Multidirectional Instability in a Neglected Elbow Dislocation Managed with Circumferential Ligament Reconstruction. A Case Report / Instabilidade multidirecional em uma luxação negligenciada do cotovelo gerenciada com reconstrução do ligamento circunferencial. Um relato de caso

Abstract Neglected elbow dislocation is an uncommon condition and its treatment remains challenging. We present a case of a middle-aged woman presenting with neglected elbow dislocation and multi-direction instability in whom open reduction of the elbow joint and circumferential ligamentous reconstruction with a gracilis tendon graft was done. The functional outcome assessed with the Mayo elbow performance index was excellent. This circumferential technique is undoubtedly a viable technique and the indications can be extended to even manage a neglected dislocation. This procedure reduces the need or diminishes the duration of external fixation requirement and thereby encourages early mobilization.

Resumo A luxação negligenciada do cotovelo é uma condição incomum e seu tratamento permanece desafiador. Apresentamos o caso de uma mulher de meia-idade que apresentou luxação negligenciada do cotovelo e instabilidade multidirecional, na qual foi realizada redução aberta da articulação do cotovelo e reconstrução ligamentar circunferencial com enxerto de tendão gracilis. O resultado funcional avaliado com o índice de desempenho do cotovelo de Mayo foi excelente. Essa técnica circunferencial é, sem dúvida, uma técnica viável e as indicações podem ser estendidas para gerenciar até mesmo um deslocamento negligenciado. Este procedimento reduz a necessidade ou diminui a duração da exigência de fixação externa e, assim, incentiva a mobilização precoce.

Application of Modified Intraoperative Axillary Fluoroscopy for Posterior Acromioclavicular Joint Dislocation / 中山大学学报(医学科学版)

ObjectiveThe study aims to determine whether the horizontal posterior displacement of the distal clavicle in patients with acromioclavicular joint dislocation can be corrected via the application of modified intraoperative axillary fluoroscopy. MethodsFrom February 2019 to April 2021， 50 patients with Rockwood type Ⅲ acromioclavicular joint dislocation eligible for inclusion were randomly divided into two groups： the normal （32 cases） and the experimental （18 cases）. The conventional anteroposterior position radiographs were obtained to detect the surgery effect on the patients in the normal group. In experimental group， modified intraoperative axillary radiographs were obtained， with the concept of polar coordinates introduced to reduce the horizontal posterior translation of the clavicle. Then we compared the perioperative parameters， such as average operative time， intraoperative blood loss between the two groups. The Constant score was used for assessing the postoperative function of the shoulder joint in the follow-up visits. ResultsNo statistically significant difference was found in gender， age， duration of injury， underlying diseases， intraoperative blood loss and operative time between the two groups. The postoperative shoulder function score of the experimental group was higher than that of the normal group. ConclusionsThe application of modified intraoperative axillary fluoroscopy is recommendable for accurately reducing posterior translation of the distal clavicle， and meanwhile helpful for the precise placement of the clavicular plate.

Analysis of the effect of double button plate combined with strengthened anchor in the treatment of acromioclavicular dislocation / 中国骨伤

