Irreducible Dislocation Research Articles

The Irreducible Knee Dislocation.

Irreducible knee dislocations are a small subset of acute knee dislocations and are extremely rare. The most common type of irreducible knee dislocation is posterolateral, which can be challenging to diagnose both clinically and on plain radiographs. Vascular injury is uncommon and closed reduction is seldom possible due to medial femoral condyle buttonholing through soft tissues requiring open or arthroscopic reduction. Ligament injuries mostly include medial collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Literature has numerous case reports with a couple of small series giving short- to mid-term outcomes of posterolateral knee dislocations. There is, however, no consensus on management of ligament injuries with case reports showing good outcomes in early or delayed ligament reconstruction. This article sheds light on previous case reports and describes how to identify irreducible knee dislocations and provides an algorithm on how to manage ligament injuries in posterolateral dislocations.

The irreducible ankle dislocation: beware of the Bosworth injury

A luxation fracture of the ankle characterized by a dislocation of the fibula posterior to the tibial tubercle is defined as a Bosworth injury. The Bosworth fracture is a frequently overlooked complex injury of the ankle joint. Associated injuries such as apilon fracture and posterior malleolus fracture have rarely been reported. In the case of a closed irreducible ankle fracture dislocation, Bosworth injuries should be considered as apotential cause. This article reports the course, treatment and clinical outcome 12months after trauma of aBosworth fracture with associated impaction of the posteromedial pilon and fracture of the posterior malleolus. To date, there are only few reports of comparable injuries in the German language literature.

Developmental dysplasia of the hip: a systematic literature review of the genes related with its occurrence.

Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and is characterized by mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur and irreducible hip dislocation. It is the leading cause of early hip osteoarthritis in young individuals.Both genetic and environmental factors have been proposed to play an important role in the pathogenesis of DDH. A high prevalence is present in Asian, Caucasian, Mediterranean and American populations, with females being more frequently affected. We evaluated a variety of genetic studies indexed in the PubMed database.Several susceptive genes, including WISP3, PAPPA2, HOXB9, HOXD9, GDF5, TGF Beta 1, CX3CR1, UQCC, COL1A1, TbX4 and ASPN have been identified as being associated with the development of DDH. Moreover, genetic association has also been reported between hip dysplasia and other comorbidities. Even though genetic components are a crucial part in the aetiology of DDH, several DDH susceptibility genes need further investigation.The purpose of this review is to present current literature evidence regarding genes responsible for DDH development.Cite this article: EFORT Open Rev 2019;4:595-601. DOI: 10.1302/2058-5241.4.190006

Arthroscopic treatment of irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions

To investigate the effectiveness of arthroscopic treatment for irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions. Between February 2008 and August 2016, 11 patients with irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions, were treated with arthroscopic reduction and fixation of bony Bankart lesions. There were 7 males and 4 females, with an average age of 23.7 years (mean, 15-36 years). The injury was caused by traffic accident in 8 cases and falling from height in 3 cases. The interval between hip dislocation and the first manual reduction was 2-8 hours (mean, 5.3 hours) and between the first manual reduction and arthroscopic surgery was 6-31 days (mean, 12.8 days). The preoperative visual analogue scale (VAS) was 5.2±0.9, the modified Harris score was 32±8, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was 30±5. The operative time was 90-150 minutes (mean, 120.9 minutes), with no hip arthroscopic surgery related complications. All incisions healed by first intention. All patients were followed up 26-68 months (mean, 42.7 months). Postoperative X-ray films showed that all hip joints were reduction; CT showed that the reduction of posterior acetabular wall fracture was satisfactory. And all fractures healed at last follow-up with no avascular necrosis of the femoral head or osteoarthritis. At last follow-up, the VAS score was 0.5±0.5, the modified Harris score was 94±5, and the WOMAC score was 95±4. There were significant differences in those indexes between pre- and post-operation ( P<0.05). The irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions is rare. Arthroscopic therapy has the advantages of less trauma, quick recovery, and less complications.

