Dislocation In Adults Research Articles

The Role of Medial Retinaculum Plication Versus Medial Patellofemoral Ligament Reconstruction in Combined Procedures for Recurrent Patellar Instability in Adults

Background: The comparative clinical outcome of medial retinaculum plication (MRP) versus medial patellofemoral ligament reconstruction (MPFLR) for recurrent patellar instability in adults is unknown. Hypothesis: Arthroscopic MRP can yield similar results to MPFLR for recurrent patellar instability in adults. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: One hundred patients with recurrent patellar instability were randomly divided into 2 groups receiving either arthroscopic MRP or MPFLR. Lateral release and anteromedial or distal tibial tubercle transfers were also performed as indicated. Follow-ups were performed at 12, 24, and 60 months postoperatively, and computed tomography (CT) was performed immediately after the operation and at follow-up. The passive patella glide test was performed before surgery and at each follow-up point. The degree of knee function was evaluated preoperatively and at 2 and 5 years postoperatively using the International Knee Documentation Committee (IKDC), Lysholm, and Kujala rating scales. Survival analysis was performed, and redislocation or multiple episodes of patellar instability were considered as indicating failure. Results: Forty-three patients in the MRP group and 45 patients in the MPFLR group were followed for 5 years and received complete evaluations. The correction of the static patellar position deteriorated over time in both groups, but significantly better results were observed for the MPFLR group. The results of the passive patella glide test indicated more stable patellae in the MPFLR group at each follow-up point. Functional evaluations at 2 and 5 years (final Lysholm score, 69.3 ± 6.9 vs 86.9 ± 6.1; Kujala score, 73.8 ± 5.5 vs 87.4 ± 5.7) revealed statistically significant superior results in the MPFLR group. Finally, 4 patients (9.3%) in the MRP group and 1 (2.2%) in the MPFLR group experienced episodes of redislocation, and 7 patients (16.3%) in the MRP group and 3 (6.7%) in the MPFLR group experienced multiple episodes of patellar instability (P = .037). Kaplan-Meier survival analysis and a log-rank test indicated better results and a significantly higher survival rate (P = .006) in the MPFLR group. Conclusion: MPFLR results in better static patellar position and functional outcome than MRP in the treatment of recurrent patellar dislocation in adults.

First time patellar dislocation in adults—consensus of management among the orthopaedic surgeons in UK

First time patellar dislocation in adults—consensus of management among the orthopaedic surgeons in UK

Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults

Dislocation of the acromioclavicular joint is one of the most common shoulder problems in general orthopaedic practice. The question of whether surgery should be used remains controversial. To assess the relative effects of surgical versus conservative (non-surgical) interventions for treating acromioclavicular dislocations in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to February 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to February 2009), EMBASE (1988 to February 2009), and LILACS (1982 to February 2009), trial registries and reference lists of articles. There were no restrictions based on language or publication status. All randomised and quasi-randomised trials that compared surgical with conservative treatment of acromioclavicular dislocation in adults were included. All review authors independently performed study selection. Two authors independently assessed the included trials and performed data extraction. Three trials were included in this review. These involved a total of 174 mainly male participants. Two trials were randomised and one was quasi-randomised. None used validated measures for assessing functional outcome.Fixation of the acromioclavicular joint using coracoclavicular screws, acromioclavicular pins or, usually threaded, wires was compared with supporting the arm in a sling or similar device. There were no significant differences between the two groups in unsatisfactory longer-term (one year) shoulder function based on a composite measure including pain, movement and strength or function (risk ratio 1.49, 95% confidence interval 0.75 to 2.95), nor in treatment failure that generally required an operation (risk ratio 1.72, 95% confidence interval 0.72 to 4.12). However, there were fixation failures in all three trials. Particularly, the trial using wires reported a high incidence of wire breakage (16/39 (41%)). Two trials reported that surgery significantly delayed the return to work. The methods used in the three trials also meant a routine second operation for implant removal was necessary. There is insufficient evidence from randomised controlled trials to determine when surgical treatment is indicated for acromioclavicular dislocation in adults in current practice. Sufficiently powered, good quality, well-reported randomised trials of currently-used surgical interventions versus conservative treatment for well-defined injuries are required.

