Grade Of Dislocation Research Articles

Rates and risk factors for failure of reduction in closed reduction in developmental dysplasia of the hip: a systematic review and meta-analysis.

In developmental dysplasia of the hip (DDH), concentric reduction of dislocated hips cannot be achieved by closed reduction in many cases, and open reduction is required ('failure of reduction'). The incidence of cases requiring open reduction and the significance of risk factors for unsuccessful reduction remain unclear. We investigated the overall rate and the risk factors for failed closed reduction in DDH. We followed the Cochrane recommendations in our systematic review and meta-analysis. We performed a systematic search in three medical databases to identify all studies reporting on pediatric patients with hip dislocation in DDH on 2 July 2022. Eligible studies reported on the rate of failure in children younger than 36 months. We calculated odds ratios (ORs) with 95% CIs from two-by-two tables (event rate in risk group, event rate in non-risk group). We identified 13 316 studies and included 62 studies (5281 hips) for failure rate and 34 studies (3810 hips) for risk factor analysis. The overall rate of failure in closed reduction was 20%. The risk of failure of reduction increased with the grade of dislocation and was significantly higher for high dislocations (group 0-24: IHDI 4 vs IHDI 2 OR: 17.45, CI: 9.26-32.92; Tönnis 4 vs Tönnis 2 OR: 14.67, CI: 1.21-177.37; Graf IV vs Graf III OR: 3.4, CI: 2.27-5.09). Male gender was also a significant risk factor (OR: 2.27, CI: 1.13-4.56) in group 0-36. Higher grade dislocations and male gender are significant risk factors for failure of reduction in closed reduction in hip dislocation in DDH.

Association of Posterior Tibial Slope With Outcomes After Multiligamentous Knee Reconstruction for Knee Dislocation Grades 2 to 4.

Patients with isolated anterior cruciate ligament (ACL) reconstruction have demonstrated an increased risk of ACL graft failure and lower patient-reported outcome (PRO) scores when increased posterior tibial slope (PTS) is present. However, there is a paucity of literature evaluating the effect of PTS on outcomes after combined bicruciate multiligamentous knee reconstruction. To determine whether differences exist for graft failure rates or PRO scores based on PTS after combined bicruciate multiligamentous knee reconstruction. Cohort study; Level of evidence, 3. All patients who underwent combined ACL and posterior cruciate ligament (PCL) reconstruction between 2000 and 2020 at our institution were identified. Exclusion criteria were age <18 years, knee dislocation grade 5 injuries, concomitant osteotomy procedures, and <2 years of clinical follow-up. Demographic and outcomes data were collected from our prospectively gathered multiligamentous knee injury database. Lysholm and International Knee Documentation Committee (IKDC) scores were analyzed in relation to PTS. Outcomes were compared for patients with a PTS above and below the mean for the total cohort, PTS >12° versus <12°, positive versus negative Lachman test at follow-up, and positive versus negative posterior drawer test at follow-up. A total of 98 knees in 98 patients were included in the study, with a mean clinical follow-up of 5.1 years (median, 4.6 years; range, 2-16 years). The mean PTS was 8.7° (range, 0.4°-16.9°). Linear regression analysis showed no significant correlation between PTS and IKDC or Lysholm scores. Patients with a PTS above the mean of 8.7° trended toward lower IKDC (P = .08) and Lysholm (P = .06) scores. Four patients experienced ACL graft failure and 5 patients experienced PCL graft failure. There were no differences in graft failure rates or PRO scores for patients with a PTS >12°. Patients with a positive Lachman test trended toward higher PTS (9.6° vs 8.5°, P = .15). In this series of bicruciate multiligamentous knee reconstructions at midterm follow-up, no differences in graft failures, complications, reoperations, revisions, or PRO scores based on PTS were identified. Patients with a positive Lachman test were found to have a slightly higher PTS, although this did not reach statistical significance.