OBJECTIVE@#To evaluate the efficacy and prognosis of double button plate combined with strengthened anchor technique and clavicular hook plate internal fixation for complete acromioclavicular joint dislocation.@*METHODS@#From July 2017 to September 2020, a total of 42 patients with acromioclavicular joint dislocation treated by surgery were choosen as study objects and divided into observation group (21 cases) and control group (21 cases). In the observation group, there were 14 males and 7 females, aged 21 to 63 years old, with an average of (45.05±8.70) years old. In the control group, there were 16 males and 5 females, aged 25 to 68 years old, with an average of(45.00±9.44) years old. The patients in the observation group were treated with double button plate combined with strengthened anchor technique, whereas those in the control group received clavicular hook plate internal fixation. The two groups were compared in terms of operating time, intraoperative blood loss, postoperative hospital stay, shoulder pain(visual analogue scale, VAS) score, shoulder function Constant-Murley score and postoperative complications.@*RESULTS@#There was no significant difference between the two groups in intraoperative blood loss or postoperative hospital stay(P>0.05). The operating time of double button plate combined with strengthened anchor technique group (65.24±5.36) min was significantly longer than that of the clavicular hook plate group (48.81±4.72) min, and the difference was statistically significant (P<0.05). There was no significant difference in shoulder function or pain degree between the two groups before operation (P>0.05). After 1 month, 3 months and 6 months, the Constant-Murley score of the observation group was 73.29±2.15, 85.43±1.47, 93.86±1.24 separately, which were significantly higher than those of the control group;and the VAS score was 2.76±0.62, 1.71±0.64, 0.57±0.51 separately, which were significantly lower than those of the control group (P<0.05). One instance of shoulder discomfort was found in the observation group, while 5 cases of shoulder pain, 2 cases of restricted shoulder mobility, and 1 case of subacromial bone absorption were found in the control group. In both group, there was no loss of reduction.@*CONCLUSION@#In the treatment of complete acromioclavicular joint dislocation double button plate combined with strengthened anchor technique achieves favorable clinical result. Internal fixation does not need to be removed. The recovery of shoulder joint function and pain relief are superior than clavicular hook plate internal fixation, which is more worthy of clinical promotion.

Effects of traction therapy on atlantoaxial joint dislocation-induced cervical vertigo

Cervical vertigo is a common complication of atlantoaxial joint dislocation. However, there is no consensus on the effects of different therapies on the recovery of the patients suffering cervical vertigo. The objective of this randomized controlled trial was to investigate the effect of traction therapy on reducing cervical vertigo induced by atlantoaxial joint dislocation. A total of 96 patients were randomized to receive traction therapy or traditional therapy for two weeks. The overall clinical efficacy was measured based on the 30-point cervical vertigo symptom and function evaluation form. The therapeutic effects were also evaluated based on lateral atlantodental space (LADS), vertigo scale, neck and shoulder pain scale, headache scale, daily life and work scale, psychosocial adaptation scale, and quality of life. Compared with the traditional therapy group, the traction group demonstrated markedly higher overall clinical efficacy (P=0.038). Both the traction therapy group and the traditional therapy group showed significant decrease in LADS (P<0.001), but the traction therapy group had a greater reduction of LAD compared with the traditional group (P<0.01). Traction therapy consistently led to significantly greater relief of cervical vertigo symptoms, including dizziness, neck and shoulder pain, headache, inconvenience in daily living and work activities, impaired psychosocial adaptation, while improving quality of life. The efficacy of traction therapy for cervical vertigo surpasses that of traditional therapy, suggesting that traction therapy is potentially more clinically useful in treating these patients.

Condylar Dislocation for Intracranial Fossa: a Review of the Last 10 Years

The displacement of the mandibular condyle into the cranial fossa is an uncommon event; when it occurs, there is a need for immediate and multidisciplinary surgical intervention. Due to its rare advent, there is still no consolidated service dynamics, as this condition has not yet been described in a sedimented way in the literature databases. In the present article, we performed a literature review of condylar dislocation for the intracranial fossa described in the past 10 years in the PubMed and Lilacs search databases.

Effectiveness of arthroscopic assisted double Endobutton "8" buckle fixation in treatment of Rockwood Ⅲ type acute acromioclavicular joint dislocation / 中国修复重建外科杂志

