Dislocation Of Head Research Articles

Femoral Preparation Before Head Dislocation in Hip Hemiarthroplasty for Fractured Neck of Femur Saves Time and Keeps the Acetabulum Clean of loose bone fragments: A Retrospective Study and Technical Report

Introduction: Femoral neck fractures are the most common traumatic injuries associated with increasing age and osteoporosis, occurring most in older females. The femoral neck is under constant strain from externally and internally generated forces, approximately 500 – 200 micro-strains from daily activities. Common causes are falls in the elderly and road traffic accidents in younger patients. There is a significant in-house mortality and one-year mortality rate associated with femoral fractures. Fractures can be classified using the Garden Classification or the 2018 AO/OTA classification. Management includes open reduction and internal fixation, cannulated or sliding screws and hemiarthroplasty or total hip arthroplasty. This study examines the benefits of femoral preparation before head dislocation in hip hemiarthroplasties by assessing differences between pre-operative and post-operative haemoglobin levels and surgical times. Methods: We report the surgical techniques of hip hemiarthroplasty where the femur is prepared before the femoral head is removed and the hip is reduced in the flexion position. A retrospective review of electronic patient records of patients who underwent hemiarthroplasties from June 2022 to June 2023 was conducted. Results: Surgical times for this surgical technique were 30 minutes faster than traditional methods while the differences in haemoglobin levels were minimal. Conclusion: Longer surgical times are associated with adverse events such as infections and wound dehiscence while increasing risks via surgeon fatigue and longer anaesthesia durations. Innovations in surgical techniques should thus aim to minimise surgical time without compromising procedures. This technique saves 30 min on average while having similar levels of blood loss to traditional techniques, maintaining standards, and not compromising on patient safety. Femoral preparation before dislocating the femoral head reduces the steps taken in leg repositioning which saves time and effort by the assistant. The reduction technique also avoids any risk of intra-operative iatrogenic fracture that can happen, especially if the assistant is a junior surgeon who lacks experience with hip reduction.

Dissociation of Implant following Hemi Replacement Arthroplasty in an Osteoporotic Male Patient: A Case Report

Hip fracture is a major health concern in elderly people. Thc standard line of management is hip arthroplasty classified whether it is intracapsular or extracapsular. Hemi arthroplasty is the preferred surgery in geriatric population as less mobility and the large diameter of the femur head reduces the chances of dislocation. There are 4 surgical techniques for Hemi -arthroplasty: anterior (Smith-Peterson), anterolateral (Watson. lones), lateral (Hardinge or Liverpool) and posterior (moore). Common complications of hip replacement include infection, fracture, dislocation, venous thrombosis, nerve palsy, chronic pain and implant failure. ln literature: there are very few reported cases of Dissociation of the Implant in hemi arthroplasty. We hereby present a case report on dissociation of prosthesis which was timely recognised and treated adequately. The cemented bipolar prosthesis used can also lead to dissociation of the implant components and thereby the need for open reduction. Identification of the difference between dislocation of head and dissociation of the prosthetic componcnts is vital for favourable patient prognosis.

The Risk Factors of the Hip Dislocation After Total Hip Arthroplasty (Literature Review)

Summary. The dislocation of the endoprosthesis head is one of hip arthroplasty complications. In the vast majority of cases, the cause of dislocation is multifactorial. That is why only a thorough analysis of the patient’s peculiarities, surgery and rehabilitation will help to avoid the relapse. Risk factors associated with the patient include: old age, male gender, obesity, concomitant diseases, low level of preoperative physical activity, low compliance, and some others. The problem of biomechanical ratio in the segment “spine – pelvis – lower limb” deserves special attention. Besides, there are risk factors associated with the surgeon: access option, type of implant, fixation and position of endoprosthesis components, experience and surgical technique of the orthopedic surgeon. The strategy of dislocations rate reduction is based on a detailed study of dislocation causes and their elimination, and adequate surgery planning. The treatment of a patient with dislocation should take into account the multifactorial etiology of the condition.