Traumatic hip dislocation in adults

Traumatic hip dislocation occurs during high-energy trauma and is often associated with other life threatening injuries. Dislocation can be anterior or posterior and urgent reduction is mandatory to reduce the risk of avascular necrosis of the femoral head. Undisplaced femoral neck fractures should be excluded prior to attempted reduction. Various closed reduction techniques have been described and most dislocations can be reduced with a closed technique. Failure to achieve reduction makes open reduction mandatory. This review describes the diagnosis, investigation and management of this complex and challenging injury.

Letter to the Editor: Congenital Disease of the Hip

To the Editor: It was with great interest that we read the articles from the symposium on Developmental Dysplasia of the Hip published in April 2008. We participated in this symposium with the article “The Morphologic Variations of Low and High Hip Dislocation” [7]. We wish, however, to comment on the terminology “developmental dysplasia of the hip,” as used by most of this symposium's authors. We have been concerned about that terminology's propriety, mainly for two reasons. First, the term “developmental” is not descriptive of the congenital origin of the deformity; second, an indiscriminate use of the word “dysplasia” is not in agreement with the variety of underlying pathology. Before the availability of radiographs Dupuytren [4], in 1826, observed some newborn infants with displacement of the head of the femur from the acetabulum; he named this condition “congenital displacement.” Dupuytren's recognition of the congenital nature of the deformity has been accepted as original [4]. In 1897, based on anatomic specimens, Phelps [14] also concluded the majority of such cases are really dislocations in uterus or at birth. Since that time, after pioneer works with anatomic dissections and studies of the pathologic features at open operations [3, 8, 9, 12, 13, 15], the majority of authors have accepted the congenital nature of the deformity. Therefore, in considering the current use of the term “developmental” that focuses on the possibility of the deformity to develop, one wonders why the original word “congenital,” indicating the deformity's origin in uterus, has been abandoned. Such a change came after Klisic's [10] brief report in 1989 arguing “congenital dislocation of the hip,” a term used up to that time, is a misleading term, because the disorder is of variable pathology, not always a dislocation, and even when dislocation occurs, it often happens postnatally; therefore it is not truly congenital. He recommended, without convincing arguments, the use of the term “developmental displacement.” Surprisingly, many authors and the American Academy of Orthopaedic Surgeons accepted the wording change of “congenital” to “developmental” but replaced the word “displacement” with “dysplasia.” Thus, from a term that had a deficient second component (“dislocation”), we unfortunately acquired a nonspecific term deficient in both its components (“developmental” and “dysplasia”). The term “dysplasia” is composed of the Greek words δvζ (bad) and πλSymbolση (formation). Thus, dysplasia could be used for the total spectrum of hip deformities. Yet, to avoid confusion and diagnostic inaccuracies, it is preferable for the term “dysplasia” to be reserved for the milder types of hip deformities. It is clear we still do not have an agreed terminology covering the entire pathology of congenital deformities of the hip or a generally accepted classification of its types that will improve our communication, treatment planning, and evaluation of results of various treatments.SymbolStanisavljevic and Mitchell [15] were, to our knowledge, the first who used the terminology “congenital disease of the hip” for the total spectrum of congenital hip deformities in infancy, classified as dysplasia, subluxation, and dislocation. Their historical study published in 1963 was based on 240 deseeded hips of 120 stillborn and newborn babies between 1958 and 1961. Subsequently, several authors accepted the proposed term “congenital disease of the hip” and the classification in infants as dysplasia, subluxation, and dislocation [2, 16, 17]. We have adapted such concepts and used the term “congenital disease of the hip” in adults, and relying on radiographic and morphologic criteria validated during THA, we have described three types of diseases of increasing severity: dysplasia, low dislocation, and high dislocation [5, 6]. We strongly recommend using the terminology “congenital disease of the hip” for the entire spectrum of related deformities, with the classification as dysplasia, subluxation, and dislocation in infants and as dysplasia, low dislocation, and high dislocation in adults. Finally, the short and interesting report “50 Years in CORR” [1], noted Massie suggested no dislocation of the hip could occur embryologically. However, Massie's [11] report in 1956 referred to a 5.5-week embryo when the components of the hip do not have their definite position. Furthermore, in a previous article, in 1951, Massie and Howorth [12] illustrated a case of bilateral dislocation of hip at the eighth month of fetal life.

