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Introducción: Las luxaciones traumáticas de codo posteromediales asociadas a fracturas de cóndilo externo constituyen una lesión poco común dentro de la patología ortopédica. Pueden pasar desapercibidas si no se tiene la sospecha clínica, y la falla en el diagnóstico y tratamiento pueden derivar en un mal pronóstico funcional para el miembro lesionado. Metodología: Entre el año 2020 y 2022 identificamos 3 pacientes pediátricos con luxación posteromedial de codo asociado a fractura del cóndilo externo. Los tres pacientes presentaron fractura de cóndilo externo tipo 2 de la clasificación de Milch. Todos los pacientes fueron tratados de manera quirúrgica. Tuvieron un seguimiento de 2 años, salvo en uno de ellos, el cual fue de 18 meses. Se realizó un seguimiento clínico y radiológico para la evaluación de la lesión, al tiempo que se aplicó el cuestionario DASH a los 3 pacientes. Resultados: Se obtuvieron excelentes resultados en 2 de los pacientes y buen resultado en uno de ellos dado por una pérdida de la extensión de 15 grados. Aunque todos tuvieron un buen resultado en el cuestionario funcional DASH adaptado. Conclusión: La luxación de codo asociado a la fractura de cóndilo externo es una lesión poco común. Es necesario realizar un diagnóstico precoz a través de un correcto estudio de la lesión, ya sea con radiografías, artrografía, tomografía o resonancia magnética. Se pueden lograr buenos resultados siempre que se realice un correcto tratamiento de la misma con un exhaustivo control evolutivo.
Introduction: Traumatic posteromedial elbow dislocations associated with external condyle fractures constitute a rare injury in orthopedic pathology. They can go unnoticed if there is no clinical suspicion, and failure in diagnosis and treatment can lead to a poor functional prognosis for the injured limb. Methods: Between 2020 and 2022, we identified 3 pediatric patients with posteromedial elbow dislocation associated with an external condyle fracture. The three patients presented type 2 external condyle fracture of the Milch classification. All patients were treated surgically. A 2-year follow-up was carried out, except in one of them. A clinical and radiological follow-up was performed to evaluate the injury. The DASH questionnaire was administered to the 3 patients. Results: Excellent results were obtained in 2 of the patients and a good result in one of them due to a loss of extension of 15 degrees. Although everyone had a good DASH functional questionnaire. Conclusion: Elbow dislocation associated with lateral condyle fracture is a rare injury. It is necessary to make an early diagnosis through a correct study of the injury, whether with x-rays, arthrography, tomography or magnetic resonance imaging. Good results can be achieved as long as correct treatment is carried out with exhaustive evolutionary control.
Introdução: As luxações póstero-mediais traumáticas do cotovelo associadas a fraturas do côndilo externo constituem uma lesão rara na patologia ortopédica. Podem passar despercebidos se não houver suspeita clínica, e a falha no diagnóstico e tratamento pode levar a um mau prognóstico funcional para o membro lesado. Metodologia: Entre 2020 e 2022 identificamos 3 pacientes pediátricos com luxação posteromedial do cotovelo associada a fratura do côndilo externo. Os três pacientes apresentavam fratura de côndilo externo tipo 2 da classificação de Milch. Todos os pacientes foram tratados cirurgicamente. Tiveram seguimento de 2 anos, exceto em um deles, que foi de 18 meses. Foi realizado acompanhamento clínico e radiológico para avaliação da lesão e aplicado o questionário DASH nos três pacientes. Resultados: Excelentes resultados foram obtidos em 2 dos pacientes e bom resultado em um deles devido à perda de extensão de 15 graus. Embora todos tenham obtido bom resultado no questionário funcional DASH adaptado. Conclusão: A luxação do cotovelo associada à fratura do côndilo externo é uma lesão rara. É necessário fazer um diagnóstico precoce através de um estudo correto da lesão, seja com radiografias, artrografia, tomografia ou ressonância magnética. Bons resultados podem ser alcançados desde que realizado um tratamento correto e com exaustivo controle evolutivo.
Subject(s)
Humans , Male , Female , Child , Fracture Dislocation/surgery , Closed Fracture Reduction , Open Fracture Reduction , Fracture Fixation, Internal , Elbow Injuries/surgery , Humeral Fractures, Distal/complicationsABSTRACT
Developmental Dysplasia of the Hip (DDH) has an incidence of 3.9% in Chile, and comprises a pathological spectrum from acetabular dysplasia to congenital dislocation of the joint, and can affect all components of the hip. Without treatment, degenerative changes occur progressively, so early management is essential. In cases of absence of treatment, total hip arthroplasty becomes the only therapeutic alternative, becoming a great challenge for the treating team. We present a case of a 56-year-old female patient, with a history of bilateral coxarthrosis secondary to bilateral CDD, referred to the specialty due to claudication and long-standing coxalgia, her study was compatible with advanced coxarthrosis associated with sequelae of bilateral high congenital dislocation. She underwent left total hip arthroplasty (THA), restoring the center of rotation of the joint, associated with sub trochanteric osteotomy to achieve femoral descent without neurological injury. In a second time, after 6 months, a right THA is performed, repeating the previous procedure, with excellent clinical and radiological results in both surgeries. Evolution is shown after 3 years, showing the total remodeling of the femoral osteotomies, with no evidence of osteolysis or wear of the prosthetic components, with excellent clinical results, highlighting gait with minimal claudication.
