Posterolateral Dislocation Research Articles

Open reduction of irreducible posterolateral rotary knee dislocation without sectioning of incarcerated vastus medialis: A case report with video illustration

Traumatic knee joint dislocations are relatively rare. Most of knee dislocations are reduced by closed manipulation. However occasionally, especially in the case of soft tissue incarceration, closed reduction may not be possible and open reduction is mandatory. This report introduces a case of irreducible posterolateral rotary knee dislocation with interposition of vastus medialis treated through two-staged operations. In this report, we included preoperative magnetic resonance images (MRI), detailed intraoperative descriptions with photographs and video illustration that show the status of an injured knee joint and the effectiveness of the treatment.

Occult posterolateral rotatory dislocation of the elbow with olecranon fracture in a child: a case report

IntroductionAcute posterolateral rotator elbow dislocation in a child is rare and can be easily misdiagnosed due to immaturity of the epiphysis. This is the first case of occult posterolateral rotator elbow dislocation in combination with an olecranon fracture. We report our experience with this case, which was not diagnosed correctly by plain radiographs.Case presentationAn 11-year-old Asian boy suffered severe pain and swelling of his right elbow after his outstretched arm hit a car dashboard in a motor vehicle accident. Plain radiographs showed only a minimally displaced olecranon fracture and a tiny lateral epicondylar avulsion fracture. However, stress radiographs under general anesthesia revealed severe posterolateral rotatory instability. During surgery, we found that the cartilaginous lateral epicondylar apophysis was much larger than the epicondylar fragment on the radiographs. After the lateral epicondylar osteochondral fragment and lateral collateral ligament complex were fixed, the instability disappeared.ConclusionOur experience with this case shows that it is important to check for instability with pediatric elbow fractures, because a tiny avulsion fracture was able to cause severe posterolateral rotatory instability in a child.

New mechanism of the posterior elbow dislocation

To suggest a new model on the most common kind of posterior elbow dislocation using MRI findings on acute elbow injuries. Fifteen patients with simple elbow dislocation (Group A) and 19 patients sustaining pure ligament injuries (Group B) were enrolled in this study. Using MRI scans, bony contusion at radial head and posterior capitellum (lateral bone contusion) and medial aspect of the ulnohumeral joint (medial bone contusion) were investigated with the injury patterns of the collateral ligament and overlying muscles. In Group A, the injury patterns of the ulnar and lateral ulnar collateral ligaments were classified into distraction or stripping type; in Group B, into rupture or strain. Based on these findings, we speculated the injury mechanism of the elbow dislocation. In Group A, posterolateral (PL) dislocation was found in 12 cases of distractive ulnar collateral ligament type and stripping lateral ulnar collateral ligament type, where lateral bone contusion was found in 11 cases. Posteromedial (PM) dislocation was observed in only two cases of distraction type of the LUCL, where medial bone contusion was seen in two cases. In PL dislocation of the elbow joint, we always found more severe damage of soft tissue at the medial side of the elbow joint compared to the lateral side. Lateral bone contusion was speculated to be caused by bony abutment under pathologic forearm external rotation (PFER) and medial bone contusion, by bony abutment under varus stress. In Group B, the ulnar collateral ligament was more commonly injured than the lateral ulnar collateral ligament, and lateral bone contusion accompanied most cases. PL dislocation is thought to start from the medial side in contrary to PM dislocation beginning at the lateral side. If the disengagement of the coronoid process is not completed due to the insufficient valgus/varus distraction, a coronoid fracture will develop at the same time as the elbow dislocation during PFER.

A promising new technique for closed reduction of arytenoid dislocation

To study the effect of a new technique for closed reduction of dislocated arytenoids. The study included 21 females (72.4 per cent) and eight males (27.6 per cent) with a diagnosis of arytenoid dislocation. There were 18 cases of left arytenoid dislocation and 11 of right arytenoid dislocation. Twenty-eight cases had anteromedial dislocation and one had posterolateral dislocation. All patients were treated with closed reduction using custom-made metal rods and an operating microscope, under general anaesthesia. Post-operatively, 21 patients' voices returned completely to normal (including full vocal fold mobility), five had an improved voice and three failed to show any improvement. There were no post-operative complications. This new closed reduction technique is a safe procedure for patients with dislocated arytenoids. It is repeatable and the outcome is reliable and effective. Closed reduction can be a useful treatment for arytenoid dislocation.

Irreducible open posterolateral knee dislocation due to medial meniscus interposition.

