Traumatic Dislocation Research Articles

Patient Reported Outcome Scores Following Traumatic Hip Dislocations

Patient Reported Outcome Scores Following Traumatic Hip Dislocations

Traumatic inferior shoulder dislocation: A case report with a comprehensive review of acute care and post-reduction management strategies

Traumatic inferior shoulder dislocation: A case report with a comprehensive review of acute care and post-reduction management strategies

Similar patient-reported outcomes, but lower re-dislocation and higher revision rates following primary Latarjet vs primary Arthroscopic Bankart Repair in patients with 10-20% glenoid bone loss at minimum 2 years follow-up.

The amount of glenoid bone loss is closely related to the success rate of surgical treatment following anterior shoulder dislocations. There is an ongoing debate on the most successful treatment in patients with a subcritical amount (10-20%) of glenoid bone loss (GBL). This study aimed to compare patient-reported outcome measures (PROMs) following primary open Latarjet procedure and primary arthroscopic Bankart repair (ABR) in patients with 10-20% GBL at minimum 2 years follow-up. This multicenter retrospective cohort study included 53 patients with traumatic anterior shoulder dislocations treated with Latarjet or ABR between 2011 and 2019. PROMs included the Western Ontario Shoulder Instability Index (WOSI) and Oxford Shoulder Instability Score (OSIS). Secondary outcomes included recurrence, complications, revision surgery, patient satisfaction, and return to sport (RTS). The mean follow-up was 77±31.7 months. Baseline characteristics were similar between ABR and Latarjet, except for time to follow-up (91±30 vs 61±26 months, p<0.001) and percentage GBL (15±3 vs 17±3, p=0.024). WOSI scores were higher in Latarjet patient compared to ABR, however this difference was not statistically significant (220 vs 457, p = 0.10). OSIS scores were similar following ABR and Latarjet (42 vs 45, p = 0.33). Recurrence rates were higher in ABR patients (7 (24%) vs 0 (0%) recurrences, p=0.01), whereas revision rates were higher in Latarjet patients (4 vs 0 revisions, p=0.04). Patient satisfaction and complications were not different between the two procedures and neither were RTS and RTS to pre-injury level. The null hypothesis in which Latarjet and ABR show similar patient-reported outcomes could not be rejected based on the underpowered analysis. Patients treated with Latarjet did not have any recurrences versus 7 in the ABR group (p=0.01). However, revision rates were higher in Latarjet patients (4 vs 0 revisions, p=0.04).

Analysis of Animal Models of Traumatic Osteonecrosis of the Femoral Head Based on Blood Supply: A Literature Review.

Traumatic osteonecrosis of the femoral head (TONFH) refers to ischemic osteonecrosis is resulting from an acute mechanical interruption of the blood supply to the femoral head. The early diagnosis and optimal treatment have been central focuses of research and continue to undergo improvement. Reliable animal models are essential for advancing research into the treatment of the disease. This review aims to provide a comprehensive overview of tetrapod models (rats, rabbits, dogs, and sheep) and bipod models (emus, ostriches), as well as various modeling methods (traumatic hip dislocation, dissection of the round ligament and ligature of the femoral neck, femoral neck fracture (FNF), reduction and internal fixation after femoral neck fracture, and highly selective disruption of the anterior-superior retinacular vessels). This review examines the advantages, disadvantages, and applicability of each model. Based on blood flow analysis, it proposes a more reliable direction for TONFH modeling: simulating partial blood flow injury in the context of FNF.

Return to work following traumatic hip dislocation: a prognostic outcome study.

Traumatic hip dislocations are associated with high morbidity and overall limitations of daily living activities. Residual disability inhibits returning to work after severe injuries and minimizes financial independence and social involvement, which are both related to well-being and good health. The aim of this study was to analyze epidemiological and socioeconomic status following traumatic hip dislocations to identify predictors for return to work. Patients with traumatic hip dislocations from three level one trauma centers from 2009 to 2021 were followed up in terms of epidemiological data, return to work, change of work, and predictors of socioeconomic outcome. Inclusion criteria were age ≥ 18 years, employed patients, and a minimum follow-up of ≥ 2 years. Patients with incomplete or missing medical records, including radiological imaging and retired patients, were excluded. 107 patients met the inclusion criteria and 67 (63%) patients were available for follow-up. A total of 81 male and 26 female patients with a mean age of 41.82 years (SD ± 15.65) were finally evaluated. A work-related accident was found in 28 patients (26%). Demographic data and treatment course did not differ significantly between the work-related and non-work-related accidents. Sixty-seven (63%) patients (51 male and 16 female) with a mean age of 42 years (SD ± 15.79) were included in the follow-up. Eighteen patients (27%) had not returned to their previous job and 12 patients (18%) had reduced income. Higher age and Body Mass Index (BMI) were significantly associated with a lower return rate to the pre-accident job (p < 0.05). Furthermore, lower Tegner Activity Scale, pain score, and modified Harris Hip Score were also significantly associated with lower return to work rate (p < 0.001) and reduced income. Traumatic hip dislocations are associated with high rates of work-related injury and unsatisfactory low rates of return to previous work. Younger age, lower BMI, higher Patient reported outcome measures and lower pain levels may predict a successful return to previous job and a reduced risk of reduction in earning capacity. Understanding the predictive factors is crucial to identify patients at risk of not returning to work and to develop strategies that may help improve their chances of successfully returning to their previous employment.

