Concomitant Dislocation Research Articles

No Association Between Growth Hormone Therapy and Upper Extremity Physeal Tension Injuries: A Matched Case-control Study.

Recent evidence has identified a strong association between growth hormone therapy and physeal injuries in the lower extremity; however, few studies have investigated this association in the upper extremity. (1) Do pediatric patients with physeal tension injuries of the shoulder and elbow have higher odds of having exposure to recombinant growth hormone therapy than matched controls? (2) Are the odds of having exposure to recombinant growth hormone therapy in physeal tension injuries different when stratified by shoulder and elbow injuries? Using a matched case-control study design, patients between 4 and 18 years of age treated at a large, urban, academic center from February 1, 2016, to November 6, 2023, were identified by ICD-10 codes using EPIC SlicerDicer, an electronic medical record-based data mining tool. Patients diagnosed with physeal tension injuries in the shoulder or elbow were included in the case group, and those with midshaft radius, metaphyseal radius, or both-bone forearm fractures were included in the control group. A total of 618 patients with physeal injuries and 1244 with non-physeal fractures were identified and screened for inclusion. After further chart review to confirm diagnoses, 46% (283) of patients with physeal injuries and 54% (670) of patients with non-physeal fractures were included. A further 6% (16) of patients with physeal injuries and 2% (15) of patients with non-physeal injuries were excluded due concomitant dislocations or missing data, resulting in 267 eligible patients with physeal injuries and 655 eligible patients with non-physeal fractures. Two patients with concurrent elbow and shoulder physeal injuries were additionally excluded from stratified analyses. Patients with physeal injuries and non-physeal fractures were 1:1 matched by age ± 0.5 years, sex, and BMI ± 2 kg/m2. In all, 522 patients were included in the analysis, including 261 patients with physeal injuries and 261 with non-physeal fractures. The mean ± SD ages for both patient groups was 13 ± 2 years (p = 0.44), 88% (229 of 261) of all participants were male, and the mean BMIs were 19.9 ± 3.0 kg/m2 and 19.4 ± 3.0 kg/m2 (p = 0.11), respectively. Growth hormone exposure was compared between patients with physeal injuries and non-physeal fractures using a conditional logistic regression model. Overall, 4% (10 of 261) of patients with physeal injuries had exposure to growth hormone therapy as compared with 2% (4 of 261) of patients with non-physeal fractures (OR 2.5 [95% confidence interval 0.8 to 8.0]). Subgroup analyses of shoulder and elbow injuries demonstrated no difference in growth hormone exposure between patients with physeal injuries and non-physeal fractures (OR 2 [95% CI 0.4 to 10.2] and OR 3 [95% CI 0.6 to 14.9], respectively). In light of these results, clinicians may not need to advise precaution against sports or other activities that put the upper extremity physes under stress when treating patients with growth hormone supplementation therapy. Future multicenter studies, however, are indicated to further investigate for the existence of any subtle association between growth hormone therapy and upper extremity physeal injuries relative to the large association previously noted in the lower extremity in pediatric and adolescent patients. Level III, therapeutic study.

Traumatic rotator cuff tears with concomitant shoulder dislocation: tear characteristics and postsurgical outcomes.