La Displasia del Desarrollo de la Cadera (DDC) presenta una incidencia de un 3.9% en Chile, y comprende un espectro patológico desde la displasia acetabular hasta la luxación congénita de la articulación, pudiendo afectar a todos los componentes de la cadera. Sin tratamiento se producen cambios degenerativos de forma progresiva, por lo que el manejo precoz es fundamental. En casos de ausencia de tratamiento, la artroplastia total de caderas se transforma en la única alternativa terapéutica, transformándose en un gran desafío para el equipo tratante. Se presenta un caso de una paciente femenina de 56 años, con antecedente de coxartrosis bilateral secundaria a DDC bilateral, derivada a la especialidad por claudicación y coxalgia de larga data, su estudio resulta compatible con coxartrosis avanzada asociada a secuelas de luxación congénita alta bilateral. Es sometida a artroplastia total de cadera (ATC) izquierda, restaurando el centro de rotación de la articulación, asociado a osteotomía sub trocantérica para lograr descenso femoral sin lesión neurológica. En un segundo tiempo, luego de 6 meses se realiza ATC derecha, repitiendo el procedimiento anterior, con excelentes resultados clínicos y radiológicos en ambas cirugías. Se muestra evolución a los 3 años, evidenciándose la total remodelación de las osteotomías femorales, sin evidencias de osteolisis ni desgaste de los componentes protésicos, con excelentes resultados clínicos, destacando marcha con mínima claudicación.
Subject(s)
Humans , Female , Middle Aged , Arthroplasty, Replacement, Hip , Femur/surgery , Hip Dislocation, Congenital/surgery , Osteotomy , Pelvis/diagnostic imaging , Postoperative Period , Pain Measurement , Radiography , Osteoarthritis, Hip/surgery , Clinical EvolutionABSTRACT
Resumen La luxación de rodilla es la pérdida de la relación articular femorotibial, asociada a lesiones de mínimo dos ligamentos mayores; ocurre en el 0,02 % de lesiones en ortopedia. El objetivo de este artículo es presentar el caso de una paciente adulta intermedia con obesidad grado I, quien presentó caída desde su altura, con trauma en rodilla derecha. La radiografía de ingreso evidenció luxación anteromedial en esta articulación, por lo cual es llevada a reducción cerrada e inmovilización y, posteriormente, se realiza radiografía posreducción, Doppler arteriovenoso y resonancia magnética encontrando desgarro del menisco lateral, ruptura de los ligamentos cruzado posterior, cruzado anterior, retináculo lateral y fractura de la cabeza del peroné. Este caso es significativo al tratarse de una luxación en trauma de ultra baja energía en un paciente con obesidad, que no es la presentación típica y resalta la importancia de la búsqueda activa de lesiones asociadas.
Abstract Knee dislocation is the loss of the femorotibial joint relationship associated with injuries to at least two major ligaments and occurs in 0,02 % of injuries in orthopedics. The objective of this article is to present the case of an intermediate adult patient with grade I obesity, who fell from her height with trauma to the right knee. The admission x-ray showed ante-romedial dislocation in this joint, which is why she underwent reduction. closed and immobilization and subsequently a post-reduction radiography, arteriovenous Doppler and magnetic resonance imaging were performed, finding a tear of the lateral meniscus, rupture of the posterior cruciate ligaments, anterior cruciate ligament, lateral retinaculum and fracture of the head of the fibula. This case is significant as it is a dislocation in ultra-low energy trauma, in a patient with obesity, which is not the typical presentation and highlights the importance of actively searching for associated injuries.
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Abstract Small osteolabral avulsions of the hip can be easily missed, and postreduction stress testing and computed tomography (CT) scans of the hip should be performed to look for these injuries. The usual modality of treatment of these unstable osteolabral avulsions is suture anchors, Herbert screws or spring plates. But when the bony avulsion is small, the use of these implants becomes a tedious job. We present a novel technique to fix small osteochondral avulsion fractures not amenable to fixation using screws or spring plates. We performed a retrospective analysis of 57 cases of patients who underwent open reduction and internal fixation for posterior fracture dislocation of the acetabulum, and we identified 6 cases of small posterior labral osteochondral fragments leading to instability. These injuries were fixed using a novel method. The mean Harris Hip Score at the final follow-up was of 92.5. Fixation of osteochondral avulsions associated with posterior hip fracture dislocation can be a difficult task if the bony fragment is small. Our technique is a simple, cost-effective and reliable way of fixing such avulsions with satisfactory outcomes.
