Irreducible Dislocation Research Articles

Retrospective study of temporomandibular joint dislocation by surgical treatment

This study aimed to retrospectively analyze temporomandibular joint dislocation by surgical treatment and evaluate the treatment effect. From May 2012 to April 2016, a total of 17 cases of temporomandibular joint dislocation were surgically treated, including 8 cases of irreducible dislocation (ID) and 9 cases of recurrent dislocation (RD). Synovial injection of sclerosing agent by arthroscope was performed in 5 cases, 9 sides; augmentation of the articular eminence by titanium plate implantation was performed in 7 cases, 12 sides; iliac bone transplantation was performed in 1 case, 1 side; Medpore implantation was performed in 3 cases, 6 sides; and eminectomy and capsular tightening were performed in 1 case, 2 sides. Follow-up was conducted 1-5 years after the operation, and the success rate statistics was obtained. The cure rate of synovial injection of sclerosing agent by arthroscope was 77.8% (7/9), and the effective rate was 100%. The cure rate of titanium plate implantation was 75% (9/12), and the effective rate was 100%. The cure rates of augmentation of the articular eminence by Medpore implantation (6/6), iliac bone graft (1/1), and eminectomy (2/2) were 100%. The surgical method of temporomandibular joint dislocation was selected according to the state of the patients. The postoperative recurrent patients were advised to undergo augmentation of the articular eminence by Medpore implantation, which offered a reduced chance of recurrence and relatively less injury, as well as a simple operative method.

Missed Pediatric Monteggia Fractures.

* Careful scrutiny of radiographs is important in the assessment of pediatric elbow injuries. Disruption of the radiocapitellar line and an increased bow of the posterior ulnar border are sometimes subtle signs of a Monteggia injury.* An attempt at closed reduction up to 4 weeks after injury has been cited in the literature as successfully treating some missed injuries.* Operative reduction of chronic radial-head dislocation provides good to excellent range of motion and functional outcome in the setting of irreducible chronic radial-head dislocation.* Ulnar osteotomy and correction of the ulnar deformity component of the missed Monteggia injury are the key to indirect anatomic reduction of the radiocapitellar joint.* Supplemental procedures aimed at increasing the stability of the radiocapitellar joint (e.g., annular ligament reconstruction, radiocapitellar Kirschner wire fixation, radioulnar Kirschner wire fixation) should be directed by a thorough assessment of radiocapitellar stability following ulnar osteotomy and correction of the ulnar deformity.

Irreducible Dislocations of the Proximal Interphalangeal Joint: Algorithm for Open Reduction and Soft-tissue Repair.

The "jammed finger" is among the most common hand injuries and may include simple sprains, dislocations, fractures, and fracture-dislocations. In contrast, irreducible dislocations of the proximal interphalangeal joint are rare injuries. However, they must not be overlooked in the primary assessment, because persistent subluxation may lead to joint contracture, severely compromising hand function. Irreducible dislocations are challenging injuries with interposed soft tissues, preventing closed reduction. Thorough preoperative diagnosis and soft-tissue imaging guide the approach to open reduction and repair of injured periarticular structures. We introduce a systematic algorithm with considerations on classification and management of irreducible proximal interphalangeal joint dislocations. The algorithm is useful for the primary assessment and for hand surgeons responsible for open reduction and rehabilitation.

Irreducible Dislocation of the Radial Head Associated With Pediatric Monteggia Lesions.

Background:In pediatric patients with Monteggia lesions, the radial head can be reduced manually when displacement of the fractured ulna is corrected. Occasionally, however, a dislocated radial head could not be reduced manually even when the length and/or angulation of the fractured ulna had been corrected. We can find such cases in the literature, but those are single case reports. We encountered 17 cases of irreducible dislocation of the radial head in pediatric Monteggia lesions during the past 43 years. The purposes of this study were to identify the characteristics of our cases and to discuss the factors that inhibited reduction of the radial head.Methods:Of 109 children treated for Monteggia lesions between 1972 and 2015, we encountered 17 cases of irreducible dislocation of the radial head. The patients' ages averaged 7.1 years, ranging from 2.6 to 12.1 years. Directions of the radial head dislocation were anterior in five cases, anteromedial in four, lateral in one, and anterolateral in seven. Most of the patients were referred to us from local orthopaedic clinics because of irreducibility of the radial head. We reduced the radial head surgically and confirmed the causes of irreducibility.Results:In 10 of the 17 cases, the problem was identified as pseudoreduction. In those cases, the radial head was reduced in a supination position but redisplaced in a pronation position. Causes of irreducibility were traced to the annular ligament in 15 cases, biceps tendon in 1, and posterior interosseous nerve in 1.Conclusions:In cases of pediatric Monteggia lesions, we should pay attention to patients in whom the dislocated radial head is not reduced after closed reduction. The most frequent cause of hindered reduction was interposition of the annular ligament in the radiocapitellar joint. Here, the radial head seems to be reduced in the supination position but becomes redisplaced in the pronation position. After closed reduction, it is important to confirm whether the radial head is stable in both pronation and supination positions.Level of Evidence:Diagnostic level IV.

Management of irreducible unilateral facet joint dislocations in subaxial cervical spine: two case reports and a review of the literature

BackgroundSkeletal and soft tissue damage are often associated with unilateral facet dislocations, which undoubtedly lead to instability of the spine and further increase difficulties in cervical reduction. This type of irreducible facet dislocation is usually accompanied with potential catastrophic consequences including neurological deficit and severe disability. Therefore, a consistent and evidence-based treatment plan is imperative.Case presentationThe literature regarding the management of traumatic unilateral locked cervical facet dislocations was reviewed. Two patient cases (a 30-year-old Asian man and a 25-year-old Asian woman) who suffered irreducible cervical facet dislocations were presented. These two patients received surgical treatments including posterior reduction by poking facet joints, adjacent spinous process fixation by wire rope banding, anterior plate fixation, and intervertebral fusion after the failure of skull traction and closed reduction. At the postoperative 24-month follow-up, intervertebral fusion was achieved and our patients’ neurological status improved based on the American Spinal Injury Association scale, compared with their preoperative status.ConclusionsUnilateral facet joint dislocations of subaxial cervical spine are difficult to reduce when complicated with posterior facet fractures or ligamentous injury. Magnetic resonance imaging can be beneficial for identifying ventral and dorsal compressive lesions, as well as ligamentous or capsule rupture. The combination of posterior reduction and anterior fixation with fusion has advantages in terms of clinical safety, ease of operation, and less iatrogenic damage.

Euthyphoria reduction combined with percutaneous iliosacral screw fixation for irreducible sacroiliac dislocation

Objective To evaluate euthyphoria reduction combined with percutaneous iliosacral screw fixation in the treatment of irreducible sacroiliac dislocation. Methods From March 2012 to May 2015, 29 patients with irreducible sacroiliac dislocation were treated using euthyphoria reduction followed by percutaneous iliosacral screw fixation. They were 18 men and 11 women, aged from 25 to 68 years (average, 37.9 years). According to the Tile classification, there were 7 cases of type C1, 9 cases of type C2, and 13 cases of type C3. The intervals from injury to surgery ranged from 6 to 32 days (average, 11.3 days). Results The operation time for this cohort ranged from 40 to 125 minutes (average, 76.2 minutes). The intraoperative bleeding ranged from 50 to 360 mL (average, 148.6 mL). Their follow-ups ranged from 24 to 41 months (average, 28.9 months). According to the Matta criteria for reduction, 20 cases were rated as excellent and 9 as good, yielding an excellent to good rate of 100%. Their Majeed scores at the final follow-up averaged 90.1 points (range, from 67 to 100 points), giving 20 excellent, 7 good and 2 fair cases (with an excellent to good rate of 93.1%). No screw loosening or lameness of the affected limb was observed during follow-ups. Conclusions Euthyphoria reduction combined with percutaneous iliosacral screw fixation can lead to satisfactory outcomes in the treatment of irreducible sacroiliac dislocation. Additionally it may improve operative safety. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Bone nails; Reduction

One-Stage Arthroscopic Reduction Combined with Multiligament Reconstruction or Repair for Irreducible Posterolateral Knee Dislocation: A Retrospective Case Series with Minimum 2-Year Follow-Up.

The purpose of this study was to evaluate the clinical outcomes after arthroscopic management of irreducible posterolateral knee dislocation. Twenty-one patients with irreducible posterolateral knee dislocation were treated in our institution from January 2009 to May 2014. Inclusion criteria were as follows: (1) patients who underwent one-stage arthroscopic reduction combined with multiligament reconstruction or repair and (2) patients with a minimum 2-year follow-up. Knee stability was assessed using physical examination and side-to-side differences (SSD) determined with a KT-1000 arthrometer and Telos stress device. Other assessments included the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner score, and patient satisfaction rate. Thirteen of the 21 patients (8 males and 5 females) met our inclusion criteria and were included in this analysis. The mean age was 37.8 years (range, 27-56 years). The mean time from injury to surgery was 1.84 days (range, 1-3 days). The mean follow-up period was 32.6 months (range, 24-46 months). At the final follow-up, with the exception of one patient who had an abnormal valgus stress test, all patients achieved normal or nearly normal Lachman test, pivot shift test, posterior drawer test, and varus and valgus stress tests. The mean SSD of total anterior-posterior translation and isolated anterior translation determined with a KT-1000 arthrometer were 2.15 ± 1.57 mm (range, 0-6 mm) and 1.61 ± 0.86 mm (range, 1-4 mm), respectively. The mean SSD of anterior translation, posterior translation, and medial and lateral joint gapping determined with a Telos stress device were 2.23 ± 0.92 mm (range, 1-4 mm), 3.23 ± 1.16 mm (range, 2-5 mm), 1.77 ± 1.87 mm (range, 0-7 mm), and 0.46 ± 0.52 mm (range, 0-2 mm), respectively. The IKDC subjective score, Lysholm score, and Tegner score improved significantly postoperatively (p = 0.001) with a satisfaction rate of 84.6%. One-stage arthroscopic reduction combined with multiligament reconstruction or repair was an effective, reliable treatment for irreducible posterolateral knee dislocation. This is a case series with level of evidence as IV.

Locked Lateral Patella Dislocation; the Role for the Skyline View in the Trauma Setting

Objective:Acute traumatic dislocation of the patella is a common problem. These cases often either spontaneously reduce or undergo successful closed reduction in Emergency Departments. We describe a rare case of an irreducible patella dislocation in a 15 year old boy following direct trauma.Method:Intra-operative skyline views revealed lateral dislocation of the patella with the patella ‘locked’ in internal rotation.Result:Closed reduction in theatre failed and open reduction was required.Conclusion:This case illustrates the benefit of the skyline view in the radiograph series following failed closed reduction, aiding the identification of atypical dislocations and osteochondral fracture fragments.

A case report of irreducible radial head dislocation with medial epicondyle fracture

A case report of irreducible radial head dislocation with medial epicondyle fracture

Open Reduction of Irreducible Dislocation of the Radial Head of Monteggia Fractures

Open Reduction of Irreducible Dislocation of the Radial Head of Monteggia Fractures

Dorsal-approach open reduction for irreducible dislocation of the hallux interphalangeal joint: A case series

IntroductionThe common treatment for hallux interphalangeal joint dislocation is closed reduction, but some cannot be reduced by interposition of the sesamoid or the plantar plate in the interphalangeal joint, and such cases need open reduction. Presentation of caseIn case 1, the patient was a 17-year-old boy who was injured when a motorcycle fell on his right hallux. X-ray revealed Miki type 2 IP joint dislocation. Because closed reduction failed, open reduction via the dorsal approach to the hallux IP joint was performed. In case 2, the patient was a 17-year-old boy who was hit by a car whilst walking. X-ray revealed Miki type 2 dorsal dislocation of the hallux IP joint. After closed reduction, X-ray and CT revealed that the IP joint dislocation changed from Miki type 2 to type 1. Open reduction was performed through the dorsal approach. DiscussionFifteen cases of Miki type 2 changed to type 1 after closed reduction, and type 1 dislocation is often overlooked, leading to some chronic cases. X-rays should be performed after repositioning, specifically in lateral and oblique views. ConclusionWe experienced two cases of irreducible dislocation of the hallux IP joint. One of our cases was reclassified from Miki type 2 to type 1, but we did not overlook the failed closed reduction, as we performed CT. Hence, we recommend additional lateral-view X-rays and/or CT imaging.

Irreducible dislocation of the interphalangeal joint of the great toe due to interposition of a sesamoid and plantar plate: A case report

Irreducible dislocation of the interphalangeal joint of the great toe due to interposition of a sesamoid and plantar plate: A case report

HOFFA’S FRACTURE WITH IRREDUCIBLE PATELLAR DISLOCATION: APPROACH TO AVOID COMPLICATIONS IN A RARE INJURY

Hoffa’s fracture is coronal oriented fracture of distal femur with the fracture line extending through the femoral condyles. Hoffa’s fracture is rarely associated with ipsilateral femur and tibia fractures. Proper clinical examination and radiographic evaluation is necessary to diagnose associated injuries around the knee joint with Hoffa’s fracture. Closed reduction of dislocated patella in emergency room and field triage should be avoided to prevent patellar tendon incarcenation, patellar tendon rupture and osteochondral damage. We report a rare case of Hoffa’s fracture with irreducible patellar dislocation and tibial intercondylar eminence fracture following road traffic accident.

