SciCombinator

Discover the most talked about and latest scientific content & concepts.

Concept: Joint dislocation

169

PurposeIn this retrospective study we investigated the clinical and radiological outcome after operative treatment of acute Rockwood III-V injuries of the AC-joint using two acromioclavicular (AC) cerclages and one coracoclavicular (CC) cerclage with resorbable sutures. METHODS: Between 2007 and 2009 a total of 39 patients fit the inclusion criteria after operative treatment of acute AC joint dislocation. All patients underwent open reduction and anatomic reconstruction of the AC and CC-ligaments using PDS® sutures (Polydioxane, Ethicon, Norderstedt, Germany). Thirty-three patients could be investigated at a mean follow up of 32+/-9 months (range 24–56 months). RESULTS: The mean Constant score was 94.3+/-7.1 (range 73–100) with an age and gender correlated score of 104.2%+/-6.9 (88-123%). The DASH score (mean 3.46+/-6.6 points), the ASES score (94.6+/-9.7points) and the Visual Analogue Scale (mean 0.5+/-0,6) revealed a good to excellent clinical outcome. The difference in the coracoclavicular distance compared to the contralateral side was <5 mm for 28 patients, between 5-10 mm for 4 patients, and more than 10 mm for another patient. In the axial view, the anterior border of the clavicle was within 1 cm (ventral-dorsal direction) of the anterior rim of the acromion in 28 patients (85%). Re-dislocations occured in three patients (9%). CONCLUSION: Open AC joint reconstruction using AC and CC PDS cerclages provides good to excellent clinical results in the majority of cases. However, radiographically, the CC distance increased significantly at final follow up, but neither the amount of re-dislocation nor calcifications of the CC ligaments or osteoarthritis of the AC joint had significant influence on the outcome.Level of evidenceCase series, Level IV.

Concepts: Osteoarthritis, Joint, Joints, Ligament, Joint dislocation, Clavicle, Acromioclavicular joint, Acromion

168

INTRODUCTION: We present the case of a patient with extensor carpi ulnaris tendon subluxation who was first treated for distal radioulnar joint sprain. CASE PRESENTATION: A 25-year-old Caucasian man was seen at our policlinic one month after he had fallen on his outstretched hand. A diagnosis of extensor carpi ulnaris subluxation was made clinically but we also had the magnetic resonance imaging scan of the patient’s wrist which displayed an increased signal on T2-weighted images consistent with inflammation around the extensor carpi ulnaris tendon. The extensor carpi ulnaris tendon was found to be dislocating during supination and relocating during pronation. The sheath was reconstructed using extensor retinaculum due to attenuation of subsheath. CONCLUSION: There was no recurrent dislocation of the extensor carpi ulnaris tendon of the patient at his last follow up 12 months after the operation.

Concepts: Nuclear magnetic resonance, Magnetic resonance imaging, Wrist, Joint dislocation, Distal radioulnar articulation, Extensor carpi ulnaris muscle, Extensor carpi radialis longus muscle, Proximal radioulnar articulation

28

Acute acromioclavicular joint dislocations indicated for surgery can be treated with several stabilization techniques. This in vitro study evaluated the acromioclavicular joint stability after 3 types of validated repair techniques compared with the native situation.

Concepts: Synovial joint, Joints, Joint dislocation, Acromioclavicular joint, Acromioclavicular ligament

27

Immobilization of the shoulder in 60 ° external rotation and 30 ° abduction after primary anterior shoulder dislocation has been shown to allow anatomical reduction and potential healing of the capsule-labrum complex. The purpose of the present study was to evaluate commercially available shoulder braces concerning functionality and comfort as well as for potential problems.

Concepts: Present, Shoulder, Joint dislocation, Dislocated shoulder

27

PURPOSE: Acute elbow instability leading to dislocation is thought to be a spectrum initiated by an injury to the lateral stabilizing structures of the elbow. Previous cadaveric studies have shown elbow dislocations to occur in flexion. The purpose of this study was to analyze videographic evidence of the deforming forces and upper extremity position during elbow dislocations. We sought to corroborate previous biomechanics studies with in vivo observations. METHODS: We included 62 YouTube.com videos with a clear videographic view of an elbow dislocation. Three senior elbow surgeons independently evaluated arm position at the time of dislocation, along with the suspected deforming forces at the elbow based on these positions. RESULTS: Of the 62 visualized elbow dislocation events, the vast majority (92%) dislocated at or near full extension. The most common arm positions were forearm pronation (68%) with shoulder abduction (97%) and forward flexion (63%). The typical elbow deforming forces were a valgus moment (89%), an axial load (90%), and progressive supination (94%). We identified 4 discrete patterns of arm position and deforming forces. CONCLUSIONS: Acute elbow dislocations in vivo occur in relative extension irrespective of forearm position, a finding distinct from previous cadaveric studies. The most common mechanism appears to involve a valgus moment to an extended elbow, which suggests a requisite disruption of the medial collateral ligament, the known primary constraint to valgus force. These videographic findings suggest that some acute elbow dislocations may result from acute valgus instability and therefore are distinct in nature and mechanism from posterolateral rotatory instability. This information could lead to improved understanding of the sequence of structural failure, modification of rehabilitation protocols, and overall treatment. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.