Resumo Pequenas avulsões osteolabrais do quadril podem passar despercebidas, e testes de estresse pós-redução e tomografia computadorizada do quadril devem ser realizados para sua detecção. O tratamento dessas avulsões osteolabrais instáveis geralmente é feito com âncoras de sutura, parafusos de Herbert ou placas-molas. Em avulsões ósseas pequenas, porém, o uso desses implantes é um trabalho tedioso. Apresentamos uma nova técnica de fixação de pequenas fraturas com avulsões osteocondrais não passíveis de fixação com parafusos ou placas-molas. Realizamos uma análise retrospectiva de 57 casos de pacientes submetidos à redução aberta e fixação interna de fratura-luxação posterior do acetábulo, e identificamos 6 casos em que um pequeno fragmento osteocondral labral posterior causava instabilidade. Essas lesões foram corrigidas com um novo método. A pontuação média no Harris Hip Score no último acompanhamento foi de 92,5. A fixação de avulsões osteocondrais associadas a fratura-luxação posterior do quadril pode ser difícil se o fragmento ósseo for pequeno. Nossa técnica é uma maneira simples, econômica e confiável de corrigir tais avulsões com resultados satisfatórios.
Subject(s)
Humans , Fractures, Bone , Fracture Dislocation , Fractures, Avulsion , Open Fracture Reduction , Acetabulum/surgeryABSTRACT
Abstract Total hip arthroplasty (THA) is a successful surgery in the treatment of hip pain, but there are potential complications, of which dislocation is one of the most common. Dislocation management is a challenging problem that requires a multimodal approach, and the use of dual mobility implants is an option. We present a patient with a history of femoral neck fracture who underwent THA with a double mobility implant. On the 18th postoperative day, after a fall to the ground, she developed prosthesis dislocation and had a complication after closed reduction, a subsequent intraprosthetic dislocation. After a radiographic diagnosis, the patient presented mechanical signs of hip flexion caused by a disassociated double mobility implant. The revision surgery was indicated, but the patient chose not to perform the necessary surgical procedure. A careful postoperative study of the radiographs revealed an eccentric femoral head and evidence of disassociated implantation in the surrounding soft tissues. Radiographs after closed reduction of intraprosthetic dislocations should be examined thoroughly.
Resumo A artroplastia total do quadril (ATQ) é uma cirurgia bem-sucedida no tratamento da dor no quadril, mas existem complicações potenciais, das quais a luxação é uma das mais comuns. O gerenciamento das luxações é um problema desafiador que requer uma abordagem multimodal, e o uso de implantes de mobilidade dupla é uma opção. Apresentamos uma paciente com história de fratura do colo do fêmur que foi submetida a ATQ com um implante de dupla mobilidade. No 18° dia pós-operatório, após queda ao solo, a paciente evoluiu com luxação da prótese e teve uma complicação após redução fechada, uma luxação intraprotética subsequente. Após um diagnóstico radiográfico, a paciente apresentou sinais mecânicos na flexão do quadril causados por um implante de mobilidade dupla desassociado. A cirurgia de revisão foi indicada, mas a paciente optou por não realizar o procedimento cirúrgico necessário. O estudo pós-operatório cuidadoso das radiografias revelou uma cabeça femoral excêntrica e evidências do implante desassociado nos tecidos moles circundantes. As radiografias após a redução fechada das luxações intraprotéticas devem ser examinadas minunciosamente.
Subject(s)
Humans , Female , Aged, 80 and over , Arthroplasty, Replacement, Hip , Periprosthetic Fractures/surgery , Hip , Hip DislocationABSTRACT
Background: Failure to appropriately address intra-articular fractures of the proximal interphalangeal (PIP) joint may result in enduring pain, stiffness, and post-traumatic arthritis. Our approach employs a straightforward and economical method of creating a static traction splint using an aluminum splint. This splint is removed after 2 weeks, followed by the initiation of early mobilization. Materials and Methods: A flexible aluminum splint is placed on the injured finger. A polypropylene suture passes through the nail and is tied to the splint for sustained traction, and the finger is immobilized for 2 weeks. After this period, the splint is removed, and active assisted finger mobilization begins. Patients are assessed post-surgery using the Ishida score. Results: This study involved 30 treated patients, with a mean age of 31.47 ± 11.11 years, ranging from 18 to 69 years. Among them, 26 were male and 4 were female, with 20 experiencing right-side involvement. Sports-related injuries were reported in 17 cases, followed by road traffic accidents in 7 cases and slips in 6 cases. The mean range of motion, measured in degrees, was 83.3 ± 0.22. Overall, the patients achieved excellent results. Conclusion: Utilizing static traction for intra-articular PIP joint fractures is a safe, relatively straightforward, and cost-effective method with minimal complications. This approach guarantees anatomical joint alignment, promotes favorable fracture healing, and facilitates early mobilization, leading to a swift and satisfactory recovery.