Irreducible Patellar Dislocation; Incarcerated into a Distal Femur Fracture: A Case Report and Review of the Literature

Irreducible Patellar Dislocation; Incarcerated into a Distal Femur Fracture: A Case Report and Review of the Literature

Chronic Dislocation of the Distal Interphalangeal Joints

Irreducible dislocation of the distal interphalangeal (DIP) joint is a rare traumatic condition commonly seen in sports injuries. Herein, we present a case with chronic dislocation of the DIP joint caused by high energy trauma accompanied by a fracture of the ipsilateral clavicle. The local deformity resulting from the dislocation can be trivial. Therefore, obtaining radiographs of all the interphalangeal joint injuries, regardless of the findings on inspection, is crucial for accurate diagnosis in the case of high energy trauma. The good functional improvement was obtained by open reduction and temporary wire fixation for 4 weeks.

Developmental Dysplasia of Hip: Perspectives in Genetic Screening.

Development dysplasia of the hip (DDH) is a complex developmental disorder despite being a relatively common condition mainly caused by incompatibility of the femoral head and the abnormal joint socket. Development dysplasia of the hip describes a wide spectrum of disorders ranging from minor acetabular dysplasia to irreducible dislocation of the hip. Modern medicine still suffers from lack of information about screening and precise genetic examination. Genome wide linkage and association studies have brought significant progress to DDH diagnosis. Association studies managed to identify many candidate (susceptible) genes, such as PAPPA2, COL2A1, HOXD9, GDF-5, and TGFB1, which play a considerable role in the pathogenesis of DDH. Early detection of DDH has a big chance to help in preventing further disability and improve the psychological health and quality of life in those children. This emphasizes the importance to establish a universal screening program along with the genetic counseling.

Irreducible Knee Dislocation with Vastus Medialis Muscle Interposition.

Knee dislocation is one of the rare orthopedic emergencies that require special management with an annual incidence rate of less than 0.02%. Knee dislocations are classified by Kennedy, according to the direction of tibial dislocation in relation to the femur, as anteromedial, posteromedial, anterolateral, and posterolateral. Operative intervention and multi-ligament reconstruction are usually required in knee dislocation. Interposition of the vastus medialis inside the joint of a dislocated knee is an uncommon scenario where reduction becomes impossible. In this report, we present a case of irreducible knee dislocation with vastus medialis muscle interposition. Before reduction, we performed arthroscopy of the knee and removal of the interposed muscle to prevent extravasation of the fluid by sealing the torn capsular area.

A genome-wide association study identifies new genes associated with developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) is one of the most common congenital malformations and covers a spectrum of hip disorders from mild dysplasia to irreducible dislocation. The pathological mechanisms of DDH are poorly understood, which hampers the development of diagnostic tools and treatments. To gain insight into its disease mechanism, we explored the potential biological processes that underlie DDH by integrating pathway analysis tools and performing a genome-wide association study (GWAS). A total of 406 DDH-associated genes (P < 0.001) were identified by our GWAS using a Chinese Han cohort consisting of 386 DDH cases and 500 healthy controls (Set A). We verified the significant loci (P < 10-5 ) in another Chinese Han cohort consisting of 574 DDH patients and 569 healthy controls (Set B). An intronic Single Nucleotide Polymorphism (SNP) (rs61930502) showed significant association in Set A and Set B (P = 2.65 × 10-7 and 2.0 × 10-4 , respectively). The minor allele, rs61930502-A, which tended to prevent DDH showed a dominant effect. Heat shock 70 kDa protein 8 (HSPA8) showed the most direct interactions with other proteins which were coded by DDH-associated genes in the protein-protein interaction analysis. Interestingly, Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis suggested a relation between DDH and the genes involved in type II diabetes mellitus pathway (P = 0.0067). Our genetic and protein interaction evidence could open avenues for future studies of DDH.

Effectiveness of posterior reduction and fixation in atlantoaxial dislocation: a retrospective cohort study of 135 patients with a treatment algorithm proposal.