Supervised vs. Self-Managed Exercise Therapy for Improving Shoulder Function After Traumatic Dislocation and Sprain: A Systematic Review and Meta-Analysis.

Trauma-induced shoulder dislocations and sprains rank among the most common upper extremity injuries, with contact sports accounting for the majority of cases. These injuries often lead to substantial impairments in joint function and long recovery times, requiring targeted therapeutic interventions to restore mobility and prevent recurrent injuries. Given the pivotal role of exercise therapy in restoring shoulder function, this study systematically reviews the literature on the comparative effectiveness of supervised versus self-managed exercise therapy following acute shoulder trauma. PubMed, Cochrane CENTRAL, Embase, Web of Science, and Science Direct were searched up to 13 December 2024. Conservative and post-surgical treatment modes were analyzed separately. Five studies with a total 689 participants were included (conservative: n = 538 across two studies; post-surgical: n = 151 across three studies). Both treatment modes showed similar pooled effects (standardized mean difference, SMDconservative: -0.35, 95% CI [-1.39, 0.69]; SMDpost-surgical: -0.23, 95% CI [-1.21, 0.75]), with a marginal improvement in shoulder function favoring supervised therapy. Four studies had some risk of bias, and one had serious risk; GRADE certainty was low. Supervised exercise therapy may offer slightly greater functional improvements over self-managed training, but evidence is limited by heterogeneity and low certainty. Further high-quality trials with standardized protocols and improved adherence tracking are needed to establish more definitive conclusions and guide clinical decision-making.

Traumatic Cuboid Dislocation Without Cuboid Fracture: Literature Review and Case Report of a Rare Injury Pattern

Isolated cuboid dislocation in the absence of fracture is a rare injury pattern that can be easily missed on initial clinical assessment. We present a case report of such injury which required open reduction and internal fixation to reduce and stabilize the cuboid. We performed a literature review to guide the management of similar injuries. Ten studies of cuboid dislocation without fracture were identified. Six articles reported a plantar flexion and inversion mechanism of injury, with inferomedial dislocation of the cuboid. Open reduction was required in all but 1 case. In this paper, we discuss a case of an isolated cuboid dislocation in the absence of fracture, which required an operation with open reduction internal fixation. Furthermore, we undertake a review of similar such cases reported in the literature and present a suitable management strategy from the present evidence. Level of Clinical Evidence: Level IV.

Sulcus-deepening trochleoplasty grants satisfactory results with minimal patellofemoral arthritis at 23-30 years of follow-up.

The purpose of this study was to evaluate the radiographic and clinical outcomes of sulcus-deepening trochleoplasty at a minimum follow-up of 23 years. The authors evaluated a retrospective series of 10 patients (11 knees) who underwent trochleoplasty between 1993 and 2000. All patients were assessed at a minimum follow-up of 23 years by an independent clinician who noted any patellar redislocations and collected the International Knee Documentation Committee (IKDC), Kujala scores and range of motion. Radiographic examination was performed to assess patellofemoral arthritis using the Iwano classification. A total of 11 knees, from five women and five men aged 25.6 ± 6.9 years (range, 15-47 years) underwent trochleoplasty during the inclusion period. All 11 knees underwent adjuvant procedures during trochleoplasty (100%): 10 had tibial tuberosity osteotomy (TTO) and vastus medialis plasty and 1 had only vastus medialis plasty (had prior TTO). At a follow-up of 24.4 ± 2.1 years (range, 23-30 years), two patients were lost to follow-up (18%). The Iwano classification was Grade 1 in three patients (33%), Grade 2 in four patients (44%) and Grade 4 in two patients (22%). The flexion range was 130 ± 8.7° and satisfaction was 9.2 ± 0.7, Kujala was 76.9 ± 8.5 and IKDC was 65.5 ± 13.8. At 23-30 years following sulcus-deepening trochleoplasty in this small series of 10 patients (11 knees), patients had satisfactory clinical scores, only 1 patient reported an episode of traumatic patellar dislocation, and two knees had patellofemoral arthritis of Iwano Grade >2 (22%). Level IV.