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Background: Anterior shoulder instability (ASI) is highly prevalent in the general population causing a significant functional decline and increased healthcare burden. Among the surgical stabilization options, the Latarjet procedure is commonly preferred to treat traumatic ASI in young active individuals. Despite the advances in surgical procedures, the research evidence regarding the content of post-operative rehabilitation programmes following a Latarjet procedure for ASI is inconclusive. Methods: This protocol will adhere on the preferred reporting items for systemic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) and the Joanna Briggs Institute guidelines. MEDLINE, OvidSP, Embase, Cochrane Library, CINAHL, PubMed, SPORTS Discus and Scopus databases will be searched for relevant studies. Two reviewers will independently screen the results against the eligibility criteria defined by the population concept and context of this scoping review. A PRISMA-ScR flow diagram will be used to present the number of sources of evidence identified. The two reviewers will extract the data aiming to synthesize the results in appropriate tables. The most relevant details of the post-operative rehabilitation programmes will be presented based on consensus on exercise reporting template checklist. Conclusions: This scoping review can provide critical information regarding the content of the post-operative rehabilitation programmes after shoulder stabilization with a Latarjet procedure in patients with ASI.
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Managing an injured patient who is pregnant can be difficult in the management and investigation of the case especially when the patient presents atypically. We encountered a 25-year-old female patient who sustained a posterior dislocation of the right hip and was pregnant at 12 weeks gestation following a road traffic accident. The patient presented to OPD with an atypical attitude of limb i.e., both hip and knee in flexion without any internal rotation and adduction of the limb following which MRI was done which showed right hip posterior dislocation. Through an interdepartmental, skilful team approach the patient, after taking the obstetrician’s opinion and the patient under short GA, Closed reduction by Rochester method (longitudinal traction and rotation control) was done for the right hip joint without any complication. As pregnant females possess more risk and complication and more challenges are expected in management, Orthopaedic surgeons are well equipped to treat such patients to reduce patient morbidity and mortality resulting in better outcomes.
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Objetivo: Valorar la efectividad de nuevas técnicas como el método de reducción en las luxaciones glenohumerales anteriores. Método: Revisión de la literatura con enfoque descriptivo. Resultados y conclusiones: La revisión literaria establece que existe un nuevo método de reducción en las luxaciones glenohumerales anteriores: la técnica de Prakash. La técnica presenta una buena efectividad, rapidez y de uso fácil, sin que haya complicaciones a posterior. La técnica Prakash es uno de los métodos que se debe usar como principal, antes de emplear los comunes por su nivel de eficiencia. Sin embargo, es necesario hacer hincapié que se necesita de más investigaciones controladas, para que la implementación de dicho método sea validada.
Objective: To assess the effectiveness of new techniques as a reduction method in anterior glenohumeral dislocations. Method: Literature review with descriptive approach. Results and Conclusions: The literature review establishes that there is a new reduction method for anterior glenohumeral dislocations: the Prakash technique. The technique is effective, fast and easy to use, with no subsequent complications. The Prakash technique is one of the methods that should be used as the main one, before using the common ones because of its level of efficiency. However, it is necessary to emphasize that more controlled research is needed for the implementation of this method to be validated.
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BACKGROUND:Reconstruction of the medial patellofemoral ligament is the primary and basic treatment for patellofemoral dislocation.Generally,autologous or allogeneic tendons are used to fix the patellofemoral podogram area and the femoral insertion,respectively.There are various fixation methods.Patellar lateral insertion fixation methods are relatively diverse,mainly traditional transosseous fixation and recent anchoring methods,including single tunnel,double-tunnel transosseous fixation,and two-wire anchor fixation.However,which fixation method is more effective in reducing patellofemoral joint stress and is more biomechanical has not been determined. OBJECTIVE:To observe the mechanical effects of patellofemoral joint and medial patellofemoral ligament reconstruction with transosseous and wire anchor fixation. METHODS:A three-dimensional finite element model of the knee joint was constructed.The medial patellofemoral ligament was reconstructed by a single tunnel through the bony canal or two wire anchors at the medial edge of the patella.The femoral side was fixed by extrusion nails to the medial epicondyle of the femur and the midpoint of the adductor tubercle.We observed the effects of the two fixation methods on patellofemoral joint and medial patellofemoral ligament loading during knee flexion at 0°,30°,60°,90°,and 120°. RESULTS AND CONCLUSION:(1)The stress on the patellofemoral joint was large when the knee was at flexion of 0-60°,peaked at 30°,and gradually decreased at 90° and 120°.The two fixation methods had little difference in the stress on the patellofemoral joint.(2)The stress on the medial patellofemoral ligament peaked at 30° and decreased significantly at 60°,and the load on the medial patellofemoral ligament was significantly greater at all angles with anchor fixation than with bony canal fixation.(3)The results showed that there was no significant difference in patellofemoral joint loading between the two fixation methods,but the stress on the medial patellofemoral ligament in anchoring was significantly greater than that in transosseous fixation.
