Posteriorly Dislocated Research Articles

Using a Capsular Tension Ring (CTR) Inserter for CTR Explantation in Cases of Posteriorly Dislocated Intraocular Lens-CTR-Capsule Complex.

Explantation of a dislocated capsular tension ring (CTR) from the vitreous cavity can be challenging, typically requiring a bimanual hand-shake technique or cutting the CTR into segments. We present three cases of dislocated intraocular lens (IOL)-CTR-capsule complexes in which CTRs were explanted efficiently and safely by using a CTR inserter (CTR-I) through a clear corneal incision. Retrospective case series. Capsular tension rings were successfully explanted by freeing the eyelet of the CTR from the capsule, engaging it with the CTR-I hook and retracting the CTR into the device's shaft while maintaining the entire IOL-CTR-capsule complex in a safe position behind the iris plane. No complications of the procedure were observed in all three cases. All patients had subsequent uneventful IOL exchange through sutureless scleral fixation during the same surgery. The CTR inserter provides a simple and efficient approach to CTR removal from IOL-CTR-capsule complexes dislocated into the vitreous cavity. Greater awareness of this technique among providers is needed.

A New Technique of Pars Plana Vitrectomy With Microinterventional Nucleus Disassembly to Reduce the Energy of Fragmatome Lensectomy for Posteriorly Dislocated Crystalline Lens Removal.

To describe a novel technique of lens disassembly in posteriorly dislocated crystalline lens removal. A microinterventional microfilament loop device was introduced through the sclerotomy created for the fragmatome to cleave the lens into smaller, manageable pieces. Five cases were performed with this technique with improved visual acuity and no complications. The use of microinterventional nucleus disassembly during pars plana vitrectomy for retained lens material is a novel approach with potential advantages including decreased operating time and reduced complications secondary to excessive production of ultrasound energy.

Clinical Outcomes and Return to Sports After Open Reduction and Hamstring Tendon Autograft Reconstruction in Patients With Acute Traumatic First-Time Posterior Dislocation of the Sternoclavicular Joint

Background: Traumatic posterior dislocations of the sternoclavicular joint (SCJ) are rare. Multiple case reports, case series, and systematic reviews have been published on the treatment of posterior SCJ dislocations. However, they have usually been of small numbers, described a variety of surgical techniques on a mixture of acute and chronic dislocations, and have not focused on functional recovery or return to sports. Purpose/Hypothesis: The purpose of this study was to assess the clinical outcomes and return to sports after SCJ open reduction and reconstruction using a hamstring tendon autograft in patients with an acute first-time traumatic posterior dislocation of the SCJ. We hypothesized that SCJ open reduction and reconstruction would result in high survivorship, good clinical outcomes, and a high rate of return to sports. Study Design: Case series; Level of evidence, 4. Methods: This study included all patients who underwent SCJ open reduction and reconstruction within 14 days of sustaining a first-time traumatic posteriorly dislocated SCJ, with a minimum 3-year follow-up. Patient-reported outcomes were assessed by the following scores: short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Rockwood SCJ, modified Constant, and Single Assessment Numeric Evaluation (SANE). Survivorship was defined as no clinical failure, such as instability or recurrent dislocation, and no revision surgery. Return to sports was assessed using a customized questionnaire. Results: A total of 19 patients who underwent surgery were included, with a mean age of 30.8 years (range, 18-52 years). Seventeen patients were available at final follow-up at a mean 94.5 months (range, 37-155 months). At final follow-up, the mean scores were as follows: QuickDASH, 4.3 (range, 0-20.4); Rockwood, 13.9 (range, 12-15); modified Constant, 94.4 (range, 71-100); and SANE, 92.1 (range, 70-100). The construct survivorship was 96%. Of the 14 patients who participated in sports, 12 (86%) returned to their preinjury levels. Conclusion: After an acute first-time traumatic posterior SCJ dislocation, open reduction and stabilization with a hamstring tendon autograft, undertaken within 14 days of injury, provides good clinical outcomes and high rates of survivorship and return to sports.

Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus.

Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation (n = 11), while most surgical neck fractures were treated with locked plating (n = 6). Patients with impression type fractures showed significantly better ASES scores (p = 0.041), Simple Shoulder Test scores (p = 0.003), Rowe scores (p = 0.013) and WOSI scores (p = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.

Modified balanced two-string technique of internal scleral fixation of posteriorly dislocated intraocular lens.

Posterior dislocation of the intraocular lens (IOL) is a rare but potentially dangerous complication encountered by a cataract surgeon. We describe a modified balanced two-string technique of internally fixing a posteriorly dislocated rigid IOL using the pars plana approach in eyes which lack adequate capsular support. Five eyes of five patients underwent the procedure. All eyes had successful IOL refixation. One eye had mild temporal decentration. BCVA improved in all patients. Our technique is an alternate method of scleral fixation of posteriorly dislocated IOL with advantages of minimal postoperative astigmatism, minimal anterior segment manipulation, and good IOL centration.

Technique for Sutured Scleral Fixation of One-Piece Hydrophobic Acrylic Intraocular Lenses Dislocated Into the Vitreous.

To present a suturing technique for safe refixation of posteriorly dislocated one-piece hydrophobic acrylic intraocular lenses (IOLs). Retrospective data analysis of a series of 12 cases operated with vitrectomy, followed by IOL relocation to the retropupillary area, after which polypropylene sutures are passed through the optic-haptic junctions of the dislocated IOL and subsequently secured to the sclera. In all cases, the IOL remained centered throughout the follow-up period (mean 10.5 months, range 3 weeks-36 months). One case was complicated by vitreous hemorrhage the first postoperative day and later cystoid macular edema. Visual acuity was not compromised at the end of follow-up. The presented technique is safe and provides long-term stable refixation in cases of late posterior dislocation of a one-piece hydrophobic acrylic IOL. The risk that sutures looped around haptics will slip off the haptic is thereby avoided.

Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach.

To present updated risk factors, anatomical and visual outcomes and a surgical approach to posteriorly dislocated intraocular lenses (IOL). A retrospective case series review of patients presenting with posteriorly dislocated IOL to the vitreous was performed. All cases were managed surgically with pars plana vitrectomy (PPV) followed by IOL repositioning and refixation or IOL exchange. Clinical characteristics, risk factors for IOL dislocation, visual outcomes and intraoperative and postoperative complications were investigated. Forty patients with posteriorly dislocated IOL underwent 3-port PPV and lens retrieval at an average of 6.5years after cataract surgery. The main causes of IOL dislocation were previous PPV, myopia, pseudoexfoliation syndrome, ocular trauma and recurrent intravitreal injections. The existing IOL was repositioned and secured in 90% of the cases. Visual acuity improved in 34 patients, maintained in 5 and deteriorated in 1. All IOLs were central and stable at final follow-up. Posterior intraocular lens dislocation is becoming more prevalent. The main underlying causes found in this series were previous vitrectomy, myopia and recurrent intra-vitreal substance injections. Visual acuity improved in most cases after lens repositioning; however visual outcome is often limited due to associated ocular co-morbidities despite adequate lens position. Despite complete lack of zonular support, a posteriorly dislocated IOL can often be preserved by repositioning and fixation of the lens in the posterior chamber. Pathologies primarily associated with this type of lens malposition include history of vitrectomy, high myopia and multiple intravitreal substance injections.

Surgical and visual outcomes of posterior dislocated lens fragments after cataract surgery during 5-years at a tertiary eye hospital of North India.