Incidence of peroneal tendon dislocation with talus fracture.

Traumatic peroneal tendon dislocation (PTD) is known to occur with pilon and calcaneus fractures, however, literature describing PTD in concurrence with injury to the talus remains limited. This was a retrospective review of adult patients with operatively treated talus fractures treated at a level I academic trauma center between 2007 and 2021. Charts, radiographs, and advanced imaging, when available, were reviewed for patient demographics, injury characteristics, and complications. 126 patients with 128 talus fractures were included. Incidence of PTD after talus fracture was 21.1 % (n = 27). Among isolated talus fractures only (n = 60), incidence of PTD was 16.7 % (n = 10). Peroneal rupture was separately found in 3 instances (2.3 %). PTD was significantly associated with lateral process fractures, making up one-third of total cases of PTD (p = 0.02), with 39 % of lateral process fractures demonstrating PTD. PTD was also associated with presence of fleck sign on injury radiographs (p < 0.00001). Among 27 cases of PTD, 14 (51.9 %) were diagnosed based on advanced imaging only (13 via CT scan and 1 by MRI), 4 (14.8 %) by operative report only, and 9 (33.3 %) based on both imaging and the operative report. Diagnosis was made acutely for 25 (89.3 %) PTDs, whereas 2 (7.4 %) were diagnosed in a delayed fashion. Three PTDs underwent delayed surgical intervention due to delayed diagnosis (n = 1), or missed dislocation by the surgeon although evident on injury scans (n = 2). Fractures with PTD developed higher rates of avascular necrosis (30.4 % versus 12.7 % among fractures without PTD, p = 0.044). PTD with talus fracture is relatively common and was identified in one out of five fractures within the studied cohort. Surgeons and radiologists should be cognizant of this injury, especially in the setting of a lateral process fracture and a positive fleck sign. III.

Risk factors related to loss of reduction after anatomic repair of acromioclavicular joint dislocation in patients with acute traumatic acromioclavicular joint dislocation

Risk factors related to loss of reduction after anatomic repair of acromioclavicular joint dislocation in patients with acute traumatic acromioclavicular joint dislocation

Recurrent anterior dislocation of radial head treated with ulnar distraction osteotomy and reconstruction of annular ligament using palmaris longus tendon with bioabsorbable screw anchoring: A case report

Introduction: Radial head dislocation in children may be either congenital, an isolated injury or more commonly part of a complex injury to the elbow. Isolated traumatic radial head dislocation in children is a rare and easily missed condition.The reported case shows various treatment and intervention with ulnar osteotomy and annular ligament reconstruction in order to reach the definitive reduction of recurrent dislocation of radial head. Case Presentation: Male 9 years old with anterior dislocation of the radial head, came with difficulty on flexing his elbow due to bony prominence on his anterior elbow. He had recurrent radial head dislocation with redundant annular ligament. From the physical examination there was a prominent radial head on anterior region of elbow. From x-ray examination we found anterior dislocation of ulnar head without any fracture or deformity of ulna. Patient underwent ulnar distraction osteotomy to achieve radial traction and allow stable reduction of radial head. After 5 months he had reconstruction of annular ligament with palmaris longus tendon graft and anchoring with bioabsorbable screw in order to reduce and stabilize the radial head. Conclusion: In this case we found ulnar osteotomy may gave improvement for the reduction of the radial head. But additional annular ligament reconstruction give stability of the radial head which will held in place with full range of motion of the elbow. So this combined procedures hopefully can gave best achievement and satisfactory results of the children and last a lifetime.

Traumatic knee dislocations: immediate interventions and long-term outcomes

Traumatic knee dislocations are severe orthopedic injuries that result from high-energy trauma and involve complete disruption of the tibiofemoral joint. These injuries are rare but represent a significant clinical challenge due to the risk of associated vascular, nerve, and soft tissue damage. Early diagnosis and timely intervention are critical for reducing the risk of permanent disability. The immediate management involves a comprehensive assessment, including history, physical examination, and imaging, followed by the restoration of joint alignment through reduction techniques. Proper management of associated vascular injuries, particularly popliteal artery damage, and nerve injuries, such as peroneal nerve damage, is crucial to prevent long-term complications. Following reduction, knee stabilization and immobilization are necessary to promote healing. Long-term outcomes can be challenging, with complications such as joint instability, post-traumatic arthritis, chronic pain, and the potential for recurrent dislocations. Rehabilitation, which includes range of motion exercises, strength training, and proprioceptive training, plays a vital role in restoring function. In some cases, surgical intervention, including ligament reconstruction or total knee arthroplasty, may be required. This review examines the immediate interventions for traumatic knee dislocations, the associated complications, and long-term outcomes, highlighting the importance of a multidisciplinary approach for optimal recovery and functional restoration.