Posterolateral knee dislocations are generally irreducible due to the interposition of the medial capsule and retinaculum. These injuries have a 'dimple sign' which shows the invagination of the tissues in the medial joint line. We present an unusual case of an open posterolateral traumatic knee dislocation (KD-4 [ACL/PCL/MCL/LCL-PLC torn] open knee dislocation) without a 'dimple sign'. Closed reduction attempts were unsuccessful. In surgery, it was found that the medial meniscus was detached from the meniscocapsular junction and entrapped in the joint. The medial meniscus was extracted from the joint, and the joint was reduced. The medial meniscus was sutured to the meniscocapsular junction with anchors. This is the first study reporting medial meniscus interposition in an open posterolateral knee dislocation. Moreover, the presented case is peculiar because although it was a posterolateral knee dislocation, the posterolateral ligament complex was also torn.

Irreducible lateral knee dislocation with incarceration of the lateral femoral condyle in the posterolateral capsuloligamentary structures: a case report and literature review

Knee dislocations are relatively rare 1 , often associated with neurovascular injury, and usually amenable to closed reduction 2 . The irreducible knee dislocation is an even rarer occurrence 3 , 4 . Irreducibility of a knee dislocation is usually due to the medial femoral condyle being buttonholed through the gap formed by medial capsuloligamentary structures. We have treated a rare irreducible dislocation of the left knee in which the neurovascular status was intact. MRI revealed entrapment of the posterolateral capsuloligamentary structures in the intercondylar notch. Emergency operation was performed to reduce the dislocation and reconstruct the injured ligaments. We have described the case in order to present the characteristics of this dislocation and guidelines for its diagnosis and treatment.

Triple injury of forearm and elbow—a case report

Fracture of the forearm with ipsilateral dislocation of the elbow is uncommon. Such double injuries are often missed at initial assessment. We report a case of triple injury of forearm and elbow—open elbow dislocation, closed distal radius, and ulna fracture with missed medial epicondyle fracture. To the best of our knowledge, this has not been previously described in literature. The most probable mechanism of injury is a fall on outstretched hand with wrist in dorsiflexion causing the distal radius and ulna fracture with dorsal displacement. Further continuation of the axial compression along with supination of the forearm and valgus at the elbow resulted in posterolateral elbow dislocation and a medial epicondyle avulsion. Early debridement and reduction resulted in satisfactory function. The report attempts to highlight the importance of good clinical and radiological assessment and to understand the mechanism of injury, to rule out other injuries caused by the same mechanism.

IPSILATERAL SIMULTANEOUS SHOULDER AND ELBOW DISLOCATION a case report

Ipsilateral dislocation of the shoulder and elbow joints is a rare and complex injury. Only six patients have been reported in the international literature with ipsilateral dislocation of the shoulder and elbow. Here, we reported a 48 year-old woman who suffered ipsilateral shoulder and elbow dislocation. The patient first presented to a regional hospital and the radiographs taken following the initial evaluation revealed posterolateral dislocation of right elbow. The reduction of the dislocated elbow was performed at that facility. However, since no radiographic examination of the injured shoulder had been carried out, the dislocation injury of the shoulder was missed. Three days later the patient presented to Tepecik Training and Research Hospital emergency Department (Izmir-Turkey), complaining of shoulder pain. Radiographs showed the missed anterior dislocation of right shoulder, which had been reduced under general anaesthesia. At final follow-up, 2.5 years later, the elbow and the shoulder were pain free and had full range of motion. Following a high energy trauma in upper extremities, radiographic examination of the shoulder, elbow and wrists must be performed in case of suspicion.

Akute und chronische Instabilitäten des Ellenbogengelenks

Successful treatment of elbow instability is aided by fundamental biomechanical understanding. This allows for clinical instability to be traced back to structural injuries, which can be addressed with targeted therapy. Acute instability of the elbow joint after frequent posterolateral dislocations tends to affect the radial ligamentous complex. In addition to simple ligamentous injuries, fractures can also contribute to elbow instability; comminuted fractures of the radial head often correlate with a rupture of the ulnar collateral ligament. Improperly healed acute injuries can result in chronic instability. However, recurrent microtrauma such as that seen in throwing athletes can also lead to changes in joint laxity. Conservative therapy of simple elbow dislocation usually leads to satisfactory results. In isolated cases, chronic lateral instability may result that requires operative stabilization. Recently, chronic posterolateral instability has been seen as the primary underlying pathology in unstable elbows. Chronic medial instability is also a problem for active athletes and may even lead to inability to participate in athletics. Conservative therapy should be the primary course of treatment. Surgical treatment may be indicated if conservative measures fail, if an athlete desires additional treatment, or in cases of high-grade medial instability. In this case, a rehabilitation period of up to one year should be expected.