Objective: To investigate the short-term effectiveness of arthroscopic assisted double Endobutton "8" buckle fixation in the treatment of Rockwood Ⅲ type acute acromioclavicular joint dislocation. Methods: The clinical data of 12 patients with Rockwood Ⅲ type acute acromioclavicular joint dislocation who were treated with arthroscopic assisted double Endobutton "8" buckle fixation between June 2016 and June 2019 were analyzed retrospectively. There were 8 males and 4 females, with an average age of 47.0 years (range, 36-58 years). There were 4 cases of left shoulder and 8 cases of right shoulder. The causes of injury included traffic accident injury in 7 cases and falling injury in 5 cases. The average time from injury to operation was 5.0 days (range, 3-14 days). Before operation and at last follow-up, the shoulder joint activity was recorded; the improvements of function and pain were evaluated by Constant score and visual analogue scale (VAS) score, respectively; the reduction was evaluated by measuring the coracoid spacing of the affected side on the anteroposterior X-ray film of shoulder joint. Results: All 12 cases were followed up 6-36 months, with an average of 20.6 months. All the incisions healed by first intention. There was no complications such as clavicle and coracoid fractures and Endobuton displacement. At last follow-up, the range of motion of the abduction improved from preoperative (77.5±4.5)° to (162.5±6.5)°, the range of motion of forward flexion improved from (84.1±5.2)° to (169.5±5.8)°, the Constant score improved from 42.5±2.3 to 92.4±2.3, the VAS score improved from 5.4±0.8 to 0.6±0.5, and the coracoid spacing reduced from (20.5±1.4) mm to (9.2±0.6) mm, all showing significant differences ( P<0.05). Conclusion: Arthroscopic assisted double Endobutton "8" buckle fixation for the treatment of Rockwood Ⅲ type acute acromioclavicular joint dislocation is safe, less invasive, and quicker recovery. It can effectively alleviate shoulder pain, significantly improve the mobility of the shoulder joint, and achieve good short-term effectiveness.

Development and biomechanical study of a new sternoclavicular hook plate / 中国组织工程研究

BACKGROUND: At present, most of the treatment of unstable dislocation of sternoclavicular joint is to insert the hook plate of acromioclavicular joint into the cavity of sternal bone marrow or put it behind the sternum. The difficulty of operation is increased because of the insufficient application of steel plate, which reduces the effect of joint reduction. OBJECTIVE: The research team has developed a new type of sternoclavicular hook plate (Patent No. ZL201520515237.3), and compared the biomechanical properties of acromioclavicular hook plate and new sternoclavicular hook plate to fix sternoclavicular joint from the aspect of biomechanics. METHODS: The sternum and clavicle at both ends of the sternoclavicular joint were replaced with a rectangular artificial bone. Eighteen pairs of artificial sternoclavicular joints were randomly divided into two groups. In control group (n=6), the plate screw hole section of the shortest segment 3-hole common acromioclavicular hook plate was fixed to the artificial clavicle end; and the hook end was placed on the back side of the artificial sternum. Load and displacement changes in artificial sternal fractures were measured with MTS biomaterial test system. In the experimental group (n=12), the plate screw hole section of the shortest rod section 2 hole new sternoclavicular hook plate was fixed to the artificial clavicle end; and the hook end was inserted into the artificial sternum. The MTS biomaterial test system was used to detect changes in load and displacement of the anterior cortical bone (n=6) and posterior cortical bone (n-6). RESULTS AND CONCLUSION: In the control group, the mean of maximum destructive force was (390±51) N. The mean of maximum destructive force of anterior cortical bone was (421±55) N. In the experimental group, the mean of maximum destructive force of posterior cortical bone was (437±56) N. There were no significant differences between the three groups (P > 0.05). Results indicated that the new sternoclavicular hook plate did not increase the risk of sternum fracture, and it was a safe and effective internal fixation material.