Iatrogenic injury of the axillary artery as a complication of a bony Bankart repair following traumatic anterior shoulder dislocation—a case report

Iatrogenic injury of the axillary artery as a complication of a bony Bankart repair following traumatic anterior shoulder dislocation—a case report

Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis.

Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions. Cases involving dislocations due to congenital anomalies or inflammatory processes were excluded. The search yielded 31 eligible cases of TPAD without an associated fracture. The majority (81%) of the cases were males, with traffic accidents being the leading cause (87%). Notably, 52% of the cases presented without any neurological deficits. Regarding treatment approaches, 23% of the cases were managed through closed reduction alone, 32% required fusion following closed reduction, and 45% underwent open reduction and fusion. A time delay exceeding 7.5 days was associated with a significantly higher risk of closed reduction failure (odds ratio, 56.463; p =0.011). This review identified key management strategies for TRAD without fracture, informed by the available evidence. Optimal management entails prompt closed reduction under C-arm while monitoring neurological status once hemodynamic stability is achieved. Surgical fusion is indicated for cases with magnetic resonance imaging-confirmed transverse ligament rupture or residual instability. If closed reduction fails, open reduction and fusion should be carried out. Posterior C1-C2 screws fixation is the preferred fusion technique, providing high levels of safety and biomechanical stability.

Traumatic Posterior Sternoclavicular Joint Dislocation With a Five-Day Delayed Presentation: A Case Report

Traumatic Posterior Sternoclavicular Joint Dislocation With a Five-Day Delayed Presentation: A Case Report

A Rare Paediatric Case Report of Neglected Traumatic Posterior Hip Dislocation

Traumatic posterior hip dislocation in paediatric age group is a rare but potentially debilitating condition, particularly when neglected. The delay in seeking medical care frequently leads to missed diagnosis, which can lead to an array of future complications. Hence, timely intervention is crucial in treating neglected traumatic hip dislocations in children to prevent complications like avascular necrosis of femoral head, sciatic nerve injury and early degenerative arthritis. Various treatment options exist, ranging from closed reduction and hip spica application to surgical interventions like open reductions and osteotomies. The primary goal of any treatment modality in hip dislocation is to achieve concentric reduction and preventing the possible associated complications. Additionally, there is limited research evaluating the outcomes of closed reduction in neglected traumatic posterior hip dislocations specifically in children. The present case report aims to address this gap by presenting a case of a six-year-old female child with a neglected posterior hip dislocation following a fall from tree six weeks prior, which was managed with continuous traction followed by closed reduction and hip spica cast application. The serial follow-up of the child showed satisfactory clinical outcome as evidenced by improved hip range of motion and normal gait. The successful outcome supports the effectiveness of this approach in managing neglected traumatic hip dislocations in children. This case also emphasises that there should be attempts of closed reduction in all neglected paediatric hip dislocations, followed by hip spica application, before undertaking any surgical interventions, even if they present after six weeks.

Association Between Articular Incongruence After Trochleoplasty and Long-term Patellofemoral Osteoarthritis.

Trochleoplasty has shown promising results in selected patients with patellar instability. However, concerns persist regarding its potential relationship with long-term osteoarthritis (OA) and the underlying causes. To evaluate the correlation between postoperative patellofemoral incongruence after trochleoplasty and long-term OA. Cohort study; Level of evidence, 3. The authors conducted a retrospective review of patients who underwent sulcus-deepening trochleoplasty between 2003 and 2013 and identified 43 patients after their initial search. All patients were assessed at a minimum follow-up of 10 years. Preoperative, immediate postoperative, and end-of-follow-up lateral and axial view knee radiographs were used to evaluate patellofemoral OA using the Iwano classification, the patellar articular surface angle (PA), and the trochlear articular surface angle (TA). Data on patellar redislocation, reoperations, and International Knee Documentation Committee (IKDC), Kujala, and patient satisfaction scores were also collected. Pearson correlation analysis was used to evaluate the relationship between articular surface angles and OA, and Spearman rank correlation analysis was used to assess the association between categorical and ordinal variables. A 2-tailed Student t test was used to compare the mean values of the clinical scores between groups. Ten patients (10 knees) met the inclusion criteria, with a mean follow-up of 15.3 ± 3.93 years. The PA and TA were 148.5°± 24.75° and 148.5°± 17.85°, respectively, with a mean patellofemoral incongruence of 21.4°± 16.03°. None of the patients had preoperative OA, and 4 (40%) developed postoperative OA: 2 with Iwano grade 1 and 2 with Iwano grade 2. Higher patellofemoral incongruence was found to correlate with the development of patellofemoral OA (P = .017). No independent correlation was found between the TA and OA (P = .553) or the PA and OA (P = .884). The satisfaction, Kujala, and IKDC scores were 8.2 ± 1.75, 82.5 ± 10.09, and 84.4 ± 9.79, respectively. Only 1 patient (10%) reported a traumatic patellar dislocation, none required reoperations, and all (100%) indicated they would undergo surgery again. This study demonstrated that patellofemoral incongruence after trochleoplasty was associated with the development of long-term OA without an independent correlation with a flat trochlea or a flat patella.

