Bilateral Dislocation Research Articles

Bilateral Traumatic Dislocation Diverging from the Hip

Traumatic bilateral hip dislocation is very rare; 56 cases have been reported in the literature so far, the first in 1936 by Marquardt. We report a case of bilateral divergent dislocation of the hip with 6 months of follow-up.

Are There Cephalometric Measurements Associated With Recurrent Temporomandibular Joint Dislocation?

Several theories have been proposed for the etiology of recurrent temporomandibular joint (TMJ) dislocation. The purpose of the present study was to determine whether there are cephalometric measurements associated with this phenomenon. A retrospective case-control study was performed, which included individuals who suffered from recurrent TMJ dislocation and a control group composed of patients who suffered from unrelated odontogenic infections and did not have any TMJ disorder. All the patients were referred to the Department of Oral and Maxillofacial Surgery at the Hadassah Medical Center between 2010 and 2021 and underwent multidetector computed tomography of the jaws. The main predictor variable was a history of recurrent TMJ dislocations. Covariates included age and gender. The primary outcome variable was a set of 11 cephalometric measurements. A statistical analysis was performed with the Mann-Whitney U-test for continuous variables and the Chi-squared test or Fisher's exact test for categorical variables, followed by a logistic regression model. Multiple comparisons were made by using the Benjamini-Hochberg method. The total 32 subjects included in the analysis consisted of 16 patients presenting with bilateral recurrent TMJ dislocation and a control population of 16 patients. The mean age was 34.19±12.7years, 40.6% (n=13) were males, with no statistically significant differences between the groups. An increased overbite was detected in the TMJ dislocation group, whereas over-jet was greater among the control group, although not statistically significant. Skeletal ratio analysis showed that the TMJ dislocation group had a statistically significantly greater Articulare-Gonion length (46.96mm±5.2mm vs 43.01mm±5.3mm; P=.043) and a lower angle of occlusal plane to Frankfort horizontal (4.56o±5.7o vs 9.60o ± 3.9o; P=.007), Y-axis (58.01o±4.9o vs 61.72o ± 3.3o; P=.019), and Frankfurt mandibular plane (24.10o±6.1o vs 30.14o ± 4.7o; P=.004). Specific cephalometric measurements are associated with recurrent TMJ dislocation. The high Articulare-Gonion length and the low rates of occlusal plane to Frankfort horizontal angle, Y-axis, and Frankfurt mandibular plane found in the study population suggest that the resultant vertically oriented elevator muscles may be considered a predisposing factor for this phenomenon.

A delayed presentation of bilateral anterior fracture dislocation of the shoulder from a domestic electric supply

Bilateral anterior fracture dislocation of the shoulder secondary to a high voltage electric shock is extremely rare, with only a few case reports available. To our knowledge, a prolonged delayed presentation (>4 weeks) of an anterior fracture dislocation of the shoulder has not yet been reported in the English literature. We report an unusual case of a bilateral anterior fracture-dislocation of the shoulder, following an electric shock from a high voltage domestic electric supply. The patient was treated operatively with an open-reduction of both dislocated shoulder joints, followed by splinting immobilisation of the joint in full internal rotation for 3 weeks and attendance to physiotherapy for 6 months. At the last follow-up after more than 10 years after the injury, the patient was pain free with no impingement of activities of daily living and had returned to his former job.

Bilateral Facet Dislocations With and Without Head Impact Sustained by Restrained Occupants

This paper aims to understand the different injury mechanisms involved with traumatic Bilateral Facet Dislocation (BFD) and fracture of the cervical spine. The intent is to demonstrate and elucidate tensile and compression induced injury mechanisms producing BFD by employing real-world crash investigations in association with all the past laboratory testing and studies done by numerous researchers. The study indicates that in a frontal crash scenario, maintaining the position of the shoulder belt is paramount, and any migration towards the base of the neck allows the fulcrum formation that amplifies distractive moments on the neck producing BFD. Similarly, in a rollover crash scenario, roof intrusion magnitude, and its rate along with roof deformation pattern can impose a rotational constraint on the head and plays a vital role in producing BFD. Roof design must address the formation of pocketing in the roof due to deformations imposing rotational head constraint exposing the neck to buckling and subsequent BFD as the roof intrusion continues.

Bilateral Anterior Shoulder Dislocation Following Tramadol Induced Seizure After Low Dose Consumption in a Healthy Adult

Tramadol is a synthetic analgesic used for the treatment of moderate to severe pain with a dual mechanism of action. Although Tramadol-induced seizures are reported in the literature, however, the incidence is rare with its use in therapeutic dosage. Bilateral symmetrical anterior dislocation following a seizure is an unusual complication. We present a rare case of bilateral symmetrical anterior shoulder dislocation following Tramadol-induced epileptiform reaction in an otherwise healthy adult male. The dislocations were diagnosed early and reduced immediately with a satisfactory outcome. An awareness of this entity and a high index of suspicion are required to make an early diagnosis and offer prompt treatment in order to avoid unpleasant complications.

Seat Belt Syndrome of a Breastfeeding Mother: Bilateral Facet Dislocation Without Fracture in Lumbar Spine and Delayed Ileal Perforation

Introduction: The seat belt syndrome is a term used for multiple injuries associated with seat belt use during a traffic accident. Among these injuries, attention should be paid to spine and abdominal traumas that could be fatal. Case Presentation: This case report describes a 34-year-old woman wearing only a lap belt removing the upper part of her seat belt to breastfeed her baby in the back seat of the car during a traffic accident. Bilateral facet dislocation in lumbar spine without fracture and delayed ileal perforation were found. Spine surgery was performed urgently. Abdominal injury was detected 24 hours after spine surgery. Discussion: This case demonstrates the importance of the seat belt syndrome. It also supports why this type of injured patient needs close follow-up. Various rare injuries may be encountered. The trauma team must be alert in seat belt related traffic accidents, where many different injuries can be seen

Management of Misdiagnosed Bilateral Cervical Facet Dislocation: A Case Report

Background: Despite improvement in technology and decision-making, misdiagnosis or delayed diagnosis of cervical spine injuries in trauma patients can cause severe irreparable neurological damage.
 Case Report: We present here a 56-year-old man, with a history of old bilateral C4-C5 dislocation who, contrarily to classically described unfavorable results of cranial traction in patients with older than 3 weeks cervical injury, underwent optimal reduction under cranial traction for four days and surgical intervention with an anterior surgical approach.
 Conclusion: Relatively high incidence of missed cervical spine injuries in polytrauma patients illustrates that proper clinical examination, use of designed protocols for clearance of cervical trauma, and accurate interpretation of radiological imaging can sometimes be neglected.

Bilateral Hip Dislocation: Unusual Injury Mechanism

Bilateral Hip Dislocation: Unusual Injury Mechanism

Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures

PurposeEpileptic seizures can cause multiple shoulder injuries, the most common of which are dislocations, recurrent instability, fractures, and isolated lesions of the rotator cuff. Currently, only limited literature exists which describes the frequency and types of lesions in cohorts of epileptic patients and the corresponding treatment outcome. This study aims to document the occurrence of shoulder lesions in patients affected by seizures and to provide detailed information on trauma dynamics, specific lesion characteristics and treatment complications.MethodsAll patients referring to a tertiary epilepsy center were screened for shoulder injuries and the clinical records of those sustaining them during a seizure were reviewed. Demographic information, lesions’ characteristics and trauma dynamics were analysed, as wells as—when carried out—the type of surgical intervention and any postoperative complications.ResultsThe average age at the time of injury of 106 included patients was 39.7 ± 17.5 years and a male predominance was recorded (65%). Bilateral injuries occurred in 29 patients, simultaneously in 17 cases. A younger age, bilateral shoulder injuries and shoulder dislocations were significantly associated with the occurrence of a shoulder injury solely by muscular activation (p = 0.0054, p = 0.011, p < 0.0001). The complication rate in 57 surgically treated patients with follow-up data was 38.7%, with recurring instability being the most frequently reported complication (62.5%).ConclusionsUncontrolled muscle activation during a seizure is a distinctive but not exclusive dynamic of injury in epileptic patients, accounting for more than the half of all shoulder lesions, especially in the younger. This can lead both to anterior and posterior dislocations or fracture-dislocations and is frequently cause of bilateral lesions and of instability recurrence after surgery. The high complication rates after surgical treatment in this selected subgroup of patients require that appropriate preventative measures are taken to increase the probability of treatment success.Level of evidenceCohort study, level III.

Awake Cranial Traction and Isolated Anterior Cervical Discectomy and Fusion in the Treatment of Traumatic Subaxial Cervical Facet Joint Dislocations: Analysis of a Cohort of 70 Patients and Predictors of Surgical Failure.

Cervical facet dislocations are among the most common traumatic spinal injuries. The management of this type of lesions is still controversial. The objective of the present study was to analyze the results of subaxial cervical facet dislocations submitted to an isolated anterior cervical discectomy and fusion (ACDF) after attempted closed reduction with cranial traction and to identify risk factors for treatment failure. All patients who were operated on in a tertiary trauma center during an 11-year period (2008-2018) for traumatic single-level cervical facet joint dislocation (AO C F4 injuries) were retrospectively reviewed. Age, use of cranial traction, dislocation characteristics, neurologic injury, surgical data, and follow-up records were reviewed. A minimum of 18 months follow-up was required. A total of 70 patients with a mean age of 56 years (18-90) (72% men) were identified. The C6-C7 level was the most frequently affected (36/70 cases). Spinal cord injury (SCI) was present in 34% of the cases. Bilateral dislocations and rigid spines were risk factors for SCI. Cranial traction was performed in 59 cases with success in 52 cases (88%). There were 3 failures after anterior fusion, which required revision surgery with a 360° fusion, all occurring at the C7-T1 level. Cranial traction of the cervical spine is an effective and fast way to achieve closed reduction of cervical facet dislocations. After successful reduction, ACDF, as a single procedure, offers an excellent surgical option. All cases of failure occurred at the C7-T1 level, suggesting that a 360° fusion may be needed at this level.

Ehlers-Danlos Syndrome Type Arthrochalasia: A Systematic Review.

Ehlers–Danlos syndrome type arthrochalasia (aEDS) is a rare genetic disease characterized by severe generalized joint hypermobility, bilateral congenital hip dislocation, skin hyperextensibility, muscle hypotonia, and mild dysmorphic features. It is an autosomal dominant connective tissue disease causing defects in collagen, associated with two genes, COL1A1 or COL1A2. Only about 42 cases have been published worldwide. Treatment is currently symptomatic and focuses on increasing the quality of life of these patients, as there is no curative treatment. The main objective of the review was to update information on Ehlers–Danlos syndrome type arthrochalasia from scientific publications. The review report was carried out in accordance with the criteria of the Preferred Reporting Items for Systematic reviews and MetaAnalyses (PRISMA) review protocol, by searching Orphanet, OMIM, PubMed, and Scopus, as well as free sources. A total of 20 articles were analyzed, which, after analysis, provide an updated report that aims to establish a solid starting point for future lines of research.

Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries.

Introduction: Traumatic hip dislocations (THDs) are severe injuries associated with considerable morbidity. Delayed recognition of fracture dislocations and neurovascular deficits have been proposed to cause deleterious long-term clinical outcomes. Therefore, in this study, we aimed to identify characteristics of epidemiology, injury mechanisms, and associated injuries to identify patients at risk. Methods: For this study based on the TraumaRegister DGU® (January 2002–December 2017), the inclusion criterion was an Injury Severity Score (ISS) ≥9 points. Exclusion criteria were an isolated head injury and early transfer to another hospital. The THD group was compared to a control group without hip dislocation. The ISS and New ISS were used for injury severity and the Abbreviated Injury Scale for associated injuries classification. Univariate and logistic regression analyses were performed. Results: The final study cohort comprised n = 170,934 major trauma patients. We identified 1359 individuals (0.8%) with THD; 12 patients had sustained bilateral hip dislocations. Patients with THD were predominantly male (79.5%, mean age 43 years, mean ISS 22.4 points). Aortic injuries (2.1% vs. 0.9%, p ≤ 0.001) were observed more frequently in the THD group. Among the predictors for THDs were specific injury mechanisms, including motor vehicle accidents (odds ratio (OR) 2.98, 95% confidence interval (CI) 2.57–3.45, p ≤ 0.001), motorcycle accidents (OR 1.99, 95% CI 1.66–2.39, p ≤ 0.001), and suicide attempts (OR 1.36, 95% CI 1.06–1.75, p = 0.016). Despite a lower rate of head injuries and a comparable level of care measured by trauma center admission, both intensive care unit and total hospital stay were prolonged in patients with THD. Conclusions: Since early diagnosis, as well as timely and sufficient treatment, of THDs are of high relevance for long-term outcomes of severely injured individuals, knowledge of patients at risk for this injury pattern is of utmost importance. THDs are frequently related to high-energy mechanisms and associated with severe concomitant injuries in major trauma patients.