Reccurence of Heterotopic Ossification as the Result of Total Hip Endoprosthesis Dislocation: A Case Report

Background. Heterotopic ossification (HO) is the formation of mature bone in soft tissues. HO in the hip area can be a consequence of both injury to the nervous system and local trauma. After total hip arthroplasty HO develops in 30% of cases.
 The aim of the study is to demonstrate a rare clinical case of a recurrence of HO in patient after a primary total hip arthroplasty, accompanied by ankylosing.
 Case presentation. A 32-year-old patient was admitted to the clinic for revision hip arthroplasty with a diagnosis long-standing dislocation of the right hip joint endoprosthesis head, heterotopic ossification 3 years after dislocation. During the surgery, there were difficulties with the sciatic nerve dissection, as well as the structures of the endoprosthesis. We removed all the ossifications that obstructed the dislocation of the endoprosthesis. The patient had sciatic nerve neuropathy on the right lower limb with lesions of the fibular and tibial nerves on the background of edema. The patient was discharged on the 21st day. The presented clinical case is interesting because the patients relapse could be caused by a combination of various risk factors. Taking into account the fact that the injury was received as a result of an accident and the patient had a fracture of the bones of the contralateral shin, it could be the effect of a local hip injury that aggravated the process.
 Conclusions. This clinical observation highlights the importance of preventing possible complications after surgery and maintaining feedback with patients, especially those belonging to the high-risk group. It is likely that with adequate prevention of the HO formation and timely reduction of dislocation, the problems described in the article after primary total hip arthroplasty could have been avoided.

Safety of surgical hip dislocation in femoral head fracture and dislocation (FHFD) and avascular necrosis risk factor analysis of FHFD: midterm results confirmed by SPECT/CT and MRI

BackgroundThe study aim was to report the treatment outcomes of trochanteric flip osteotomy (TFO) with surgical hip dislocation (SHD) for femoral head fracture and dislocation (FHFD) and to investigate the risk factors for avascular necrosis (AVN) of the femoral head.MethodsThe data of 34 patients (29 men, 5 women; mean age 37.9 years) diagnosed with FHFD and treated with TFO with SHD between May 2009 and February 2018 with an average follow-up period of 5.1 years (range 2.8–10.5 years) were analyzed. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score and Thompson–Epstein Scale. Radiologic outcomes were classified according to the Matta classification. AVN was confirmed using magnetic resonance imaging or single-photon emission computed tomography/computed tomography. The occurrence of complications was examined, and factors influencing complications, AVN.ResultsRegarding the Pipkin’s classification, there were 7 patients with type II, 2 patients with type III, and 25 patients with type IV fractures. Posterior wall fractures accompanied all associated acetabular fractures in the patients with Pipkin type IV fractures. Radiologically, the union of acetabular and femoral head fractures was observed within 6.1 months on average (range 4–10 months) in 32 patients, except two patients who developed femoral head AVN. Clinically, the average Merle d'Aubigné–Postel score was 14.4 points (range 8–17 points), and 22 patients had good or excellent results on the Thompson–Epstein Scale. Two patients developed femoral head AVN with both having displaced femoral neck fractures associated with FHFD. AVN was significantly correlated with femoral neck fractures (P = 0.000).ConclusionTFO with SHD is a safe and useful approach for the treatment of FHFD. Particular attention should be paid when treating femoral head fractures associated with displaced femoral neck fractures because of the high risk of AVN development.

Pediatric Monteggia Fracture Outcome Assessment - Preliminary Report.