Traumatic occipitocervical disruption: a new technique for stabilisation

Traumatic atlanto-occipital dislocation in adults is usually fatal and survival without neurological deficit is rare. The surgical management of those who do survive is difficult and controversial. Most authorities recommend posterior occipitoaxial fusion, but this compromises cervical rotation. We describe a case in which a patient with a traumatic atlanto-occipital disruption but no neurological deficit was treated by atlanto-occipital fusion using a new technique consisting of cancellous bone autografting supported by an occipital plate linked by rods to lateral mass screws in the atlas. The technique is described in detail. At one year the neck was stable, radiological fusion had been achieved, and atlantoaxial rotation preserved. The rationale behind this approach is discussed and the relevant literature reviewed. We recommend the technique for injuries of this type.

Tardy ulnar nerve palsy in cubitus varus deformity associated with ulnar nerve dislocation in adults

Seven patients with tardy ulnar nerve palsy from a posttraumatic cubitus varus deformity were reviewed retrospectively. The severity of symptoms was grade I in 3 patients and grade II in 4 patients according to McGowan's classification. The mean internal rotation angle was 30.7 degrees (range, 25 degrees -45 degrees ). The most prominent feature was dislocation of the nerve anterior to the medial epicondyle and entrapment of the nerve by the fibrous band of the flexor carpi ulnaris muscle. Of these 7 patients, 4 were treated by 3-dimensional osteotomy with ulnar nerve transposition, and 3 were treated by anterior transposition of the ulnar nerve. All patients improved clinically, and there was no significant difference between anterior transposition of the nerve in the group with osteotomy and the group without osteotomy. Ulnar nerve instability due to internal rotation deformity and distal entrapment was considered to be the main cause of neuropathy.

Isolated, Traumatic Anterior Dislocation of the Radial Head In An Adult

Isolated radial head dislocation in adults is extremely rare and has been predominantly posterior. A case of isolated, acute anterior dislocation of the radial head an adult is reported. A 26-year-old male sustained an isolated radial head dislocation following a fall on the outstretched hand. The dislocation was treated by closed reduction and transcapitellar Kirschner wire fixation. At final follow-up the patient had recovered full range of motion of the elbow. Radiographs of the forearm including elbow and wrist were normal. A management algorithm for this injury is proposed, based on a review of the literature.

Untreated Hip Dislocation in Cerebral Palsy

The purpose of this study was to evaluate the problems associated with hip dislocation in adults with cerebral palsy. Twenty-nine subjects with dislocated hips and no prior hip surgery were identified. There were a total of 38 dislocated hips. Age range was 21 to 52 years (average 34). Seven dislocated hips (18%) were definitely painful and four hips (11%) produced only mild or intermittent pain. Twenty-seven hips (71%) were not painful. The seven painful hips underwent proximal femoral resection, resulting in excellent range of motion and no pain. In conclusion, for established nonpainful hip dislocation in the severely involved spastic quadriplegic patient, aggressive surgical treatment should be undertaken only after careful consideration of the natural history. If a dislocated hip becomes painful in adulthood or develops an adduction contracture interfering with perineal care, a proximal femoral resection can be performed with reliably good success.

Epidemiology, demographics, and natural history of congenital hip disease in adults.

This study examined the epidemiology and demographics of congenital hip disease in 468 (660 hips) patients who were examined between 1970 and 1996. In 356 (54%) hips, the diagnosis was secondary osteoarthritis due to congenital hip disease, and in 272 (41%) hips, the diagnosis was idiopathic osteoarthritis. In the remaining 32 (5%) hips, the diagnosis was uncertain. Of the hips with congenital hip disease, 170 (47.7%) hips were dysplastic, 85 (23.9%) had low dislocation, and 101 (28.4%) high dislocation. The majority of patients with congenital hip disease were women (338 [95%] hips). The natural history of the three types of congenital hip disease was studied in 157 patients (202 hips: 102 dysplastic, 42 low dislocation, and 58 high dislocation) who had received no treatment before the initial examination. Average length of follow-up was 17 years. In dysplastic hips, the disease remained undiagnosed until the onset of symptoms at an average age of 34.5 years. In patients with low dislocation, pain had started at an average of 32.5 years due to progressive degenerative arthritis within the false acetabulum. In patients with high dislocation, in the presence of a false acetabulum, pain started at an average age of 31.2 years, while in its absence, pain started at an average age of 46.4 years due to muscle fatigue. These findings suggest dysplasia, low dislocation, and high dislocation in adults are the results of untreated dysplasia, subluxation, and complete dislocation in infancy, respectively.

Operative Treatment of Elbow Fractures and Dislocations in Adults

Operative Treatment of Elbow Fractures and Dislocations in Adults