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BACKGROUND:Orthopedic robots have been widely used in clinical practice,and relevant reports have shown that they have many advantages such as minimal trauma and short surgical time.However,there is currently no clear report on how accurate they are. OBJECTIVE:To evaluate the accuracy of robot-assisted sacroiliac screw insertion. METHODS:A total of 131 patients with sacroiliac joint fracture and dislocation and sacral fracture admitted to the Department of Trauma Surgery,Gansu Provincial Hospital from January 2020 to April 2023 were retrospectively collected,including 131 S1 screws and 46 S2 screws,totaling 177 screws.They were divided into two groups based on whether robot-assisted navigation was performed.There were 63 cases of sacroiliac screws inserted under robot-assisted navigation(observation group),with 36 males and 27 females,aged 19-72 years,with a mean age of(45.3±17.6)years.Among them,39 cases were fixed with only S1 screws,while 24 cases were fixed with S1S2 screws,resulting in a total of 87 sacroiliac screws.Under C-arm fluoroscopy,68 cases of sacroiliac screws were inserted with bare hands(control group),including 41 males and 27 females,aged 23-67 years,with a mean age of(42.6±21.3)years.Among them,46 cases were fixed with simple S1 screws,while 22 cases were fixed with S1S2 screws,resulting in a total of 90 sacroiliac screws.A postoperative CT scan was performed to evaluate the number of S1 screws,S2 screws,total screw level,and calculate accuracy based on the method introduced by SMITH et al. RESULTS AND CONCLUSION:(1)In the observation group,62 S1 screws were accurately placed(62/63),with an accuracy rate of 98%.24 S2 screws were accurately placed(24/24),with an accuracy rate of 100%.The total number of screws accurately placed was 86(86/87),with an accuracy rate of 99%.(2)In the control group,58 S1 screws were accurately inserted(58/68),with an accuracy rate of 85%.19 S2 screws were accurately inserted(19/22),with an accuracy rate of 86%.The total number of screws accurately inserted was 77(77/90),with an accuracy rate of 86%.(3)There was a statistically significant difference in the accuracy of the S1 screw,S2 screw,and total screw between the two groups(P<0.05).It is suggested that the placement of sacroiliac screws under robot navigation has higher accuracy compared to manual placement under C-arm fluoroscopy,but still has a lower error rate in placement.
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BACKGROUND:Atlantoaxial dislocation is often facilitated by interlaminar bone grafting.However,there are relatively few reports on the treatment of complex atlantoaxial dislocation with posterior atlantoaxial lateral mass interarticular release and fusion. OBJECTIVE:To explore the safety and effectiveness of atlantoaxial dislocation treated by simple posterior atlantoaxial lateral block interarticular release and fusion. METHODS:We retrospectively analyzed the clinical data of 30 patients with atlantoaxial dislocation who were treated from January 2017 to July 2021,all of whom suffered from reducible atlantoaxial dislocation.Posterior atlantoaxial lateral mass interarticular release and fusion were performed in all patients.During the surgery,patented instruments were used to release the atlantoaxial lateral mass joint,and posterior screw reduction and fixation were used with bone grafting in the lateral mass joint space.The postoperative follow-up period was 6 to 24 months,mean(13.0±5.4)months.During the follow-up period,cervical MRI was reviewed to observe the decompression of the upper cervical spine.X-ray films and CT scans were reviewed to observe the reduction of the upper cervical spine,as well as the internal fixation for looseness and breakage.CT scans were reviewed to assess interlateral block implant fusion.The Japanese Orthopaedic Association score was used to evaluate the improvement of spinal cord function.The neck disability index and the quality of life scale were used to assess the improvement of daily life function.The atlanto-anterior interspace and atlanto-planar spinal effective space were used to evaluate atlantoaxial repositioning and decompression. RESULTS AND CONCLUSION:(1)The surgery of 30 patients went smoothly,and no serious complications such as spinal nerve and vertebral artery injuries occurred during the operation.Postoperative review of cervical MRI showed that the spinal cord compression was lifted.X-ray film and CT showed that the atlanto-anterior gap was significantly reduced;the effective space of atlantoaxial spinal cord was significantly increased,and neurological dysfunctional symptoms were significantly reduced.(2)During the follow-up period,X-ray film and CT showed that the internal fixation was solid;no broken nails or rods occurred,and there was no recurrence of atlantoaxial dislocation.(3)The Japanese Orthopaedic Association scores,neck disability index,and quality of life scores were significantly improved at the last follow-up compared with the preoperative period(P<0.05).The average improvement rate of Japanese Orthopaedic Association scores at the last follow-up was 73.1%.The average neck disability index was 8.80%.All of the patients had a continuous bone-scalp connection between atlantoaxial lateral block joints to achieve osseous fusion.(4)These findings indicate that the use of simple posterior atlantoaxial lateral block interarticular release and fusion for the treatment of atlantoaxial dislocation can significantly increase the fusion rate and shorten the fusion time.
