Posterior Dislocation Research Articles

Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures: A CORTICES Survey.

Pediatric pelvic and acetabular fractures are rare but potentially devastating injuries and significant management variation exists across the United States. This study sought to elucidate treatment decision-making trends, involvement of adult trauma fellowship-trained surgeons in pediatric care, and pre- and postoperative transfer patterns. Pediatric orthopaedic surgeons who serve as trauma liaisons at 20 PTCs were surveyed regarding training, practice volume, and factors contributing to institutional management of pelvic and acetabular injuries. Five clinical scenarios of pelvic ring and acetabular fractures that varied by injury pattern, age, and sex were presented. Descriptive statistics were used to summarize the results. Eighteen institutions responded to the survey (90% response rate, 16 Level, 1 PTC). All surgeons were pediatric fellowship-trained (77.7% in practice >5y). The four most common factors affecting whether surgeons independently managed both pelvic ring and acetabular fractures were patient age, fracture characteristics, displacement and need for surgery. The majority reported managing <10 acetabular (72.2%) but >10 pelvic ring (77.8%) injuries per year. In the clinical scenarios, patients <10 were more likely to have treatment decisions made by a pediatric orthopaedic surgeon. Older patients were more likely to be transferred to another institution for surgery but were often transferred back to the PTC postoperatively. In all clinical scenarios other than posterior hip dislocation, a trauma fellowship-trained surgeon was more likely to be the operative surgeon, even when the patient was not transferred. There is substantial variation in the management of pediatric and adolescent pelvic and acetabular fractures. Even at tertiary care PTCs, volumes are low, and trauma fellowship-trained surgeons are often involved in decision-making and operative management. Age and injury pattern seem to play a large role in variation, and patient transfers between facilities are common. V.

Оutcome of neglected posterior elbow dislocation with gross ligamentous instability by arthrolysis combined with circumferential reconstruction of MCL, LUCL using triceps tendon fascia

Dislocation of the elbow joint, which has not been treated for more than 3 weeks, is considered outdated. Due to the high risk of complications and the uncertainty of the effectiveness of the treatment of an old dislocation of the elbow joint, it is quite a difficult task for surgeons. There are various described techniques for repairing the lateral ligamentous complex (including the LUCL) and the medial collateral ligament. Objective. To describe the author's unique technique, which consists in using one graft to restore both lateral and medial ligaments. Methods. The personal experience of treating 14 patients with chronic dislocation of the elbow joint with deformation and multidirectional instability is presented. All patients were operated on by one surgeon using the arthrolysis method in combination with MCL, LUCL reconstruction using an ipsilateral autograft of the triceps tendinous fascia. Further observation was carried out at 3, 6 and 12 weeks, as well as at 6 and 9 months. In our case, we evaluated stability, range of motion, and the presence of pain syndrome. The results. Satisfactory results were obtained in terms of pain-free full range of motion and adequate stability of the elbow joint in all cases. All patients performed their active routine exercise with minimal limitation. Conclusions. The advantage of the technique is a unique comprehensive approach that uses one circular graft to restore both the lateral and medial ligament complexes, which ensures stability and possible early rehabilitation. This leads to an excellent functional result — a quick restoration of the full range of motion in the joint and its stability.

Safety and efficacy of short percutaneous fixation in AO3 and AO4 lumbar fractures: a single-centre experience of 35 cases.

