Traumatic Luxation Research Articles

Traumatic coccygeal luxation and distal amputation of the tail of an Appaloosa mare

SummaryA 17‐year‐old Appaloosa mare presented to the emergency service for acute, traumatic, partial amputation of the tail at the level of the ninth coccygeal vertebra. The patient did not have tail or anal tone and did not respond to sharp stimulation of skin in the perineal region. Two grade 1 rectal tears were found during rectal palpation. Radiographs revealed dislocation of the second (Cd2) and third (Cd3) caudal vertebrae. The patient was treated with antibiotics, an anti‐inflammatory drug and stall confinement. The ninth caudal vertebra was surgically removed to facilitate closure of skin over the wound. When the mare was discharged after 7 days of hospitalisation, she had regained partial sensation of the perineum and partial function of the internal and external anal sphincters. At re‐evaluation one year following injury, the mare was able to move her tail laterally and had regained sensation of her perineum and tail; however, she still was unable to lift her tail.

The efficacy of different surgeries for traumatic luxation of lens with secondary glaucoma

Objective To observe the effect of different surgeries for secondary glaucoma caused by traumatic luxation of lens. Methods Fifty-one eys of 51 cases of traumatic luxation of lens with secondary glaucoma from 2011 to 2014 were collected in this study. Twenty-four eyes accepted lens extraction combined with anti-glaucoma surgery. The other 27 eyes accepted lens extraction only. After operation, the intraocular pressure(IOP) was followed up. Results The IOP was normal in patients who underwent combined surgery. The IOP of the patients who did not receive anti-glaucoma surgery was not controlled well and the anti-glaucoma surgery was performed in 21 eyes within 2 months after lens extraction. Conclusion For the traumatic luxation of lens with secondary glaucoma, lens extraction combined with anti-glaucoma surgery should be performed. Key words: luxation, lens, traumatic; Glaucoma, secondary; Trabeculectomy; Trauma, ocular

Traumatic globe luxation: A case report.

Globe luxation is a rare clinical event. Most of the cases are usually traumatic, although spontaneous globe luxation has also been reported. The majority of the posttraumatic cases are usually associated with the injury or fracture of the bony orbit. We report here a case of globe luxation that occurred per se without any injury to the orbital or maxillo-facial bony structures.

Cervical spine fractures in patients with ankylosing spondylitis: Importance of early management

IntroductionAnkylosing spondylitis (AS) affects 0.5% of the population. Alteration of the biomechanical properties of the spine related to AS explains the high prevalence of traumatic vertebral fractures and risk of instability. At admission, 65% of patients present neurological signs. There are no reported studies regarding secondary neurological deterioration. The aim of this study was to evaluate the rate of secondary neurological deterioration before surgical treatment of spine fracture in a context of AS. MethodsThis retrospective cases series consisted of patients admitted for traumatic cervical spine fractures or luxation in a context of AS between June 2007 and December 2012. Clinical status was evaluated using Frankel classification at time of trauma, at admission to the neurosurgery ward, as well as before and after surgery. Delay between trauma and admission, and between admission and surgery was recorded. Causes of morbidity, mortality and surgical management were discussed. ResultsDuring the study period, seven patients were admitted for traumatic cervical spine fracture or luxation. All patients were autonomous before trauma. Between trauma and transfer to neurosurgery ward, the status of four patients worsened. Mean delay between trauma and admission was 12.9 days (range 1 to 60days). Between admission to neurosurgery ward and surgical treatment, two more patients worsened and only two patients remained autonomous. Mean delay between admission and surgery was 15.7h (range 2 to 24h). Neurological deterioration was due to both deterioration during transfer despite immobilization with a rigid cervical collar and failure of X-ray to reveal any fractures, in two and three cases respectively. After surgery, clinical status remained unchanged in two patients, four patients improved, and one patient worsened. Two patients died from respiratory failure a few days after surgery due to neurological deterioration. Five patients had a delayed diagnosis (>24h). ConclusionCervical spine fracture in AS is a serious condition with high instability. Our series emphasizes the necessity of early surgical treatment because of risk of secondary neurological deterioration in cases of delayed treatment. CT scan must be the gold standard for exploration of these patients.

Use of sedation and ropivacaine‐morphine epidural for femoral head and neck ostectomy in a dog

A five-year-old male German shepherd dog presented with traumatic craniodorsal luxation of the right coxofemoral joint with pre-existing moderate hip dysplasia. A femoral head and neck ostectomy was performed. The patient was sedated with acepromazine and morphine administered intramuscularly. A lumbosacral epidural was performed using a combination of morphine and ropivacaine. Intraoperatively, an infusion of medetomidine, morphine, lidocaine, and ketamine was administered intravenously, and oxygen was administered via facemask. Heart rate, respiratory rate and oscillometric arterial blood pressures were monitored. Postoperatively, carprofen was administered once subcutaneously. On the day of hospital discharge, carprofen and tramadol were administered orally every 12 hours. Twenty-one days later, the dog was doing well and the surgical staples were removed. Sedation with acepromazine and morphine, administration of an epidural containing morphine and ropivacaine, and intraoperative sedation with medetomidine, morphine, lidocaine and ketamine were suitable for femoral head and neck ostectomy.