ОСОБЕННОСТИ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ ПРИ МАЛЬФОРМАЦИИ КИАРИ 0, 1 И «ПОГРАНИЧНОГО» ТИПОВ

Introduction. Introduction of advanced neuroimaging methods has made it possible to identify subtle structural features of the posterior cranial fossa and craniovertebral junction, as well as the dislocation of cerebellar tonsils into the foramen magnum, which have clinically overt and subclinical forms. Aim: To study the clinical manifestation features of Chiari type 0, 1, and “borderline” malformations. Materials and Methods. For literature analysis, the sources were used from international databases, such as Web of Science, Scopus, and PubMed, and the Russian library system, eLibrary. Results and Discussion. The most common pathology of the posterior cranial fossa is Chiari type 1 malformation associated with a mesodermal defect and with discrepancies between the sizes of the posterior cranial fossa and the neural structures that fill it. To assess the Chiari malformation grade, it is advisable to specify the dislocation grades of cerebellar tonsils. There is a common classification of cerebellar tonsil dislocations, in which the dislocation grade 1 of cerebellar tonsils is characterized by the descent of cerebellar tonsils below the foramen magnum level; grade 2 is inherent in dislocation of the cerebellar tonsils down to the C2 vertebra level in combination with displacing the pons and medulla oblongata below the Twining line. Grade 3 dislocation of the cerebellar tonsils is where the cerebellum tonsil displacement is combined with intracranial hypertension. In case of the degree 4 dislocation of the cerebellar tonsils, cerebellar hypoplasia is observed, accompanied by a displacement of the medulla oblongata. The occurrence of syringomyelia in Chiari type 0 malformation is associated with liquor dynamic disorders in the craniovertebral junction region; the similar liquor circulation disorders are detected in Chiari type 1 malformation. Chiari type 1 and “borderline”- type malformations manifest as persistent cranialgia, pain in the cervical spine, otoneurologic and visual disorders, respiratory, psychological, and cognitive disorders, damage to the cerebellar and stem structures of the brain, damage to the spinal cord, and other, more rare signs of damage to the central nervous system. Conclusions. Thus, it is necessary to further study the features of developing clinical symptoms in Chiari type 1, 0, and “borderline” malformations to assess the changes in the course of the disease and select an adequate treatment strategy.

Inflammatory reaction in eyes with late in-the-bag intraocular lens dislocation.

To investigate the inflammatory reaction in eyes with late in-the-bag intraocular lens (IOL) dislocation. This prospective clinical study with fellow-eye comparison consists of 76 of the patients (76 eyes) with late in-the-bag IOL dislocation enrolled in the LION trial. The main outcome measure was anterior chamber flare before surgery measured with a laser flare meter in photon counts per millisecond (pc/ms). The dislocation was graded as 1 (small: optic still covering the visual axis), 2 (optic equator close to the visual axis) or 3 (optic decentred beyond the visual axis, but the IOL-capsule complex partly visible in the pupillary area). The secondary aim was to compare intraocular pressure (IOP) before surgery. Flare levels before surgery were significantly higher in the dislocation eyes than in the fellow eyes with a median flare of 21.5 (range 5.4-135.7) pc/ms versus 14.1 (2.0-42.9) pc/ms, respectively (p ˂ 0.001). A regression analysis of log-transformed flare values showed that the dislocation eyes had a non-significant tendency towards higher flare in dislocation grade 1 with a median flare of 24.6 (5.4-135.7) pc/ms compared to grade 2; 19.6 (6.5-41.5) pc/ms (p = 0.06), and no significant difference compared to grade 3; 19.4 (10.2-53.5) pc/ms (p = 0.47). The IOP was significantly higher in the dislocation eyes than in the fellow eyes (p ˂ 0.001). Eyes with late in-the-bag IOL dislocation had increased flare levels compared to their fellow eyes. This suggests that inflammation is part of the clinical picture of late in-the-bag IOL dislocation.