Arthroscopic suture bridge technique with suture anchor in the treatment of acromioclavicular dislocation / 中国组织工程研究

BACKGROUND: There is no uniform standard for acromioclavicular dislocation. Clavicular hook plate fixation is a commonly used fixation method clinically, but minimally invasive ligament reconstruction technology and arthroscopic surgery have become a research hotspot. OBJECTIVE: To observe the application value of suture bridge with thread anchor under arthroscopy in the treatment of acromioclavicular dislocation. METHODS: Patients with Tossy type III acromioclavicular dislocation who were admitted to Department of Orthopedic Surgery of General Hospital of Jizhong Energy Xingtai Mining Group between January 2016 and April 2018 were selected as the subjects. The patients were randomly divided into two groups. The patients in the arthroscopy group were treated with arthroscopic suture bridge technique with suture anchor for reduction and fixation, while those in the clavicle hook plate group were treated with clavicular hook plate for internal fixation. The length of surgical incision, duration of surgery, hospitalization time and time to return to work of both groups were recorded. The shoulder function was evaluated according to the Lazzcano criterion of curative effect at 3, 6 and 12 months after surgery. The visual analogue scale score of shoulder pain, abduction and raising, forward bend and raising were compared between the two groups. All patients were followed up for 1 year to record the occurrence of complications. This study was approved by the Medical Ethics Committee of General Hospital of Jizhong Energy Xingtai Mining Group. All subjects signed the informed consent. RESULTS AND CONCLUSION: (1) There was no significant difference in the duration of surgery between the two groups (P > 0.05). The surgical incision, hospitalization time and time to return to work of the arthroscopy group were significantly better than those of the clavicle hook plate group (P 0.05). (3) Visual analogue scale scores of the two groups showed a decreasing trend at 3, 6 and 12 months after surgery (P < 0.01). The visual analogue scale score of arthroscopy group was significantly lower than that of the clavicle hook plate group at the same time point (P < 0.01). (4) Angles of abduction and raising, forward bend and raising of both groups showed an increasing trend at 3, 6 and 12 months after surgery (P < 0.01). The angles of abduction and raising, forward bend and raising of the arthroscopy group were larger than those of the clavicle hook plate group at the same time point (P < 0.01). (5) The 1-year follow-up results showed that the incidence of complications in the arthroscopy group (6%) was significantly lower than that in the clavicle hook plate group (63%) (P < 0.01). (6) Compared with clavicular hook plate fixation, the technique of suture anchors under arthroscopy has the advantages of small trauma, quick recovery, fewer complications and no need to remove endografts again. Meanwhile, the surgery can also clearly diagnose the concomitant lesions in the joints and treat them when necessary, so as to improve the treatment effect.

Osteomyelitis post acromioclavicular joint reconstruction / 中华创伤杂志(英文版)

Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.

Treatment of sacroiliac joint dislocation by Zhuang medicine tendon therapy combined with chiropractic manipulation / 中国骨伤

OBJECTIVE@#To analyze the clinical effect of Zhuang medicine tendon therapy combined with chiropractic manipulation in treating sacroiliac joint dislocation.@*METHODS@#From January 2017 to May 2018, 60 patients with sacroiliac joint dislocation were divided into treatment group and control group according to the order of admission. There were 19 males and 11 females in the treatment group, aged from 23 to 52 (38.97±3.23) years old, with a course of 2 h to 5.1 months, with an average of (2.19±1.12) months. There were 14 males and 16 females in the control group, aged from 26 to 50 (39.07±3.30) years old, with a course of 3 h to 6 months, with an average of(2.41±1.05) months. The treatment group was treated with Zhuang medicine tendon therapy combined with chiropractic manipulation, while the control group was treated with conventional acupuncture and massage. Before treatment, the main clinical symptoms of the patients were lumbosacral pain, posterior superior iliac spine not at the same level and accompanied with dyskinesia. The pelvic separation test and the "4" test were positive. After treatment, the curative effect was evaluated according to the improved Macnab standard and the "score of treatment of lumbar diseases".@*RESULTS@#Sixty patients were followed up for an average of 8 months. At the latest follow-up, the clinical effect of modified Macnab was better in the treatment group than in the control group(<0.01). After treatment, the treatment group was better than the control group on lumbar function score (<0.01).@*CONCLUSIONS@#The treatment of sacroiliac joint dislocation by Zhuang medicine tendon therapy combined with chiropractic manipulation has good clinical effect and is worth further application and development.