To determine the surgical and visual outcomes of posteriorly dislocated lens fragments in the vitreous cavity in patients undergoing cataract surgery. A total of 149 eyes of 149 patients from 2013 to 2018 were included in the study. The primary cataract surgery was performed either at the base hospital and its peripheral centres or referred from elsewhere. Pars plana vasectomy and nucleus removal was performed along with implantation of intraocular lens, wherever possible. Success was defined as best corrected visual acuity (BCVA) ≥ 6/12 at 3 months follow up. Poor visual outcome was defined as per WHO guidelines as BCVA ≤ 3/60. Posterior capsular rupture and dislocation into vitreous cavity most frequently occurred during phaco-fragmentation in cases of phacoemulsification and during nucleus delivery in cases of small incision cataract surgery. Early vitrectomy was performed within 3 days in 36.2% of cases and within 14 days in 63.8% of cases. Successful visual outcome was achieved in 85.2% of patients at 3 months follow up after vitrectomy. Iatrogenic retinal break occurred in five patients during vitrectomyand five patients had retinal detachment. Poor visual outcome was observed in 12eyes, out of which glaucomatous optic neuropathy seen in 5 cases, cystoid or diabeticmacular edema in 4 cases and age related macular degeneration in 3 cases. Posterior dislocation of lens can be successfully managed in majority of cases with vitreoretinal surgical intervention. The timing of vitrectomy whether performed early or late did not affect the visual outcome. The most important predictorof final visual acuity after PPV for retained lens fragments is a less complicated clinical course without any associated complications such as retinal detachment, cystoidmacula edema and glaucoma. Expertise of the primary cataract surgeon could not be assessed in this study, though surgeon grade with more experience is an important factor in the assessment of complications during the cataract surgery.

Posterior fracture dislocation of the proximal humerus

Posterior dislocation fractures of the humerus occur as impression fractures of the humeral head (reverse Hill–Sachs fracture) and posteriorly dislocated proximal humeral (PH) fractures with a subcapital component. This study evaluated fracture patterns, current treatment, and revision rates. Data of patients who underwent surgical treatment for PH dislocation fractures in two level-I trauma centers between 2010 and 2018 were retrospectively reviewed. We identified 41 shoulders in 37 patients (n = 12 female, n = 25 male; average age 52 [25–91] years) with open surgical treatment of PH posterior dislocation fractures. In 14 patients, the cause was convulsive seizure or electrical accident, in 23 patients, a fall or high-energy trauma. There were 22 shoulders with impression fractures without a subcapital aspect; 19 shoulders had a posteriorly dislocated subcapital fracture. All patients were treated surgically via a deltopectoral approach. Five of the impression type fractures were treated prosthetically; the other 17 impression type fractures had humeral head-preserving reconstruction. The 19 cases of subcapital dislocation fractures were treated with open reduction and internal fixation with a PHILOS plate (n = 13) or with a prosthesis (n = 6). Within a mean follow-up period of 4.3 (1–9) years, the overall revision rate was 15% (6/41). Four patients underwent elective arthroscopic capsulotomy and implant removal. Two patients required revision surgery due to loss of reduction or humeral head necrosis. Impression type fractures were slightly more common than posteriorly dislocated PH fractures with a subcapital fracture component. In 73% of cases (n = 30), humeral head-preserving reconstruction was performed. The overall mid-term revision rate was 15% with a low-rate of secondary conversion to total shoulder arthroplasty (3%). Longer term functional outcomes of the patients are needed to better evaluate the treatment concept.

Treatment options for locked posterior shoulder dislocations and clinical outcomes.

Posterior dislocations are rare and diagnostically difficult injuries. Diagnosis is often delayed and this leads to a locked posteriorly dislocated humeral head.Treatment options include conservative methods and surgical anatomic reconstruction options as well as non-anatomic surgical procedures such as subscapularis tendon transfer, hemiarthroplasty and total shoulder arthroplasty.Decision-making for treatment as well as prognosis depend on the extent of the articular defect size of the humeral head, duration of the dislocation and patient-specific conditions such as age and activity levels.Cite this article: EFORT Open Rev 2019;4:194-200. DOI: 10.1302/2058-5241.4.180043

Open reduction through a posterior incision in the surgical treatment of shoulder posterior dislocation associated with proximal humeral fractures.