Spinal fractures with subsequent bone fragment dislocation are among the injuries most feared by patients and physicians. The surgical strategy is tailored to the individual patient's characteristics and often consists of pedicle instrumentation with rod-screw systems. Short instrumentation has been associated with worse spinal correction and increased complications. However, recent studies have suggested similar results in terms of kyphosis correction and the maintenance of sagittal alignment compared to longer instrumentation. This single-center retrospective study was conducted between January 2018 and April 2021. We included 35 single lumbar burst fractures AO Spine grade A3 or A4 with evidence of intra-canal fragments. Patients underwent minimally invasive percutaneous posterior lumbar instrumentation with pedicle screws. Patients received short segmental fixation involving only one level above and below the fractured vertebra. An immediate postoperative computed tomography (CT) scan demonstrated a significant reduction in vertebral kyphotic deformation (11.7° ± 1.6 vs 16.7° ± 5, p<0.001) and sagittal Cobb angle (9.8° ± 1.3 vs 11.7° ± 1.5, p < 0.001). The correction was slightly reduced but remained significant at 12 months for both kyphotic (12.3° ± 1.4, p = 0.03) and sagittal Cobb (10.3° ± 0.9, p = 0.04). Upper lumbar vertebrae showed even larger correction indices compared to lower lumbar segments. No implant failure or screws pullout was seen at the last follow-up. Short spinal fixation is a safe and effective treatment of complete and incomplete burst fractures with posterior bone fragment dislocation. All included patients fared well and achieved good kyphotic correction with no perioperative or long-term complications.

CLINICAL CASE OF A NEW METHOD FOR SURGICAL TREATMENT OF HILL-SACHS REVERSAL FRACTURE IN OLD-ENGINED POSTERIOR SHOULDER DISLOCATION.

The article presents a clinical case in which the use of a new method of surgical treatment of a HILL-SACHS type reversal fracture in chronic posterior shoulder dislocation is considered. In this clinical case, we proposed an operational-biomechanical theory, the main goal of which is surgical treatment of a HILL-SACHS reversal fracture with stabilization of the shoulder joint by moving the tendon of the long head of the biceps to the impression zone and fixing it with anchors. The outcome of this clinical case is the absence of clinical symptoms of instability of the shoulder joint and restoration of function of the shoulder joint in the late postoperative period.

Lateral Sternoclavicular Joint Dislocation

Case: We report a case of a 29-year-old woman who sustained a left lateral sternoclavicular joint (SCJ) dislocation. Imaging demonstrated a 30-mm gap between the sternum and medial clavicle. Given well-preserved shoulder range of motion and well-controlled pain, she was ultimately treated nonoperatively. Conclusion: SCJ dislocations are rare injuries, comprising 1% of all traumatic joint dislocations. They are typically classified into anterior and posterior dislocations. A direct lateral SCJ dislocation is considered to be a lesser-known type. This case is presented to discuss the rarity of this injury along with the clinical findings, diagnosis, associated injuries, and treatment parameters.

Posterior Stabilization and Reverse Hill-Sachs Remplissage Using Linked Knotless Anchors

Posterior glenohumeral dislocation can result in impaction fractures to the anteromedial humeral head, known as a reverse Hill-Sachs lesion. They may also cause damage to the posterior capsuloligamentous structures. This can lead to ongoing posterior instability and altered biomechanics resulting in early degenerative changes. Ongoing symptoms may result in challenges to a patient’s day-to-day and sporting activities. Early intervention to stabilize the shoulder may help avoid these. We present a reproducible technique for posterior stabilization using linked knotless anchors to perform a remplissage of the subscapularis into the reverse Hill-Sachs lesion defect that avoids the need for exposure of the subcoracoid bursa.

Survey on the use of nasal tamponades in sinunasal surgery

Currently, there is an intensive discussion about enhancing and expanding outpatient rhinosurgical procedures. Many questions about how to stratify into out- and inpatient procedures are still not sufficiently clarified. Particularly, the use of nasal packing materials is not adequately discussed. We performed a Germany-wide survey among otorhinolaryngologists regarding the use of nasal packing materials in sinonasal surgery. Additionally, we asked for any complication in relation to nasal packing. In 85,6% nasal packing was used for septal and turbinate surgery at least occasionally, in 44,2% always. In sinus surgery these numbers are 94,1% and 49%, respectively. Non-resorbable nasal packing materials were predominantly used.Most frequent complications were bleeding with nasal packing in situ (> 50% of respondents) and posterior dislocation (24% of respondents), requiring emergency treatment. Death was listed in 5 patients. One patient suffered from permanent brain damage due to hypoxia. Application of non-resorbable nasal packing materials with occlusion of the nasal cavity carry a substantial risk of complications, which necessitate emergency treatment, thus requiring inpatient care.