Comparison of arthroscopy-assisted Tightrope technique and clavicular hook plating for acromioclavicular joint dislocation of Rockwood type Ⅲ / 中华创伤骨科杂志

Objective To compare the clinical outcomes of arthroscopy-assisted Tightrope technique and clavicular hook plating for the treatment of acromioclavicular joint dislocation of Rockwood Type Ⅲ in aduhs.Methods The clinical data were reviewed of the 60 patients who had been treated for acromioclavicular joint dislocation of Rockwood Type Ⅲ from January 2012 to December 2015 at Department of Orthopedics,Jinhua Municipal Central Hospital.Their age ranged from 34 to 62 years (mean,40 years).Injury was at the left side in 28 cases and at the right in 32 ones.They were randomly assigned to receive treatment either using arthroscopy-assisted Tightrope technique (group A,30 cases) or using clavicular hook plate (group B,30 cases).The 2 groups were compared in terms of incision length,operation time,blood loss,visual analogue scale (VAS) and Constant-Murley shoulder function scores at postoperative 3 and 12 months.Results The 2 groups were compatible because there were no significant between-group differences in gender,age,injury laterality,Rockwood fracture typing or injury cause (P ＞ 0.05).All the patients were followed up for a mean of 10 months (from 6 to 12 months).Primary incision healing was achieved in both groups with no neural lesion.The incision length in group A (3.4 ± 0.6 cm) was significantly shorter than that in group B (8.8 ± 1.8 cm),and the blood loss in the former (40.0 ± 8.2 mL) significantly less than that in the latter (70.9 ± 9.8 mL) (P ＜ 0.05).The VAS scores and Constant-Murley shoulder function scores at postoperative 3 and 12 months in group A (respectively:2.2±1.1 and 1.1 ±0.9 points;85.5±2.1 and 98.0±3.1points) were significantly better than those in group B (respectively:3.2 ± 1.8 and 2.1 ± 1.2 points;75.0 ±4.1 and 85.1 ±2.9 points) (P ＜ 0.05).There were no obvious complications during the follow-up period in either group.Conclusions Although both arthroscopy-assisted Tightrope technique and clavicular hook plating can relieve shoulder pain in the adult patients with acromioclavicular joint dislocation of Rockwood Type Ⅲ,the former shows advantages of a smaller incision,less bleeding,lower VAS scores,and reduced pain and financial cost for the patients due to no trouble of implant removal.

Curative effect of micro-strip line anchors combined with posterior capsulorrhaphy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis / 中国综合临床

Objective To study the short-term and medium-term effects of mini- strip anchor and capsulotomy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis (RA). Methods From January 2015 to December 2016,fifty-eight RA patients with first metacarpophalangeal joint dislocation were randomly divided into study group (20 cases),joint replacement group (19 cases) and non-operation group (19 cases). Postoperative evaluation indexes: the wound healing was observed in accordance with ＂trial standard of functional evaluation of upper limbs of Chinese Medical Association Hand Surgery Society＂. The surgical outcomes of the three groups were compared. The hand function and quality of life were assessed by Michiga Hand Outcomes Questionnaire ( MHQ ) and arthritis impact measurement scale 2 (AIMS2) before treatment, 6 months after treatment and 12 months after treatment. Results All the patients in the study group and the joint replacement group healed by first intention without any early complications. According to the criteria of upper extremity functional evaluation of Chinese Medical Association,the curative effect of the operation was evaluated. In the study group,15 cases were excellent,3 cases were good,2 cases were poor,the excellent and good rate was 90. 0%. In the joint replacement group, 15 cases were excellent,3 cases were good,1 case was poor,and the excellent and good rate was 94. 7%. After treatment for 6months, the MHQ scores were improved significantly in the three groups (( 48. 36 ±8. 24) vs. (73. 06±10. 55); (47. 56±7. 75) vs. (81. 42±8. 54); (48. 75±8. 85) vs. (65. 91±8. 26)) (F＝33. 19,35. 12,28. 42, P＜0. 05). The MHQ scores of study group ( (73. 06±10. 55)points) and joint replacement group ( ( 81. 42 ± 8. 54) points) were significantly higher than those of non-operation group ((65. 91± 8. 26) points) ( P＜0. 05), and the MHQ scores of joint replacement group were significantly higher than those of study group (P＜0. 05). At 12 months after treatment,there was no significant difference in MHQ score between the study group ((82. 45±7. 18)points) and the arthroplasty group ((84. 36±6. 33) points) (P＞0. 05) . At 6 and 12 months after treatment, AIMS2 scores of each group were significantly improved,but AIMS2 scores of study group (( 216. 51 ± 35. 28) points, ( 230. 28 ± 23. 51) points) and arthroplasty group ((221. 45±31. 63) points,(234. 15±21. 42) points) were significantly higher than those of non-operation group ((192.69±41.31) points,(200.43 ±28.42) points) (P＜0.05).At 6 and 12 months after treatment,there was no significant difference in AIMS2 scores between the study group and the arthroplasty group ( P ＞ 0. 05 ) . Conclusion Micro-strip line anchors combined with posterior capsulorrhaphy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis can achieve good stability of articular reduction,significantly improve the joint function and quality of life and have ideal short-term and mid-term effect.