Irreducible Galeazzi Fracture-Dislocations.

Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms "Galeazzi" and "fracture." Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.

Clicky hip alone is not a true risk factor for developmental dysplasia of the hip.

A clicky hip is a common referral for clinical and sonographic screening for developmental dysplasia of the hip (DDH). There is controversy regarding whether it represents a true risk factor for pathological DDH. Therefore a 20-year prospective, longitudinal, observational study was undertaken to assess the relationship between the presence of a neonatal clicky hip and pathological DDH. A total of 362 infants from 1997 to 2016 were referred with clicky hips to our 'one-stop' paediatric hip screening clinic. Hips were assessed clinically for instability and by ultrasound imaging using a simplified Graf/Harcke classification. Dislocated or dislocatable hips were classified as Graf Type IV hips. The mean age at presentation was 13.8 weeks (12.8 to 14.7). In all 351 out of 362 children (97.0%) had Graf Type I hips (normal) that required no treatment. Nine children (2.5%) had Graf Type II hips but all resolved to Graf Type I hips on follow-up scans. One child (0.3%) had Graf Type III hip dysplasia and one child (0.3%) had an irreducible hip dislocation. The two pathological hips were associated with unilateral limited hip abduction. Mean referrals increased from 12.9 to 23.3 each year (p = 0.002) from the first decade of the study to the second, driven by increasing primary care referrals (5.5 versus 16.7 per year, p < 0.001). Most clicky hips required no treatment other than reassurance to parents. Clicky hips with a normal hip examination should be considered a variant of normal childhood and not a risk factor for DDH. However, an abnormal hip examination including unilateral limited hip abduction should prompt urgent further investigations. Cite this article: Bone Joint J 2017;99-B:1533-6.

93 - Cervical Alignment Comparative Analysis of Fixed Irreducible and Reducible Atlantoaxial Dislocations

93 - Cervical Alignment Comparative Analysis of Fixed Irreducible and Reducible Atlantoaxial Dislocations

''Basket Weave'' Technique Of Mpfl Reconstruction. A Prospective Study In 62 Knees

“Basket Weave’ technique of MPFL reconstruction devised by the author has given encouraging results. It is anatomical and does not require bone tunnels or implants. It restores normal patellar stability and mobility. Combining it with other procedures for patellar instability does not compromise its results. It has a low failure rate. It is a safe, effective, reliable and reproducible technique. MPFL reconstruction methods using bone tunnels and implant fixations are known to compromise results due to rigid fixations and non anatomical reconstructions. These methods are not advisable in the skeletally immature. Implant fixation and bone tunneling methods cannot reconstruct the medial quadriceps tendon femoral ligament (MQTFL) which has a soft tissue attachment to the quadriceps. The “Basket Weave” technique of MPFL reconstruction was devised by the author to overcome deficiencies of other techniques, to avoid bone tunnels and implants, provide an anatomical reconstruction and a physiometric construct with differential tensioning. A prospective study was performed to assess outcomes and complication rate. 62 knees of lateral patellar dislocation were treated in the past 60 months by “Basket Weave” technique of MPFL reconstruction. Cases selected for this reconstruction were symptomatic for patello-femoral instability, had a ‘dislocatable’ patella under examination or were subluxating patellae not responding symptomatically to appropriate physiotherapy. Cases with habitual patellar dislocation, chronic irreducible patellar dislocation, patello-femoral arthrosis and those responding well to physiotherapy were excluded. 42 were female and 20 male knees. The mean age was 20.3 years (range 9-48 years). Mean followup was 24 months. Five knees had previously failed stabilization procedure of lateral release with medial retinacular plication. 35 cases had Dejours Type A or B and 12 had Type C trochlear dysplasia. 1 had excess femoral ante version of 35 degrees. Arthroscopy was performed to assess associated injuries and presence of loose bodies. 8 knees required loose body removal. 6 knees underwent lateral retinacular release. 5 knees had associated tibial tuberosity medialization. 1 knee had an associated anterior cruciate ligament reconstruction. 1 knee with abnormal increased femoral ante version underwent an associated distal femoral derotation osteotomy. An anatomical MPFL reconstruction with MQTFL reconstruction was performed using hamstring autograft. A “Y” graft construct was created with differential tensioning. The proximal limb fixed in 30° knee flexion and the distal limb in 90°. Intraoperative fluoroscopy was not required. Only soft tissue fixation was performed on the femoral and patellar side with this newly devised reconstruction technique and a novel “Pretzel stitch” suturing technique using absorbable sutures. A rapid postoperative rehabilitation protocol was implemented with monthly follow-ups until normalcy and 6 monthly thereafter. All knees achieved full range of motion with normal medio-lateral patello-femoral stability. There was no recurrence of dislocation or subjective instability. No intraoperative complications or major surgery related postoperative complications. 1 patella fracture at 8 months postoperative, was due to a fall from stairs and developed terminal restriction of flexion following fracture fixation. Those in sports could return to their preoperative level of sporting activities (Tegner 1–9). Cases with osteochondral fractures had occasional pain immediate postoperatively which subsided in 1 year. Mean Kujala score improved from 65.4 to 99.6 with KOOS score near normal in all. This novel method of MPFL reconstruction gives excellent results. It avoids bone tunnelling, implants and related complications. It is a safe, effective, reliable and reproducible technique of MPFL reconstruction.