The term Monteggia fracture refers to a class of injuries encompassing the fracture ofthe proximal end of the ulna with subluxation or dislocation of the radial head. These injuries account for 0.4-1% of all forearm fractures in children. Despite its low incidence, Monteggia fractures require particular attention, since as much as 30-50% of the cases may be unrecognized, which subsequently leads to complications. The purpose of this paper is to evaluate treatment outcomes of Monteggia fractures in children. Both conservative treatment and surgery were analyzed. 15 children (7 boys and 8 girls) between the ages of 4-16.3 years (mean age 8.3 years) with Monteggia fractures were hospitalized at our center in the years 2015-2020. Closed reduction and immobilization in a cast were performed in 12 patients, while three children underwent surgical treatment with internal fixation of the ulna. The radial head dislocation was reduced successfully in every patient. Every child from the study group who received conservative treatment regained full elbow mobility as well as normal forearm supination and pronation. Only one ofthepatients who underwent the surgery demonstrated a 20° deficit in elbow flexion that did not affect limb function. 1. Our experience shows that closed reduction together with immobilization in a cast is usually a sufficient treatment in Monteggia fractures. 2. However, the dislocated radial head should be properly reduced in all patients. 3. Correct diagnosis and treatment followed by appropriate rehabilitation result in full recovery and no mobility limitations in children and teenagers.

Classification of proximal humerus fractures according to pattern recognition is associated with high intraobserver and interobserver agreement.

BackgroundThe Mayo-Fundación Jiménez Díaz (FJD) classification for proximal humerus fractures aims to identify specific fracture patterns and apply displacement criteria to each pattern. The classification includes 7 common fracture patterns: isolated fractures of the greater or lesser tuberosity, fractures of the surgical neck, impacted fractures involving head rotation in a varus and posteromedial direction or in valgus, and fractures where the humeral head is dislocated (head dislocation), split (head splitting), or depressed (head impaction). The purpose of this study was to evaluate the intraobserver and interobserver agreement of the Mayo-FJD classification system using plain radiographs (xR) and computed tomography (CT).MethodsThree fellowship-trained shoulder surgeons blindly and independently evaluated the xR and CT of 103 consecutive proximal humerus fractures treated at a Level I trauma center. Each surgeon classified all fractures according to the Mayo-FJD classification system on 4 separate sessions at least 6 weeks apart. K values were calculated for intraobserver and interobserver reliability.ResultsThe average intraobserver agreement was 0.9 (almost perfect) for xR and 0.9 (almost perfect) for CT scans. The average interobserver agreement was 0.69 (substantial) for xR and 0.81 (almost perfect) for CT scans at the first round, and 0.66 (substantial) for xR and 0.75 (substantial) for CT scans at the second round.ConclusionThe pattern-based Mayo-FJD classification scheme for proximal humerus fractures was associated with adequate intraobserver and interobserver agreement using both xR and CT scan. Interobserver agreement was best when fractures were classified using CT scans.

Delayed radial head dislocation after radial shaft fracture fixation: a case report and review of the literature

BackgroundIpsilateral fracture of the radial shaft with dislocation of the radial head was a rare injury, but a delayed radial head dislocation after radial shaft fracture fixation was more extremely rare.Case presentationA 39-year-old man fell from the height on his outstretched hand and injured his left, non-dominant forearm. Preoperative radiographs demonstrated a comminuted fracture of the proximal third of the radius but with no apparent dislocation of the distal or proximal radioulnar joints or the elbow. Seven days after the injury, the radius was fixed with a reconstruction locking plate, and the immediate postoperative radiograph revealed a satisfactory reduction. However, a radiograph done at the 4th week postoperatively showed that the radial head dislocated. Manual reduction under anesthesia was tried but failed and the patient refused to take another open surgery. The patient had an acceptable range of motion 12 months after the surgery: elbow flexion 120°, full elbow extension, forearm pronation 80°, forearm supination 80°, but he complained the pain around the elbow.ConclusionIn the case of radial shaft fracture especially the when occurs at the proximal third of the radial shaft, even if the radiograph does not show the injury of the proximal radioulnar joint, we should also make a thorough examination of the proximal radioulnar joint. If the radial head dislocation is not initially diagnosed or treated late, a delayed dislocation would be very difficult to manage with a poor expected outcome.

Application Value of Combined Diagnosis of Ultrasound, MRI, and X-Ray in Developmental Dysplasia of the Hip in Children.