The use of suture anchors in posterolateral corner reconstruction in the setting of multiligament knee injury: Clinical and radiological outcomes in 58 patients with a mean follow-up of 15 months

The two-tailed posterolateral corner (PLC) reconstruction in multi-ligament knee injuries (MLKI) is mostly described with interference screws. Data on the use of suture anchors is limited. Our purpose was to report clinical and radiological outcomes of the modified technique, and to describe a technique for concomitant biceps femoris tendon repair. Demographic data, clinical and radiological outcomes were collected from 60 patients who underwent two-tailed PLC reconstruction in the setting of MLKI between 2017 and 2021. Patients were assessed for range of motion (ROM) and functional outcomes including Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores. Complications and reoperations were also reported. Radiographic parameters focused on measurements of the lateral femorotibial space in varus stress views to evaluate stability and determine failure rate. Analysis based on time from injury to reconstruction was additionally performed. With two (3.3%) loss to follow-up, 58 patients with a mean age of 33.8 and a mean follow-up of 15.1 months (range: 4.2–44.8) were included. Sixty-five percent were men. Knee dislocation grades included KD 3-L, 4 and 5. No isolated PLC reconstructions were performed. Twenty-five patients (43.1%) underwent acute reconstruction and 5 (8.6%) presented with a neurovascular injury. Seventy-five percent had concomitant meniscal tears requiring repair. The mean postoperative ROM was 1.7–133.2 degrees. Mean Tegner, Lysholm, and IKDC scores were 5.1 ± 2.3, 84.6 ± 12.1, and 73.4 ± 18.2, respectively. The mean lateral femorotibial space on varus stress views was 0.3 ± 1.2 mm. Fourteen (24.1%) patients required revision surgery for hardware removal, stiffness, or clinical failure, and 6 (10.3%) had complications including infection and anchor pull-out. In addition, patients with acute reconstructions had better functional outcomes compared to those who presented with a chronic injury. The use of suture anchors as fixation method of choice for fibular head docking in two-tailed PLC reconstruction can reliably restore varus stability and provide fair functional outcomes in patients with either acute or chronic MLKI with posterolateral instability, associated with a low rate of implant-specific complications.

1034 Radiological Outcomes Following Surgery for Developmental Dysplasia of the Hip

Abstract Aim Developmental dysplasia of the hip (DDH) is a condition affecting newborns, in which abnormal acetabulum development can result in femoral head subluxation or dislocation. This study aims to retrospectively evaluate radiological outcomes of patients with DDH, treated by either closed reduction, open reduction, or open reduction with osteotomy. Method This study included 59 hips of 54 patients with a median age of 19.6 months at the time of surgery. Radiographs were assessed for the International Hip Dysplasia Institute (IHDI) grade of dislocation, acetabular index (AI), centre-edge angle (CEA), Severin classification and avascular necrosis (AVN). Results Median duration of follow up between primary operation and latest available radiograph was 4.9 years. Pre-operatively, 41 hips were IHDI Grade IV, 16 hips were Grade III and two hips were Grade II. Mean pre-operative AI was 37.9°, which decreased to 22.7° at the latest follow up. Mean CEA was 22.9°. 25 hips were found to be Severin class I, eight hips were class II and three hips were class III. Four hips developed Group II AVN and one hip developed Group III. Nine hips required further surgery. Conclusions The study found overall favourable radiological outcomes of treatment of DDH, with minimal differences between each operation. Longer follow up is needed to evaluate time-dependent outcomes such as Severin class and AVN. A patient-reported outcome questionnaire is necessary to provide information on the correlation of radiological outcomes and physical function.

Risk Factors for Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip.

Background:Avascular necrosis (AVN) is a major complication after closed reduction for developmental dysplasia of the hip. The factors that predispose to AVN remain controversial. The purpose of this study was to analyze the risk factors, especially patient factors, such as age at reduction, grade of dislocation, and ossific nucleus development, related to AVN.Materials and Methods:We retrospectively reviewed children with dysplasia of the hip treated by closed reduction between 1997 and 2006. AVN was evaluated using Salter criteria and Kalamchi and MacEwen classification. Related factors were analyzed.Results:One hundred and eight children (140 hips) with an average age of 16.6 months at closed reduction (range: 6-24 mo) were included in the study. For an average duration of 10.1 years (range 7–16 y) of follow-up, 44 hips (31.4%) developed AVN. Grade II or higher AVN occurred in 14 hips (10%). The incidence of AVN increased with the grade of dislocation (P=0.022) and underdevelopment of the ossific nucleus (P<0.001). Underdevelopment of the ossific nucleus was also found to be positively correlated with the dislocation grade (P=0.047). The age at the time of reduction, sex, and side were not significant factors. Children who underwent secondary operation were all older than 1 year at reduction.Conclusions:High-grade dislocation correlates with the underdevelopment of the ossific nucleus. Patients with these 2 characteristics are predisposed to AVN. As underdevelopment of the ossific nucleus occurred regardless of age, it is not advisable to delay reduction because it does not alter the AVN rate, and instead, it increases the secondary operation rate.Level of Evidence:Level IV case series.