Management Options for Traumatic Posterior Sternoclavicular Joint Dislocation: A Narrative Review with a Single Institution's Experience.

Background: Posterior sternoclavicular joint (SCJ) dislocations are rare events that can evolve into real emergencies due to the vital structures in the mediastinum. When closed reduction maneuvers fail, open SCJ reconstruction becomes mandatory, with literature proposing several stabilization techniques that either preserve or remove the SCJ's mobility. This study is a narrative review of the most recent literature regarding posterior trauma to the SCJ along with a single institution's experience of this pathology, managed either conservatively or surgically, with a figure-of-eight autologous semitendinosus graft in case of closed reduction failure. Methods: This article provides an overview of posterior traumatic SCJ dislocation, and it describes five cases of patients managed for traumatic posterior SCJ dislocation treated either conservatively or surgically with a figure-of-eight semitendinosus tendon autograft reinforced with high-strength suture tape. A comparison with the most recent literature is performed, focusing on biomechanics. Results: The demographics, the mechanism of injury, the management algorithm and the surgical strategy align with the most recent literature. Despite the final treatment, at one year of follow-up, the ROM was restored with full strength throughout the range of motion of the shoulder with no neurological deficits. The reduced joint successfully healed in imaging, and patients returned to their daily lives. The surgical site wounds and donor harvest sites were perfectly healed. Conclusions: Although recent recommendations for treating posterior traumatic SCJ dislocation have advanced, no universally accepted method of stabilization exists, and the surgical strategy is generally entrusted to the surgeon's experience. The literature still increasingly supports figure-of-eight ligament reconstruction with a biological or synthetic graft. This work further implements the literature by reporting good outcomes at follow-up.

Revue à 18 ans de recul minimum, de 10 patients présentant une luxation périlunaire isolée du carpe

Objective: To evaluate, in long-term, the functional abilities and the occurrence of osteoarthritis in patients treated for a posterior perilunate carpal dislocation without bone lesion associated.Patients and method: This was a monocentric retrospective observational study on patients operated on at the University Hospital of Guadeloupe for a posterior perilunate dislocation without bone lesion associated with a minimum of 18 years of follow-up. Ten patients were included with a mean follow-up of 22.8 years. The evaluation criteria were clinical (PRWE, QuickDASH, pain, grip strength, wrist joint mobility, Watson and Reagan tests, Cooney functional score) and radiographic (Gilula curves, carpal height, carpal ulnar translation, scapholunate and radiolunar angles, scapholunate and triquetro-lunar interlines in statics and dynamics, Herzberg’s classification of complications).Results: The average Cooney score was 67.5/100. Mean PRWE and QuickDASH scores were 33.9 and 24.8 respectively. The mean flexion-extension arc on the injured side was 71.5° (66,7% compared to the healthy side). Mean grip strength was 27kg (72,8% compared to the healthy side). The prevalence of osteoarthritis was 60%, with three A types, two A1 types, one B type and four B1 types according to Herzberg.Conclusion: The factors influencing the long-term prognosis are the initial displacement of the lunate, the quality of the reduction and the presence of chronic carpal instability, particularly scapholunate. The high prevalence of osteoarthritis in our series (60%) is apparently not correlated with the functional capacities of patients over the long term.

Traumatic native hip dislocation in the absence of acetabular or femoral fracture in adults: a retrospective study reporting clinical and radiological outcomes from a major trauma centre in the United Kingdom.

Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD. A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II-V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes. 13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II-V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries (p = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence (n = 0) compared to controls (n = 18, p = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males. Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients.

