     

Traumatic inferior hip dislocation in an adult with ipsilateral trochanteric fracture

Traumatic Inferior dislocation of hip in adult is an extremely rare occurrence. We report a case of an inferior hip dislocation associated with an intertrochanteric fracture. Treatment consisted of an initial closed manipulative reduction of the dislocation with the aid of a Schanz screw inserted in a T handle universal chuck and using C-arm imaging. A dynamic hip screw was then used to fix the intertrochanteric fracture. At 2.5 years after the injury, the patient has symmetrical range of motion versus his contra lateral normal hip. Radiographs of the hip show normal anatomy without signs of avascular necrosis of the femoral head. To our knowledge, this is the first reported case of an adult with an inferior hip dislocation with a trochanteric fracture.     

Atypical Subglenoid Inferior Glenohumeral Dislocation Clinically Mimicking Anterior Dislocation

Abstract Inferior shoulder dislocation is a rare form of shoulder dislocation. A subglenoid subtype of an inferior glenohumeral dislocation is described which clinically mimicked anterior dislocation, as the pathognomonic upright arm posture was conspicuous by its absence. An awareness of associated potential axillary artery injury, brachial plexus complications and rotator cuff tears is important in this rare entity and should be excluded with a high index of suspicion.     

Peritalar dislocation: three case reports and literature review

Peritalar dislocation is an uncommon lesion, although its incidence has increased on account of the rise in motor vehicle accidents and improved radiological diagnostic techniques. In our review of the literature, we counted 312 cases described over the past 50 years. Medial dislocation represented the majority of cases (79%), lateral dislocation accounted for 22%, while poster and anterior dislocations seemed to occur rarely. We report the results of the treatment of 3 patients, one with an irreducible lateral dislocation, one with a irreducible medial dislocation, and one with a reducible medial dislocation. The obstruction to closed reduction for lateral dislocation was the interposed posterior tibial tendon. The obstruction to closed reduction for medial dislocation was an osteochondral impact-fracture of the upper medial part of the head of the talus spiking to the lateral corner of the navicular. Management consisted of immediate reduction and application of a short leg cast for 4 weeks. At long-term follow-up, all 3 patients had no complications and had returned to their pre-injury activities. Received: 18 June 2002, Accepted: 30 July 2002 Correspondence to: F. Rivera     

复发性髌骨脱位治疗中内侧髌股韧带重建术的研究进展

复发性髌骨脱位是引起青少年膝关节功能障碍的常见疾病,其定义为髌骨脱位发生两次及两次以上,是一种骨科及运动医学临床常见的疾病。复发性髌骨脱位的病因有很多,但归根结底,髌骨在活动中所处的异常力学环境是引起不稳的根本原因。研究发现内侧髌股韧带被认为是限制髌骨向外脱位最重要的软组织结构,因而重建内侧髌股韧带对成功治疗复发性髌骨脱位起着重要的作用。但复发性髌骨脱位往往是一个多因素引起的临床问题,除了纠正软组织的异常外,骨性结构的异常也是一个不容忽视的问题。本文对近年来对内侧髌股韧带的解剖、生物力学、手术技巧、治疗结果及术后并发症的研究情况进行了综述。     

Open anterior-inferior hip dislocation

Traumatic hip dislocations result from high-energy trauma. These dislocations are usually posterior in direction and have severe associated injuries. The less common anterior dislocation is usually of the inferior type. We report a case of an open anterior-inferior hip dislocation secondary to a high-speed motor vehicle collision. The wound was in the medial upper ipsilateral thigh. To our knowledge, this is the first reported case of an adult with an open inferior-type anterior hip dislocation.     

Congenital dislocation of the patella

Congenital dislocation of the patella may occur as a persistent lateral dislocation of the patella that presents with a knee flexion contracture and the patella tethered lateral to the femoral condyles or as an intermittent dislocation of the patella. In the latter syndrome, the patella dislocates completely with each flexion and extension cycle of the knee and is best termed obligatory dislocation of the patella, because the patient has no control over the patella dislocating as he or she moves the knee. The first type of congenital dislocation, which is fixed, often is associated with syndromes such as arthrogryposis and should be corrected surgically by lateral release and realignment of the patella. Obligatory dislocation of the patella tends to be an isolated dysplastic anomaly and may be relatively well tolerated. Rebalancing of the patella usually is done at a later age because of less interference with function. The current author describes the natural history of patella femoral dysplasia, detailing the pathologic changes that are present, and recommends surgical techniques for correcting both types of congenital dislocation of the patella.