Reduction Of Dislocation Research Articles

Comparing Propofol With Fentanyl and Midazolam for Sedation in Closed Reductions of Traumatic Hip Dislocations.

Traumatic native hip dislocations require prompt reduction of the dislocation to limit the risk of avascular necrosis and resultant hip arthrosis. Although closed reduction under sedation is frequently attempted, there is minimal evidence about which sedative agent is most safe and effective. The goal of this study was to compare the efficacy of propofol vs combination fentanyl/midazolam for closed reduction under sedation of traumatic native hip dislocations. This was a single-center retrospective review. The main outcome measures were the rate of successful closed reduction with propofol vs combination fentanyl/midazolam and time from the start of sedation to radiographic evidence of reduction. Fifty-four patients with traumatic native hip dislocations were identified. Closed reduction under sedation with propofol was successful in 11 of 14 attempts compared with 4 of 11 attempts with combination fentanyl/midazolam (P=.04). The fentanyl/midazolam group had 6.4 times the odds (95% CI, 1.1-37.7) of failed closed reduction compared with the propofol group. The median time to reduction in the propofol group was 14 minutes vs 45 minutes for the fentanyl/midazolam group (P=.18). Patients who had failed closed reduction with fentanyl/midazolam had a median time to reduction of 100 minutes. There was no difference in sedation-related complications between the 2 groups. We therefore conclude that sedation with propofol is significantly more effective than combination fentanyl/midazolam for closed reduction of native hip dislocations. To minimize unsuccessful reduction attempts and shorten total time to reduction, we recommend against the use of combination fentanyl/midazolam because of the high risk of failure. [Orthopedics. 2023;46(2):86-92.].

INTRA-ARTICULAR LIGNOCAINE AS ANALGESIA DURING MANUAL REDUCTION OF ACUTE ANTERIOR SHOULDER DISLOCATION: AN OBSERVATIONAL STUDY.

Background:Acute anterior shoulder dislocation needs prompt reduction to provide pain relief. The ideal reduction method should be simple, fast, effective and non- traumatic, with minimal pain, and should not cause further injury to the affected shoulder. Intra-articular lignocaine has been advocated as a means of providing analgesia and subsequent relaxation to the patient.Aim: To assess the efciency of intraarticular lignocaine for reduction of anterior shoulder dislocations. Patients s & Methods: Thirty cases of acute anterior shoulder dislocation were reduced using intraarticular local lignocaine injection as a method of analgesia by Rockwood's traction and counter traction method. Ten to Fifteen ml of 1% lignocaine was injected into the glenohumeral joint through a 20 gauge, 35-mm needle. Approximately ten to fteen minutes were allowed for the local anaesthetic to take effect before any manipulation of the shoulder was attempted. Results: The mean age was 37.2years±18.23 SD with majority of patients in age group of 20 to 40 years. 80% of patients were females. Among thirty patients studied 28 (93.3 %) had primary dislocation and in 18 patients (60 %) dominant shoulder was dislocated. Majority of the dislocations were reduced within 6 hours of injury. Pain assessed through application of a Visual Analog Scale during the maneuver revealed scores ranging from two to eight with mean score of 4.39 ± 1.46 SD (p value 0.049). Conclusion: We conclude method is not only safe and effective but also reduces hospital stay and has negligible adverse effects making it a popular choice for most orthopedists.

Improved mechanical properties of the cast Mg–2.5Gd–0.5Zr alloy via hot extrusion

Microstructural evolution and mechanical properties of the Mg–2.5Gd–0.5Zr alloy in the as-cast and extruded conditions were studied. Their flow behavior was investigated at room and elevated temperatures of 100, 175 and 250 °C through the shear punch testing (SPT) method. The as-cast alloy exhibited a non-dendritic microstructure due to the presence of Zr, which provided nucleation sites during solidification. A recrystallized microstructure was developed in the extruded alloy, due to the counteraction of Zr against the retarding effect of Gd on DRX. The enhancement in the strength of the extruded alloy was mainly ascribed to grain boundary strengthening. The reduction of shear yield stress (SYS) and ultimate shear strength (USS) with increasing the testing temperature in both as-cast and extruded conditions was a direct result of dislocation annihilation and reduction in the CRSS of non-basal slip systems. Both conditions developed reasonable ductility that was slightly enhanced with increasing temperature. The as-cast alloy, however, showed higher ductility and a more ductile fracture behavior compared to the extruded one at each testing temperature, caused by the synergy of twinning and slip in this condition and the very fine-grained structure of the extruded condition.