Arthroscopic rotator cuff repair has been shown to have favorable outcomes following traumatic rotator cuff tear with concomitant shoulder dislocation. The aim of this study was to compare outcomes and tear characteristics between patients who underwent arthroscopic rotator cuff repair following traumatic tear with shoulder dislocation to those without dislocation. A retrospective review of 226 consecutive patients with traumatic rotator cuff tears who underwent arthroscopic repair between 2013 and 2017 with a minimum of 1-year follow-up was performed. Patients with traumatic dislocations and concomitant rotator cuff tears were placed in the Dislocation & Tear cohort (DT cohort) and were matched 1:2 with a second cohort sustaining traumatic cuff tears without dislocation (T cohort). Primary outcomes were injury characteristics including tendon involvement and atrophy and tear size and thickness. Secondary outcomes were postoperative strength and range of motion (ROM) in forward flexion (FF), external rotation (ER), and internal rotation (IR); patient-reported outcomes including Subjective Shoulder Value, visual analog scale, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form; complications including repair failure (defined as symptomatic retear confirmed on postoperative magnetic resonance imaging), infection, adhesive capsulitis, and impingement; and rates of revision surgery. There were 18 patients in the DT Cohort and 36 patients in the T Cohort with no significant differences in time to final follow-up (50.4±24.5 months vs. 49.0±30.4 months, P=.73). The DT cohort displayed a larger mean tear size (34±12 mm vs. 19±12 mm, P=.01) and had greater infraspinatus involvement (78% vs. 36%, P=.004) and subscapularis involvement (72% vs. 39%, P=.02) than the T cohort. With regard to strength, postoperative ER strength was less likely to be 5/5 in the DT Cohort (53% vs. 94% of patients with 5/5 strength, P=.002) compared with the T cohort. With regard to ROM, the DT cohort had significantly lower preoperative FF (90°±55° vs. 149°±33°, P<.001), ER (36±21° vs. 52° ±14°, P=.02), and IR (5.4 ±2.1 vs. 7.5 ±1.2, P=.002) compared with the T cohort but had similar FF, ER, and IR outcomes postoperatively. There were no differences between the groups for complications and postoperative patient-reported outcomes. Traumatic rotator cuff tears with concomitant dislocations are associated with larger tear size and greater infraspinatus and subscapularis involvement than traumatic tears without dislocation. Arthroscopic repair of this injury is associated with lower preoperative ROM in FF, ER, and IR, as well as lower postoperative ER strength compared with traumatic tears without dislocation. Nonetheless, excellent patient-reported outcomes can be achieved following arthroscopic repair similar to patients without dislocation.

When Is an Isolated Olecranon Fracture Pathognomonic for Osteogenesis Imperfecta?

Isolated fractures of the olecranon process of the ulna in pediatric patients with open physes are classically considered pathognomonic for osteogenesis imperfecta (OI). The purpose of this study was to distinguish the clinical manifestations of isolated olecranon fractures in patients with and without OI to help practitioners assess when further evaluation for OI may be necessary. All patients younger than 18 years old who were treated for an isolated olecranon fracture at a pediatric tertiary care center between 2009 and 2021 were identified. Patients without radiographs available for review, those with known skeletal dysplasia other than OI, and patients with multiple fractures (eg, polytraumas) or with concomitant dislocations were excluded. Of the 701 patients identified, 403 were included for analysis. Demographic variables, mechanism of injury, treatment type, and determination of OI diagnosis were collected. Patients with a previously confirmed diagnosis of OI or with genetic confirmation of OI following their fracture were designated as OI (+), and the remainder were designated OI (-). The Mann-Whitney U and χ2 tests were used to compare groups. Of the 403 patients, the median age was 7.8 years (interquartile range 5.2 to 12.5), and 270 (67%) were male. There were 14 confirmed cases of OI (3.5%). The OI (+) and OI (-) groups did not differ significantly by age or sex (P>0.05). OI (+) patients were more likely to sustain an injury from low-energy mechanisms (86% vs. 32%, P<0.001), sustain displaced fractures (86% vs. 21%, P<0.001) and undergo operative treatment (86% vs. 20%, P<0.001), and to report a history of previous fracture (79% vs. 16%, P<0.001) than OI (-) patients. 36% of OI (+) patients sustained a second olecranon fracture during the study period; there were no subsequent olecranon fractures in the OI (-) group. Isolated olecranon fractures may not be pathognomonic for OI. However, orthopaedists must be vigilant about the possibility of OI in patients who sustain displaced, isolated olecranon fractures under low-energy mechanisms with a history of previous fracture(s). Level III.