Posterior Labral Suture of Hip Joint by a 2-Step Camera Rotation Switching for Establishment of Bird’s-Eye View

Labral tear of the hip joint is an important factor causing joint pain and locking, as well as mobility disturbance. Although femoroacetabular impingement syndrome often results in anterior labral tears, posterior labral tears are present in a subset of patients, especially those with a history of posterior hip dislocation. Posterior labral repair under arthroscopy usually requires switching between the viewing approach and the operating approach, but this undoubtedly increases the operative time and the destruction of soft tissue. This article introduces a technique for rapid posterior labral suture by rotating the arthroscopic camera without switching the surgical approach.

Using an Intraoperative Stress Exam to Direct Treatment in Posterior Femoral Head Fracture-Dislocations.

To examine the results of a treatment algorithm incorporating an EUA performed intraoperatively after fixation of the femoral head through a Smith Petersen approach to determine need for posterior wall or capsule repair. Design: Retrospective review. Two Level 1 trauma centers. All acute, traumatic femoral head fractures from posterior hip dislocations treated at participating centers over a 5-year period from 2017-2022. Injuries were classified according to the Pipkin system. The primary outcome was the result of intraoperative EUA performed after femoral head fixation to determine the need for Kocher-Langenbeck exposure for posterior wall and/or capsule fixation. The secondary outcomes included rates of avascular necrosis, heterotopic bone formation, late instability, and conversion to total hip arthroplasty. Studied were 63 males and 22 females with mean age 32.5 (range 18-71). 79 of 85 (92.9%) patients had a stable EUA after fixation of the femoral head through a Smith-Petersen approach. Six (6/85, 7.1%) underwent an additional Kocher-Langenbeck approach for posterior wall or capsule fixation. This included 1 Pipkin I, 1 Pipkin II, and 4 Pipkin IV injuries. Of the Pipkin IV injuries, 51/55 (92.7%) had stable EUA and did not require fixation of their posterior wall. This included 7 patients with wall involvement >20%. Five patients were excluded because of planned fixation of their posterior wall based on preoperative imaging. Of patients with at least 6 months follow up, 16 of 65 (26.4%) developed radiographic evidence of AVN and 21 of 65 (32.3%) evidence of heterotopic bone formation. Seven out of 65 (10.8%) were converted to total hip arthroplasty over the study period. When comparing patients with a single exposure with those with additional KL exposure, they did not vary in their rate of AVN (27.1% vs. 0.0%, P=0.3228), HO formation (30.5% vs. 50.0%, P=0.3788), or conversion to total hip arthroplasty (10.2% vs. 16.7%, P=0.510). This study found residual posterior hip instability after femoral head fixation in patients with and without posterior wall fractures after posterior dislocations. The results of this study support use of an EUA after femoral head fixation to identify residual posterior hip instability in all femoral head fractures from posterior hip dislocations, regardless of Pipkin type. Use of the Smith-Petersen exposure remains a viable surgical option and may be improved with incorporation of an EUA after femoral head fixation. For Pipkin IV injuries with posterior wall fractures with indeterminate stability, an EUA accurately identifies residual instability. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Dynamic change of acetabular component position in total hip arthroplasty based on the spinopelvic classification: a prospective radiographic study

