Dorsal Radiocarpal Dislocation with Radial Styloid Fracture Treated with Arthroscopy-Assisted Reduction and Internal Fixation: A Report of Two Cases.

Radiocarpal dislocation is an uncommon injury that is usually caused by high-energy trauma. Herein, we present two cases of dorsal radiocarpal dislocation with radial styloid fractures that were treated by arthroscopy-assisted reduction and internal fixation. Wrist arthroscopy provides accurate information on intra-articular fractures and carpal and/or intracarpal ligamentous tears of the radiocarpal joint. Furthermore, the procedure enables simultaneous anatomical reduction of intra-articular fractures and radiocarpal and/or intercarpal ligament repair. Arthroscopy-assisted reduction and internal fixation yield satisfactory outcomes for patients presenting with dorsal radiocarpal dislocation and radial styloid fractures.

First Metatarsal Headphones-Like Lesion: A Case of Unreducible Sesamoid Complex Dislocation.

CASE: A 34-year-old woman sustained a direct trauma to the left hallux during a fall. Radiographs showed a dorsal dislocation of the first metatarsophalangeal joint and a wide separation of sesamoid complex. Closed reduction was tried: postreduction radiographs displayed reduction of first metatarsophalangeal joint and a complete sesamoid complex dislocation. The patient was scheduled for surgery. Through a medial approach, open reduction together with plantar structures release and repair were performed. Functional and radiographic outcomes were satisfactory at the last follow-up. CONCLUSION: In case of a "headphones-like lesion" surgery is required, together with plantar structures repair.

Rearfoot and Ankle Dislocations.

Subtalar dislocations, ankle dislocations, and total talar dislocations are high-energy injuries. As such, there may be associated osseous or soft tissue injuries that can be diagnosed with advanced imaging such as computed tomography (CT) or MRI. With closed injuries, closed reduction may require sedation or general anesthesia, flexion of the knee to release the tension of the gastrocnemius-soleus complex, distraction is applied, the deformity is accentuated, then the deformity is corrected. Open injuries are usually associated with a higher level of energy and a higher rate of infection. It is important to thoroughly irrigate and debride open dislocations both before and after reduction.

Successful recovery from cardiac arrest due to atlantoaxial subluxation in Down syndrome: a case report.

INTRODUCTION: Down syndrome is the most common chromosomal abnormality associated with intellectual impairments. Unexpected deaths are common with this disease. There are certain difficulties in clarifying the cause of death because the manifestations may be quite diverse and involve many organ systems. Atlantoaxial subluxation is a dangerous complication of Down syndrome, as it may lead to cervical cord-medullary compression. CASE PRESENTATION: Herein, we present a case of Down syndrome in a patient who completely recovered from cardiac arrest due to atlantoaxial subluxation. The neck was immobilized during post-cardiac arrest care, and the patient underwent surgery after 14 days. The patient could walk independently and was discharged 3 months later. At the last follow-up 5 years after surgery, the patient's general condition was good. DISCUSSION: Physicians should be aware that atlantoaxial instability can cause cardiac arrest in patients with genetic syndromes.

Conservative treatment of congenital radial head subluxation and non-traumatic elbow locking: A case report.

Congenital radial head subluxation is relatively rare and may be overlooked due to mild symptoms. The diagnosis mainly relies on imaging and history. Observation is an option for those with insignificant symptoms, while surgical intervention, such as ulnar osteotomy or arthroscopy, is often required when dysfunction exists. A 30-year-old man was admitted with congenital radial head dislocation, which was treated with manipulative repositioning. During follow-up, the patient regained the original mobility of the elbow joint and had no recurrence of dislocation. In conclusion, in adults with congenital dislocation of the radial head, we recommend conservative treatment as a first step.

Weight-bearing Ultrasound to Diagnose Talar Dislocation Causing Tarsal Tunnel Syndrome.

The neuropathic compression of the tibial nerve and/or its branches on the medial side of the ankle is called tarsal tunnel syndrome (TTS). Patients with TTS presents pain, paresthesia, hypoesthesia, hyperesthesia, muscle cramps or numbness which affects the sole of the foot, the heel, or both. The clinical diagnosis is challenging because of the fairly non-specific and several symptomatology. We demonstrate a case of TTS caused by medial dislocation of the talar bone on the calcaneus bone impacting the tibial nerve diagnosed only by ultrasound with the patient in the standing position.