We explored the surgical technique of reducing the humeral head and repairing the fractures through a combined approach in the treatment of this complex injury. Six patients with posterior shoulder dislocations associated with proximal humerus fractures were enrolled in this study. The posteriorly dislocated head was first reduced through a shoulder posterior incision and the ruptured posterior capsular tissues were repaired simultaneously using a suture anchor. The fractures were then reduced and fixed with a PHILOS through a deltopectoral approach. The affected shoulders were immobilized in a neutral position for 6 weeks postoperatively with a customized orthosis and then permitted active shoulder exercises after removal of the orthosis. At the last visit, union of the fractures was evaluated. Degrees of anterior forward of the affected shoulder were recorded. Outcomes were evaluated according to UCLA and Constant criteria. Six patients were followed up for an average of 24.5 ± 7.4 (range 13-35) months. At the last visit, the mean degree of anterior forward was 171.7 ± 7.5 (range 160-180) degrees. An average of 32.9 ± 1.2 (range 31-34) points was obtained according to UCLA criteria, demonstrating excellent and good results in two and four cases, respectively. The mean Constant score was 87.3 ± 4.1 (range 83-92) points. The dislocated humeral head can be reduced through a posterior approach, while fractures can be reduced and fixed through a deltopectoral approach. This technique has the advantages of simplicity and its minimally invasive approach for reducing the dislocation.

Management of a Traumatic Retrosternal Dislocation of the Clavicle

The purpose of this case report was to discuss the surgical management of posterior sternoclavicular dislocations. This uncommon injury has been found to be very challenging. This report outlines the details of the anatomy of the sternoclavicular joint, and its relationship to nearby important structures. The relationship of the anatomy and how it impacts on the stability of the joint as well as the implications and potential consequences of a posteriorly dislocated joint is discussed. These factors emphasize the need for immediate recognition of this injury and the need for emergent management. The ideal surgical management has been a source of debate for decades. Various options including the ones used in the index case are discussed.

Surgical Technique: Hand-Over-Hand Retrieval of a Posteriorly Dislocated DSAEK Graft in an Eye With an Iris Reconstruction Lens

Descemet's stripping automated endothelial keratoplasty (DSAEK) has become the preferred surgical treatment for corneal endothelial pathologies. An intraoperative complication of DSAEK is posterior dislocation of the donor graft into the vitreous cavity. As the number of performed DSAEK procedures grows each year, the possibility of encountering a posteriorly dislocated donor graft increases. The authors report a case of intraoperative graft dislocation and a novel hand-over-hand retrieval method from the retinal surface. The hand-over-hand method provides an added surgical strategy for rescuing grafts that have fallen into the vitreous cavity.

Ostéotomie de recentrage dans le traitement de la luxation postérieure de l’épaule de la paralysie obstétricale

Summary Background The main objective of this study is to describe a new surgical technique that, through a gleno-humeral approach, reduces the incongruent joint while a humeral head centering osteotomy achieves shoulder stabilization. A humeral medial derotational osteotomy is performed associated with the articular reduction. Patients and methods Fourteen patients with obstetrical palsy presenting a posterior humeral head dislocation were submitted to a centering osteotomy procedure. Our study included patients with: (1) more than 1.5 year postoperative follow-up, (2) presence of humeral head posterior dislocation. The exclusion criteria were the following: (1) patients with total flaccid paralysis, (2) low paralysis and (3) any kind of active infection at the time of the procedure. Results Before treatment, in all patients, the shoulder joint was posteriorly dislocated and in internal rotation. All patients went on to have successful healing at the osteotomy site. In all cases an improvement in the functional Mallet scale was observed. In all patients, except one, the posterior dislocation was corrected. In two cases a second surgery (external derotation osteotomy) was performed to improve the upper extremity's position. Conclusions Articular congruency, after posterior dislocations of the humeral head, is achieved by humeral head centering osteotomy in patients with obstetrical palsy late deformities and also improves function. Level of evidence Level IV case series.

Centering osteotomy for treatment of posterior shoulder dislocation in obstetrical palsy

The main objective of this study is to describe a new surgical technique that, through a gleno-humeral approach, reduces the incongruent joint while a humeral head centering osteotomy achieves shoulder stabilization. A humeral medial derotational osteotomy is performed associated with the articular reduction. Fourteen patients with obstetrical palsy presenting a posterior humeral head dislocation were submitted to a centering osteotomy procedure. Our study included patients with: (1) more than 1.5 years postoperative follow-up, (2) presence of humeral head posterior dislocation. The exclusion criteria were the following: (1) patients with total flaccid paralysis, (2) low paralysis and (3) any kind of active infection at the time of the procedure. Before treatment, in all patients, the shoulder joint was posteriorly dislocated and in internal rotation. All patients went on to have successful healing at the osteotomy site. In all cases, an improvement in the functional Mallet scale was observed. In all patients, except one, the posterior dislocation was corrected. In two cases, a second surgery (external derotation osteotomy) was performed to improve the upper extremity's position. Articular congruency, after posterior dislocations of the humeral head, is achieved by humeral head centering osteotomy in patients with obstetrical palsy late deformities and also improves function. Level IV; case series.