Initial management of traumatic ventral shoulder dislocation

In the current literature aconsensus on the specific management of primary anterior traumatic shoulder instability has not been reached. While the steps of the initial diagnostic and therapeutic procedures are mostly well-defined, avariety of factors need to be considered for the planning of further treatment. This article aims at giving an overview of the essential aspects of the initial management in the rescue center, clinical and radiological diagnostic procedures and the subsequent treatment options. The content of this article is based on our own clinical experiences in combination with asystematic literature search for relevant clinical and baseline studies. Besides adetailed anamnesis and clinical examination, X‑rays in two planes are important for the diagnosis. Potential nerve injuries or fractures need to be borne in mind before and after reduction of the joint and documented accordingly. The Matsen's maneuver can be recommended as it enables acareful repositioning. In rare cases of an irreducible shoulder dislocation due to soft tissue or bony articular interpositions, an open reduction might be necessary. Further therapeutic concepts should be adapted to patient age, activity level and accompanying pathologies, which determine the risk of arecurrent dislocation. Asurgical approach for stabilization of the shoulder is highly recommended in cases of concomitant bony defects as well as in young and physically active patients. Awell-structured treatment plan is essential for the initial management of primary anterior traumatic shoulder instability. Agenerally applicable algorithm for further management is not yet established. The treatment should therefore be individually planned based on patient-specific characteristics.

A Novel Technique for the Bedside Reduction of the Posterior Hip Dislocation

The dislocated hip is a common condition seen in the emergency room and requires urgent reduction, especially in the case of the native hip, which carries a high risk of a vascular necrosis with increasing time to reduction. There are several reduction techniques described in the literature, the Allis technique being the among the more common methods utilized by orthopedic surgeons. This technique requires multiple assistants, applies significant force about the knee, and places the physician at risk for back strains and even falling off the gurney during the reduction maneuver. We describe a case of a historically irreducible recurrent total hip dislocation successfully relocated in the emergency room utilizing a novel technique that offers several advantages over the standard reduction method.

Late presentation of developmental dysplasia of the hip : a 15-year observational study.

Despite the presence of screening programmes, infants continue to present with late developmental dysplasia of the hip (DDH), the impact of which is significant. The aim of this study was to assess infants with late presenting dislocation of the hip despite universal clinical neonatal and selective ultrasound screening. Between 01 January 1997 to 31 December 2011, a prospective, longitudinal study was undertaken of a cohort of 64 670 live births. Late presenting dislocation was defined as presentation after three months of age. Diagnosis was confirmed by ultrasound and plain radiography. Patient demographics, referral type, reason for referral, risk factors (breech presentation/strong family history) and clinical and radiological findings were recorded. There were 31 infants with an irreducible dislocation of the hip, an incidence of 0.48 (95% confidence interval (CI) 0.34 to 0.68) per 1000 live births. Of these, 18 (0.28 (95% CI 0.17 to 0.44) per 1000 live births; 58%) presented late. All infants had a documented normal newborn clinical examination and no abnormality reported in the six to eight week check. Of the 18 late presenting cases 72% (n = 13) had no risk factors: 16 were referred by GPs and two were late due to administrative issues (missed appointments). The mean time to diagnosis was 62.4 weeks (19 to 84). Despite universal clinical neonatal and selective ultrasound screening, late cases of irreducible hip dislocation still occur. We recommend an update of the national screening programme for DDH, a review of training and education of healthcare professionals involved in the physical examination of neonates and infants, and the addition of a further assessment after the six to eight week check. Cite this article: Bone Joint J 2017;99-B:1250-5.