Akutverletzungen und Überlastungsschäden der Schulter im Sport

During sports the shoulder complex is exposed to considerable load especially where throwing is important and various pathological changes can occur. In the last two decades the shoulder in athletes has become a special term in clinical sports medicine Selective literature review in PubMed and consideration of personal experience, research results as well as national and international recommendations In general acute lesions of the shoulder caused by sudden sport injuries, such as traumatic luxation, acromioclavicular (AC) joint disruption, traumatic tendon ruptures, labral lesions, cartilage defects and fractures have to be distinguished from chronic or long-standing pathologies due to recurrent microtrauma, such as overuse bursitis and tendinitis, as well as secondary forms of impingement along with rotator cuff tears and labral lesions. Besides common pathological changes that can be observed in almost all overhead-sports, there are also injuries that are more sport-specific due to the particular load profile in each sport. These injuries are especially common in racquet and throwing sports (e.g. golf, tennis, handball and volleyball) as well as in individual and artistic sports (e.g. swimming, gymnastics, dancing and rowing), contact and extreme sports (e.g. judo, mixed martial arts, bodybuilding, weightlifting, motocross and downhill mountain biking). Knowledge about sport-specific load profiles as well as about the variety of treatment options is crucial for successful treatment of these injuries.

Caudal Elbow Luxation in a Dog Managed by Temporary Transarticular External Skeletal Fixation

This case report details a caudal unilateral traumatic elbow luxation in a 4-year-old male neutered Labrador following a road traffic trauma. This is a highly unusual injury in the dog. The pathogenesis and successful treatment by closed reduction followed by stabilisation with a temporary transarticular external skeletal fixator are discussed. The dog was assessed at 4 weeks and 6 months after surgery. Findings at 6 months after treatment demonstrated a normal gait with no pain or crepitation. A mild amount of soft tissue thickening around the elbow was noted. The range of motion of the elbow was limited to 45 degrees of flexion and 150 degrees of extension. This is the first case of a traumatic caudal luxation of the elbow in a dog described in the English veterinary literature and the first report of successful management of an elbow luxation in a dog by closed reduction and temporary transarticular fixation.

Emergency orthodontic management of luxated permanent anterior teeth: A report of two cases showing role of orthodontist in multidisciplinary approach.

Traumatic luxation of permanent anterior teeth requires an appropriate emergency management and treatment plan. Very less data in literature is available regarding emergency orthodontic treatment in luxated teeth. Light orthodontic forces given in early period of trauma in selected cases can restore teeth in original position that can allow better periodontal healing. This article focuses on the principles which orthodontic specialist should consider while planning orthodontic movement of recently traumatized permanent teeth. Two cases are presented of emergency orthodontic treatment.

Surgical management of traumatic isolated sternal fracture and manubriosternal dislocation

The aim of this study was to evaluate the surgical procedures of osteosynthesis and the respective costs in isolated sternal fractures and manubriosternal dislocations. Between January 2006 and July 2011, we treated 47 patients with an isolated fracture and 18 patients with a dislocation of the sternum surgically. In case of sternal fracture, the titanium plate was used in 30 (64%), steel plate in 12 (25%), and steel wire in 5 patients (11%). The stabilization after traumatic luxation was obtained with steel wire in 4 patients (22%) and titanium plate associated with demineralized bone matrix in 14 patients (78%). The quality adjusted life years (QALYs) was analyzed, as well as the incremental cost-effectiveness ratio based on QALYs. In the sternal fractures, titanium plate showed a decreased time of intervention (30 [2] minutes), length of stay (3 [1] days), and total cost (&OV0556;2,277.10) compared with steel plate (&OV0556;2,667.70) and steel wire (&OV0556;2,801.60) procedures, displaying an excellent difference in QALYs (0.825 and 1.615, respectively). In the sternal dislocation, steel wire technique highlighted a poor QALYs, although this approach was less expensive than titanium plate with demineralized bone matrix (&OV0556;3,553.60 vs. &OV0556;6,047.80). Incremental cost-effectiveness ratio revealed that the titanium plate costs were &OV0556;623.55 more than the steel wire per QALYs gained. The rigid titanium plate application ensured a safe and easy management of traumatic sternal lesions with a good prognosis of patients, justified by the improved QALYs compared with other methods. Therapeutic study, level IV; economic analysis, level IV.