Clinical features, radiographical findings and outcome evaluation for the treatment of acromioclavicular joint dislocation with lock hook plate

Background: Acromioclavicular joint (ACJ) dislocation is a common shoulder injury. Currently, there is no consensus on conservative treatment and surgical technique options. Reduction and fixation with hook surgery are effective in treating acute ACJ dislocation. However, there are very few studies evaluating the results of this method. Objectives: To describe the clinical characteristics, radiographical findings and evaluate outcomes of acute ACJ dislocation treated by internal fixation with a lock hook plate. Materials and methods: A prospective clinical study on 35 patients diagnosed with ACJ dislocation grade III or higher according to Rockwood classification were assigned surgical treatment with a hook plate, at Can Tho Central General Hospital in 2020- 2022. We documented the general characteristics of patients, clinical features, radiographical findings and treatment outcomes. Results: 35 patients (26 men/9 women, 44.2 y) were included in the study. The ACJ dislocation of grades III and V were almost equal in proportion. The averaged surgery time was approximately 60 minutes. The result of reduction of ACJ was 100%. According to the Constant-Murley Score, the functional results increased from 54.8±4.2 before surgery to 88.5±3.8 after 6 months of surgery, and the Constant-Murley level achieved 100% good to excellent.The satisfaction level of patients was 77.1% very satisfied and 22.9% satisfied. Conclusion: Reduction and fixation surgery with lock hook plate in the treatment of acute ACJ dislocation (&lt;3 weeks) is one of the suitable methods with the ability to reduce and rehabilitate good function of the joint so that the patients can return to activity and work soon.

Results of a Clinical Scoring System Regarding Symptoms and Surgical Treatment of Isolated Unilateral Zygomatico-Orbital Fractures: A Single-Centre Retrospective Analysis of 461 Cases.

Systematic assessment of computed tomography (CT) scans and clinical symptoms is necessary to quickly indicate the correct treatment of zygomatico-orbital (ZMO) fractures. For this purpose, a clinical scoring system (=Clinical Score) was developed and correlated with CT scans to analyse its validity. Every operated, isolated, and unilateral ZMO fracture between January 2012 and December 2016 was screened retrospectively, including patient and treatment data. All available CT scans were analysed, and the grade of dislocation was measured for each case and plane. Four hundred and sixty-one cases were included and showed a median surgery time of 66.0 min (5.0–361.0) and a median postoperative hospital stay of three days (0–25). The distribution of gender, aetiologies and age groups was significantly different (each p = 0.001), and the aetiology had a significant influence on the Clinical Score (p = 0.038). The degree of dislocation in the coronary and sagittal planes correlated significantly with the Clinical Score with regard to the orbital involvement (p < 0.001, ρ = 0.566; p < 0.001, ρ = 0.609). The simple, quick, and easy-to-apply Clinical Score showed a significant correlation with the most important planes in CT scans as well as with the clinical course. It may facilitate fast risk stratification of the patient. However, the validity of the proposed score in determining indications must now be evaluated in a prospective setting, including both operated and non-operated fractures.

Diagnostic value and forensic relevance of a novel photorealistic 3D reconstruction technique in post-mortem CT.