A cross-sectional study evaluating patients’ preferences for Salter innominate osteotomy

BackgroundResidual acetabular dysplasia in children after reduction of hip dislocation is often treated using Salter innominate osteotomy to prevent future osteoarthritis. Preventive surgery for asymptomatic patients, which could result in overtreatment, should be carefully applied with consideration of patients’ opinions. In this study, we aimed to describe opinions on Salter innominate osteotomy as preventive surgery for children among adult patients who had undergone periacetabular osteotomy for hip pain due to hip dysplasia. MethodsA mail-in questionnaire survey was conducted with 77 patients who underwent periacetabular osteotomy. Participants responded whether they would recommend Salter innominate osteotomy as preventive surgery for children and the reason for their opinion. We also performed a patient-based evaluation using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire and assessed clinical outcome measures with the Japanese Orthopedic Association score. Their recommendations and reasons were evaluated, and associations between their opinions and demographic and clinical characteristics were analyzed. ResultsForty-three patients (56%) responded to the questionnaire. Of these, 10 (23%) patients recommended undergoing Salter innominate osteotomy, 28 (65%) patients did not, and 5 (12%) patients responded they were undecided. No significant association was observed between their opinions and demographic/clinical characteristics evaluated in the survey. The most frequent reason for why they do not recommend Salter innominate osteotomy was related to uncertainty about future hip pain. ConclusionsIn total, 65% of the study participants did not recommend Salter innominate osteotomy for children with risk of dysplasia in the future. Participants’ preferences regarding preventive surgery were not influenced by demographic and clinical characteristics.

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

ObjectivesTo study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of nerve function of patients with craniovertebral junction disorders who were treated with transoral approach operations.MethodsThis research analyzed 20 cases collected from October 2009 to May 2010. All these patients were with CVJ disorders, including 8 males and 12 females, aged 2 to 66 (38.1 on average), and they were all treated with transoral approach operations. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points, including 3 days before operation/before gargling, 3 days after continuous gargling/after anesthesia intubation on the day of operation, after intraoperative cleaning and washing of the mouth, and after intraoperative iodophor immersion. The microflora was stained by means of smear and further counted after an investigation by microscope. The neural function of patients was evaluated by the ASIA classification and the JOA scores. All patients but two with posterior stabilization performed respectively underwent transoral atlantoaxial reduction plate (TARP) fixation consecutively in the same sitting. A regular reexamination of cervical vertebra with lateral and open mouth X-ray, CT and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesions and tumor recurrence.ResultsThis bacteriological research showed that the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state after a series of oral preoperative preparations and intraoperative iodophor disinfection, which was considered as type I incision. The bacterial culture results of the mucosa samples of the posterior pharyngeal wall collected at different time points showed significant differences (χ2 = 42.762, P = 0.000). All the patients had improvement in ASIA, and their neural functions were improved to different levels after operation. There was a significant difference in JOA scores before and after operation (t = 8.677, P = 0.000). Postoperative imaging examination showed that the atlantoaxial screw position was good and firm, and the CVJ disorders were treated appropriately.ConclusionIt is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach.

Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis.

ObjectiveAnterior shoulder dislocations are commonly treated in the emergency department (ED). Analgesia for reduction is provided by intra-articular lidocaine (IAL) injection or intravenous sedation (IV sedation). The objective of this systematic review and meta-analysis was to compare IAL versus IV sedation for closed reduction of acute anterior shoulder dislocation in the ED.MethodsElectronic searches of MEDLINE and EMBASE (1946–September 2021) were completed and reference lists were hand-searched. Randomized controlled trials (RCTs) comparing IAL and IV sedation for reduction of acute anterior shoulder dislocations among patients ≥ 15 years old in the ED were included. Outcomes of interest included a successful reduction, adverse events, ED length of stay, pain scores, procedure time, ease of reduction, patient satisfaction, and cost. Two reviewers independently screened abstracts, assessed study quality and extracted data. Data were pooled using random-effects models and reported as mean differences and risk ratios (RR) with 95% confidence intervals (CIs).Results12 RCTs were included with a total of 630 patients (IAL = 327; IV sedation = 303). There was no difference in reduction success between IAL and IV sedation (RR 0.93; 95% CI 0.86–1.01, I2 = 69%), significantly lower adverse events with IAL (RR 0.16; 95% CI 0.07–0.33, I2 = 0%), shorter ED length of stay with IAL (mean difference − 1.48; 95% CI − 2.48 to − 0.47, I2 = 93%), no difference in pain scores post-analgesia and no difference in ease of reduction.ConclusionsIntra-articular lidocaine may have similar effectiveness as IV sedation in the successful reduction of anterior shoulder dislocations in the ED with fewer adverse events, shorter ED length of stay, and no difference in pain scores or ease of reduction. Intra-articular lidocaine may be an effective alternative to IV sedation for reducing anterior shoulder dislocations, particularly when IV sedation is contraindicated or not feasible.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-022-00368-z.