Surgical Imbrication of Plantar Plate to Metatarsal Neck in the Setting of Lesser Toe Metatarsophalangeal Joint Instability

Category:Lesser Toes; Midfoot/ForefootIntroduction/Purpose:Persistent metatarsalgia refractory to non-operative therapy with accompanying plantar plate injury represents a common and challenging treatment problem. In previous studies, radiofrequency shrinkage has been used for the treatment of MTP joint instability secondary to low-grade plantar plate lesions.1 In the shoulder, this technique shows histological evidence of modest regenerative capacity but is also associated with several chronic sequelae including capsular stretching, nerve damage, recurrent instability, adhesive capsulitis, and thermally-induced chondrolysis.2-6 The purpose of this observational study was to examine the efficacy of surgical imbrication of the plantar plate to the metatarsal neck as a novel, cost-effective approach to repair Grade 0-1 plantar plate injuries. We sought to characterize patient-reported and radiographic outcomes in patients undergoing this procedure.Methods:Patients from a single fellowship-trained orthopaedic surgeon (1/2017 - 12/2020) were screened by electronic medical record review. Inclusion criteria were age >18 years, a pre-operatively measured Patient-Reported Outcomes Measurement Information System (PROMIS) score, a Grade 0 or 1 plantar plate tear discovered at time of surgery, and repair via surgical imbrication to the metatarsal neck. PROMIS Physical Function and Pain Interference scores were obtained from 14 enrolled patients (median age was 55 years; range: 40-69; 12 female) post-operatively at 6-9 weeks, 3 months, 6 months, and 1-2 years.Basic demographic information and pertinent medical information were also obtained. Three fellowship-trained orthopaedic surgeons independently reviewed radiographs to assess reduction of the metatarsophalangeal joint, and joints were graded as reduced, subluxated, or dislocated. Wilcoxon signed-rank tests compared pre- and post-operative PROMIS scores. Changes in PROMIS scores were compared to numerical and categorical patient characteristics via univariate linear regressions and Mann- Whitney U-tests, respectively.Results:Median postoperative times to most recent PROMIS score and radiographs were respectively 13.0 months (95% confidence interval: 10.0-21.4) and 7.6 months (2.9-10.0). Median preoperative and most recent Physical Function scores were 39.5 (35-50) and 52.5 (41-62), respectively (p=0.003), and median Pain Interference scores changed from 61.0 (56-68) to 53.5 (39- 58) (p=0.002) (Fig. 1). Changes in PROMIS scores showed no association with BMI, age, preoperative opioid use, wound complications, concomitant dislocation, fibromyalgia, or mood disorder (p>0.10). Preoperatively, 9 second MTP joints were concentrically reduced, and 5 were subluxated (n=14). At 6 weeks post-operation, 13 joints remained reduced (n=14). At most recent measurement, all (n=10) joints were reduced (4 patients missing data). 9 of 14 patients underwent concomitant correction of hallux valgus at time of surgery.Conclusion:Patients with Grade 0-1 plantar plate injuries improved significantly in radiographic parameters and patient reported outcome scores following surgical imbrication of the plantar plate to the metatarsal neck. This procedure represents a novel, alternative approach that is both efficacious and cost-effective. Our work contributes valuable surgical outcomes data to a limited knowledgebase regarding pathophysiology and management for low-grade plantar plate lesions in MTP joint instability. Future work will involve larger, prospective studies to better understand outcomes of and indications for this approach.

Monteggia Fracture-Dislocation.

A Monteggia fracture-dislocation involves a proximal one-third of the ulna fracture with a concomitant dislocation of the radial head proximally at the elbow. This fracture and dislocation often results from a fall on the outstretched hand (FOOSH) low-energy mechanism of injury. One must have a high index of suspicion with any ulnar fractures to look for a radial head dislocation so that the dislocation component is not missed. These injuries often require early orthopedic intervention. Any delays in treatment can lead to poor long-term outcomes including chronic valgus instability and radiocapitellar osteoarthrosis.

Epidemiological Characteristics of Major Joints Fracture-Dislocations.