Evaluation of performance and forensic relevance of a novel, photorealistic, 3D reconstruction method (cinematic rendering, (CR)) in comparison with conventional post-mortem CT (PMCT) and volume rendering (VR) technique for visualization of traumatic injuries. 112 pathologies (fractures, soft tissue injuries and foreign bodies) from 33 human cadavers undergoing whole body PMCT after traumatic death were retrospectively analyzed. Pathologies were reconstructed with CR and VR techniques. Fractures were classified according to their dislocation. Images were evaluated according to their expressiveness and judicial relevance by two forensic pathologists using a five-level Likert-scale (1: high expressiveness, 5: low expressiveness). They decided whether CR reconstructions were suitable for judicial reviews. The detection rate of pathologies was determined by two radiologists. CR was more expressive than VR for all three trauma categories (p < 0.01) and than conventional CT when used for fractures with dislocation (p < 0.001), injuries of the ventral body surface (p < 0.001), and demonstration of foreign bodies (p = 0.033). CR and VR became more expressive with a higher grade of fracture dislocation (p < 0.001). 20% of all pathologies in the CR and VR reconstructions were not detectable by radiologists. CR reconstructions are superior to VR regarding the expressiveness. For fractures with substantial dislocation, soft tissue injuries, and foreign bodies in situ, CR showed a significantly better expressiveness than conventional PMCT. CR and VR have significant limitations in cases of fractures with minor dislocations and covered soft tissue injuries. CR is a helpful tool to present pathologies found in PMCT for judicial reviews.

The prevalence of intraarticular associated lesions after acute acromioclavicular joint injuries is 20%. A systematic review and meta-analysis.

To synthesise the evidence on the prevalence of associated intraarticular lesions in subjects with acute acromioclavicular joint (ACJ) dislocations. A search in two electronic databases (PUMBMED and EMBASE) was performed from 1985 to 2019. Two independent reviewers selected studies that complied with the following inclusion criteria: (1) the study included data on surgically treated ACJ dislocation grade III-V in the Rockwood classification, (2) the ACJ injuries were acute (the surgery was performed less than 6weeks after injury), (3) an arthroscopic evaluation of the glenohumeral joint was performed during surgery. The quality of the studies included was assessed using the tool of the Joanna Briggs Institute. A total of 47 studies with acute ACJ injuries met the initial inclusion criteria. Of these, 21 studies (9 retrospective case series, 9 prospective case series and 3 retrospective cohort studies) presented data on associated intraarticular lesions amenable for use in the meta-analysis. The meta-analysed studies included a total of 860 subjects with acute ACJ dislocations with a male/female ratio of 6.5 and a mean age of 32years. The meta-analysis showed a prevalence of associated intraarticular lesions in subjects with acute ACJ of 19.9% (95% confidence interval [CI] 14.0-26.4%; 21 studies, 860 analysed participants; P = 0.000; I2: 74.5% random-effects model; low risk of bias). One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. The case for a customary arthroscopic evaluation of the joint, even when an open procedure is performed to deal with the ACJ dislocation, is strong. Level of evidence IV Trial registry Systematic review registration number: PROSPERO CRD42018090609.

Complications of surgical approaches for osteosynthesis treatment of acetabular fractures: Analysis of pitfalls and how to avoid them

BackgroundFractures of the acetabulum are rare injuries. The indication for surgical stabilization depends on the grade of instability and dislocation. Exact knowledge of the different possible surgical approaches is essential for the planning of the surgical treatment. Both, knowledge of anatomical structures and possible risks of the different approaches, are important. MethodsOver a period of 15 years, we analyzed all patients with acetabular fractures, treated in our Level I Trauma Center with special interest in surgical and approach-related complications. Based on our complication rates, we describe the used different surgical approaches and the accessible anatomical structures respectively. Finally, we focus on strategies to reduce the risk of approach-related complications in acetabular surgery. ResultsBetween January 2003 and December 2017, 523 patients with an acetabular fracture were treated in our Tertiary Referral Hospital. Of these, 101 patients had at least one complication, resulting in an overall complication rate of 19.3%. 296 patients underwent surgical treatment of the acetabular fracture, while 227 patients were treated non-operatively. Surgically treated patients had a significantly higher complication rate of 21.2% (63/296) compared to conservatively treated patients with a complication rate of 16.7% (38/227). Neurovascular and thromboembolic adverse events were the most often complications. ConclusionsPatients with acetabular fractures are at a high risk for different kind of complications. The most common risks are neuro-vascular and thromboembolic incidents. The risk of getting a complication is increased in surgically treated patients, therefore both the indication for surgical treatment and the surgical approach should be carried out carefully, including individual patient parameters and fracture types as well as the surgeons expertise.