Objective To explore the application value of the combined diagnosis of ultrasound, MRI, and X-ray in developmental dysplasia of the hip (DDH) in children. Methods Ninety children with suspected DDH admitted to our hospital from June 2017 to June 2020 were selected as the research objects to conduct a retrospective study. According to the age of the children, they were divided into a group with 0–6 months (group X), a group with 7–12 months (group Y), and a group older than 12 months (group Z), with 30 cases in each group. X-ray and high-frequency ultrasound were performed in all groups, and MRI examination was added to the children in groups Y and Z to compare the diagnostic value of the three imaging examinations in DDH children. Results No obvious differences in the general data and maternal risk factors were observed among the three groups (P < 0.05). The final comprehensive diagnostic results were taken as the gold standard, including 23 cases with acetabular dysplasia, 28 cases with subluxation of the femoral head, 31 cases with complete dislocation of the femoral head, and 8 non-DDH cases. The diagnostic accuracy of the three methods from high to low was MRI, high-frequency ultrasound, and X-ray, with obviously higher diagnostic accuracy of MRI than that of X-ray (P < 0.05). The ROC curves showed that the diagnostic efficacy from high to low was MRI + high-frequency ultrasound + X-ray, high-frequency ultrasound + X-ray, MRI, high-frequency ultrasound, and X-ray. Conclusion Ultrasound combined with X-ray has obvious advantages in the diagnosis of children at low months of age, while MRI has outstanding advantages in the diagnosis of children at high months of age. MRI combined with ultrasound and X-ray can significantly improve the diagnostic accuracy of DDH and provide objective data support for the clinical treatment of children.

Surgical treatment of the humeral head osteochondral defects in chronic shoulder dislocation: Literature review

Background. The shoulder joint is the one most amenable to dislocation. Dislocation of the humeral head is complicated by combined injuries of the shoulder joint, and if the patient does not seek treatment on the first day after the dislocation, irreversible changes in bone and soft tissue structures are formed.The aim of this review was to analyze modern methods of diagnosis and treatment of patients with defects in the articular surfaces of the scapula and humerus head with chronic shoulder dislocations.Material and methods. To search for literature data, we used the electronic databases MEDLINE, PudMed, eLIBRARY with a selection of sources published from 2000 to 2020. The analysis was carried out on works devoted to the diagnosis, surgical treatment and complications of traumatic shoulder dislocations.Results. When analyzing the literature on the surgical treatment of shoulder dislocations, we did not find clear criteria for planning the extent of surgery. The obtained results of surgical treatment testify to well-studied technologies for treating osteochondral defects of the humeral head up to 25 % of its total area. In the presence of a defect of 50 % of humeral head area or more, satisfactory results are shown when carrying out arthroplasty of the joint using a reverse endoprosthesis. However, the treatment of defects ranging in size from 25 to 50 % is still an unexplored problem. There are single techniques using allografts, mainly in English-speaking countries and, to a lesser extent, on the territory of the Russian Federation. Thus, the search for an algorithm for choosing a surgical treatment based on multi-layer spiral computed tomography and/or magnetic resonance imaging data, and the development of a new method of surgical treatment taking into account the obtained data are priority areas in modern traumatology and orthopedics.

Latissimus dorsi tendon transposition combined with shoulder joint proximal capsule plasty with peroneal longus tendon autograft in the treatment of patients with massive rotator cuff ruptures and proximal dislocation of the humerus head (clinical case)

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and 40 % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In the treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures.