Irreducible Pipkin II femoral head fractures: Is transgluteal approach the best strategy?

Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment. Level IV retrospective historical study.

Neglected irreducible posterolateral knee dislocation

Knee dislocations are rare injuries. Posterolateral knee dislocations are only a small subset of them. There is a paucity of literature regarding the management of such neglected cases. We report here, a case of neglected irreducible posterolateral knee dislocation treated with open reduction and isolated posterior cruciate ligament reconstruction followed by gradual rehabilitation with good outcome at 3 years followup.

Ein modifizierter posterolateraler Zugang für die operative Versorgung von Tibiakopffrakturen

Open reduction and internal fixation of posterolateral tibial plateau fractures. Tibial plateau fractures involving the posterolateral quadrant. Critical soft-tissue conditions. Tibial plateau fractures which do not involve the posterolateral quadrant. 90 degrees side positioning on the contralateral side, skin incision along the fibular head, exposure of the peroneal nerve, lateral arthrotomy and exposure of the joint, dissection of the popliteal cavity between the lateral head of the gastrocnemius muscle and soleus muscle. Blunt preparation between popliteus muscle and soleus muscle under preservation of the popliteal artery and vein. Sharp dissection of the soleus muscle from the dorsal parts of fibula and tibia until the peroneal nerve at the fibular neck enters into the muscle. Exposure of the posterolateral tibial head. The dorsal joint capsule and the popliteal corner are prevented from any soft-tissue damage. Visual control of fracture reduction by viewing in the joint gap through lateral arthrotomy. Reduction of the fracture from dorsal with pointed reduction forceps. A conventional or locking radius T-plate can be pinched off with lateral cutters and anatomically bent for fracture fixation and is dorsally fixed at the tibial plateau. 10 kg partial weight bearing for 6-8 weeks. Limited range of motion 0-0-90 degrees for 6 weeks. In a period of 2 years, seven patients with posterolateral tibial plateau fractures received open reduction and internal fixation by using the modified posterolateral approach. The patients were examined at follow-up between 12 and 24 months after surgery. Six patients were free of pain with full range of motion and stable knee joints. Radiologically, a good fracture reduction was achieved in six cases. In one patient with a posterolateral comminuted dislocation fracture, a small fracture step and a gap could be observed. No approach-related complications were found.

Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases

Elbow instability is a common feature after medial epicondyle fractures, displaced or not, even in the absence of dislocation. Undisplaced or minimally displaced fractures often have an underestimated degree of instability secondary to unrecognised capsuloligamentous and muscular injuries. The purpose of this retrospective study was to analyze and to assess objectively the results of the surgical treatment of these acute injuries. One hundred and thirty-nine displaced medial epicondyle fractures were surgically treated and reviewed. A valgus stress test was performed on each child under general anesthesia or sedation. Functional outcome was assessed using a scoring system based on a series of clinical and radiographic criteria. The mean age of patients at the time of accident was 11.9 years. Mean follow-up was 3.9 years. All fractures had associated with instability of the elbow. A posterolateral elbow dislocation was associated in 80 fractures. The medial epicondylar fragment was anatomically reduced and fixed in all cases. The final result was excellent in 130 cases and good in 9 cases. Elbow were stable and pain free in all patients. Normal elbow range of motion was reported in 133 cases. Union was achieved in all cases. Among these cases, nine had presented a <<fibrous>> union with no change on valgus stress views. No cases of cubitus valgus >/=10 degrees were observed. Anatomical abnormalities of the elbow were present in 28 cases: periarticular calcification in 18 cases, medial condyle groove formation in 4 cases, moderate hypertrophy and fragmentation of the medial epicondyle, respectively, in 3 cases. The positive valgus stress test performed at the time of surgery for all epicondyle fractures without associated dislocation regardless of there degree of displacement justified our operative approach. Operative intervention is a good management of these fractures and results in an anatomic reduction, a solid bone union and prevents valgus instability. Even with postoperative immobilization of the elbow (mean of 4 weeks), stiffness is rare. Damage to the medial stabilizing structure of the elbow rather than the extent of medial epicondyle displacement has a far greater influence on joint stability and outcome.