ObjectiveTo describe the epidemiological features of major joints fracture‐dislocations between 2015 and 2019.MethodsThis retrospective study enrolled patients with majorintra‐articular fracture‐dislocations who were treated in the third hospital of Hebei Medical University from January 2015 to December 2019. A total of 582 patients (389 [66.84%] males and 193 [33.16%] females) were identified. The distribution characteristics of intra‐articular fracture‐dislocations involving shoulder, elbow, wrist, hip, knee, and ankle joints were included. The potential associations between fractures with concomitant dislocations and related factors, such as age, gender and sites were explored.ResultsThere were 92 cases (15.81%) of shoulder joints, 67 cases (11.51%) of elbow joints, 45 cases (7.73%) of wrist joints, 181 cases (31.10%) of hip joints, 42 cases (7.22%) of knee joints, and 155 cases (26.63%) of ankle joints. The overall male‐to‐female ratio was 2.02:1.The highest proportion age group of the six types intra‐articular fracture‐dislocations included the ages 25‐34 years. For males, the highest proportion age group was 25‐34 years, for females, it was 45–54 years. For male patients, hip was the most common, accounted for 35.48%, but ankle fracture‐dislocation was the most common for females, accounted for 30.57%. The highest proportion age group of shoulder fracture‐dislocation included the ages 55‐64 years(22.83%), with a male to female ratio of 1.24:1. While the age group with the highest risk of elbow, wrist, hip, knee and ankle fracture‐ dislocation was 25‐34 years (28.36%) with a male to female ratio of 2.19:1, 25‐34 years (31.11%) with a male to female ratio of 8:1, 45‐54 years (27.07%) with a male to female ratio of 3.21:1, 15‐24 years (45.24%) with a male to female ratio of 0.75:1, 25‐44 years (43.87%) with a male to female ratio of 1.63:1, respectively. The most common site of joint fracture‐dislocation in different age groups was corresponding as follows, 0‐14 years(elbow), 15‐24 years(knee), 25‐34 years(hip), 35‐44 years(hip), 45‐54 years(hip), 55‐64 years(ankle), 65‐74 years(shoulder), ≥75 years(shoulder).ConclusionMajor joints fracture‐dislocations were most common in the hip and the least common in the knee, and there were more men than women. Hip was the most common affected joint in men while ankle in women. Age and sex factors can significantly affect the location of intra articular fracture and dislocation. The current study could aid orthopaedic surgeons in a better understanding of this injury and help to implement targeted preventive measures.

OPEN REDUCTION OF MEDIAL EPICONDYLE FRACTURES IN CHILDREN AND ADOLESCENTS: SUPINE VERSUS PRONE POSITION

Background:Operative treatment of medial epicondyle (ME) fractures can be performed in either supine or prone position. In the supine position, visualization and fixation of the fracture is difficult. However, the prone position requires extensive patient repositioning but may improve visualization.Purpose:The purpose of this study was to compare the results of ORIF of ME fractures between supine and prone positions.Methods:In a retrospective review, patients <18 who underwent open reduction of an acute ME fracture from 2011-2019 were identified. Results and complications were compared between the supine and prone positions.Results:204 patients were included, with a mean age of 11.7 years. 133(65.1%) were sports injuries, and 67(32.8%) had concomitant dislocation, with 17(8.3%) having an incarcerated fracture. 122(60%) patients were in the supine group, and 82(40%) in prone. The mean wheels in-wheels out time was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Mean tourniquet time was 53.1 and 55 minutes in supine and prone positions (P=0.4). C-arm usage was 27.9 and 26.9 seconds in the supine and prone groups, respectively (P=0.7). Displacement of the fracture on the first post-operative x-rays was 2.06 and 1.1 millimeters for the supine and prone groups (P<0.001). A total of 39(19%) patients had some ROM limitation at follow-up, with the majority (33 patients) having <10° loss of ROM. Five patients (2.5%) underwent 7 reoperations due to stiffness, 2 patients due to tardy ulnar nerve palsy, 2 due to non-union, and 53(26%) had a surgical hardware removal. Surgical position was not predictive of complications/reoperation. All of the nine surgeons (out of 16) who have operated at least one patient in the prone position have changed their preferred surgical position to prone.Conclusion:With the largest study population in the literature, the results of our study show that surgical stabilization of medial epicondyle fractures is safe, with minimal complications. While the prone position requires additional time in the operating room, presumably for positioning, the surgical procedure takes the same time and the prone position allows for a more accurate reduction. While the clinical significance of a 1mm difference in reduction quality is unknown, the observation that no surgeon that has tried the prone position had ever gone back to the supine position suggests that the surgical procedure is technically easier in this position.

Дифференциальная диагностика спонтанных внутричерепных кровоизлияний у молодых

In recent years, cerebral vascular diseases have been increasingly detected in young patients. It is due not only to better physicians’ knowledge about this pathology, but also to the improvement of its diagnosis methods. Modern neuroimaging techniques allow us to clarify the nature of hemorrhage, to determine the volume and location of intracerebral hematoma, and to establish the degree of concomitant edema and dislocation of the brain. However, despite the high accuracy of the research, it is not always possible to establish the cause that led to a brain accident, which greatly affects the tactics of management and outcomes in this category of patients. A special feature of the structure of cerebrovascular diseases of young people is the high proportion of hemorrhagic stroke, the causes of which are most often arterio-venous malformations. Meanwhile, there are a number of other causes that can lead to hemorrhage into the brain substance. These include disorders of blood clotting, and various vasculitis, and exposure to toxic substances and drugs, and tumor formations (primary and secondary). All these pathological factors outline the range of diagnostic search in young patients who underwent hemorrhagic stroke. Diagnosis of these pathological conditions with the help of modern visualization techniques is considered to be easy, but this is not always the case. In this article, the authors give their own clinical observation of a hemorrhagic stroke in a young patient, which demonstrates the complexity of the diagnostic search in patients with this pathology.

POSTEROMEDIAL ELBOW DISLOCATION WITH IPSILATERAL DISTAL RADIUS FRACTURE

Distal radius fractures with concomitant ipsilateral elbow dislocation are a rare injury pattern. Only a few cases of a distal radius fracture with ipsilateral elbow dislocation have been reported. We discuss the case of a 46-year-old gentleman presenting with posteromedial elbow dislocation with an ipsilateral closed extra-articular fracture of the distal radius. Plain radiographs showed a right posterior-medial elbow dislocation and ipsilateral distal radius fracture. CT scans of the elbow showed impaction fractures of the coronoid and trochlea, suggesting a concomitant posteromedial varus elbow dislocation injury. CT scans of the wrist showed the presence of a comminuted, extra-articular distal radius fracture. Surgical fixation of the distal radius was performed, as well as repair of the right elbow lateral capsule-ligamentous complex with suture anchors. Proper recognition of the posteromedial varus instability type injury to the elbow, as in this case is important, should be addressed. If VPMRI is missed, it can lead to ulno-humeral osteoarthritis of the elbow joint.

Heat shock transcription factor 1 is SUMOylated in the activated trimeric state

The heat shock response is a transcriptional program of organisms to counteract an imbalance in protein homeostasis. It is orchestrated in all eukaryotic cells by heat shock transcription factor 1 (Hsf1). Despite very intensive research, the intricacies of the Hsf1 activation-attenuation cycle remain elusive at a molecular level. Post-translational modifications belong to one of the key mechanisms proposed to adapt the Hsf1 activity to the needs of individual cells, and phosphorylation of Hsf1 at multiple sites has attracted much attention. According to cell biological and proteomics data, Hsf1 is also modified by small ubiquitin-like modifier (SUMO) at several sites. How SUMOylation affects Hsf1 activity at a molecular level is still unclear. Here, we analyzed Hsf1 SUMOylation in vitro with purified components to address questions that could not be answered in cell culture models. In vitro Hsf1 is primarily conjugated at lysine 298 with a single SUMO, though we did detect low-level SUMOylation at other sites. Different SUMO E3 ligases such as protein inhibitor of activated STAT 4 enhanced the efficiency of in vitro modification but did not alter SUMO site preferences. We provide evidence that Hsf1 trimerization and phosphorylation at serines 303 and 307 increases SUMOylation efficiency, suggesting that Hsf1 is SUMOylated in its activated state. Hsf1 can be SUMOylated when DNA bound, and SUMOylation of Hsf1 does neither alter DNA-binding affinity nor affects heat shock cognate 71kDa protein (HSPA8)+DnaJ homolog subfamily B member 1-mediated monomerization of Hsf1 trimers and concomitant dislocation from DNA. We propose that SUMOylation acts at the transcription level of the heat shock response.