PurposeRecent studies have proposed optimizing the position of the acetabular component based on spinal deformity and stiffness classification to avoid mechanical complication after total hip arthroplasty (THA). The aim of this study was to characterize the dynamic changes in cup alignment post-THA based on the spinopelvic classification and to evaluate the efficacy of cup placement of preventing dislocation.MethodsThis prospective study included a total of 169 consecutive patients awaiting THA who were classified into four groups based on spinal deformity (pelvic incidence minus lumbar lordosis) and spinal stiffness (change in sacral slope from the standing to seated positions). The cups were aligned based on the group with fluoroscopy. Additionally, postoperative radiographic inclination (RI), radiographic anteversion (RA) in standard anteroposterior radiograph, and lateral anteinclination (AI) in sitting and standing positions were measured. The cumulative incidence of dislocation was evaluated at a follow-up two years post-THA.ResultRA was significantly greater in the group with normal spine alignment and stiff spine than in other groups (P = 0.0006), and AI in the sitting position was lower than in other groups (P = 0.012). Standing AI did not significantly differ between the groups. One posterior dislocation occurred during the study period (0.6%).ConclusionAI in the sitting position was lower in patients with normal spinal alignment and stiff spine despite larger RA in the standard anteroposterior radiographs. Consequently, with more anteversion in the normal spinal alignment and stiff spine group, spinopelvic parameters can help guide cup placement to prevent short-term dislocation post-THA.

MANAGEMENT OF CHRONIC PELVIC DISCONTINUITY DURING REVISION HIP ARTHROPLASTY USING THE “ACETABULAR DISTRACTION TECHNIQUE”: CLINICAL AND RADIOLOGICAL OUTCOMES AT TWO TO TEN YEARS FROM A TWO-CENTRE STUDY

Chronic pelvic discontinuity (CPD) during revision hip arthroplasty is a challenging entity to address. The aim of this study was to evaluate the clinical and radiologic outcomes, and complications of the “acetabular distraction technique” for the management of CPD during revision hip arthroplasty.Patients with CPD, who underwent acetabular revision between 2014 and 2022 at two tertiary care centres, using an identical distraction technique, were evaluated. Demographic parameters, pre-operative acetabular bone loss, duration of follow-up, clinical and radiologic outcomes, and survivorship were evaluated.In all, 46 patients with a mean follow-up of 34.4 (SD=19.6, range: 24–120) months were available for evaluation. There were 25 (54.3%) male, and 21 (45.7%) female patients, with a mean age of 58.1 (SD=10.5, range: 40–81) years at the time of revision surgery. Based on the Paprosky classification of acetabular bone loss, 19 (41.3%), 12 (26.1%), and 15 (32.6%) patients had type 3b, 3a, and 2c defects. All patients were managed using the Trabecular Metal™ Acetabular Revision System; 16 patients required additional Trabecular Metal™ augments. The mean HHS improved from 50.1 (SD=7.6, range: 34.3 – 59.8) pre-operatively, to 86.6 (SD=4.2, range: 74.8 -91.8) at the last follow-up. Two patients (4.3 %) developed partial sciatic nerve palsy, two (4.3%) had posterior dislocation, and one (2.2%) required re-revision for aseptic loosening. Radiologically, 36 (78.3%) patients showed healing of the pelvic discontinuity. The Kaplan-Meier construct survivorship was 97.78% when using re-revision for aseptic acetabular loosening as an endpoint.The acetabular distraction technique has good clinical and radiologic outcomes in the management of CPD during revision hip arthroplasty.

Treatment concepts for the medial clavicle and the sternoclavicular joint

Medial clavicle fractures and injuries to the sternoclavicular joint are rare injuries but can have life-threatening consequences. There are no standardized treatment algorithms or guidelines for the diagnostics and treatment. This article provides an overview of the individual topographies as well as the conservative and surgical treatment strategies.Conservative treatment is preferred for medial clavicle fractures. The indications for surgical treatment are variable but this is frequently carried out if there is a fracture displacement > 1 cm or1 shaft width and high functional demands. In the case of accompanying injuries to neurovascular structures, an open fracture or the threat of perforation of the skin, surgical treatment is mandatory. Open reduction and internal fixation using (locking) plates is currently the preferred form of treatment.In the case of posterior dislocation of the sternoclavicular joint, an immediate closed reduction must be attempted with the patient under analgosedation and with emergency treatment on standby. This temporal urgency does not exist for anterior and superior dislocations. Surgical treatment is indicated in cases of unsuccessful reduction, persistent symptomatic instability or injuries of the neurovascular bundle. From a multitude of treatment options, arthrodesis with suture cerclage has shown good results. Tendon grafts as well as special hook plates are increasingly being used due to better biomechanical qualities. The surgical treatment of combined injuries is determined by the individual injury pattern.Despite the variety of treatment strategies, the long-term outcome has consistently been positively described.