Surgical management of chronic temporomandibular joint dislocations

Temporomandibular joint dislocation is described as the movement of mandibular condyle out of the fossa beyond its anatomical and functional boundaries causing pain and discomfort. It is often managed by conservative methods, but in long-standing, chronic conditions, surgical treatment is the only option. The goal of surgical treatment is to reposition the condyle and prevent further recurrences. Materials and Methods: This retrospective analysis involving a single center and a surgeon with 19 patients and 23 joint surgeries performed over a 10-year period. Patients who fulfilled inclusion and exclusion criteria and had earlier undergone surgical correction with hook-shaped miniplates and miniscrews fixed with or without bone grafts formed the study group. Results: In all, 12 were female (mean age, 41.9 ± 12.07 years) and the rest 9 were male (mean age, 39.8 ± 13.6 years), ranging from 32 years to 58 years. All patients had the dislocation for an average period of 19.26 ± 12.6 months before the surgery. The mean maximal mouth opening (without pain) preoperatively was 17.78 ± 2.13 mm (12–25 mm) while postoperatively it was 32.28 ± 3.17 mm (27–37 mm). There were no immediate or late surgical complications in the follow-up period that ranged from 8 to 37 months. Discussion: When proper case selection is employed and properly done, using hook-shaped miniplates with or without bone graft is more cost-effective, giving excellent short- and long-term effects. Conclusion: The results in this Indian population are very similar to that reported from other parts of the world.

Development and biomechanical study of anatomical locking plate of sternoclavicular joint / 中国修复重建外科杂志

Objective: To develop an anatomical locking plate in accordance with the anatomical characteristics of the sternoclavicular joint, which is reliable fixation and easy to operate, so as to provide an ideal internal fixation device for the treatment of sternoclavicular joint dislocation or peripheral fractures.

Clinical and Radiological Results of Hook Plate Fixation in Acute Acromioclavicular Joint Dislocations and Distal Clavicle Fractures