Effect of annealing on chemically deposited Cu2Se thin films

Cu2Se is a promising candidate in the field of photovoltaic and thermoelectric devices. The pristine Cu2Se thin films are observed to be unstable under ambient conditions. One of the instabilities reported in this material is the formation of dendritic structures on the surface. The present work discusses the effect of post-deposition annealing on the dendritic growth formation. The pristine Cu2Se films were vacuum annealed at 60 °C, 80 °C, 100 °C, 150 °C, and 180 °C and the properties of the samples were investigated. The XRD peak profile analysis was done to evaluate the microstructural parameters like crystallite size, microstrain, stress and energy density. The various techniques used for this study include Scherrer method, Modified Scherrer Method, Williamson-Hall Plots, and Size Strain Plot. The modified variants of W–H Plots were employed which included Uniform Deformation Model, Uniform Stress Deformation Model and Uniform Deformation Energy Density Model. In all these cases, the crystallite size was found to increase on annealing. This is attributed to the reduction in defects and dislocations due to annealing of the sample. Microstrain is also observed to increase with the increase in annealing temperature. The calculation of crystallite size and lattice strain using UDM model deviates more from other models. This may be due to the incompatibility of its basic assumption of isotropic strain in UDM model. The W–H plots also suggest the presence of tensile strain in the lattice. The Cu ions in pristine Cu2Se thin films are in a disordered state due to their high mobility and diffusion coefficient. These mobile Cu ions form the centres of anisotropy and participate in dendritic growth formation with suitable stimulants. With an increase in annealing temperature, these ions get ordered due to strain hardening which in turn stabilizes the Cu2Se structure. The minimum temperature required to resist dendritic growth formation was found to be 150 °C. Thus annealing of pristine sample is suggested as a simple but effective method towards stabilization of the matrix. During the annealing process in the temperature range 60 °C–180 °C, it is observed that the optical band gap decreased from 2.2 eV to 1.9 eV.

Ga+ Focused Ion Beam Damage in n-type Ga2O3 and Its Recovery after Annealing Treatment

Focused Ga+ ion milling of lightly Si-doped, n-type Ga2O3 was performed with 2–30 kV ions at normal incidence and beam currents that were a function of beam voltage. The electrical effects of the ion damage were characterized by Schottky barrier height and diode ideality factor on vertical rectifier structures comprising 10 µm epitaxial n- Ga2O3 on n+ Ga2O3 substrates, while the structural damage was imaged by Transmission Electron Microscopy. The forward current-voltage characteristics showed significant deterioration at 5kV. The I-V characteristics no longer showed rectification for the 30kV condition. Subsequent annealing up to 400°C produced substantial recovery of the I-V characteristics for all beam energies and was sufficient to restore the initial ideality factor completely for beam energies up to 5kV. A remarkable reduction of dislocations can be observed in 30 kV ion exposed sample after annealing at 400°C.

Early Intraprosthetic Dislocation of Total Hip Arthroplasty with Double Mobility Implant: Case Report.

Total hip arthroplasty (THA) is a successful surgery in the treatment of hip pain, but there are potential complications, of which dislocation is one of the most common. Dislocation management is a challenging problem that requires a multimodal approach, and the use of dual mobility implants is an option. We present a patient with a history of femoral neck fracture who underwent THA with a double mobility implant. On the 18 th postoperative day, after a fall to the ground, she developed prosthesis dislocation and had a complication after closed reduction, a subsequent intraprosthetic dislocation. After a radiographic diagnosis, the patient presented mechanical signs of hip flexion caused by a disassociated double mobility implant. The revision surgery was indicated, but the patient chose not to perform the necessary surgical procedure. A careful postoperative study of the radiographs revealed an eccentric femoral head and evidence of disassociated implantation in the surrounding soft tissues. Radiographs after closed reduction of intraprosthetic dislocations should be examined thoroughly.