Hook plate fixation with coracoclavicular ligaments repair and augmentation for management of acute acromioclavicular joint dislocation

Background Several surgical techniques and implants have been proposed for the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of the study was to assess the results of hook plate fixation combined with coracoclavicular (CC) ligaments repair and augmentation for the management of ACJ dislocation. Patients and methods Between March 2011 and October 2014, 22 patients (15 male and seven female) with ACJ dislocation were treated with open reduction and hook plate fixation with CC ligament repair and augmentation at Benha University Hospital. The inclusion criteria included patients with isolated ACJ dislocation grades III–V according to Rockwood classification. Exclusion criteria were neglected cases greater than 4 weeks, chronic dislocations, open dislocation, and fracture dislocation of the ACJ. The average age of the patients was 31.8±9.7 years, ranging from 18 to 60 years. The right side was affected in 14 patients and the left in eight patients. Functional outcomes were assessed according to range of motion (ROM) and the Constant–Murley scoring system, disabilities of the arm, shoulder and hand (DASH) score, and visual analog scale score for pain. Results The mean operative time was 66 min (50–90 min). The mean follow-up period was 20.3±7.8 months, ranging from 12 to 40 months. In all but one of the 22 cases, the plates were removed after 3–6 months. The mean postoperative shoulder forward flexion was 160.4±15.8°, the extension was 51±8.6°, internal rotation 58.1±11.7°, the external rotation was 68.1±12.7°, and the abduction was 160.4±18.3°. The mean constant score was 94±5.1. The mean DASH score was 8.7±4.8. The mean pain visual analog scale score was 1.2±1. No major complications occurred in this study, except for one case that developed an asymptomatic 1-cm widening of the AC distance after 12 months. No patient developed wound infection, redislocation, AC ligament ossification, or acromion osteolysis over the hook even in the only case of retained plate for 18 months. Conclusion The use of hook plate is a good choice for stabilization of acute ACJ dislocation. When combined with CC ligaments repair and augmentation, the complication rates were low, with good functional outcome.

Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases

Rib fractures represent the most common bone fracture, occurring in 10–20% of all blunt trauma patients and leading to concomitant injuries of the inner organs in severe cases. The purpose of this study was to identify specific serial rib fracture patterns after blunt chest trauma. 380 serial rib fracture cases were investigated. Fractures were assigned to five different locations within the transverse plane. Rib level, fracture type, and dislocation grades were recorded and related to the cause of accident. In total, 3735 rib fractures were identified (9.8 per patient). 54% of the rib fractures were detected on the left thorax. Rib fracture distribution exhibited a hotspot at rib levels 4 to 7 in the lateral and posterolateral segments. On average, most rib fractures occurred in crush/burying injuries (15.8, n = 13) and pedestrian accidents (12.8, n = 13), least in car/truck accidents (8.9, n = 75). In the car/truck accident group, 47% of all rib fractures were in the lateral segment, in case of frontal collision (n = 24) even 60%. Fall injuries (n = 141) entailed mostly posterolateral rib fractures (35%). In case of falls >3 m (n = 45), 48% more rib fractures were detected on the left thorax. In cardiopulmonary resuscitation related serial rib fractures (n = 33), 70% of all rib fractures were located anterolaterally. Infractions were the most observed fracture type (44%), followed by oblique (25%) and transverse (18%) fractures, while 46% of all rib fractures were dislocated (15% ≥ rib width). Serial rib fractures showed distinct fracture patterns depending on the cause of accident. When developing a serial rib fracture classification system, data regarding patterns, fracture types, dislocation grades, and associated fractures should be included.

Mini invasive double endobutton in patients with acute AC joint dislocation grade III and V: Functional outcome and complication

AC joint dislocation is a common shoulder injury confronted by an orthopaedic surgeon as a diagnostic as well as therapeutic challenge. Still there is no gold standard treatment and no sufficient evidence from randomized control trial to guide for the treatment. Many fixation methods were studied, used and rejected as per experimental and clinical evidences. Aim of our study in this path is to assess functional outcome and complications of mini invasive double endobutton for the treatment of acute ACJ dislocation grade III and V in means of Constant score.Material and Methods: Anatomical reconstruction was done in 23 patients by using double endobutton and polyester no. 5 suture assembly with minimum follow up of 12 months. Constant score was used for functional outcome.Results: Twenty three patients were operated for acute ACJ dislocation. Loss of reduction was noted major complication in 5 patients and superficial infection occurred in 1 patient. Constant score at final follow up was 91.17.Conclusion: Double endobutton is an impressive modality to treat acute ACJ dislocation with high functional scores and low complications.