BACKGROUND: The purpose of this study was to evaluate the clinical outcomes and complications of hook plate fixation in acromioclavicular (AC) joint dislocations and distal clavicle fractures. METHODS: We retrospectively reviewed a series of 60 consecutive patients with hook plate fixation for AC joint dislocation (group I) and distal clavicle fracture (group II). Groups I and II had 39 and 21 patients, respectively. Clinical results were evaluated using the pain visual analogue scale (VAS), simple shoulder test, and Constant-Murley scores. In addition, subacromial erosion and stiffness were evaluated as complications. RESULTS: At the removal, the pain VAS was 2.69 ± 1.30 and 4.10 ± 2.14 in groups I and II, respectively, which were significantly different (p=0.003). The simple shoulder test score was 9.59 ± 1.60 and 7.81 ± 2.67 in groups I and II, respectively, which were also significantly different (p=0.002). Subacromial erosion was significantly more frequent in group II (14/21 patients, 66.7%) than in group I (15/39 patients, 38.5%) (p=0.037), and stiffness was also higher in group II (17/21 patients, 81.0%) than in group I (22/39 patients, 56.4%), but it was not significant. CONCLUSIONS: Hook plate fixation showed good clinical and functional results for the treatment of acute unstable AC joint dislocation and distal clavicle fracture. But, in distal clavicle fractures, there are more subacromial erosion and stiffness compare with acute unstable AC joint dislocation.

Surgical Treatment of Patellar Instability in Children and Adolescents / 대한정형외과학회잡지

Patellar instability in children and adolescents is caused by abnormalities of various knee structures. Instability of the patellofemoral joint can manifest as an acute dislocation, recurrent dislocation, habitual dislocation, and congenital dislocation. Patellar instability is associated with abnormalities in the anatomical structures around the knee, and a comprehensive analysis of the cause should be undertaken. Surgery can be performed to reconstruct any abnormal musculo-skeletal alignment. Considerable progress has been made in the treatment of patellar instability in recent years, and surgical methods include lateral release, soft tissue realignment procedure, transfer of the autologous tendon, trochleaplasty, and reconstruction of the medial patellofemoral ligament.

Research progress in the treatment of sternoclavicular joint dislocation / 中国综合临床

The incidence of sternoclavicular joint dislocation is rare due to its specially physiological anatomy. At present, the main therapy of sternoclavicular joint dislocation is operation, including the sternoclavicular joint reconstruction, internal clavicle resection and internal fixation with thoracoclavicular joint. Overall,surgical treatment is difficult to operate and has high risk. The article summarized the relevant literature and reviewed the treatment of sternoclavicular joint dislocation as follows.

Retrospective study of temporomandibular joint dislocation by surgical treatment / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to retrospectively analyze temporomandibular joint dislocation by surgical treatment and evaluate the treatment effect.</p><p><b>METHODS</b>From May 2012 to April 2016, a total of 17 cases of temporomandibular joint dislocation were surgically treated, including 8 cases of irreducible dislocation (ID) and 9 cases of recurrent dislocation (RD). Synovial injection of sclerosing agent by arthroscope was performed in 5 cases, 9 sides; augmentation of the articular eminence by titanium plate implantation was performed in 7 cases, 12 sides; iliac bone transplantation was performed in 1 case, 1 side; Medpore implantation was performed in 3 cases, 6 sides; and eminectomy and capsular tightening were performed in 1 case, 2 sides. Follow-up was conducted 1-5 years after the operation, and the success rate statistics was obtained.</p><p><b>RESULTS</b>The cure rate of synovial injection of sclerosing agent by arthroscope was 77.8% (7/9), and the effective rate was 100%. The cure rate of titanium plate implantation was 75% (9/12), and the effective rate was 100%. The cure rates of augmentation of the articular eminence by Medpore implantation (6/6), iliac bone graft (1/1), and eminectomy (2/2) were 100%.</p><p><b>CONCLUSIONS</b>The surgical method of temporomandibular joint dislocation was selected according to the state of the patients. The postoperative recurrent patients were advised to undergo augmentation of the articular eminence by Medpore implantation, which offered a reduced chance of recurrence and relatively less injury, as well as a simple operative method.</p>

Meta-analysis on effect of endobutton plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation / 局解手术学杂志