Reliability of the computed tomography criteria after closed reduction of developmental dislocation of the hip

BACKGROUND: Developmental dislocation of the hip includes femoral head subluxation or dislocation and/or acetabular dysplasia. Closed reduction of the hip should be performed under general anesthesia. Appropriate performance and interpretation of closed reduction are difficult and require experience. The role of computed tomography (CT) in different aspects of treatment of developmental hip dysplasia is well established. It was an accurate way to assess the adequacy of reduction of dislocated hips for patients in spica casts.
 AIM: This study aimed to assess the role of CT in the evaluation of closed reduction of developmental hip dislocation in infants and children immobilized in spica casts.
 MATERIALS AND METHODS: This study included 16 patients with 20 involved hips who presented with developmental hip dysplasia. The youngest patient was 12 months old, and the oldest was 24 months old, with a mean age of 19.62 4.27 months. There were 15 girls (93.75%) and one boy (6.25%). There were four patients with bilateral hip involvement (25%), and the right side was involved in five hips (31.25%), whereas the left side was affected in 7 (43.75%) hips.
 RESULTS: Closed reduction was performed in 20 hips, and according to the post-reduction CT evaluation, the final results were satisfactory in 16 (80%) hips and unsatisfactory in 4 (20%) hips. On the coronal CT cuts, the modified Shentons line gave a sensitivity of 75%, specificity of 81.25%, and accuracy of 80%. Second, the calculation of femoral head coverage on coronal CT cuts showed the highest sensitivity of 100%, specificity of 50%, and accuracy of 60%. Lastly, the posterior neck line identified on the axial CT cuts gave a sensitivity of 75%, specificity of 87%, and accuracy of 85%. On comparing and evaluating the three methods, the method that gave the best level of reliability for the adequacy of the reduction was the posterior neckline (82.23 %), followed by modified Shentons line (78.75%), and finally femoral head coverage (70%).
 CONCLUSIONS: The posterior neck line is the preferred method to confirm the adequacy of hip relocation on multi-slice post-reduction axial CT.

Improving mechanical properties of austenitic stainless steel by the grain refinement in wire and arc additive manufacturing assisted with ultrasonic impact treatment

In this study, the ER321 stainless steel is fabricated by wire and arc additive manufacturing (WAAM) assisted with ultrasonic impact treatment (UIT). The mechanical properties and microstructure characterizations of ER321 stainless steel with and without UIT are investigated. It is found that grain structure of ER321 stainless steel is reduced to equiaxed dendrites (with UIT) from coarse columnar dendrites (without UIT). The UIT effectively refines grain sizes that decreases by ∼150% and homogenizes the grain structure of the deposition layers. Simultaneously, the UIT also facilitates the recrystallization that leads to the reduction of dislocation and texture densities. Furthermore, the improvement of grain structure enhances yield strength (∼10.5%), ultimate tensile strength (∼3.7%), microhardness (∼12.5%) and elongation of ER321 stainless steel. The grain boundary strengthening is the main strengthening mechanism, which leads to the yield strength increment of ER321 stainless steel under UIT condition. A way to effectively control grain structure in additive manufacturing-fabricated metal products using an UIT technique is provided in this work.

Same-Day Discharge Following Aseptic Revision and Conversion Total Joint Arthroplasty: A Single-Institution Experience

BackgroundWith hospital inpatient capacity increasingly limited and primary total joint arthroplasty (TJA) rapidly transitioning to outpatient settings, the feasibility of outpatient aseptic revision and conversion TJA (rTJA) has been considered. Before the widespread adoption of outpatient rTJA, guidelines must be established to prevent patient harm. To this end, this study describes our initial experience with same-day-discharge (SDD) aseptic rTJA. MethodsAll aseptic rTJAs performed between May 8, 2015, and December 30, 2021, were retrospectively reviewed. Revision indications, patient selection criteria, and outcomes including SDD success rate, predischarge complications, all-cause emergency department visits, inpatient readmissions, and unplanned clinic encounters within 90 days of surgery were recorded. ResultsThirty-five SDD aseptic rTJAs were performed. Conversion total hip arthroplasty (55.0%) and instability (27.3%) were the most common indications for hip revision. Instability (50%) and conversion total knee arthroplasty (20.8%) were most common for knee revision. SDD was achieved in 97% (34/35) of cases. One hip patient failed SDD due to persistent hypoxia requiring an overnight hospital stay and also underwent closed reduction for dislocation in the emergency department within 90 days of discharge. Two additional patients had unplanned clinic encounters within 90 days of the index procedure. There were no hospital readmissions or reoperations within 90 days. ConclusionsOur initial experience suggests SDD aseptic rTJA can be safe and effective when modern perioperative outpatient protocols and surgical techniques are implemented. Future studies should further define patient selection criteria to optimize outcomes and minimize complications in this population.