Caudal approach and Mini TightRope system (mTR) application for the treatment of craniodorsal hip luxation in a cat: a case report

The aim of this study was to evaluate the clinical and radiographic outcome of traumatic craniodorsal hip luxation in a cat, treated with the application of a Mini TightRope (mTR) implant. A caudal approach was carried out in order to expose the hip joint and the sciatic nerve preserving the muscle masses. Clinical follow-up and radiographic recheck were performed at 10 days, one, three, six and 12 months after surgery. Orthopaedic examination was normal 1 month after surgery while the revisit radiographs showed only mild to moderate signs of osteoarthritis (OA) one year later.    

Diagnóstico clínico e radiográfico de luxação traumática da articulação atlanto-occipital em dois cães

A luxação da articulação atlanto-occipital é considerada uma afecção incomum no homem e nos animais. Radiografias laterais são recomendadas para o diagnóstico. No entanto, estão sujeitas a erros relacionados ao ângulo de radiação, ao alvo da imagem, à distância e à sobreposição óssea. Objetivou-se neste relato descrever os achados clínicos e radiográficos de dois cães com luxação traumática da articulação atlanto-occipital que apresentavam tetraparesia, dor cervical cranial, incapacidade de elevar a cabeça e déficits de nervos cranianos. No primeiro animal, observaram-se deslocamento craniodorsal do processo articular do atlas em relação a um dos côndilos do occipital, ausência de sobreposição dos forames vertebrais laterais e sobreposição do côndilo do occipital ao processo articular do atlas, no lado direito, caracterizando uma luxação unilateral. No segundo animal, observou-se deslocamento craniodorsal dos processos articulares do atlas em relação aos côndilos do occipital, com sobreposição dos forames vertebrais laterais e ausência de visibilização dos côndilos do occipital em virtude da projeção cranial dos processos articulares do atlas em direção ao crânio, caracterizando luxação bilateral. Conclui-se que o exame radiográfico simples, nas projeções laterolateral e ventrodorsal, apesar da dificuldade de ser interpretado, é eficiente para confirmar o diagnóstico da luxação atlanto-occipital traumática, tanto a simétrica quanto a assimétrica.

Anatomische Rekonstruktion des medialen patellofemoralen Bands mit gedoppelter Gracilissehne

Elimination of patellofemoral instability by reconstruction of the medial patellofemoral ligament (MPFL) with a gracilis autograft. Recurring lateral luxation and subluxation of the patella, tibial tuberosity-trochlear groove distance (TTTG) < 20mm, persistent positive apprehension test in up to 45° of flexion, low grade trochlear dysplasia. Traumatic luxation of the patella without anatomical risk factors, isolated treatment if TTTG > 20mm, and isolated treatment for high-grade trochlear dysplasia (type B, C, D). Supine postion. Stripping of the gracilis tendon. Drilling of two tunnels into the medial margin of the patella. Insertion of both tendon ends into the tunnels and fixation with resorbable screwlocks. Undermining of the fascia of the medial oblique vastus muscle and insertion of the tendon loop into the femoral point of insertion located at the medial epicondyle. Preparation of the femoral point of insertion and drilling of the femoral tunnel. Insertion of the graft into the femoral tunnel. Positioning of the knee in 30° of flexion. Positioning of the patella and fixation of the graft with a resorbable screw. Two weeks of partial weight bearing. Knee orthesis for 6weeks. Passive motion up to 60° of flexion for the first 2weeks. Three weeks postoperatively unrestricted motion exercises, strengthening of the quadriceps muscle. Unlimited activity is possible 3 months postoperatively. The method presented in this manuscript was performed on 32patients with recurring patellar luxation; 27patients were available for clinical assessment at 1 year postoperatively. There were no recorded events of reluxation; the Kujala score increased on average from 61 points preoperatively to 93 points postoperatively.

Correction of craniodorsal coxofemoral luxation in cats and small breed dogs using a modified Knowles technique with the braided polyblend TightRope™ systems

To report the surgical technique and short-term radiographic and functional outcome data for a series of client owned, small breed dogs and cats treated for traumatic craniodorsal coxofemoral luxation using open reduction and internal fixation with the Arthrex Mini TightRope (mTR) and TightRope (TR) systems. Data were collected retrospectively from the clinical case records, including the initial clinical and radiographic findings, surgical technique, and postoperative short-term clinical and radiographic data. Functional data collected after the six weeks reassessment were obtained via owner questionnaire. Four cats (mTR = 4) and five small breed dogs (mean weight 15 kg; TR = 4, mTR = 1) were included. Median time to postoperative weight bearing was one day. Median lameness score at six weeks postoperatively was 0 out of 5. Coxofemoral joint congruity was radiographically confirmed at the six weeks postoperative visit. Telephone follow-up (at a median of 16 weeks) revealed all animals had returned to their previous level of activity. Complications were minor, and limited to postoperative swelling (n = 1). Clinical use of the Arthrex Mini TightRope and TightRope systems can be recommended for traumatic craniodorsal coxofemoral luxation in this novel application as short-term results are at least comparable to existing surgical techniques. Long-term follow-up studies are needed.