Основні критерії прогнозування вивиху головки ендопротеза у хворих із переломами шийки стегнової кістки після однополюсного ендопротезування кульшового суглоба

Мета. Визначення основних кількісних критеріїв прогнозування вивиху головки ендопротеза кульшового суглоба у пацієнтів з переломами шийки стегнової кістки при однополюсному ендопротезуванні на основі ретроспективного та проспективного аналізів результатів лікування. Матеріали та методи. Проведено ретроспективний аналіз протоколів клініко-рентгенологічного обстеження 20 хворих (5 чоловіків, 15 жінок віком 55–86 років) із переломами шийки стегнової кістки після первинного ендопротезування кульшового суглоба за загальноприйнятою методикою у 2000–2015 рр.; проспективне дослідження результатів нового способу однополюсного ендопротезування кульшового суглоба зі збереженням капсули суглоба (патент України № 119611) в 11 пацієнтів (4 чоловіки, 7 жінок віком 66–92 роки) з переломами шийки стегнової кістки, які проходили лікування у 2013–2016 рр. Всі хворі спостерігалися у Державній установі «Інститут патології хребта та суглобів ім. проф. М.І. Ситенка НАМН України» (м. Харків). Результати. Основні фактори ризику вивиху головки ендопротеза після однополюсного ендопротезування кульшового суглоба з приводу переломів шийки стегнової кістки — похилий вік (90,0 %), слабкість м’язів, що оточують кульшовий суглоб (90,0 %), надмірні рухи у суглобі у післяопераційному періоді (80,0 %), попередні оперативні втручання на кульшовому суглобі (70,0 %), надмірна маса тіла (60,0 %). У даної категорії хворих установлено чисельні значення прогностичних коефіцієнтів та їх інформативності для вірогідних пацієнто-, імпланто- та хірургічно залежних факторів ризику вивиху головки ендопротеза. Висновки. Запропонований авторами спосіб профілактики та лікування вивиху головки ендопротеза через збереження капсули кульшового суглоба при первинному однополюсному ендопротезуванні хворих із переломами шийки стегнової кістки забезпечує сприятливий результат хірургічного лікування, незважаючи на наявність факторів ризику вивиху головки ендопротеза у післяопераційному періоді.

Деформации позвоночника у детей с церебральным параличом: естественное течение и методы коррекции

Introduction Spinal deformity is one of major orthopaedic manifestations of cerebral palsy (CP). Despite the prevalence of the nosologic condition there is a deficiency in the availability of criteria for screening and management of the spinal pathology in CP patients, difficulties in interdisciplinary logistics, lack of registry and restraints in the continuity of the rehabilitation system. The purpose of the work was to focus the attention of mainstream audience of dedicated experts on the aspects of the course and correction techniques of spinal deformities in CP patients. Evidence level 5 (UK Oxford, version 2011). Results The type of spinal deformity depends on the functional level classified with the GMFCS. Vertebral evaluation included identification of the leading component of the deformity, apex location, mobility, trunk balance, chest deformity, type of pelvic obliquity, the way contractures and dislocation of the femoral heads affected the lumbar spine mobility. The goal of spinal deformity correction in CP patients is to maintain or improve the functionality of the patients, improve the quality of life for the patient and the family. The use of transpedicular multi-support fixation systems and bone allografts can be recommended for bone fusion in the patients. Spinal fixation can be extended from the upper thoracic vertebrae down to the pelvis. Dynamic fixation systems, multilevel or multi-rod fixation can be an option depending on the age, extent of the maturity of the axial skeleton and size of the curve. Conclusion The severity of manifestations of spinal deformity increases in CP patients with greater level of global motor functions and does not depend on the skeletal maturity. Conservative treatment is ineffective at a long term. Correction and instrumentation transpedicular fixation allows for threedimensional correction without the need for anterior fusion. Surgical treatment significantly improves body balance, functional level and quality of life.

Outcomes using the Ilizarov external mini-fixator for Monteggia fractures in children

Objective To evaluate the use of Ilizarov external mini-fixation in the treatment of Monteggia fractures (dislocation of the radial head with an associated fracture of the proximal ulna) in children. Methods Children with proximal ulnar fracture were included and underwent fracture reduction surgery with Ilizarov external mini-fixators, followed by immobilization of the supinated forearm with plaster. The reduction was evaluated intra-operatively using arthrography. Mackay criteria were used to evaluate clinical outcomes at follow-up. Results A total of 15 children were included in the study. Mackay efficacy was 100 %, indicating excellent outcomes using the Ilizarov external mini-fixator. Conclusion Use of the Ilizarov external mini–fixator is particularly suitable in the treatment of children with comminuted and compression fractures of proximal ulna. It is easy to operate, low invasive and is worthy of promotion.