Superficial Peroneal Nerve Laceration and Repair in the Setting of a Bosworth Fracture: A Case Report

The superficial peroneal nerve (SPN) is at increased risk of injury in the setting of ankle fractures. We report a case of SPN laceration in the setting of a Bosworth fracture that likely occurred as the fibula became entrapped behind the tibia upon initial injury, pulling the SPN posterior and resulting in a traction tear. Radiographic evaluation performed when the patient presented to the emergency department demonstrated a Bosworth fracture, widening of the medial clear space, and posterior ankle dislocation. Closed reduction was attempted. Although the fibula remained entrapped behind the tibia, the talus was successfully reduced, and a short leg splint was applied. Fracture fixation and acute, direct repair of the nerve were completed during operative fixation 15 days from the initial injury, following the resolution of soft tissue swelling. The patient reported a complete return of sensation in SPN distribution 2 weeks postoperatively. Radiography showed an anatomically reduced ankle with hardware intact and in place. At 1-year follow-up, SPN sensation remained intact, radiography ultimately indicated a healed fracture site, and the patient reported that she was able to ambulate without pain. Our case provides support for acute, direct repair of SPN lacerations in concomitant Bosworth fractures. Level of Evidence: Level V, case report.

Imaging evaluation of hip capsule disorders: a comprehensive review.

The hip capsule and capsular ligaments play crucial roles in providing hip stability and mobility. Their role in hip pathologies is being increasingly recognized, underscoring the need for thorough imaging evaluation, which is better performed through MRI-arthrography. Various diseases affect the hip capsule directly or indirectly. Improper mechanical loading, as seen in conditions such as femoroacetabular impingement or chondrolabral pathology, can induce capsule thickening, whereas thinning and laxity of the capsule are characteristics of microinstability. Inflammatory conditions, including adhesive capsulitis of the hip, crystal deposition disease, polymyalgia rheumatica, and infections, also lead to capsular changes. Traumatic events, particularly posterior hip dislocations, cause capsule ligament disruption and may lead to hip macroinstability. Friction syndromes can lead to capsular edema due to impingement of the adjacent capsule. Hip arthroscopy can result in various postoperative findings ranging from fibrotic adhesions to focal or extensive capsule discontinuation. Although the significance of hip capsule thickness and morphology in the pathogenesis of hip diseases remains unclear, radiologists must recognize capsule alterations on imaging evaluation. These insights can aid clinicians in accurately diagnosing and effectively managing patients with hip conditions.

Influence of the type of atlantoaxial dislocation secondary to os odontoideum on sagittal alignment and balance of the subaxial cervical spine after posterior atlantoaxial fusion.

This retrospective study aims to investigate the effect of the type of atlantoaxial dislocation due to os odontoideum on the sagittal alignment and balance of the cervical spine after posterior atlantoaxial fusion. Data of 48 consecutive patients who underwent posterior C1-C2 fusion to treat atlantoaxial dislocation/instability due to os odontoideum were retrospectively reviewed. Radiographic variables, namely the T1 slope (T1S), C1-C2 angle, C2-C7 angle, C1-C2 sagittal vertical axis (SVA), C2-C7 SVA, and modified atlas-dens interval (MADI), were measured preoperatively, immediate postoperatively, and at final follow-up. Patients were divided into three groups based on the preoperative MADI. Differences within and between groups in radiographic variables and relationships between the investigated variables were analyzed. The MADI was correlated with the preoperative to postoperative changes in the C1-C2 angle (r = 0.776, P < 0.05) and C2-C7 angle (r = -0.357, P < 0.05). In the group with anterior atlantoaxial dislocation, the C1-C2 angle and C2-C7 SVA were significantly enlarged at final follow-up (P < 0.05), while the C2-C7 angle was significantly reduced (P < 0.05). The changes in C1-C2 angle and C2-C7 angle were opposite between the posterior group and the anterior dislocation group. The direction/type of atlantoaxial subluxation correlates with the changes in lower cervical curvature after atlantoaxial fusion. Patients with atlantoaxial posterior dislocation and atlantoaxial instability are less likely than those with atlantoaxial anterior dislocation to develop loss of lordosis after posterior atlantoaxial fusion.