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BACKGROUND:Atlantoaxial dislocation,because of its high difficulty and high risk of surgery,has been regarded as the"surgical restricted area"by the international orthopedic community.However,with the rapid development of intelligent digitization in orthopedics,robot-assisted navigation screw placement technology has been widely used in clinical practice,which significantly reduces the difficulty and risk of surgery and improves the safety of surgery.However,there are few reports on the application of this technique in the treatment of atlantoaxial dislocation. OBJECTIVE:To explore the application value of robot-assisted pedicle screw internal fixation in the treatment of atlantoaxial dislocation. METHODS:The medical records of five patients with atlantoaxial dislocation treated with C1-C2 pedicle screw fixation under robot-assisted navigation in Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine from October 2021 to July 2022 were retrospectively analyzed.Operation time,length of neck incision,blood loss,postoperative drainage volume,and length of hospital stay were recorded.Attention should be paid to cerebrospinal fluid leakage,vertebral artery injury,nerve injury,operative area infection and other complications.The visual analog scale score of neck pain,the spinal cord injury grade of the American Spinal Injury Association,the cervical spine score of the Japanese Orthopaedic Association,and the imaging indicators were collected before surgery and at the last follow-up.Screw placement accuracy was assessed. RESULTS AND CONCLUSION:(1)Five patients were successfully completed surgery,without vascular,nerve injury or other complications,and were followed up for 12-20 months.(2)A total of 20 cervical pedicle screws were placed in 5 patients,including 9 type A screws,10 type B screws,and 1 type C screw.The accuracy of screw placement was 95%.(3)At the last follow-up,the visual analog scale score was(0.80±0.71)points,which was significantly lower than that before operation(4.00±2.83)points;the Japanese Orthopaedic Association score was(14.80±0.84)points,which was significantly higher than that before operation(8.00±0.71)points.Anterior atlantodental interval decreased from(7.86±3.25)mm to(2.82±0.93)mm;space available of the spinal cord increased from(6.74±1.99)mm to(12.10±3.51)mm;cervicomedullary angle increased from(133.32±13.55)° to(153.44±9.53)°;clivus-canal angle increased from(128.02±9.92)° to(143.25±12.99)°.The results of the last follow-up indexes were improved compared with those before operation,and the differences were significant(all P<0.05).(4)Postoperative imaging follow-up showed that all patients had bone fusion in the bone graft area,and no internal fixation loosening,fracture or pull-out occurred.(5)This method can avoid relying on the doctor's experience and hand feeling,ensure the accuracy of upper cervical screw placement,reduce the risk of surgery,and obtain satisfactory results in mid-term follow-up.
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A 50-year-old female presented with bilateral cervical arteriosclerosis and right-sided plaque formation,after 25 d of treatment with rosuvastatin calcium tablets(20 mg,po,qn),the patient developed temporomandibular joint dislocation,the adverse reactions occurred again after giving manipulative repositioning.The patients were healthy,had no history of trauma and related diseases in stomatology,no history of drug allergy,patients did not open their mouth loudly at the onset of the disease,no external factors affecting the use of drugs during the combined use of other drugs.It was considered"very likely"that the dislocation of the jaw joint was caused by rosuvastatin calcium tablets.The patients were followed up for 3 months after the treatment of manipulative repositioning and other treatments,did not have any further dislocation of the temporomandibular joint dislocation.It is suggested that when using rosuvastatin calcium in clinical practice,attention should be paid to strengthening drug observation to ensure drug safety.
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Injury of the posterior pelvic ring can easily be caused by high-energy impact,and sacroiliac joint dislocation is the most common.The sacroiliac joint,as the hub of load transfer between the trunk and lower extremities,is essential to maintain the stability of the posterior pelvic ring,and once dislocation occurs,restoring the stability of the posterior pelvic ring by timely surgery is necessary.The current surgical approaches for the internal fixation of sacroiliac joint are mainly divided into anterior approach and posterior approach.The choice of the surgical approach directly affects the exposure of the surgical field,the stability of internal fixation and the prognosis of patients;therefore,it is particularly important to select the appropriate surgical approach and fixation method.In this paper,we briefly review the selection of sacroiliac joint fixation points,surgical approaches and postoperative complications.
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Objective To explore the method and the clinical effect of minimally invasive treating ac-romioclavicular joint dislocation by modified technique bare-handed Tight Rope.Methods A retrospec-tive analysis was performed on 61 cases of acromioclavicular joint dislocation(35 males and 26 fe-males,aged 45.6±5.2 years),treated with minimally invasive internal fixation by modified technique bare-handed Tight Rope between June 2018 and November 2021 in our hospital.According to Tossy classification,21 of them were Tossy Ⅱ and 40 were Tossy Ⅲ.The clinical effect was evaluated by Karlsson criteria,and the shoulder function was assessed by using the Oxford shoulder joint and Con-stant-Murley scores.Results All patients were followed up 9~12 months(11.2 months on the average).Sixty of them were restored without re-dislocation,reaching 60 of excellence and an excellence rate of 98.36%.At the last follow-up,the Constant-Murley and Oxford shoulder joint scores were 95.65±2.32 and 12.92±0.81,both significantly better than before surgery(P<0.01),with the satisfaction rate of 96.74%.Conclusion The treatment of acromioclavicular joint dislocation with modified technique bare-handed Tight Rope is minimally invasive,stable,not easy to relocate,and friendly to acromiocla-vicular joint and subacromial structure.Moreover,the shoulder joint function is well-recovered after the surgery with satisfactory effect.
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Acromioclavicular joint dislocation is a common shoulder injury caused by injuries to the acromioclavicular and coracoclavicular ligaments, which may result in pain and limited mobility in the affected shoulder. Currently, hook plate fixation is commonly used to treat Rockwood type III-VI acromioclavicular joint dislocation in clinical settings. However, there are complications such as subacromial impingement and osteolysis. Therefore, the treatment has gradually shifted from rigid fixation to elastic fixation, with a preference for reconstruction of the coracoclavicular ligament. The internal fixation with the Endobutton system allows for micro-movement of the acromioclavicular joint, but its loop length can′t be freely adjusted. The Tightrope system is developed based on the improvement of the Endobutton system, which has been increasingly used in clinical settings in recent years, with the advantages of easy operation, adjustability and minimal trauma. However, postoperative complications such as clavicular and/or coracoid fractures and loss of reduction are prone to occur. To date, there are various and inconsistent treatment plans of internal fixation with Tightrope system for acromioclavicular joint dislocation, and their clinical effects vary. To this end, the authors reviewed the structure, biomechanics, surgical techniques, and therapeutic effects of the internal fixation with Tightrope system in the treatment of acromioclavicular joint dislocation, aiming to provide a reference for the selection of its clinical treatment.
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Objective:To investigate the efficacy of robot-assisted femoral tunnel localization in reconstruction of the medial patellofemoral ligament (MPFL).Methods:A retrospective study was conducted to analyze the 36 patients who had been admitted to Department of Sports Medicine, The Fourth Hospital of Wuhan between January 2019 and January 2022 due to recurrent patellar dislocation. There were 15 males and 21 females; age: 23.5 (18.3, 29.0) years; number of dislocations: 2.5 (2.0, 3.0). They were stratified into 2 cohorts based on utilization of robot-assistance. In the observation group (17 cases), the femoral tunnel localization was robot-assisted in MPFL reconstruction; in the control group (19 cases), the femoral tunnel localization was guided by C-arm fluoroscopy in MPFL reconstruction. The 2 groups were compared in terms of operation time, frequency of guide wire placement, visual analogue scale (VAS) at postoperative 1 d, patellar tilt angle (PTA) and the disparity between actual femoral tunnel insertion and ideal tunnel insertion point (Sch?ttle point) at postoperative 1 to 3 d, and Lysholm knee score and International Knee Documentation Committee (IKDC) score at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). All patients were followed up for 12.0 (10.3, 13.0) months. In the observation group, the operation time [(64.1±16.7) min], frequency of guide wire placement [1.0 (1.0, 2.0) times], VAS [2.5 (2.0, 3.0) points], and disparity between actual femoral tunnel insertion and ideal tunnel insertion point [(4.7±1.2) mm] were significantly better than those in the control group [(84.2±19.7) min, 3.0 (2.0, 4.0) times, 3.5 (3.0, 4.0) points, and (6.1±1.2) mm] ( P<0.05). There was no statistical difference between the 2 groups in PTA, Lysholm knee score or IKDC score ( P>0.05). Conclusions:The short-term clinical efficacy of robot-assisted femoral tunnel localization is satisfactory in MPFL reconstruction. Compared with the intraoperative C-arm fluoroscopy, robot-assisted localization can decrease the frequency of guide wire placement, enhance femoral tunnel accuracy and efficiency, and alleviate more postoperative pain for the patients.