Outcomes of Treatment of Monteggia Fractures with Reduction and Internal Titanium Elastic Nail Fixation of the Ulna.

The purpose of this paper is to evaluate the usefulness of radiographic indices of humero-radial joint instability in order to predict treatment outcomes in Monteggia fractures. A retrospective analysis was conducted in a group of patients who underwent closed reduction and internal titanium elastic nail (TEN) fixation of the ulna and closed reduction of a dislocation of the radial head between 2016 and 2018. The indications for intrame-dullary fixation comprised transverse or short oblique fractures. The direction of the dislocation was classified according to Bado. The following radiographic indies were assessed: Radiocapitellar Line, Lateral Humeral Line, Proximity Index, and Radial Head Displacement Index. Treatment outcomes were assessed with the Oxford Elbow Score and Mayo Elbow Performance Score, and com-plications were assessed with a modified Clavien-Dindo-Sink scale. No coincidence between poor functional and radio-graphic outcomes was demonstrated. 1. Regardless of the severity of the injury, eligibility for surgery and correctly performed surgical treatment guarantee a good final outcome. 2. Patients treated with TEN regain their preoperative mobility. 3. There was no coincidence between poor functional and radiographic outcomes, except for one patient in whom subluxation of the radial head persisted despite surgery and was confirmed radiographically and functionally. 4. It would be beneficial for clinical practice to introduce simple, reproducible radiographic parameters for unambiguous assessment of the effectiveness of treatment and predicting treatment outcomes; unfortunately none of the parameters we investigated were sufficiently reliable. 5. The radiographic parameters analysed in this paper are dependent on the quality of the radiological examinations performed.

Reconstruction of the plantar plate of the metatarsophalangeal joint using adorsal transarticular approach

Reconstruction of the plantar plate to stabilize adislocated or instable lesser metatarsophalangeal joint using adorsal approach in combination with aWeil osteotomy. Dislocated or instable lesser metatarsophalangeal joint with rupture of the plantar plate. Infection, circulatory disorders, symptomatic degenerative arthritis lesser metatarsophalangeal joint. Weil osteotomy using adorsal approach. Temporary dislocation of the metatarsal head as proximal as possible. Inspection of the plantar plate. Assessment and classification of type and extent of the rupture. Suturing of the plantar plate to the plantar bases of the proximal phalanx. Fixation of the Weil osteotomy with correction of the metatarsal alignment. Weight bearing in apostoperative shoe as tolerated. X‑ray control 6weeks postoperative. Full weight bearing in aconventional shoe after bony consolidation. A total of 23surgical reconstructions of the plantar plate (complete plantar plate repair) between 12/2012 and 10/2014 were performed. The mean follow-up was 18.6 (12-30) months. Five secondary dislocations were observed: onedeep postoperative infection, one early dislocation of unknown cause, one secondary dislocation caused by severe hallux valgus recurrence, onemassive foreign body reaction to the non-resorbable sutures, and one late secondary dislocation occurred between 6weeks and 1year postoperative. Normal function of the reconstructed joint was achieved in 13 of the 23reconstructions (57%). Areduced toe purchase was observed in 3reconstructions (13%). Afloating-toe resulted after 7reconstructions (30%).

Gradual ulnar lengthening in Masada type I/IIb deformity in patients with hereditary multiple osteochondromas: a retrospective study with a mean follow-up of 4.2\u2009years

BackgroundGradual ulnar lengthening is the most commonly used procedure in the treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children. This study aims to evaluate the clinical and radiological outcomes of ulnar gradual lengthening in our clinic.MethodsWe retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, 2 months after external frame removal, and at the last follow-up.ResultsThe current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at the index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37 ± 8 to 30 ± 7° initially (p = 0.005) and relapsed to 34 ± 8° at the last follow-up (p = 0.255). There was a minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). At the last follow-up, the mean forearm pronation and elbow flexion increased significantly (p < 0.001 and p = 0.013, respectively), and the mean carrying angle also improved significantly (p < 0.001). No patient with type IIb deformity achieved a concentric radial head reduction.ConclusionsGradual ulnar lengthening significantly reduces cosmetic deformity and improves function in patients with Masada type I/IIb deformity. Our results supported early ulnar lengthening for patients with a tendency of dislocation of the radial head.