A 5-year follow-up case of multiple intrusive luxative injuries

Introduction: Traumatic intrusive luxation is one of the most severe forms of dental injuries, usually affecting the maxillary incisors. The consequence of such an occurrence is a high risk of healing complications such as pulp necrosis, external inflammatory resorption, and external replacement resorption (ankylosis). Case Report: This report presents a case of severe intrusive luxation of multiple anterior teeth in an 11-year-old girl. The teeth were repositioned successfully by endodontic and orthodontic management. The case was monitored for 5 years. Discussion: Depending on the severity of the injury, different clinical approaches for treatment of intrusive luxation may be used. Despite the variety of treatment modalities, rehabilitation of intruded teeth is always a challenge and a multidisciplinary approach is important to achieve a successful result. In this case, intruded teeth were endodontically treated with multiple calcium hydroxide dressings and repositioned orthodontically. The follow-up of such cases is very important as the repair process after intrusion is complex. After 5 years, no clinical or radiographic pathology was detected.

Rhabdomyolysis in a Patient on Aripiprazole With Traumatic Hip Prosthesis Luxation

Rhabdomyolysis in a Patient on Aripiprazole With Traumatic Hip Prosthesis Luxation

A Case of Traumatic Luxation of the Stapes into the Vestibule

Traumatic luxation of the stapes into the vestibule is relatively rare. A 13-year-old girl suffered left-ear hearing loss and vertigo after earpick trauma. The use of 3-dimensional computed tomography (3D-CT) indicated stapes luxation and incudostapedial joint disruption. Exploratory tympanotomy showed the expected ossicular chain disruption. Repositioning the stapes in its original position and myringoplasty recovered hearing loss.

Traumatic elbow luxation in 14 dogs and 11 cats

To report the presentation and treatment of traumatic elbow luxation and to evaluate success following closed or open reduction. Retrospective case series conducted between April 1999 and April 2009. Records of 14 dogs and 11 cats were reviewed for signalment, history, radiographic findings and treatment; 14 owners were contacted via phone questionnaire to assess for limb function following treatment. Fisher's two-tailed P test was used to evaluate potential risk factors for lameness. The majority of luxations were caused by car accident and 96% of the cases luxated in a lateral direction. Closed reduction was successful in all cats and 11 dogs; 3 dogs required open reduction. Owners rated the animals' limb function as excellent (71%), good (7%), fair (22%) or poor (0%). All cats were rated excellent. An excellent result following closed reduction was achieved in 67% of canine cases. All cases of open reduction achieved fair results. All owners were satisfied with the outcome. No risk factors were significantly associated with post-reduction lameness. Elbow joints with good stability following closed reduction have a favourable outcome. Poor stability following closed reduction is an indication for surgery. Results suggest that cats tolerate elbow luxation better than dogs.

Traumatic craniolateral shoulder luxation and fracture of the lesser tubercle of the humerus in a dog

A five-year old, spayed female, Bearded Collie was presented with a 24-hour history of non-weight-bearing lameness of the right thoracic limb after sustaining vehicular trauma. Radiographs revealed a craniolateral scapulohumeral luxation and a distally and medially displaced fracture of the lesser tubercle of the humerus. Open reduction and internal fixation of the fracture was achieved with lag screw fixation and an anti-rotational Kirschner wire. Surgical repair resulted in compression across the fracture line, anatomic reduction of the articular surface, and a stable scapulohumeral joint following reduction of the humeral head in the glenoid. Six weeks postoperatively, the patient exhibited no evidence of pain or lameness on the right thoracic limb and radiographs revealed complete healing of the fracture and normal articulation of the scapulohumeral joint. This is the first report of a lesser tubercle fracture associated with a craniolateral shoulder luxation. Surgical intervention resulted in the return of full shoulder joint function in this dog.

„Toxic shock syndrome“ (TSS) bei postoperativer Kniegelenkinfektion

We report on a case of toxic shock syndrome (TSS) in a 17-year-old healthy patient after surgery of the right knee joint following a traumatic patella luxation. Two days after the intervention the patient showed fever, diarrhea, cough, and a diffuse erythroderma without any signs of postsurgical wound infection. Septic shock and acute renal failure followed. It was possible to identify a Staphylococcus, which originated the toxic shock toxin. As result of treatment, full recovery was achieved. TSS can occur in its full picture in a postoperative wound infection in a young healthy patient without showing local signs of infection at the operation site.

Severe facial laceration and zygomatic fracture accompanied by traumatic lens luxation: a case report

Severe facial laceration and zygomatic fracture accompanied by traumatic lens luxation: a case report