Dislocation of the Donor Graft to the Posterior Segment in Descemet Stripping Automated Endothelial Keratoplasty

To report a series of dislocations of the donor graft into the posterior segment associated with Descemet stripping endothelial keratoplasty (DSAEK) and to identify possible risk factors for dislocation and clinical outcomes. Retrospective case series. Cases of donor graft dislocation into the posterior segment associated with endothelial keratoplasty were identified from the clinical experience of 7 surgeons. Observations included the preoperative surgical history of each eye, preoperative and postoperative visual acuity, management of the complication, and the postoperative clinical course. No identified cases were excluded from this series. Eight posterior graft dislocations were associated with DSAEK surgery. Each eye had a history of vitrectomy. Five eyes had sutured posterior chamber intraocular lenses, 1 eye had a sulcus intraocular lens, and 2 eyes were aphakic. Each eye required repeat grafting, and in 6 of 8 eyes, pars plana vitrectomy was used to remove the dislocated graft. Final visual acuities ranged from 20/30 to no light perception. Graft dislocation into the posterior segment is a rare complication of DSAEK surgery that can lead to permanent vision loss. It has occurred in eyes that have undergone previous vitrectomy and complicated intraocular lens placement or were aphakic. As is the case with a dropped lens nucleus during cataract extraction, visual acuities after a dropped DSAEK graft range from very good to no light perception. Better postoperative results seem to be associated with prompt removal of the posteriorly dislocated graft.

Traumatische Verletzungen des Sternoklavikulargelenks

Traumatic injuries of the sternoclavicular joint occur rarely and are mainly caused by an indirect trauma mechanism with high kinetic energy. Anterior dislocation is much more common than posterior dislocation, which may be associated with life-threatening injuries. The CT scan is the diagnostic tool of choice for accurate assessment of the injury and coexisting pathologies. The primary goal in anterior and posterior dislocations is an early closed reduction. In cases of redislocation after closed reduction of an anterior dislocation we recommend primary joint reconstruction on the basis of an individual therapeutic concept. Posterior dislocations often cannot be reduced by closed means. Then open reconstruction and stabilization are performed. Chronic instabilities should only be addressed surgically in cases of persistent pain and/or functional deficit. Resection of the medial clavicula represents an effective treatment option in post-traumatic sternoclavicular joint arthritis provided that the costoclavicular ligaments are intact or will be reconstructed during surgery. Physeal injuries of the medial clavicle can occur until an approximate age of 25. Closed reduction of dislocated physeal injuries is attempted. After reposition non-operative treatment in general leads to a good functional outcome. Posteriorly dislocated physeal injuries often cannot be reduced by closed means. In these cases good function can be expected after open stabilization.

Intravitreal Phacoemulsification with Pars Plana Vitrectomy for Management of Posteriorly Dislocated Nucleus or Lens Fragments

Dislocation of crystalline lens nucleus/fragments into the vitreous cavity during phacoemulsification is a potentially serious, sight-threatening, uncommon complication of cataract surgery. It is associated with significant intraocular inflammation and can lead to poor visual outcome. The current study assesses the outcome of immediate intravitreal phacoemulsification with pars plana vitrectomy in management of posteriorly dislocated nucleus/lens fragments. In this retrospective case series, records of 23 patients who underwent immediate pars plana vitrectomy and intravitreal phacoemulsification for removal of dislocated nucleus/lens fragments at the same sitting of phacoemulsification were reviewed. Data including patients' preoperative and postoperative vision and intraoperative and postoperative complications were recorded. The mean follow-up period was 16.5 months (range, 5-31 months). Preoperative visual acuity ranged from 0.05 to 0.5. The final postoperative visual acuity ranged between HM and 1.0. Fifty-two percent of eyes (12 eyes) had a final postoperative visual acuity of 0.5 or better. Complications included 2 cases of cystoid macular edema and 2 cases of retinal detachment. Immediate vitrectomy and intravitreal phacoemulsification is a surgical option in the management of posteriorly dislocated nucleus/lens fragments without much risk of retinal damage. It is relatively safe and most patients achieved a good visual outcome. The risk of postoperative complications including uveitis, secondary glaucoma, and cystoid macular edema could be minimized.