Preoperative radiographic and clinical factors associated with postoperative floating of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity

BackgroundThis study aimed to clarify the characteristics associated with postoperative floating of the lesser toes, especially focusing on the medial and lateral lessor toes, after arthrodesis of the first metatarsophalangeal joint and resection arthroplasty of the lessor toes in rheumatoid forefoot deformity.MethodsFourty-seven feet of 43 people who underwent resection arthroplasty of the metatarsal head of the lesser toes for rheumatoid arthritis of the metatarsophalangeal joints were included. We retrospectively evaluated the preoperative radiographic findings and clinical characteristics of the patients, and the occurrence of postoperative floating of the lesser toes. The mean duration of follow-up was 36.5 (range 12 to 114) months.ResultsPreoperative dislocation grades of the second and third toes that demonstrated postoperative floating were significantly higher than those of toes that did not experience postoperative floating. The hallux valgus deformity before surgery was significantly more severe in toes with postoperative floating of the second and third lessor toes than those with no floating (p < 0.05). In addition, the Japanese Society for Surgery of the Foot (JSSF) hallux scale scores before surgery in toes with postoperative floating of the fourth and fifth lessor toes were significantly worse than those in non-dislocating toes (p < 0.05).ConclusionsThe preoperative condition of the first metatarsophalangeal joint, including hallux valgus deformity, pain, range of motion, activity of daily living, and function is significantly different between postoperative floating of the lesser toes and non-floating of them after resection arthroplasty for rheumatoid forefoot deformity.

Role of loop suture technique for treatment of acute acromioclavicular joint dislocation

Background Acromioclavicular joint has an important role in suspensory mechanism of shoulder joint to the axial skeleton. Acromio-Clavicular Joint (ACJ) dislocation is not a common injury, yet it may cause limitations. In this study, a modified novel loop technique is evaluated. Aim The aim of the study is to assess the outcome of double-loop Ethibond sutures in ACJ dislocations of grades IV, V, and VI and some cases of grade III. Patients and methods This prospective randomized study was conducted on 21 patients with acute dislocations of ACJ. All the patients were treated by loop suture technique using Ethibond sutures. Results All patients presented with acute ACJ. The final results were analyzed, and it was found that the grade of dislocation is inversely proportional with end results. Earlier operated patients got better results. Time of pins removal, compliance to physical therapy, and postoperative exercises affect the final results. Conclusion The results show high incidence of good outcome. It could not be proven that the good results are owing to CC ligament healing or Ethibond sutures.

Intraocular pressure changes before and after surgery for spontaneous in-the-bag intraocular lens dislocation

To evaluate changes in intraocular pressure (IOP) after surgical correction of spontaneous late in-the-bag intraocular lens (IOL) dislocation. Two tertiary referral hospitals in Spain. Retrospective case series. Cases of in-the-bag IOL dislocation from 2004 to 2014 were included. The IOP and grade of IOL dislocation were correlated before surgery. The IOP and number of drugs to treat glaucoma were compared before and after surgery in cases with more than 6months of follow-up in the whole group and in separate groups according to the technique used to correct IOL position. This study evaluated 134 eyes. The mean IOP at diagnosis decreased significantly as the grade of dislocation increased (P=.012). After surgery, the mean corrected distance visual acuity improved significantly and the mean IOP decreased significantly after surgery in all groups (both P=.000); the IOP decrease was significantly more pronounced in the glaucoma group than in the entire sample (P=.011). No statistically significant differences were detected in preoperative or postoperative IOP between the surgical technique groups. There was no significant increase in the number of drugs to treat glaucoma (P=.064). There was a significant trend toward a decrease in IOP as the grade of IOL dislocation increased. The IOP decreased significantly after surgical management of in-the-bag dislocated IOLs without a significant increase in number of drugs to treat glaucoma. The decrease was independent of the technique used to correct IOL dislocation.