Shoulder &amp; Elbow

The December 2024 Shoulder &amp; Elbow Roundup360 looks at: Predicting recurrence of instability after a primary traumatic anterior shoulder dislocation; Predictors of surgery and long-term outcomes in nonoperative management of full-thickness rotator cuff tears; Reverse shoulder arthroplasty viable despite acquired acromial compromise, but higher infection risk noted; LP-PRP reduces retear rates in rotator cuff repair but shows no functional outcome advantage; Long-term clinical outcomes of arthroscopic supraspinatus tendon repair using the single anchor tension band technique – minimum five-year follow-up; Arthroscopic stabilization for anterior shoulder dislocation shows low recurrence rates regardless of prior dislocations; ORIF outperforms arthroplasty for complex radial head fractures: mid-term outcomes; Routine use of surgical helmet systems may not reduce infection risk in shoulder arthroplasty.

Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Bracing in Acute First-Time Traumatic Patellar Dislocation: A Systematic Review and Meta-Analysis.

Acute first-time traumatic patellar dislocation is a prevalent knee injury, particularly in adolescents, often managed conservatively with knee bracing. Recently, medial patellofemoral ligament (MPFL) reconstruction has gained popularity for its potential benefits in reducing redislocation rates and enhancing functional outcomes. This systematic review and meta-analysis compared the outcomes of MPFL reconstruction versus knee bracing for managing acute first-time traumatic patellar dislocation. A comprehensive search of PubMed, Scopus, Google Scholar, and the Cochrane Library identified studies published within the last 10 years that directly compared these treatment approaches, with primary outcomes focusing on redislocation rates and functional recovery measured by Kujala scores. A total of six studies, involving 325 patients, were included in the analysis. Results indicated that MPFL reconstruction significantly reduced redislocation rates (OR: 0.17, 95% CI: 0.09 to 0.32, P < 0.00001) and improved functional outcomes (MD in Kujala scores: 8.10, 95% CI: 6.46 to 9.75) compared to knee bracing. Despite notable heterogeneity across studies (I² = 95%), MPFL reconstruction consistently demonstrated superior long-term knee stability and fewer reoperations. These findings suggest that surgical intervention is the preferred treatment for long-term stability; however, further high-quality randomized controlled trials are recommended to confirm these results.

Open sternal fracture with bilateral dislocation of the sternoclavicular joints after a high-speed bicycle accident: a case report

BackgroundOnly a few cases of bilateral traumatic sternoclavicular dislocations have been reported in the literature. This injury is considered one of the rarest injuries of the human musculoskeletal system. Therefore, we present the first documented case of a cyclist with a third-degree open thoracic trauma (Gustilo–Anderson 3a) associated with a dislocated manubrium sterni fracture in the upper thoracic aperture, bilateral anterior dislocations of the sternoclavicular joints, rib fractures, and pleural ruptures.Case presentationThe patient, a 27-year-old Caucasian male, incurred this injury while participating in a professional cycling race at Nürburgring, Germany and received immediate interdisciplinary surgical treatment and has encountered no complications. We conducted a 1-year follow-up and present the clinical findings of this follow up. Additionally, we conducted a comprehensive review of the existing literature on this injury.ConclusionsImmediate interdisciplinary intervention, including surgical repair and meticulous postoperative care, facilitated successful patient recovery. This underscores the critical role of comprehensive trauma management in complex polytrauma cases. In conclusion, this case report highlights the rarity and complexity of a traumatic injury involving bilateral sternoclavicular dislocation, with this case being the first case reported with concomitant open thorax trauma. Our patient benefited greatly from immediate air-bound transportation to an interdisciplinary care provider, which houses both thoracic and trauma surgery departments.