Temporomandibular joint dislocation: A 7-year retrospective study in Two Nigerian Teaching Hospitals

Context: Temporomandibular joint (TMJ) dislocation constitutes about 3% of all reported joint dislocations worldwide. The study presents our experience with TMJ dislocation and its management at two tertiary healthcare centers in Nigeria. Materials and Methods: A retrospective study of patients managed for TMJ dislocation at two healthcare facilities over a period of 7 years was conducted. The diagnosis was clinical with confirmation by radiographic findings. Bio-data, predisposing conditions, duration of onset of presenting complaints, and treatment techniques were documented. Cases were classified as unilateral (right or left) or bilateral and they were further sub-classified as acute (less than or equal to 2 weeks of presentation to the clinic), chronic (greater than 2 weeks of presentation to the clinic), or recurrent (more than one episode of dislocation before presentation). Results: A total of 25 cases were analyzed. There was a slight male preponderance 13 (52%) observed with a male/female ratio of 1.1: 1. The mean age is 35.52 ± 17.36 years and a range of 15-80 years. Majority 18 (72%) of the patients were diagnosed with acute TMJ dislocation. The principal predisposing factor was yawning 12 (48%) and most of the patients had bilateral TMJ dislocation 19 (76%). Hippocratic maneuver was the treatment main method of choice in 14 (56%) of the patients. Conclusion: Bilateral TMJ dislocation was the most common pattern seen in our environment.

Evaluation of Intermaxillary Fixation (IMF) Screw Therapy with Craniomandibular Index Analysis for Chronic Recurrent Dislocation in the Temporomandibular Joint.

Temporomandibular joint (TMJ) hypermobility is classified as a subluxation, complete (luxation), unilateral, or bilateral, acute, chronic protracted, or chronic recurrent dislocation. This controlled randomized clinical study aims to evaluate the effectiveness of intermaxillary fixation (IMF) screw application and autologous blood injections in the treatment of chronic recurrent dislocation of TMJ in comparison with the placebo group. The patients who were admitted to the Faculty of Dentistry of the Atatürk University between October 2018 and January 2020 were evaluated. Three hundred patients diagnosed with bilateral chronic recurrent dislocation of TMJ based on clinical findings and radiographs were included in the study. The patients were randomly divided into three groups according to the evaluation criteria. Group 1 received IMF, group 2 received autologous blood injection, and group 3 (placebo group) received an intraarticular saline injection. The results of the patients who received IMF, autologous blood injection, and saline injection were evaluated by the craniomandibular index. The IMF group showed significant improvement after 1 month and 6 months (P < 0.001), while the patients who received autologous blood injection and saline injection showed no significant improvement (P > 0.05). The data were analyzed with IBM SPSS V23. The significance level was P < 0.05. In our study, the IMF gave the best results among all the study groups. The IMF technique can be used in patients with protracted chronic recurrent dislocation in whom autologous blood injection has failed.

Evaluation for Vertebral Artery Injury with Cervical Dislocated Fracture and Optimal Treatment before Reduction.

Cervical dislocated fractures frequently cause vertebral artery injury (VAI), which, in turn, propagates the thrombus at the site of injury. Cerebral embolism due to a thrombus after the reduction of dislocation leads to a poorer neurological outcome. Therefore, we investigated the outcome of treatment for cervical dislocated fractures and the usefulness of parent artery occlusion (PAO) before reduction. Eight patients with cervical dislocated fractures with a locked facets treated at our hospital between January 2018 and December 2020 were evaluated. We retrospectively examined patient characteristics and clinical outcomes. Among the eight patients, two were injured at C4/5, four at C5/6, and two at C6/7. All patients had locked facets. Four patients had bilateral dislocation, while the others had unilateral dislocation. Two patients with unilateral dislocation had ipsilateral vertebral artery occlusion (VAO), while the other six did not. Both patients with VAO underwent PAO to prevent cerebral embolism before reduction. The six patients who did not have VAI underwent reduction without preprocedural treatment. No cerebral ischemic complications were observed. One patient died due to paralysis of the respiratory muscles caused by spinal cord injury but the remaining seven recovered well. PAO before reduction for cervical dislocated fractures with VAO may be effective in preventing cerebral embolism after reduction.