Autonomous vehicles and changing the future of cities: Technical and urban perspectives

When the first car hit the road in the early 19th century, municipal officials, architects and urban planners had to think differently about the infrastructure and mass development of cities, whether existing or new. The age of narrow roads, pedestrians and short journeys gave way to wide boulevards, interstate highways and suburban growth. These urban planning improvements were intended to enable the car to transport a greater number of people more quickly and safely, without the drawbacks of urban transit. This caused cities to suffer from issues such as unnecessary demolition of houses, degradation of areas for roads, reduction or loss of public transport and dislocation of intimate communities. Now that the mass market will embrace autonomous cars, buses and other innovations over the next decade, urban designers and officials need to reconsider how disruptive technologies can influence our way of life, work and play. Autonomous vehicles (AVs) provide a new way of joining social conversations about urban infrastructure, mobility, community and street functions. AVs will disrupt the urban areas between city centres and the rural outskirts. This paper analyses the impact of AVs on modelling urban forms. The AV has the advantage of optimising various parking locations, thus freeing up the downtown area for other uses. The reduced cost per kilometre is also a popular advantage. Increased access to AVs benefits workers’ welfare, traffic flow, travel distances and city size. The paper concludes by discussing the overall implications of AV implementation for urban transport and mass transit.

Comparison of Sedatives for the Reduction of Shoulder Dislocation Based on Bispectral Index System in Emergency Department: A Randomized, Three-Group, Double-Blinded Clinical Trial

Comparison of Sedatives for the Reduction of Shoulder Dislocation Based on Bispectral Index System in Emergency Department: A Randomized, Three-Group, Double-Blinded Clinical Trial

Posterior atlanto-axial intraarticular distraction technique as revision surgery to treat atlanto-axial dislocation associated with basilar invagination

Objective: To examine the effect of posterior atlanto-axial intraarticular distraction technique as revision surgery for failed posterior fossa decompression in patients with basilar invagination(BI) and atlanto-axial dislocation(AAD). Methods: The clinical data of 13 cases of AAD accompanied with BI treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. There were 3 males and 10 females,aged (42.6±9.5) years (range:30 to 63 years). All cases had assimilation of atlas and once underwent posterior fossa decompression. Anterior tissue was released through posterior approach followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line(DCL),clivus-canal angle(CCA) and the length of syrinx were collected. Paired sample t test was used to compared the data before and after operation. Results: All patients underwent surgery successfully, the mean surgical time was (187.7±47.4) minutes (range from 116 to 261 minutes). Twenty occipital condyle screws, 26 C2 pedicle screws and 3 occipital plates were implanted. Clinical symptoms improved in all patients. Twelve patients had complete reduction of basilar invagination and atlanto-axial dislocation, 1 achieved near completely reduction of basilar invagination. The postoperative ADI, DCL and CCA significantly improved((4.3±1.1) mm vs. (1.8±0.8) mm, (11.7±5.0) mm vs. (6.4±2.8) mm, (142.4±7.9)° vs. (133.3±7.9)°, all P<0.01).There were 5 cases with syringomyelia before surgery, and shrinkage of syrinx was observed 1 week after surgery in all cases. Eight patients achieved bone fusion 3 months after surgery, all patients achieved bone fusion 6 months after surgery. The JOA score increased from 12.8±2.3 before surgery to 14.8±1.3 one year after surgery, with statistically significant difference (t=4.416, P<0.01).No implant failure, spacer subsidence and infection were observed. Conclusion: In cases of failure posterior fossa decompression of basilar invagination and atlanto-axial dislocation, using posterior atlanto-axial intraarticular distraction and cantilever technique with cage implantation could achieve complete reduction and symptomatic relief.

Reoperation and revision rates at ten years after 1,312 cemented Thompson's hemiarthroplasties : any need to change to a different implant?