Neglected elbow dislocation in a young man: treatment by open reduction and elbow fixator

A 22-year-old man fell 4 floors during a fire. He had 20% burns and multiple injuries. The Injury Severity Score on admission was 44. The Glasgow Coma Score was 11/15. He had a fractured pelvis and bilateral open fractures of the os calcis and required subsequent left belowknee amputation. He had also a left intracerebral hemorrhage resulting in a right hemiplegia and dysphasia. Several attacks of convulsions occurred. The patient presented to us 1 month after injury because of left elbow pain. The left elbow was posteriorly dislocated and was fixed in full extension. There was no nerve palsy in the left upper limb, particularly the ulnar nerve. Radiographs confirmed posterior dislocation of the left elbow with no fracture (Figure 1). Open reduction was performed by the posterior approach. The operative findings were as follows: dense fibrous tissue in the olecranon fossa, a contracted fibrotic triceps, contracted collateral ligaments, preserved articular cartilage, and a fairly normal-looking ulnar nerve. Reduction was achieved after excision of the fibrous tissue remnants of the capsule, release of both collateral ligaments, and clearance of the olecranon fossa. The reduction was concentric and not particularly difficult but with only fair stability. The ulnar nerve was inspected and decompressed at the cubital tunnel. The continuity of the triceps mechanism was carefully preserved, and there was limited flexion of the reduced elbow. The center of rotation of the elbow through the anteroinferior aspect of the medial epicondyle and the center of the lateral epicondyle was identified.2 A 2-mm Kirschner wire was inserted in the axis of rotation, with the position confirmed by image intensifier. The central connecting unit with the humeral and ulnar frames was slid over the wire, and the fixator used as its own template. Humeral screws (6/5 mm) were inserted from lateral to the mid humerus with care taken to avoid the radial nerve. Ulnar screws (4.5/3.5 mm) were applied from the dorsal side at the subcutaneous border so as to allow maximum forearm rotation. The elbow was then flexed and extended to confirm correct alignment and concentric reduction. The Kirschner wire was removed. The reduction was stable, and passive range was 0° to 70° because of limitation from the tight triceps. The postoperative regimen included active mobilization of the elbow and alternate passive stretching in flexion and extension by the compression-distraction device that accompanied the elbow fixator (Figure 2). This allowed slow stretching of the contracted triceps without the risk of overloading the articular cartilage of the elbow joint. The fixator was removed at 6 weeks, and active range on removal was 40° to 125°. The young man was well motivated and had active mobilization with passive stretching by therapists. He achieved 20° to 135° flexion range after 1 more month. At 1-year follow-up, the patient had full range in flexion/ extension and rotation (Figure 3). Radiographs of the left elbow did not show heterotopic ossification or degenerative changes (Figure 4). The Mayo elbow functional score8 was 100, and he was very satisfied, as he could use his left upper limb to maneuver his wheelchair single-handedly.

Posterior sternoclavicular joint dislocation: the value of intra-operative ultrasound

The sternoclavicular joint dislocates posteriorly if the costoclavicular ligaments, posterior capsule, and anterior capsule have all been disrupted. Diagnosis of a posteriorly dislocated sternoclavicular joint is difficult on clinical examination and with plain X-rays. The treatment objective is to obtain a closed reduction, and failing this an open reduction is indicated. In the intra-operative setting the evaluation of the reduction when performed through closed means can be somewhat difficult, and intra-operative plain films do not give clear answers. Ultrasound as an imaging modality for these injuries was shown to demonstrate the state of the joint in terms of reduction, more clearly than X-rays ( P<0.001). It was accurately interpreted by the vast majority of orthopaedic surgeons in an investigation, and is of great value in the intra-operative setting to confirm whether a closed reduction has been successful or not. A case is reported illustrating its use.