A Chronic Posterolateral Knee and Patella Dislocation: Case Report

Knee dislocations are uncommon as isolated orthopaedic injuries, but their prevalence is increased in the setting of high-energy multiple trauma. In these circumstances, it is important for the orthopaedic clinician to recognize and appropriately treat the knee dislocation in parallel with other significant injuries. We report the case of an 18-year-old woman who was involved in a motor vehicle collision and sustained multiple injuries in addition to a posterolateral knee dislocation. An attempt at reduction was made in the initial trauma setting, and the patient was medically stabilized. She was discharged from the hospital in a splint with orthopaedic follow-up and presented 3 months after injury with an unreduced posterolateral dislocation. A single-stage operation was performed with reduction and stabilization of the knee. Postoperatively, the patient has done well and regained significant range of motion.

Posterolateral elbow dislocation with entrapment of the medial epicondyle in children: a case report

AbstractIntroductionElbow dislocations in children are uncommon injuries. Dislocations with associated fractures or so-called complex dislocations of the elbow can be challenging to diagnose and treat.Case presentationA 14-year-old male had a posterolateral elbow dislocation after a fall. Closed reduction with traction was performed. Radiographs after initial reduction showed a fragment entrapped into the humero-cubital joint. Computerized tomography scan showed the fragment belonging to the medial epicondyle. Open reduction and internal fixation with a 3.0 millimeter cannulated screw was performed, with restoring of the normal function of the elbow at final follow up.ConclusionElbow dislocations in children can be associated with bone lesions. These injuries must be suspected to avoid misleading diagnosis and achieve good results.

The MR dimple sign in irreducible posterolateral knee dislocations

While posterolateral knee dislocation is a rare entity, its identification has important implications. The invagination of skin seen in posterolateral knee dislocations is referred to as the "dimple sign" on physical exam. We report a case where the "dimple sign" was also demonstrated on magnetic resonance imaging. Failure to recognize this finding on imaging will render the knee irreducible, as a result of interposed tissues, until discovered by the orthopedic surgeon intraoperatively. The incarcerated medial capsule and medial collateral ligament could also be misinterpreted as torn meniscus, as occurred in our case.

Incarcération du nerf médian après luxation négligée du coude : à propos d’un cas

Entrapment of the median nerve is a rare complication following dislocation of the elbow. The authors report a case of incarceration of the median nerve in a neglected dislocation of the elbow in an 18-year-old right-handed boy. The patient sustained a closed injury of the right elbow during a game. The initial treatment was performed by a traditional bonesetter and consisted of attempts at reduction followed by immobilization in extension. There was persistent pain and limitation of movement in the elbow and paraesthesiae in the long finger. This led the patient to consult us at 45 days postinjury. Radiographs showed a posterolateral dislocation of the elbow. Surgical reduction was carried out 6 months posttrauma. After opening of the capsule, we discovered the median nerve blocking the olecranon fossa, passing at the level of the groove of the trochlea where it was wedged between the latter anteriorly and the olecranon posteriorly before resuming its normal course. Reduction was obtained and the nerve replaced in its normal position. The postoperative course was uneventful with disappearance of the paresthesiae and restoration of a good range of movement of the elbow. The authors discuss the mechanism, the clinical forms and propose a new type according to the classification of Fourrier.

Irreducible Posterolateral Knee Dislocation with Entrapment of the Adductor Magnus Tendon and Medial Skin Dimpling

This case report describes an irreducible posterolateral knee dislocation with a bone avulsion of the medial epicondyle attached to the medial collateral ligament and adductor magnus tendon entrapped within the joint space.

Posterolateral elbow dislocation with entrapment of the medial epicondyle in children: a case report

IntroductionElbow dislocations in children are uncommon injuries. Dislocations with associated fractures or so-called complex dislocations of the elbow can be challenging to diagnose and treat.Case presentationA 14-year-old male had a posterolateral elbow dislocation after a fall. Closed reduction with traction was performed. Radiographs after initial reduction showed a fragment entrapped into the humero-cubital joint. Computerized tomography scan showed the fragment belonging to the medial epicondyle. Open reduction and internal fixation with a 3.0 millimeter cannulated screw was performed, with restoring of the normal function of the elbow at final follow up.ConclusionElbow dislocations in children can be associated with bone lesions. These injuries must be suspected to avoid misleading diagnosis and achieve good results.

Acute Traumatic Open Posterolateral Dislocation of the Ankle Without Tearing of the Tibiofibular Syndesmosis Ligaments

Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5 degrees in dorsiflexion, 10 degrees in plantarflexion, 5 degrees in inversion, and 0 degrees in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability.