Countertraction method for reduction of irreducible subcoracoid dislocation of the shoulder joint with Hill-Sacks lesion / 中国骨伤

OBJECTIVE@#To investigate clinical outcomes of countertraction method in treating irreducible subcoracoid dislocation of shoulder joint combined with Hill-Sacks injury.@*METHODS@#A total of 56 patients with irreducible subcoracoid dislocation of the shoulder joint combined with Hill-Sacks injury admitted from December 2013 to June 2020 were retrospectively analyzed. Under the anesthesia of shoulder joint cavity injection, the reduction was performed by using anti-traction method (experimental group) and traditional Hippocrates method (control group), 28 cases in each group. There were 11 males and 17 females in experimental group, with an average age of (61.95±19.32) years old, 9 cases on the left side, and 19 cases on the right side. Twelve males and 16 females in control group, with an average age of (63.13±12.75) years old, 11 cases on the left side, 17 cases on the right side. The curative effects between two groups were evaluated before and after operation, including the success rate of reduction, the duration of reduction, the distance from successful reduction to injury, complications and functional rehabilitation(Constant score of shoulder joint).@*RESULTS@#The success rates of reduction in experimental group and control group were 92.86%(26/28) and 67.86% (19/28), respectively, and the difference was statistically significant (P<0.05). The duration of simple reduction was (4.25±2.13) min and ( 6.31±1.69) min, the difference was statistically significant (P<0.05);the time from successful reduction to injury was (9.16±0.94) h and (8.94±1.31) h, respectively, with no significant difference(P>0.05). There were no complications such as vascular nerve injury and fracture in experimental group, 2 cases of axillary nerve injury and 1 case of humeral head fracture in control group. Constant scores of shoulder joint between experimental group and control group were (92.34±5.62) points and (90.91±4.73) points, respectively, with no significant difference (P>0.05).@*CONCLUSION@#For patients with irreducible subcoracoid dislocation of the shoulder joint with Hill-Sacks injury, the countertraction method under anesthesia of the shoulder joint cavity achieved a higher success rate and few complications.

Short-term effectiveness of arthroscopically capsular vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity / 中国修复重建外科杂志

Objective: To evaluate the short-term effectiveness of arthroscopically capsular vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity. Methods: A retrospective analysis was performed on 6 shoulder recurrent anterior dislocation patients combined with joint laxity treated with arthroscopically capsular vertical mattress suturing between January 2017 and December 2018. There were 5 males and 1 female with an average age of 20.8 years (range, 19-24 years). The number of shoulder dislocation was 3-18 times, with an average of 9.5 times. The disease duration ranged from 2 to 60 months, with an average of 25.3 months. The preoperative Beighton score was 4-7, with an average of 5.8; the Instability Severity Index Score (ISIS) was 2-5, with an average of 3.5. There were 5 cases of simple Bankart injury and 1 case of bony Bankart injury. The range of motion of shoulder joint (including active flexion and lifting, external rotation, abduction and external rotation, and internal ratation) was recorded before operation and at last follow-up; Oxford shoulder instability score, Rowe shoulder instability score, and Simple Shoulder Test (SST) score were used to evaluate shoulder joint function before operation, at 6 months after operation, and at last follow-up, and complications were recorded. Results: All patients were followed up 16-28 months (mean, 19.3 months). During the follow-up, all patients had satisfactory motor function, and no re-dislocation and postoperative neurovascular complications occurred. At last follow-up, the activities of active external rotation and abduction and external rotation were significantly improved when compared with those before operation ( P0.05). The Oxford shoulder instability score, Rowe shoulder instability score, and SST score at 6 months after operation and at last follow-up were significantly improved when compared with those before operation ( P0.05). Conclusion: The treatment of shoulder recurrent anterior dislocation combined with joint laxity by arthroscopically vertical matress suturing can achieve good short-term effectiveness.

The study of combined unilateral intraoral and extraoral reduction approach in the treatment of anterior temporo-mandibular joint dislocation / 华西口腔医学杂志

OBJECTIVE@#To observe the clinical outcomes of a combined unilateral intraoral and extraoral reduction approach in the treatment of anterior temporomandibular joint (TMJ) dislocation.@*METHODS@#Postural muscular chains were utilized in the biomechanical analysis of stomatognathic systems for improving TMJ repositioning approaches. A total of 87 patients with anterior TMJ dislocation were included in the present study. A combined unilateral intraoral and extraoral reduction approach was applied, and the clinical effects were evaluated.@*RESULTS@#Biomechanical analysis reveal that reflexive contrac-tion of the maxillary muscle group was blocked sufficiently during the combined unilateral intraoral and extraoral reduction process. All dislocated TMJs were set successfully and efficiently with few complications.@*CONCLUSIONS@#Combined unilateral intraoral and extraoral reduction approach is an effective, convenient, and minimally invasive way to treat anterior TMJ dislo-cations.

Treatment of traumatic anterior dislocation of sternoclavicular joint with allogeneic tendon of "W" type knit / 中国修复重建外科杂志

Objective: To investigate effectiveness of allogeneic tendon of "W" type knit in repair of traumatic anterior dislocation of sternoclavicular joint. Methods: Between June 2013 and June 2017, 12 patients with traumatic anterior dislocation of sternoclavicular joint after poor conservative treatment were treated with allogeneic tendon of "W" type knit. Of them, 10 were males and 2 were females, aged from 25 to 58 years (mean, 42 years). All injuries were caused by traffic accidents. The time from injury to operation was 4-12 weeks (median, 6 weeks). All of them were closed injuries. The patients had no fracture around the shoulder, or blood vessels, nerves, and other adjacent limb joint injuries. The operation time, intraoperative blood loss, incision healing, and complications were recorded. The sternoclavicular joint was observed by X-ray film and CT at 1 year after operation. Visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, Rockwood score, modified Hospital for Special Surgery (HSS) score, and Constant-Murley score were used to evaluate the function of shoulder joint after operation. Results: The operation time was 60-80 minutes (mean, 70 minutes). The intraoperative blood loss was 50-100 mL (mean, 60 mL). Primary healing of incision was obtained in all patients without complications. All the patients were followed up 12-24 months (mean, 18 months). At 1 year after operation, X-ray film and CT examination showed that the position of sternoclavicular joint was satisfactory. At 1 year after operation, the Rockwood score was 12-14 (mean, 13). The UCLA score was 28-34 (mean, 31). The VAS score was significant lower than that before operation ( P<0.05), and the Constant-Murley score and modified HSS score were significantly higher than those before operation ( P<0.05). Conclusion: The repair of traumatic anterior dislocationr of sternoclavicula joint with allogeneic tendon of "W" type knit can effectively reconstruct the stability of the joint, retain the physiological fretting, and obtain satisfactory results.

Bilateral spontaneous anterior dislocation of intraocular lens with the capsular bag in a patient with pseudoexfoliation.

We report a rare case of bilateral spontaneous anterior partial in‑the‑bag intraocular lens (IOL) dislocation in a 75‑year‑old man with pseudoexfoliation (PXF). He underwent uneventful phacoemulsification in both eyes with in‑the‑bag IOL implantation 9 years back. In the right eye, single piece poly (methyl methacrylate) (PMMA) IOL (+19 D) and in the left eye, single piece acrylic foldable IOL (+19 D) were implanted. An attempt at pharmacological IOL repositioning was unsuccessful. The dislocated IOLs were explanted and exchanged with scleral suture fixated PMMA IOLs. Vision improved to 20/30 in both eyes following surgery, without any associated ocular morbidity. We believe that zonular weakness secondary to PXF, capsular contraction, and myopia together were the predisposing factors for partial anterior dislocation of IOLs and IOL exchange with scleral suture fixation of IOL is a safe and effective treatment option.

Acute Traumatic Irreducible Anterior Dislocation and Fracture of the Radial Head in an Adult

Traumatic dislocation of the radial head without fracture of the olecranon is very rare, especially in adults. We experienced a case of irreducible radial head dislocation with fracture without involvement of ulna. Open reduction and internal fixation was performed. During surgery, brachialis was interposed between capitellum and radial head, and also interposed between the fragments at the fracture site of the radial head. At 12 months after operation, the radial head was well reduced with normal rotation.

Reconstruction of the Glenoid Using Iliac Bone Graft for Recurrent Anterior Shoulder Instability with Severe Glenoid Bone Defect: A Report of Two Cases

PURPOSE: The purpose of this report was to assess a surgical technique-using an autogenous tricortical iliac crest bone graft in patients with epilepsy-for anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency. MATERIALS AND METHODS: We studied two cases of recurrent anterior dislocation of the shoulder due to epilepsy. These cases were treated with anatomical glenoid reconstruction using an autogenous tricortical iliac crest bone graft. RESULTS: Both cases achieved bone union in 5 months. There was no recurrence of instability and pain. Both cases had normal range of motion. CONCLUSION: Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency using an autogenous tricortical iliac crest bone graft is a successful surgical technique for achieving shoulder stability.

Patient Accompanied with Simultaneous Anterior Dislocation of Hip and Anterior Dislocation of Knee : A Case Report

We are reporting a case that a 61-year-old patient who had simultaneous anterior dislocation of left hip and anterior dislocation of right knee after fall from a height injury was treated by closed reduction respectively.