Surgical procedures on atlantoaxial dislocation remain controversial. The aim of this observational retrospective study was to investigate the treatment algorithm of surgical procedures. According to CT and intraoperative evaluation during direct posterior reduction, 135 AAD cases were categorized into three groups: Group I: reducible dislocation; Group II: irreducible dislocation (Group IIa: effective decompression achieved after posterior reduction; Group IIb: no effective decompression after posterior reduction); and Group III: fixed dislocation. Group III presented with extensive bony fusions. Group I and Group IIa were treated with direct posterior reduction and fixation. Group IIb underwent posterior fixation and transoral odontoidectomy. Group III underwent transoral odontoidectomy alone. Japanese Orthopedic Association scores (JOA) were assessed to evaluate clinical status before and 6, 12months after surgery. Our study included 118 Group I cases, 16 Group II cases (Group IIa: 11 cases; Group IIb: 5 cases), and one Group III case. Follow-up ranged from 12 to 36months. Anatomic atlantoaxial reduction was achieved in 118 of 135 patients (87.4%). Clinical improvements were seen in 96.3% (130/135) all the patients. Solid atlantoaxial fusion was shown in 134 patients. Secondary outcome: The overall complication rate was 3.7% (5/135). For Group I, the mean postoperative 6-month JOA was 14.5 versus 12.2 in preoperative patients (paired Student's t test, P < 0.01). This article proposes a clinical procedure that assists with therapeutic decision making and indicates the severity and difficulty of reduction of the atlantoaxial joint. These slides can be retrieved under Electronic Supplementary Material.

Management of valgus knee with irreducible patellar dislocation and MCL rupture: A case series

IntroductionThe high rate of recurrence in patellar dislocation treatment, requires a more comprehensive action, this is due to causes not only single but often multifactorial, including problems with static stability, dynamic stability or both. Presentation of case1st case: A-39-years-old male, complain of irreducible right patella dislocation with valgus knee and already done soft tissue procedure for patella dislocation. Long-leg radiographs of the right leg showed 18° valgus mechanical angle. 2nd case: A-26-years-old obese female, complain of dislocation of left patella and history of surgery for dislocation at 5 years old. Long-leg radiographs of the right leg showed 11° valgus mechanical angle. DiscussionAfter knowing the cause of the patellar dislocation from history taking, physical and supporting examination, we performed lateral open wedge distal femoral osteotomy also MPFL and MCL reconstruction, and tibial tuberosity medialization osteotomy. There is improvement mean score in Tegner Lysholm Knee Scoring system and IKDC Scoring at 6 months after surgery. ConclusionLateral open wedge distal femur osteotomy combine with MPFL and MCL reconstruction and tibial tuberosity medialization realignment procedure can be successfully done for improve irreducible patellar dislocation in valgus knee, from clinical and radiological evaluation have good outcome after surgery.

Irreducible lateral patellar dislocation reduced using towel clip technique: A case report

Acute lateral patellar dislocation is relatively common in younger age group and most likely caused by indirect trauma which is a medical emergency. Lateral dislocation accounts for the vast majority of patellar dislocations and make up for approximately 3% of all knee injuries. We report a case of irreducible lateral patellar dislocation which was reduced using a towel clip under spinal anaesthesia. This case is reported for its rarity and reduction technique.

One-week-old irreducible hallucal interphalangeal joint dorsomedial dislocation due to an incarcerated sesamoid: A case report and its review of literature

Among the dislocations around the great toe, hallucal interphalangeal (IP) dislocation is a rare entity, with the most common being metatarsophalangeal dislocation due to its greater lever arm. We present the case of a young manual labourer with a missed hallucal IP joint dislocation with an incarcerated sesamoid, initially managed by an osteopath. After a failed attempt of closed reduction in the emergency department, we performed open reduction and reposition of sesamoid using dorsal incision and stabilized the joint with a K wire which was removed after 4 weeks. The patient was gradually mobilized and returned to his work of manual labor after 3 months without any residual pain or deformity.