Concepts: Knee, Shoulder, Forearm, Upper limb, Joint dislocation, Work hardening, Dislocation, Pronation

27

The present multicenter, prospective study evaluated the subjective outcomes in patients after extraosseous talotarsal stabilization using the HyProCure(®) stent as a standalone procedure for the treatment of recurrent and/or partial talotarsal joint dislocation (RTTD) in a population of pediatric and adult patients. RTTD has been cited as a possible etiology for a number of foot ailments and might contribute to the development of pathologic features localized more proximally in the weightbearing musculoskeletal chain. Correction of RTTD might, therefore, lead to the reduction of pathologic features associated with this deformity. A total of 46 feet in 35 patients were included in the present investigation. Subjective evaluation used the Maryland Foot Score assessment, which was obtained preoperatively and 1, 2, and 3 weeks, 1, 2, 3, and 6 months, and 1 year postoperatively. The mean overall scores improved from a preoperative value of 69.53 ± 19.56 to a postoperative value of 89.17 ± 14.41 at the 1-year follow-up. Foot pain decreased by 36.97%, foot functional activities improved by 14.39%, and foot appearance improved by 29.49%. The greatest magnitude of improvement occurred 4 weeks postoperatively, with gradual improvement continuing through to the 1-year follow-up. Implants were removed from 2 patients (2 feet, 4.35%). No unresolved complications were observed. The positive subjective outcomes resulting from the extraosseous talotarsal stabilization procedure suggest that the intervention employing the device we have described alleviates pain and improves foot function and appearance in patients with RTTD.

Concepts: Present, Better, Improve, Foot, Joint dislocation, Case series, Imperial units

18

Ehlers-Danlos syndrome (EDS)-hypermobility type (HT) is considered to be the most common subtype of EDS and the least severe one; EDS-HT is considered to be identical to the joint hypermobility syndrome and manifests with musculoskeletal complaints, joint instability, and soft tissue overuse injury. Musculoskeletal complaints manifest with joint pain of non-inflammatory origin and/or spinal pain. Joint instability leads to dislocation or subluxation and involves peripheral joints as well as central joints, including the temporomandibular joints, sacroiliac joints, and hip joints. Soft tissue overuse injury may lead to tendonitis and bursitis without joint inflammation in most cases. Ehlers-Danlos syndrome-HT carries a high potential for disability due to recurrent dislocations and subluxations and chronic pain. Throughout the years, extra-articular manifestations have been described, including cardiovascular, autonomic nervous system, gastrointestinal, hematologic, ocular, gynecologic, neurologic, and psychiatric manifestations, emphasizing the multisystemic nature of EDS-HT. Unfortunately, EDS-HT is under-recognized and inadequately managed, leading to neglect of these patients, which may lead to severe disability that almost certainly could have been avoided. In this review article we will describe the known manifestations of the extra-articular systems.

Concepts: Joint, Marfan syndrome, Sacroiliac joint, Joints, Ehlers-Danlos syndrome, Temporomandibular joint, Joint dislocation, Hypermobility

4

Most emergency physicians routinely obtain shoulder radiographs before and after shoulder dislocations. However, currently there is limited literature demonstrating how frequently new fractures are identified on post-reduction radiographs. The primary objective of this study was to determine the frequency of new, clinically significant fractures identified on post-reduction radiographs with a secondary outcome assessing total new fractures identified.

Concepts: Primary education, Shoulder, Joint dislocation, Dislocation, Plasticity

4

To perform a randomized clinical trial of operative versus nonoperative treatment of acute acromio-clavicular (AC) joint dislocations using modern surgical fixation and both patient-based and surgeon-based outcome measures to determine which treatment method was superior.

Concepts: Epidemiology, Clinical trial, Randomized controlled trial, ClinicalTrials.gov, Pharmaceutical industry, Clinical research, Joint dislocation, Dislocation

3

Chronic pain in the Ehlers-Danlos syndromes (EDS) is common and may be severe. According to one study, nearly 90% of patients report some form of chronic pain. Pain, which is often one of the first symptoms to occur, may be widespread or localized to one region such as an arm or a leg. Studies on treatment modalities are few and insufficient to guide management. The following is a discussion of the evidence regarding the underlying mechanisms of pain in EDS. The causes of pain in this condition are multifactorial and include joint subluxations and dislocations, previous surgery, muscle weakness, proprioceptive disorders, and vertebral instability. Affected persons may also present with generalized body pain, fatigue, headaches, gastrointestinal pain, temporomandibular joint pain, dysmenorrhea, and vulvodynia. Pain management strategies may be focused around treating the cause of the pain (e.g., dislocation of a joint, proprioceptive disorder) and minimizing the sensation of pain. Management strategies for chronic pain in EDS includes physical therapy, medications, as well as durable medical equipment such as cushions, compressive garments, and braces. The different modalities are discussed in this paper. © 2017 Wiley Periodicals, Inc.

Concepts: Medicine, Symptoms, Joint, Pain, Ehlers-Danlos syndrome, Temporomandibular joint, Temporomandibular joint disorder, Joint dislocation