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Objective:To systematically investigate the short-term efficacy of total knee arthroplasty in the treatment of osteoarthritis coupled with fixed patellar dislocation.Methods:A retrospective analysis was conducted on a cohort of 11 patients diagnosed with knee osteoarthritis and fixed patellar dislocation who underwent total knee arthroplasty at Panzhihua Central Hospital from January 2018 to October 2021. The cohort comprised 4 males and 7 females, aged 63.45±4.76 years (range, 56-70 years), all of whom underwent unilateral surgery. There were 5 left and 6 right knees, with a body mass index of 23.20±2.02 kg/m 2 (range, 20.8-27.6 kg/m 2) and a disease course of 12.63±4.81 years. According to the American Society of Anesthesiologists classification, 9 cases were categorized as grade II, and 2 cases as grade III. Recovery of patellar trajectory during total knee arthroplasty, using medial synovial flap transposition to repair lateral joint capsule. Preoperative and postoperative assessments included knee joint range of motion, Knee Society score (KSS), University of California Los Angeles (UCLA) score, and visual analogue scale (VAS). Results:All 11 patients were followed up for a period of 28.64±4.01 months (range, 24-36 months). Two patients exhibited subcutaneous fat liquefaction locally after surgery, which resolved following dressing changes. All wounds achieved primary healing. Two of them developed intramuscular vein thrombosis after surgery and were cured after anticoagulant treatment. The range of motion of the knee joint increased from 63.18°±17.07° before surgery to 104.55°±16.80° at the last follow-up, with a statistically significant difference ( t=14.041, P<0.001). The KSS score increased from 38.00±6.78 points to 80.91±5.65 points, with a statistically significant difference ( t=16.472, P<0.001). The UCLA score increased from 3.18±1.17 to 6.73±1.35, with a statistically significant difference ( t=9.694, P<0.001). The VAS decreased from 6.09±0.94 points to 2.32±0.64 points, with a statistically significant difference ( t=16.600, P<0.001). At the last follow-up, imaging examinations showed no cases of patellar subluxation or dislocation, no tearing or breakage of the knee extension device, and no infection or loosening around the prosthesis. Conclusion:Utilizing medial synovial flap transposition for repairing the lateral joint capsule proves to be an effective technique for key capsule repair. Total knee arthroplasty for osteoarthritis combined with fixed patellar dislocation demonstrates satisfactory early clinical outcomes.
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Objective:To assess the effectiveness and postoperative stability of proximal femoral varus derotational osteotomy combined with modified triple innominate osteotomy in treating hip dislocation in cerebral palsy.Methods:A total of 28 hips (11 left, 17 right) from 23 patients with cerebral palsy-induced hip dislocation who underwent the said surgical procedures were retrospectively examined between November 2018 and September 2022. The median age at the time of surgery was 7.7 years. Preoperatively, 29% of hips exhibited pain. Intraoperatively, a three-dimensional subtrochanteric osteotomy was performed with internal fixation using a Pediatric Hip Plate, alongside a modified triple innominate osteotomy via the Smith-Petersen and perineal approaches. Clinical assessments included pre- and postoperative evaluations of hip pain and joint mobility, as well as imaging evaluations, including migration percentage, acetabular index, acetabular offset, neck shaft angle, and femoral neck anteversion.Results:With a median follow-up of 15 months (range: 12 months to 20 months), all patients were successfully monitored. The median surgery duration was 6.1 hours, with blood loss averaging 400±153 ml (range 200-800 ml). The difference between the median postoperative (1 week after operative) MP 0% (0%, 0%) and the median preoperative MP 50.5% (38.2%, 75.8%) was statistically significant ( Z=4.624, P<0.001). The difference between the median postoperative AI 1.0° (-3.3°, 11.8°) and the median preoperative AI 29.4° (26.3°, 38.0°) was statistically significant ( Z=4.623, P<0.001). The difference between the median postoperative AO 69.8 (66.0, 76.0) mm and the median preoperative AO 72.3 (69.1, 81.1) mm was statistically significant ( Z=4.099, P<0.001). The difference between the median postoperative NSA 124.3° (118.7°, 129.9°) and the median preoperative NSA 145.6° (139.6°, 153.5°) was statistically significant ( Z=4.541, P<0.001). The difference between the median postoperative FNA 13.0° (5.4°, 24.1°) and the median preoperative FNA 33.6° (27.8°, 39.8°) was statistically significant ( Z=4.407, P<0.001). The pain was relieved postoperatively in 7 hips (88%) and residual hip pain in 1 hip. The postoperative range of motion was preserved. No case of avascular necrosis of the femoral head was observed. There were 2 hips (7%) with nonunion in the iliac arcuate line. No case of redislocation was observed at the last follow-up, and no revision was performed recently. There was no significant difference between the median MP at the last follow-up of 0% (0%, 10.0%) and the median postoperative MP ( Z=0.561, P=0.575). Conclusion:The modified triple innominate osteotomy proved to be an effective intervention for correcting acetabular deformity in cerebral palsy-induced hip dislocation. The combination of proximal femoral varus derotational osteotomy with the modified triple approach not only significantly corrected hip dislocation but also alleviated pain and maintained joint mobility in pediatric patients with cerebral palsy.