Irreducible volar dislocation of the proximal interphalangeal joint of the little finger: a case report

Irreducible volar dislocation of the proximal interphalangeal joint of the little finger: a case report

Single portal arthroscopic-assisted reduction technique in the treatment of irreducible developmental dislocation of the hip in infants and toddlers

Objective: To investigate the efficacy of single-portal arthroscopic-assisted reduction technique in the developmental dislocation of the hip in infants. Methods: From January 2014 to December 2016, 12 dislocated hips in 12 children with a median age of 14 months (10 to 20 months) were treated with single-portal arthroscopic-assisted reduction technique. The indication for intervention was failure of closed reduction after bilateral adductor and unilateral iliopsoas release under anesthesia. Adductor and iliopsoas tendon were released routinely through a medial approach. Through the same medial approach a single-portal arthroscopic-assisted reduction technique was selected, with a medial sub-adductor portal for both 4.0 mm cannulated system with a 30° arthroscope and the instruments. After assessing of the intraarticular structures, the hypertrophic ligamentum teres and acetabular pulvinar were resected, and transverse acetabular ligament (TAL) was incised and a limited release of the capsule was performed prior to reduction of the hip. Arthrography was performed after reduction in all children. Safe zone angle and the medialization ratio on the arthrogram were compared pre and post arthroscopic reduction. Acetabular index were compared at two time points: before operation and at the latest follow-up with paired t test. Results: All hips were reduced with single-portal arthroscopic procedures. The reduction was confirmed on arthrography. With a median follow-up of 26 months (18 to 36 months), all 12 hips remained stable. Safe zone angle increased from 18.5°±3.8° to 61.9°±6.5° immediately after arthroscopic reduction(t=-28.944, P<0.01); and the medialization ratio on the arthrogram increased from 62%±20% to 104%±16% immediately after arthroscopic reduction (t=-3.519, P<0.05). The mean acetabular index decreased from 40.6°±5.0° to 29.4°±5.0° at the latest follow-up (t=5.463, P<0.01). However, Kalamchi-MacEwen type Ⅰ avascular necrosis was developed only in 1 case, and residual dysplasia was observed in 2 hips. Conclusions: Single-portal arthroscopic-assisted reduction technique is a safe and effective treatment for developmental dislocation of the hip in infants and toddlers.

Treatment of congenital vertical talus by reverse Ponseti technique

Background Congenital vertical talus (CVT), also known as congenital convex pes valgus, is a rigid flatfoot deformity characterized by fixed hindfoot equinus and an irreducible talonavicular dislocation. This deformity can either be idiopathic and isolated or can occur with other conditions such as neural tube defects (myelomeningocele and spina bifida occulta), neuromuscular disorders like cerebral palsy and anterior horn cell disease, and in chromosomal aberrations like Down’s syndrome. The use of serial manipulation and plaster cast treatment followed by minimal surgical interventions has provided good early results in the treatment of idiopathic CVT. The method of cast correction of a vertical talus is based on a specific way of manipulating the foot so as to gradually reduce the talonavicular joint. The principles are similar to those used in the Ponseti method of clubfoot correction. Aim of the study To evaluate the management and the outcome of patients with CVT managed with reverse Ponseti technique, and minimal surgical intervention. Patients and methods This prospective study included 25 feet in 17 patients with CVT, comprising eight patients with bilateral and nine with unilateral involvement. The study was done at the new Children Hospital Cairo University between January 2013 and December 2015. The follow-up period ranged from 10 to 14 months, with an average period of 11.6 months. Inclusion criteria were patients diagnosed to have idiopathic CVT and no age limit, and exclusion criteria were previous operative release and cases associated with neuromuscular disorders or syndromes. Results Three (12%) cases were classified as excellent, 12 (48%) cases were classified as good, eight (32%) cases were classified as fair, and two (8%) cases were classified as poor. Conclusion Favorable results were obtained using the reverse Ponseti method of closed manipulation and then limited open reduction and fixation with a pin in the talonavicular joint and percutaneous Achilles tenotomy. There were also fewer complications compared with extensive operative treatments, by avoiding more extensive surgery.

An Irreducible Hip Dislocation with Femoral Head Fracture

An Irreducible Hip Dislocation with Femoral Head Fracture

New technique for reduction of irreducible anterior glenohumeral shoulder dislocation.