Galeazzi Fracture Dislocations: An Illustrated Review.

Galeazzi fracture dislocations are a fracture of the distal one third of the radius shaft with a concomitant dislocation of the distal radioulnar joint (DRUJ). These injuries usually occur by axial loading on an outstretched arm with pronation or supination of the wrist which determines the angulation of the fracture. Surgical treatment has been historically by the anterior (volar) approach to the forearm with plate fixation with or without pinning of the distal radioulnar joint. Failed or inadequate treatment may lead to complications including chronic pain, malunion or instability of the DRUJ that may warrant salvage procedures.

Injury mechanisms of ankle fractures with dislocation and analysis of differences on functional outcome.

In the existing classifications, no importance is given to dislocations accompanying ankle fractures. The present study aims to investigate differences in injury mechanisms of ankle fractures with concomitant dislocation injury in respect of functional outcomes and complications. A retrospective evaluation was carried out of 285 patients who underwent surgery in our clinic for an ankle fracture between January 2012 and December 2018. A comparison was made of functional scores and complications between the patients with ankle fracture with dislocation (AF-D group) and patients with ankle fracture without dislocation (AF-WD). The correlation of dislocation with current classifications (Lauge-Hansen and Danis-Weber) and the effects on functional outcomes were also evaluated. In addition to functional scores, a record was also made for each patient of infection during follow-up, soft-tissue defect, malalignment, non-union, arthrosis and Reflex Sympathetic Dystrophy Syndrome (RSD). The mean age of the patients was 44.7±12.04 years (range, 18-72 years) and the mean follow-up period was 3.2 years. Ankle fracture with dislocation was observed in 88 (30.8%). Similar functional results were determined in the AF-WD and AF-D groups with mean AOFAS 84.05±10.5, and 80.33±9.47, respectively (p=0.379), and mean VAS scores of 1±0.5 and 1.23±0.48, respectively (p=0.117). When the AOFAS values of the dislocation function results were evaluated according to the Lauge-Hansen and Danis-Weber subgroups, no significant difference was observed (p=0.562, 0.723). Arthrosis was seen in two of the AF-WD group and seven of the AF-D group (p=0.004). RSD was determined in two of the AF-WD group and in 10 of the AF-D group (p=0.000). From a medico-legal perspective, patients should be informed about arthrosis, and RSD is another significant problem encountered in this patient group. Although dislocation accompanying ankle fracture was not seen to worsen functional results, arthrosis and RSD were determined more often in these patients.

Quantitative 3-dimensional Computerized Tomography Modeling of Isolated Greater Tuberosity Fractures with and without Shoulder Dislocation.

The aim of this study was to assess differences in fracture morphology and displacement between isolated greater tuberosity (GT) fractures (i.e. fractures of the greater tuberosity without other fractures of the proximal humerus) with and without shoulder dislocation utilizing quantitative 3-dimensional CT imaging. Thirty-four CT-scans of isolated greater tuberosity fractures were measured with 3-dimensional modeling. Twenty patients (59%) had concomitant dislocation of the shoulder that was reduced prior to CT-scanning. We measured: degree and direction of GT displacement, size of the main fracture fragment, the number of fracture fragments, and overlap of the GT fracture fragment over the intact proximal humerus. We found: (1) more overlap -over the intact humerus- in patients without concomitant shoulder dislocation as compared to those with shoulder dislocation (P=0.03), (2) there was a trend towards greater magnitude of displacement between those without (mean 19mm) and those with (mean 11mm) a concomitant shoulder dislocation (P=0.07), and (3) fractures were comparable in direction of displacement (P=0.50) and size of the fracture fragment (P=0.53). We found substantial variation in degree and direction of displacement of GT fracture fragments. Variation in degree of overlap and displacement is partially explained by concomitant shoulder dislocation.