Arthroscopic Bankart Repair for Post-seizure Anterior Instabilities of Shoulder : 2 Cases Report

PURPOSE: These case reports have been prepared to highlight the uncommon occurrence of anterior shoulder dislocation after an epileptic seizure, the recognition of which is important as this type of injury is associated with bony lesions and a high incidence of recurrence. MATERIALS AND METHODS: We report two cases of recurrent anterior dislocation of the shoulder due to grand mal epilepsy. These cases were treated as usual anterior dislocations of the shoulder, and were regularly followed to detect any recurrence of shoulder instability. RESULTS: Outcome of the surgery in the two cases was different because of the differences in seizure control. In the patient in whom seizures were well-controlled, there was no recurrence of instability, while the patient with poorly controlled seizures developed a recurrence of the dislocation following shoulder repair. CONCLUSION: The authors emphasize the need to control seizures in order to prevent injury recurrence in this subset of patients.

Arthroscopic Technique of Bone Defect in Anterior Shoulder Instability

PURPOSE: The bone defects that are associated with shoulder anterior instability may be the causes of failure of arthroscopic surgery. For the treatment of traumatic shoulder instability, we tried to determine the arthroscopic techniques that can be used for the bone defect of the glenoid and the humeral head. The purpose of this study is to assess the surgical techniques for the arthroscopic reconstruction of the shoulder with anterior instability and bone defects. MATERIALS AND METHODS: We analyzed the articles that have been recently published on anterior shoulder instability and we assessed the arthroscopic surgical techniques. We compared the articles and the methods of arthroscopic surgical techniques for treating bone defects of the anteroinferior glenoid and the posterolateral humeral head, which were considered as the causes of recurrence of shoulder instability. RESULTS: There are the anteroinferior bone defects of the glenoid and Hill-Sachs lesions in the bone defects that appear in patients with anterior shoulder instability. These bone defects are currently the causes of failure of arthroscopic surgery. CONCLUSION: Open shoulder surgery may be the treatment of the choice for a shoulder with instability and significant bone defects of the glenoid and the humeral head. But efforts are being made to overcome the weaknesses of open surgery by the use of arthroscopy

Traumatic Bilateral Anterior Hip Dislocation: A Case Report

Traumatic anterior dislocation of the hip is an uncommon injury, accounting for less than 10% of all reported cases of traumatic hip dislocation. Especially, there are no known report in our country so far. We are reporting a case of a 81 year old man who sustained bilateral anterior hip dislocation after pedestrian traffic accident, and treated by closed reduction and skeletal traction at our institute.

Isolated Anterior Dislocation of the Radial Head in Adult: A Case Report

We report an isolated anterior dislocation of the radial head in a 23-year-old man after a fall on the outstretched arm. At the time of the injury, the patient's elbow was in a position of mild flexion and pronation which was suddenly further pronated as he fell down. The radial head was incarcerated by the lateral portion of brachialis muscle, and annular ligament was interposed between capitellum and radial head. Open reduction was performed. During 12 months follow-up, reduction of radial head was well maintained without a limitation of range of motion.

Vertically Unstable Fracture of the Pelvis Combined with Anterior Dislocation of the Hip Joint: A Case Report

Pelvic fractures result from high energy trauma and often associated with concomitant injuries. But, vertically unstable pelvic fractures combined with anterior dislocation of the hip is far less common. The traumatic dislocation of the hip is a true orthopedic emergency and it should be considered that a femoral head can be exposed to deteriorized vascularity. We report a case of vertically unstable pelvic fractures combined with traumatic anterior dislocation of the hip joint with the review of the literature.

Ulnar osteotomy and external fixation for chronic anterior dislocation of head of the radius in children / 中国矫形外科杂志

[Objective]To evaluated the clinical results of the ulnar osteotomy and external fixation for the treatment of chronic anterior dislocation of head of the radius in children.[Method]From 2002 to 2004,thirteen cases of children with chronic anterior dislocation of the radial head were treated by ulnar osteotomy,external fixation and close or open reduction of elbow joint but without repair of the annular ligament. Their mean age was 5.5 years(2 to 11) and the mean interval between the injury and reconstruction was 19 months(2 months to 3 years).[Result]All radial heads remained reduced at a mean follow-up of 14 months(2 months to 3 years).Normal ranges of movement for flexion,extension,pronation and supination were improved or unchanged in 12 patients.One patient had further decreased in 10? for supination.There were one superficial pin-track infections but with no serious complication.[Conclusion]Angular ulnar osteotomy and external fixation of the ulna can lead to stable reduction of the radial head with minimal complications.Reconstruction of the annular ligament is not necessary if satisfactory re-orientation of the ulnar is achieved in all planes.