Fracture and Bilateral Facet Dislocation after Anterior Cervical Fusion in a Patient with a Distraction-Flexion Injury at the Lower Cervical Level

Fracture and Bilateral Facet Dislocation after Anterior Cervical Fusion in a Patient with a Distraction-Flexion Injury at the Lower Cervical Level

MANAGEMENT OF AN UNRECOGNIZED AND DELAYED DIAGNOSED CASE OF BILATERAL CONDYLAR DISLOCATION FOLLOWING ORAL CANCER SURGERY - A CASE REPORT

Temporomandibular joint (TMJ) dislocation is characterized by displacement of the mandibular condyle from the glenoid fossa. There are various reasons for the dislocation of TMJ, among which iatrogenic dislocation is one of the cause which is generally overlooked. Acute dislocations can be corrected by various conservative methods like manual reduction, but long standing chronic dislocation requires surgical management. Here we present a case report of an unrecognized and delayed diagnosed case of bilateral condylar dislocation following oral cancer surgery under general anaesthesia with iatrogenic fracture of ramus of mandible which was managed surgically by vertical ramus osteotomy and ORIF.

Neglected Simultaneous Bilateral Asymmetric Traumatic Hip Dislocation in a Young Male Managed by Closed Reduction Manoeuvres in a Resource-Limited Setting: A Case Report

Neglected Simultaneous Bilateral Asymmetric Traumatic Hip Dislocation in a Young Male Managed by Closed Reduction Manoeuvres in a Resource-Limited Setting: A Case Report

Asymmetrical Bilateral Traumatic Hip Dislocation with Segmental Femur Fracture

Introduction: Hip dislocations are extremely rare, but they are orthopedic emergencies that need to be immediately intervened. Traumatic hip dislocations are usually unilateral and occur toward the posterior region. Bilateral traumatic hip dislocations, on the other hand, are rarer. Asymmetric occurrence of bilateral traumatic hip dislocations is even rarer. The possibility of spontaneous hip dislocation in a healthy person is very unlikely. This is because ligaments wrapping the hip joint make it quite stable. Thus, hip dislocation usually occurs due to a high-energy trauma. Case Report: In this paper we report a unique female patient with asymmetric bilateral traumatic hip dislocation accompanied by a segmental fracture of the femur due to a traffic accident. The patient’s right hip was reduced under sedoanalgesia at the emergency department and the left hip was reduced under anesthesia at operating room. Avascular necrosis did not develop at her 2-year follow-up; however, she has been re-operated after developing nonunion in the left femoral segmental fracture. Conclusion: In conclusion, hip dislocations should be treated in first six hours due to the risk of avascular necrosis. Uncomplicated hip dislocations without accompanied fractures can be treated with sedoanalgesia in emergency service settings. However hip dislocations which are complicated with accompanied fractures should be reduced in operation rooms without delay.

A Novel KMT2D mutation in Kabuki syndrome with elevated liver enzymes and congenital bilateral hip dislocation

Kabuki syndrome (KS) is a rare syndrome that involves defects in a wide range of organs, with each organ showing a different severity of symptoms. Two genes have been associated with patients with KS: lysine (K)-specific demethylase 6A (KDM6A) and lysine (K)-specific methyltransferase 2D (KMT2D). The study reported the case of an 18-month-old Turkish boy diagnosed with KS. The patient showed a typical appearance: widely separated eyes, sparse eyebrows, long palpebral fissures, blue sclera, large prominent ears, and micrognathia. The patient was operated on because of bilateral hip dislocation and undescended testicles. He was also followed up by pediatric gastroenterology with asymptomatic liver enzyme elevation (AST- 79 U/L, ALT -68 U/L, ALP -52 U/L). The whole exome sequencing analysis revealed a novel pathogenic c.13285 C&gt;T (p.Gln4429Ter) mutation in the KMT2D gene. The genotype-phenotype correlation of KS was not precisely established. As per our knowledge, there is limited literature which gives information about the hepato-biliary manifestations of KS. Here, we propose that the new mutation of the KMT2D gene may result in the typical facial features of KS with asymptomatic elevated liver enzymes.