A rare paediatric trauma: Lateral condyle humerus fracture with concomitant postero-medial elbow dislocation.

The association of elbow dislocation with fracture of the lateral condyle in paediatrics is considered very rare and only a few isolated cases have been reported in the literature. Due to its rarity, some of the authors have classified this injury as a complex elbow injury and have deemed them technically demanding to repair. A ten-year-old boy presented to us with a lateral condyle humerus fracture [Milch type 2] with concomitant postero-medial elbow dislocation following a fall on his outstretched hand. At 34 months of follow-up, the child regained a full range of motions around the elbow joint without any deformities.This combination injury, although rare, is not technically different or difficult to treat.

Humeral Shaft Fracture with Ipsilateral Anterior Shoulder Dislocation and Posterior Elbow Dislocation: A Case Report and Review of the Literature.

Fractures of the humeral shaft are rarely complicated by ipsilateral shoulder or elbow dislocation. While the majority of isolated humeral shaft fractures can be treated nonoperatively, polytrauma, neuromuscular disease, and pathologic fractures are often indications for operative intervention1,2. Injuries resulting in concomitant joint dislocation may be associated with functionally adverse outcomes3. Since first reported in the literature in 1940, there have been twenty-three reports in eighteen papers of humeral shaft fractures associated with anterior shoulder dislocation4. There have been even fewer reports of humeral shaft fractures with ipsilateral posterior shoulder dislocation5,6 or ipsilateral elbow dislocation7. We present a case of an extremely rare injury involving a humeral shaft fracture with ipsilateral shoulder and elbow dislocation. To our knowledge, the simultaneous dislocation of both joints in association with an ipsilateral humeral shaft fracture has been reported only once in the literature7. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-six-year-old black man arrived at our level-I trauma center. He had been struck by a forklift while trying to save a two-year-old child from being hit by the machine. He sustained a left frontal intraparenchymal subarachnoid hemorrhage with associated facial and orbital fractures. Radiographs obtained in the trauma bay and physical examination revealed a fracture of the midshaft of the right humerus with an ipsilateral anterior glenohumeral dislocation and a posterior elbow dislocation (Figs. 1-A and 1-B). Anteroposterior (AP) ( Fig. 1-A ) and lateral ( Fig. 1-B ) radiographs of the right humerus and elbow demonstrating a comminuted oblique midshaft fracture with lateral apex angulation and posterior displacement of the distal fragment. Also evident are the anterior glenohumeral dislocation ( Fig. 1-A ) and the posterior elbow dislocation ( Fig. 1-B ). Fig. 1-A Fig. 1-B While the patient was in the trauma bay, we first turned our attention to the closed joint reductions. We employed general anesthesia to relax the patient adequately. In order to take tension off of the median, ulnar, and radial nerves distally, and to give us a stable and …

The Effect of Nitrogen Alloying on the Low Cycle Fatigue and Creep-Fatigue Interaction Behavior of 316LN Stainless Steel

Low cycle fatigue (LCF) and Creep-fatigue interaction (CFI) behavior of 316LN austenitic stainless steel alloyed with 0.07, 0.11, 0.14, .22 wt.% nitrogen is briefly discussed in this paper. The strain-life fatigue behavior of these steels is found to be dictated by not only cyclic plasticity but also by dynamic strain aging (DSA) and secondary cyclic hardening (SCH). The influence of the above phenomenon on cyclic stress response and fatigue life is evaluated in the present study. The above mentioned steels exhibited both single-and dual-slope strain-life fatigue behavior depending on the test temperatures. Concomitant dislocation substructural evolution has revealed transition in substructures from planar to cell structures justifying the change in slope. The beneficial effect of nitrogen on LCF life is observed to be maximum for 316LN with nitrogen in the range 0.11 - 0.14 wt.%, for the tests conducted over a range of temperatures (773-873 K) and at ±0.4 and 0.6 % strain amplitudes at a strain rate of 3*10-3 s-1. A decrease in the applied strain rate from 3*10-3 s-1 to 3*10-5 s-1 or increase in the test temperature from 773 to 873 K led to a peak in the LCF life at a nitrogen content of 0.07 wt.%. Similar results are obtained in CFI tests conducted with tensile hold periods of 13 and 30 minutes. Fractography studies of low strain rate and hold time tested specimens revealed extensive intergranular cracking.