Pushing scapula reset anterior dislocation of shoulder with fracture of surgical neck of humerus / 临床外科杂志

Objective To seek a new closed reduction for anterior dislocation of shoulder with fracture of surgical neck of humerus.Method 6 cases in present study were well followed up.There were 4 males and 2 females.The average age was 42.5 years old;the average time of injury to reduction was 3.5 hours.After local anesthesia,on prone position,one hand carried on the head of humerus, another pushed the scapula.All cases were treated successfully.Result According to the Neer criterion, 4 cases were excellent,2 cases were satisfactory.Conclusion Anterior dislocation of shoulder with fracture of surgical neck of humerus can be succeeded in manual reduction.

Arthroscopic Evaluation for Acute Traumatic Anterior Dislocation of the Shoulder / 대한정형외과학회잡지

There are many complications after traumatic shoulder dislocation including redislocation, dislocation capsulitis especially in the older age and dislocation arthropathy. Redislocation rates have been primarily related to age at the time of initial dislocation, to lesser degree, athletic participation, length of immobilization, rehabilitative exercises, and time hefore return to sports or full activity. So we wanted to confirm the difference of the lesion between the young and the old at the initial dislocation. Arthroscopic evaluation of the twelve patients with an acute traumatic anterior dislocation of the shoulder was done to identify the intraarticular pathology within 10 days of the initial injury. All patients were taken MRI and evaluated under anesthesia. We classified these shoulders into two groups based on the age of patient. Young agegroup under 30 were seven patients and old age-group over 40 were five patients. And the following results were ohtained; 1. The detachment of the anterior labrum with the inferior glenohumeral ligament from the glenoid rim was primary finding and might cause the shoulder unstable under anesthesia in the young age-group under 30. 2. In the age-group over 40, there were the capsular tears with no labral lesion and these shoulders were stable under anesthesia 3. In acute traumatic anterior dislocation, examination under anesthesia was more closely related to the prediction of the extent of labro-ligamental detachment than MRI examination. 4. We believe that arthroscopic surgical intervention after the initial shoulder dislocation should be considered as a treatment option

The Treatment of Recurrent Anterior Shoulder Dislocation with Modified Bristow Operation / 대한정형외과학회잡지

A review of 15 cases of the modified Bristow operation for recurrent anterior shoulder dislocation from Jan. 1983 to Dec. 1988 was presented. Using arthroscopy, we could examined the pathologic feature of the recurrent anterior dislocation of the shoulder. The results are as following. 1. The ages at the initial dislocation were ranged from 15 to 26 years and operated from 19 to 61 years. 2. The most common injury mechanism of the dislocation was sports injury (5 cases) and followings were traffic accident, military training, hanging with one hand. 3. The 10 cases were dislocated above 10 times before operation and 3 were dislocated above 10 times per year. 4. Bony lesions were detected on routine X-ray at 8, that is A-P and lateral view, Hill-sach's view, Stryker-notch view and West point view, Hermoddson view, and apical obique view. 5. Arthroscopic examination was done at 7 cases and could detect the pathologic lesion more exactly. 6. All were treated with modified Bristow method 7. Mean follow up periods were 2 year and 4 monthes. 8. The range of motion was not limited but external rotation was done about 18. 9. Excellent results were obtained by Rowe's grading system, mean 88.8.

Clinical Results of Anterior Dislocation of Shoulder Complicated by Fracture of Greater Tuberosity with its Attached Rotator Cuff / 대한정형외과학회잡지

In anterior dislocations of shoulder complicated by fracture of greater tuberosity, the prognosis of shoulder after reduction of dislocation depends upon associated injury of the rotator cuff. Early recognition and repair are thought to be essential if better functions is to be obtained. Among 40 patients with 41 dislocations, 28 cases with fracture of greater tuberosity were managed and treated at the Department of Orthopaedic Surgery, Hangang Sacredheart Hospital, Hallym University, from January, 1985 to December, 1988. The results obtained from this study were as follows: l. Among 40 patients with 41 cases of fracture-dislocation, 27 patients with 28 cases(68.3%) were complicated by fracture of greater tuberosity. Most of these were by traffic accident and occurred at the age of 40s and 50s. 2. According to the Depalma's classifcation, the most common type was type 2(15 cases, 53.5%). 3. Open reduction with repair of cuff was done in 2 cases of type 2 and 4 cases of type 3. 4. Rotator cuff injury was confirmed in eight operatively treated cases and in 3 cases by arthrography and ultrasonography. 5. Five operatively treated cases of fracture-dislocation with rotator cuff injury showed improved function especially in abduction. Therefore in anterior disloations with fracture of greater tuberosity, careful evaluation of anatomic reduction state of fragment after reduction and accompanying rotator cuff injury is necessary. If the fragment retracts under the acromion or still shows displacement more than 8-10mm after reduction, we may assume that a tear of rotator cuff is present and open reduction of fracture with repair of rotator cuff is essential for the better function of the shoulder.