Management of Humeral Avulsion of the Glenohumeral Ligament (HAGL) Lesion

Traumatic, anterior shoulder dislocation is a common athletic injury, especially in young, overhead athletes. The mechanism of injury is typically when the shoulder is placed in an abducted, externally rotated position and a forceful anterior moment is applied to the humerus resulting in an anterior and inferiorly directed dislocation of the humeral head from the glenoid. Due to the limited stretching capacity of the glenohumeral capsule and associated glenohumeral ligaments, the force of the traumatic dislocation overcomes the tensile strength of these ligaments resulting in a tear. Of the ligaments typically injured are those of the anterior inferior glenohumeral ligaments, which is referred to as a humeral avulsion of the glenohumeral ligament lesion. Although other structures may be injured, the topic of this review will focus on the injuries to this structure, how this is effectively diagnosed and the preferred surgical treatment technique for treatment of this injury.

Total hip replacement in femoral head osteonecrosis

The experience of hip replacement in young patients with osteonecrosis of the femoral head was analyzed in the article. The results of operations in the osteonecrosis group and osteoarthritis group in 3 years and 7 months after operations were compared. In 97.5 % of cases, cementless fixation implants with a ceramic on ceramic friction pair (45 %) and ceramic on polyethylene friction pair (45 %) were used. Surgical approaches by Moore, Hardinge and AMIS technique were applied. The clinical results of operations in the studied groups were similar, but the survival rate of endoprostheses in the osteonecrosis group was 91.5 %, and in the osteoarthritis group 97.2 %. In the osteonecrosis group an increased frequency of complications (dislocation of the endoprosthesis head, periprosthetic fracture, periprosthetic infection) and revision operations were observed. Our results show the influence of risk factors, concomitant diseases, the level of activity of young patients on the long-term total hip arthroplasty result.

Simultaneous dislocation of the radial head and distal radio-ulnar joint without fracture in an adult patient: a case report and review of literature

BackgroundSimultaneous dislocation of the radial head and distal radio-ulnar joint without fracture (Criss-Cross Injury) in an adult patient is rarely reported in previous studies. The pathological changes and injury patterns have not been clearly demonstrated.Case presentationA 26-year-old woman presented with acute pain of the right wrist and elbow after a fall from cycling. Physical examination revealed an unstable elbow and wrist joint. Plain radiographs showed volar dislocation of the radial head and dorsal dislocation of the distal radius without associated fracture, forming a criss-cross appearance of the ulna and radius on the lateral radiograph. MRI images confirmed partial rupture of the proximal interosseous membrane from its dorsal attachment on the radius, as well as partial rupture of the medial collateral ligament. Conservative treatment failed because the radiocapitellar joint and distal radio-ulnar joint could not be simultaneously reduced. Surgical exploration revealed a highly unstable radial head, but the annular ligament was found to be intact. Manual force was applied to reduce the radial head and a percutaneous K-wire was used to stabilize the proximal radioulnar joint with the forearm in full supination. After surgery, the elbow was immobilized in 90° flexion by a long arm cast for 4 weeks. The K-wire was removed at 6 weeks postoperatively. At 18 months postoperatively, the patient had regained a full range of flexion and extension, with normal supination and a slight limitation in pronation.ConclusionsThe proximal IOM, especially the dorsal band, was injured in Criss-Cross injuries, while the central part of the IOM remained intact. This injury pattern distinguished itself from Essex-Lopresti injury, which mainly involves rupture of the central band of the IOM.