ObjectiveThis study was performed to describe a new technique for reduction of anterior glenohumeral dislocation in four non-sedated patients in whom traditional techniques were unsuccessful.MethodsFour patients with clinically and radiographically proven acute anterior glenohumeral dislocations were admitted to the emergency department. An oral analgesic and local infiltration of lidocaine into the glenohumeral joint were administered prior to the reduction attempts. Four to six reduction attempts using a variety of traditional maneuvers were unsuccessful before applying our technique. The glenohumeral joint was then successfully reduced using our technique and confirmed on radiographs. A sling was placed for post-reduction pain relief.ResultsAll four patients underwent successful closed reduction, proven clinically and by radiographs, after the first attempt using our technique. No complications occurred.ConclusionOur maneuver provides safe and successful closed reduction for irreducible acute anterior glenohumeral dislocation.

Irreducible Posterior C1–2 Dislocation with Retrolisthesis of Dens: Hindsight from 10 Cases

Posterior C1-2 dislocation secondary to fracture of the dens or os odontoideum is uncommon. Little is known about posterior dislocations in which close reduction fails, requiring intraoperative maneuvers. The objective of this retrospective study was to analyze clinical presentations, factors causing irreducibility, and nuances in the achievement of intraoperative reduction. The clinicoradiological features of 10 patients with irreducible posterior C1-2 dislocation were studied. Six were posttraumatic, with odontoid fractures, and 4 had os odontoideum. The radiologic images were studied to analyze the cause of irreducibility, and the operative management of these cases was discussed. The patients with traumatic dislocation had persistent neck pain (n= 6) and early onset (n= 1) or delayed onset (n= 4) myelopathy. The fracture line was oblique, extending anterosuperiorly to posteroinferiorly in all except 1 patient, with fracture fragments distracted in 4 and interlocked in 2. There was associated lateral translation in 2. All patients had facet locking. Intraoperative reduction was achieved in all by unlocking the facets, intrafracture reduction, or both. All 4 patients with congenital posterior dislocations had retrolisthesis of dens with lateral translation. They presented with neck tilt (n=4) and severe myelopathy (n= 3). They were easier to reduce intraoperatively, but the improvement lesser in comparison with the traumatic fractures. The posterior C1-2 dislocation associated with fracture of the dens or os-odontoideum is a distinct entity. Lateral translation is often seen with retrolisthesis of the os odontoideum and occasionally in traumatic posterior dislocations. It is necessary to address the cause of irreducibility and achieve multiplanar realignment for a good outcome.

Management of Irreducible Hip Dislocations in Infants With Developmental Dysplasia of the Hip Diagnosed Below 6 Months of Age.

Background:Infants with dislocated irreducible (D/I) hips can be substantially harder to treat than infants with dislocated but reducible hips. The purpose of this study was to compare treatment methods and outcomes for infants with D/I hips in order to optimize management of this difficult patient cohort.Methods:A multicenter prospective hip dysplasia study database was analyzed from 2010 to 2016. Infants aged below 6 months with clinically and radiologically confirmed D/I hips were included in the study. Teratological hips (syndromic/neuromuscular) were excluded.Results:In total, 59 hips in 52 patients were included. All hips were clinically Ortolani negative and radiologically dislocated but irreducible on presentation and had at least 20 months of follow-up. Mean age at diagnosis was 1.9 months (range, 0.1 to 5.9 mo). There were 33 left hips, 12 right hips, and 14 bilateral hips (7 patients). In total, 48 of 59 hips were treated in Pavlik harness. The remainder were treated by alternative braces or primary closed or open reductions. Pavlik treatment was successful in 27 of 48 hips. Pavlik treatment was abandoned in 21 D/I hips, 3 due to femoral nerve palsy and the remainder due to failure to achieve reduction. There was no statistical correlation between Pavlik success and age at diagnosis (P=0.22), patient sex (P=0.61), or bilateral compared with unilateral D/I hips (P=0.07). Left hips were more likely to be successfully reduced in Pavlik harness than right hips (P=0.01). Five complications occurred: 3 patients developed femoral nerve palsy in Pavlik harness, while 2 patients developed avascular necrosis, both after failed Pavlik treatment and subsequent surgery.Conclusions:Pavlik harness treatment has been demonstrated to be a safe and sensible first-line treatment for infants with D/I hips. Left hips were more likely to be successfully reduced in Pavlik harness than right hips, but age, sex, and bilaterality were not correlated. The outcomes demonstrated from this multicentre prospective database inform management of this complex patient cohort.Level of Evidence:Level II—prognostic study: less-quality prospective study.