A Historical Perspective on the Essex-Lopresti Injury

An Essex-Lopresti injury is a fracture of the radial head with concomitant dislocation of the distal radioulnar joint and rupture of the interosseous membrane. Poor outcomes have been associated with this rare injury if the dislocation of the distal radioulnar joint is missed in the acute setting. This injury is named after the British orthopedic surgeon Peter Essex-Lopresti, who made a number of important observations about this injury in 1951. Peter Essex-Lopresti was a promising young surgeon, and his untimely death at the age of 35 brought an early end to a remarkable career. This article investigates the evolution of treatment for this injury and sheds light on the life of the surgeon for whom the injury is named.

Posterior Monteggia Fractures in Adults with and Without Concomitant Dislocation of the Elbow

Background The present study comprised a retrospective review aiming to identify the differences between patients with a posterior Monteggia injury with and without concomitant dislocation of the elbow. Methods Forty-nine consecutive adult patients with 50 posterior Monteggia fractures were identified that had operative treatment. Demographics and injury characteristics were recorded for the entire cohort (13 with and 36 without ulnohumeral dislocation) and final motion was recorded in 29 patients (10 with and 19 without dislocation) that had more than 10 months of follow-up. Results Fractures with concomitant elbow dislocation occur in younger patients (45 years versus 56 years; p = 0.046); are associated with higher-energy injuries (54% versus 21%, p = 0.037); are more likely to have a Regan-Morrey type 2 (85% versus 26%, p = 0.003)/Mayo type 1 coronoid fractures (85% versus 21%; p &lt; 0.001); and are more likely to have a Mason type 2 radial head fracture (61% versus 30%; p = 0.046). Conclusions Patients with a posterior Monteggia fracture and concomitant elbow dislocation have smaller coronoid fractures and worse ultimate ulnohumeral motion than patients without anelbow dislocation.

Long-Term Outcome of Isolated Diaphyseal Radius Fractures With and Without Dislocation of the Distal Radioulnar Joint

We tested the hypothesis that there are no differences between apparently isolated fractures of the radial diaphysis and isolated fractures of the radial diaphysis with concomitant dislocation of the distal radioulnar joint (DRUJ) in function, disability, and DRUJ stability more than 13 years after near-anatomic open reduction with plate and screw fixation. We evaluated 17 adult patients with a diaphyseal fracture of the radius without a fracture of the ulna an average of 19 years after surgery (range, 13-33 y). Of these patients, 7 had concomitant dislocation of the DRUJ (Galeazzi fracture). At the long-term follow-up, we evaluated function with several composite scores, stability of the DRUJ, and arm-specific disability by using the Disabilities of Arm, Shoulder, and Hand questionnaire. The average scores were 96 (range, 85-100) on the Mayo Modified Wrist Score, 95 (range, 80-100) on the Mayo Elbow Performance Index, and 5 (range, 0-33) on the Disabilities of Arm, Shoulder, and Hand questionnaire. There were no significant differences between patients with and without DRUJ dislocation. No patients had greater laxity of the DRUJ than the opposite uninjured side. Near-anatomic open reduction and internal fixation of diaphyseal radius fractures with and without associated DRUJ dislocation have comparable long-term results.

Concomitant dislocation of the tarsometatarsal and metatarsophalangeal joints of the second toe (floating second metatarsal): a case report

When examining patients with injuries of the tarsometatarsal joint, the physician must pay attention to the foot as a whole.An extremely rare foot injury has been described in which axial and compressive forces cause simultaneous dislocation of the tarsometatarsal joint and the metatarsophalangeal joint of the same or adjacent ray. The following is a report of one of these rare injuries.We will also discuss probable mechanism and diagnosis of this rare traumatic injury.