Objective To systematically evaluate the clinical effects of endobutton plate and clavicular hook plate in the treatment of ac-romioclavicular joint dislocation. Methods The clinical study on endobutton plate and clavicular hook plate in the treatment of acromiocla-vicular joint dislocation was subjected to computer search for CNKI,VIP,WangFang Data,PubMed,EMbase and The Cochrane Library input before July 2017. Two reviewers independently screened literature,extracted data and assessed the risk bias of included studies and then Rev-Man 5. 3 software was used to perform meta-analysis. A total of 10 studies were conducted with 725 patients. Results After operation of the patients who underwent endobutton plate,the Constant score was higher [MD=8. 55,95％CI (7. 82, 9. 29),P<0. 01] with shorter opera-tion time [MD=4. 94, 95％CI 4. 30 to 5. 59,P< 0. 01],less bleeding (MD= -1. 93,95％CI -2. 63 to -1. 22,P<0. 01],and shorter hospital stay [MD= -0. 39, 95％CI -0. 70 to -0. 09,P=0. 01],respectively. Conclusion The treatment of acromioclavicular joint dis-location with type III by endobutton plate has the advantages of shorter operation time,less intraoperative bleeding,quick recovery of shoulder function,and shorter hospital stay.

Luxación acromioclavicular (LAC) aguda. Resultados con técnica de doble Endobutton® sin reconstrucción ligamentaria / Acromio clavicular acute dislocation. Results with double endobutton technique without ligament reconstruction

Introducción Las lesiones de la articulación acromioclavicular (AC) son muy comunes y van en aumento por el incremento de los deportes de contacto y el aumento del número de deportistas. Se presentan en el 9% de todas las lesiones de la cintura escapular. La gran cantidad de técnicas quirúrgicas descritas e ilustradas nos evidencia el hecho de que la técnica ideal para tratar este tipo de lesiones sintomáticas no ha sido desarrollada. El objetivo del estudio es reportar los resultados radiográficos en luxaciones de la AC de tipo V mediante la técnica de doble Endobutton® sin reconstrucción de ligamentos. Materiales y métodos Desde enero de 2011 hasta diciembre de 2013, 15 pacientes con luxación acromioclavicular aguda (<3 semanas) fueron tratados con la técnica de doble Endobutton® sin reconstrucción ligamentaria. Todos los pacientes presentaron luxación de tipo V según clasificación de Rockwood. Entre los pacientes, 12 fueron de sexo masculino y 3 de sexo femenino, con una media de edad de 35 años (rango de 22 a 56 años), evaluados con rayos X en el postoperatorio inmediato, y 1, 3 y 12 meses después. Resultados De los 15 pacientes, 7 presentaron pérdida de reducción radiográfica durante el primer año postoperatorio en comparación con radiografía inicial. Discusión Mediante la técnica de doble Endobutton® en las luxaciones de la AC de tipo V sin asociar una reconstrucción de ligamentos, obtuvimos el 46% de pérdida de reducción en el primer año postoperatorio. Por ello, concluimos que esta técnica presenta un alto porcentaje de pérdida de reducción en este tipo de lesiones. Nivel de evidencia clínica Nivel IV.

Background The acromioclavicular (AC) joint injuries are common, accounting for 9% of all injuries to the shoulder girdle. The multitude of techniques describes and illustrates the fact that the ideal technique to treat a symptomatic AC joint dislocation remains to be found. Materials & methods From January 2011 to December 2013, 15 patients with acute acromioclavicular joint dislocation were surgically immobilized with the double Endobutton® technique without ligament reconstruction. All the patients had type V AC dislocations according to Allman-Rockwood classification. Among the patients, 12 patients were male and 3 patients were female, with an average age of 35 years (ranged from 22 to 56 years). The therapeutic effects were evaluated with postoperative X-ray, at 1, 3 and 12 months. Results From fifteen patients in this study, seven patient lost radiographic reduction during the first year of postoperative procedure compared with the first post-operative Rx. There were no other complications reported. Discussion We obtained with the double Endobutton® AC reduction without ligament reconstruction a 46% of loosening reduction in the first year. This technique has a high percentage of loss of reduction in this type of patient. Evidence level IV.