Acute Traumatic Swan Neck Deformity: A Case Report of the Oblique Retinacular Ligament Lesion.

Swan neck deformity (SND) can be the manifestation of an acute trauma. We present a case report of a young basketball player with an acute traumatic SND determined by the single ulnar oblique retinacular ligament rupture. The patient caught a ball directly upon the tip of his right's hand middle finger into extension. He immediately presented a SND with impossibility to actively flex the proximal interphalangeal joint (PIPJ), while preserving active flexion and extension of the distal interphalangeal joint (DIPJ). Hyperextension of PIPJ was reducible with passive mobilization, thus allowing full passive range of motion. The SND was seen to be caused by the lesion of the ulnar oblique retinacular ligament (ORL) on its distal insertion, with consequent dorsomedial migration of the ulnar lateral band. The early surgical distal reinsertion of the ORL allowed the restoration of the original kinematics of the finger flexion-extension.

A new patellofemoral scoring system for total knee arthroplasty.

Patellofemoral complications after total knee arthroplasty (TKA) can result in substantial dissatisfaction with the procedure for some patients. In assessing outcomes of TKA, however, there is often a discrepancy between patellofemoral symptoms and the results obtained by conventional scoring and radiographic analysis. We asked whether a new scoring system and weightbearing radiographic view would more accurately represent patellofemoral kinematics and explain related complications. Sixty-nine patients (100 knees) who underwent posterior-stabilized TKA between 1994 and 1997 were included for clinical and radiographic evaluation. A new patella score was developed to rapidly determine complications, ranged from 0 to 100 points, and included ratings for subjective and objective aspects of TKA. A new weight-bearing axial radiographic view was devised by positioning the standing patient in a semisquatted position. Measurements for patella alignment (tilt and subluxation) were performed. Preoperative Knee Society knee and function scores were 43 +/- 5 points, and 39 +/- 15 points, respectively. Postoperatively, scores increased to 93 +/- 8 and 89 +/- 8 points, respectively. The patella score averaged 89 +/- 8 points and showed satisfactory interobserver variability. The new weightbearing radiographic view demonstrated sources of patellofemoral symptoms. We report a new scoring system and weightbearing view that are easy to use and more accurately represent patellofemoral kinematics than do conventional methods of analysis.