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Objectives The purpose of the study was to evaluate long-term follow-ups of stabilized acromioclavicular joint (ACJ) dislocations using button dynamic system applied via arthroscopic technique or mini-open. Material and methods The review included follow-ups of 40 patients (39 males, 1 female) who underwent 40 ACJ stabilization procedures with Arthrex DogBone button between 2014 and 2017 using arthroscopy (n = 28) or mini-open technique (n = 12). The mean age of the patients was 34 years (range, 15 to 59 years). Patient reported outcomes were evaluated with UCLA shoulder rating scale, American Shoulder and Elbow Surgeons (ASES) shoulder score and the Constant Shoulder Score (CSS). Coraco-Clavicular Distance (ССD) was measured on preand postoperative anteroposterior views. Postoperative AP view was used to measure Clavicular Tunnel Distance (CTD). Arthroscopy patients had available preoperative radiographs (n = 21), postoperative radiographs (n = 26) and patient reported outcomes (n = 18). Mini open group had available preoperative radiographs (n = 2), postoperative radiographs (n=8) and patient reported outcomes (n = 8). Results One hundred percent of Arthroscopy/Mini open (26/26) cases were rated as excellent and good on UCLA shoulder rating scale at a long-term follow-up. One hundred percent of Arthroscopy patients (18/18) were rated as excellent and good; 75 % (6/8) of Mini-open cases evaluated as excellent and 25 % (2/8) as good on ASES shoulder score. Sixty seven percent of Arthroscopy (12/18) patients were rated as excellent and 33 % (6/18) as good; 62 % (5/8) of Mini open cases evaluated as excellent and 38 % (3/8) as good. Neither fair nor poor results were observed in both groups. No statistically significant differences were detected in median scores between Arthroscopy and Miniopen groups (p > 0.05). Preoperative radiographs showed Tossy grade IV dislocation (n = 3) and Tossy grade III (n = 20). Distal clavicle fracture was diagnosed in 2 cases. Median preoperative CCD radiologically measured 15.5 mm in both groups (n = 23). Median postoperative CCD and CTD radiologically measured 6.12 mm and 28.9 mm in both groups (n = 35), correspondingly. Decrease in postoperative CCD was significantly different (p = 0.0003). No statistically significant differences in postoperative CCD were detected between Arthroscopy and Miniopen groups (p > 0.05). Statistically significant differences in preoperative CCD were observed in both groups (n = 15) using weight-bearing/no weight-bearing AP views (P = 0.0009). Conclusion Stabilization of dislocated ACJ with dynamic systems is the method of choice providing excellent and good outcomes rated by UCLA rating scale, ASES shoulder score and CSS at long-term follow-up. One-stage surgical treatment is an advantage of dynamic systems with no need of construct removal. Standard and weighted stress radiographs of the involved side indicate to ACJ injury in comparison with contralateral side. Further research is needed for a longer term follow-up with the bone reduction maintained with dynamic system.

Modified SERI technique in the treatment of hallux valgus combined with arthritis.

Few reports encompass the treatment of first metatarsophalangeal joint (MTPJ) arthritis complicating hallux valgus. Indeed, in the literature, there is a lack of guidance concerning the management of patients affected by mild to moderate first MTPJ arthritis complicating hallux valgus. The aim of this study is to present the mid-term results of an original joint-preserving surgical technique. A group of 50 patients (60 feet) affected by mild to moderate first MTPJ arthritis complicating hallux valgus who underwent modified Giannini's SERI (simple, effective, rapid, inexpensive) surgical procedure were prospectively reviewed. They were clinically and radiographically evaluated preoperatively and after surgery and were also assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and Coughlin and Shurnas classification. The average follow-up was 38 months. A multivariate analysis was performed to evaluate the existing relationship between postoperative AOFAS results and radiological preoperative measured angles and sesamoid grade of dislocation. The average AOFAS score significantly improved at last follow-up to an average of 90.5 ± 14.5, while preoperatively it was 45.6 ± 15.3 ( p < 0.001). On multivariate analysis, a statistically significant correlation resulted among all the radiographic preoperative registered parameters and clinical postoperative results. However, it was shown that any radiological parameter alone could not predict a better clinical recovery. The surgical technique proposed here could extend the indications of the SERI procedure to those patients affected by mild to moderate hallux valgus combined with mild to moderate osteoarthritis.