AimsDespite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes.MethodsPatient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries.ResultsIn total, 1,312 Thompson’s hemiarthroplasties were analyzed (mean age at surgery 82.8 years); 125 complications were recorded, necessitating 82 returns to theatre. These included 14 patients undergoing aspiration or manipulation under anaesthesia, 68 reoperations (5.2%) for debridement and implant retention (n = 12), haematoma evacuation (n = 2), open reduction for dislocation (n = 1), fixation of periprosthetic fracture (n = 5), and 48 revised stems (3.7%), for infection (n = 13), dislocation (n = 12), aseptic loosening (n = 9), persistent pain (n = 6), periprosthetic fracture (n = 4), acetabular erosion (n = 3), and metastatic bone disease (n = 1). Their status at ten years is summarized as follows: 1,180 (89.9%) dead without revision, 34 (2.6%) dead having had revision, 84 (6.6%) alive with the stem unrevised, and 14 (1.1%) alive having had revision. Cumulative implant survivorship was 90.3% at ten years; patient survivorship was 7.4%.ConclusionThe Thompson’s stem demonstrates very low rates of complications requiring reoperation and revision, up to ten years after the index procedure. Fewer than one in ten patients live for ten years after fracture. This study supports the use of a cemented Thompson’s implant as a cost-effective option for frail hip fracture patients.Cite this article: Bone Jt Open 2022;3(9):710–715.

PREOPERATIVE CLOSE REDUCTION OF CERVICAL FRACTURE DISLOCATIONS

Study design: Retrospective study. Purpose: To determine Reduction rate of cervical fracture dislocations using preoperative gradual in hospital skull traction. Overview of literature: Cervical spine fracture dislocations are unstable injuries and require surgical intervention and stabilization. The approach may be anterior, posterior or combined. Majority of the surgeons prefer anterior approach after initial close reduction of cervical fracture dislocation. If close reduction preoperatively fails, then posterior direct reduction is needed followed by anterior surgery.In this study we intend to determine the rate of success (reduction) using preoperative gradual traction. Method: This retrospective study was conducted at Spine Unit Hayatabad Medical Complex and Aman hospital Peshawar. All patients with cervical fracture dislocations presented between Jan 2015 &amp; Jan 2019, who underwent cervical traction prior to surgical interventions were included in the study. The demographics, types of dislocation, preoperative traction, duration and neurology of all patients were recorded. The success of reduction using closed in hospital gradual traction was assessed using lateral cervical spine x-rays. Data was assessed using SPSS version 20. Results: A total of 52 patients were included in the study with a mean age of 30.06 years (SD± 8.03). In 35(67.3%) patients the dislocation was bifacetal while in 17(32.7%) it was unifacetal. Successful reduction using gradual in hospital awake traction was achieved in 39(75%) patients while in 13(25%) patients reduction was not achieved. Mean duration of preoperative traction was 3.6 (SD±1.1) days with minimum 2 days and maximum 7 days. Conclusion: Gradual in hospital traction in awake patients is an effective mean of reducing cervical fracture dislocations.

Traumatic posterior dislocation of hip with ipsilateral fracture of shaft of the femur: external maneuvers reduction and osteosynthesis by screw plate about a case and review of literature at Tambacounda regional hospital in Senegal

&lt;p&gt;Traumatic hip dislocation associated with an ipsilateral femoral fracture is a rare injury. It occurs in a high-energy traumatic context. The classic mechanism consists of a fall with landing on the hip, which initially dislocates and the femur fracture occurs secondarily by adduction of the proximal fragment. The diagnosis is difficult in front of the fracture whose signs mask the vicious attitude of the dislocation. We reported the case of a passenger of a motorcycle who collided with a parked car. He was ejected from the motorcycle and landed on his right hip. We performed X-rays of hip and lower limb at his admission which revealed a dislocation of hip in its high posterior variety and a medio-diaphyseal fracture of femur on same side. Reduction of dislocation by external maneuvers was made and osteosynthesis of femur with screwed plate performed 48 h later. After 16 months of care, functional and radiological results sufficient.&lt;/p&gt;

Risk factors for the presence of important fractures in ED patients with shoulder dislocation: a retrospective cohort study

BackgroundPrereduction shoulder X-rays are frequently done to rule out an important fracture that might preclude reduction of a shoulder dislocation in the ED. Our objective was to determine the risk...

Pulmonary embolism following reduction of traumatic anterior hip dislocation- A case report and review of literature

Anterior hip dislocations are uncommon, but are associated with the risk of occlusion of major vessels of the limb. We report a case of traumatic anterior hip dislocation who had an on-table cardiac arrest following reduction of hip. It was due to pulmonary embolism, and delayed presentation increased the risk for the same. It was an unanticipated event for us and we wish for all the providers to be aware of this occurrence.