Clinical treatment of traumatic hip dislocation in children: a single-centre retrospective study

This study aimed to analyse the treatment and outcomes of traumatic hip dislocation (THD) in children. Clinical data of children with THD were collected at our clinical centre from 1 June 2012 to 1 January 2023. Demographic data, injury mechanism, type of dislocation, combined injuries, reduction time, reduction method, and radiographs were analysed. The Merle d’Aubigné–Postel hip score was used to evaluate hip function and complications at the final follow-up. A total of 19 children with THD were enrolled, including 12 male and seven female patients, with an average age of 8.28 ± 0.99 years. Posterior dislocation was the main type of dislocation (89.47%). Fifteen patients (78.95%) had experienced high-energy injuries and traffic accidents were the main causes of injury (47.37%). Closed reduction was performed as soon as possible, and open reduction was performed if necessary. The hip scores of 18 patients (94.74%) were excellent. One patient had osteonecrosis of the femoral head, with a hip function score of 10 (moderate). High-energy injuries, such as traffic accidents, have gradually become the main cause of injury. The prognosis for THD in children is generally good.

Easy and safe: A new surgical fixation -technique for acute and chronic anterior instabilities of the sternoclavicular joint: technique and results

Instabilities of the SC joint are a rare injury, accounting for only 3% of all injuries of the shoulder-girdle. While acute posterior dislocations are an emergency and require immediate surgical intervention, anterior instabilities (first and second degree according to Allman) can mostly be treated conservatively. Chronic and highly instable acute anterior instabilities often imposes a significant limitation on the lives of affected patients. Currently, there is no established therapeutic algorithm in place. This retrospective case series with prospective collection of data was performed at a level-I trauma centre. Patients treated surgically for anterior SC joint instabilities between January 2013 and December 2019 and with a minimum follow-up of 24 months were included. The injuries comprised of six acute anterior dislocations treated with tape-cerclage in a "figure-of-8" configuration; twelve patients with chronic anterior SC instabilities were treated with autologous tendon grafts. For one highly unstable chronic anterior instability in addition to the tendon graft synthetic suture material was applied. The clinical evaluation consisted of a physical examination and a standardized questionnaire, which included subjective and objective shoulder scores. Out of 24, 19 patients (79%) with an average age of 32 years ± 15 were available for follow-up. 63% of the patients were male. After a mean follow-up of 57 months, the mean age- and sex-adapted Constant-Murley Shoulder Score (CS) of acute anterior luxations amounted to 90 points ± 20, Nottingham Clavicle Score (NCS) to 81 points ± 22 and DASH Score to 11 points ± 18. Chronic anterior instabilities had a mean CS of 90 points ± 12, NCS of 83 points ± 17 and DASH Score of 4 points ± 5. The study shows a complication rate of 10%. Two patients underwent revision surgery. To conlude, monocortical SCJ fixation in a "figure-of-8" fashion presents a low risk for complication and a low revision rate and can achieve equally good functional outcome after the treatment of highly unstable acute and chronic anterior SCJ instabilities than other published techniques. Our approach presents less risk to the neurovascular structures of the mediastinum than other published techniques requiring bicortical drilling, therefore making the technique more accessible to hospitals without a cardiothoracic surgical background.