Ensemble detection of hand joint ankylosis and subluxation in radiographic images using deep neural networks.

The modified total Sharp score (mTSS) is often used as an evaluation index for joint destruction caused by rheumatoid arthritis. In this study, special findings (ankylosis, subluxation, and dislocation) are detected to estimate the efficacy of mTSS by using deep neural networks (DNNs). The proposed method detects and classifies finger joint regions using an ensemble mechanism. This integrates multiple DNN detection models, specifically single shot multibox detectors, using different training data for each special finding. For the learning phase, we prepared a total of 260 hand X-ray images, in which proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints were annotated with mTSS by skilled rheumatologists and radiologists. We evaluated our model using five-fold cross-validation. The proposed model produced a higher detection accuracy, recall, precision, specificity, F-value, and intersection over union than individual detection models for both ankylosis and subluxation detection, with a detection rate above 99.8% for the MP and PIP joint regions. Our future research will aim at the development of an automatic diagnosis system that uses the proposed mTSS model to estimate the erosion and joint space narrowing score.

Association Between Articular Eminence Structure and Joint Spaces in Temporomandibular Joints with Anterior Disc Displacement.

BACKGROUND AND AIMS: The association among the joint spaces, articular eminence morphology, and disc displacement is not well documented in the literature. This study aims to evaluate and compare the joint spaces and the articular eminence structure (eminence height [Eh] and inclination [Ei]) using cone-beam computed tomography (CBCT) of temporomandibular joints (TMJs) with anterior disc displacements and joints with normal disc position. METHODS: The study groups consisted of 75 TMJs of 39 patients. The disc status of TMJs was diagnosed with magnetic resonance imaging, and the measurements were performed on CBCT. Three groups, that is, normal disc position (NDP) group, anterior disc displacement with reduction (ADDWR) group, and anterior disc displacement without reduction (ADDWoR) group, were established. Anterior, superior, posterior joint spaces (AJS, SJS, and PJS, respectively), articular Eh, and articular Ei were measured. Statistical Package for the Social Sciences version 22 was used for statistical analysis. Shapiro-Wilk test was used to check the normality of data. Intergroup comparisons of categorical variables were assessed with Fisher-Freeman-Halton test. For comparison of continuous variables parameters, Mann-Whitney U test and Kruskal-Wallis test were used. Statistical significance level was determined as P < 0.05. RESULTS: Significant differences were not found in intergroup comparisons for PJS. However, the difference between groups was found to be significant for AJS, SJS, Eh, and Ei. Intergroup comparisons were performed for these parameters. No significant difference was found between the NDP group and the ADDWR group for AJS, SJS, Eh, and EI. The mean AJS, SJS, Eh, and Ei values in ADDWoR were found to be significantly lower compared to the corresponding values in both NDP and ADDWR groups. CONCLUSION: Decreased AJS and SJS when TMJ is evaluated with CBCT may be an indicator of ADDWoR. Authors suggest that narrowed articular Ei and reduced articular Eh can be one of the predisposing factors for anterior disc displacement.

Comparison of Clinical Efficacy between Arthroscopic and Open Surgery for Ogden Type 1-2 Peroneal Tendon Dislocation.

OBJECTIVE: While the incidence of peroneal tendon dislocation (PTD) is relatively low, it is frequently underdiagnosed in clinical practice, and the misdiagnosis or improper treatment of this condition may lead to a decline in patients' quality of life. Currently, the surgical treatment options for PTD mainly include open and arthroscopic surgery. However, in order to evaluate the advantages and disadvantages of these two surgical approaches, further comparative research is needed. Therefore, the aim of this study is to investigate the early clinical outcomes of arthroscopic and open surgery in the treatment of Ogden type 1-2 PTD. METHODS: We conducted a comprehensive analysis of 46 patients diagnosed with PTD who underwent surgery at our institution between January 2017 and January 2023. The patients were divided into two groups: the open surgery group, consisting of 26 cases, and the arthroscopic surgery group, consisting of 20 cases. To compare the effectiveness of the surgical approach, we evaluated several parameters, including the integrity of the superior peroneal retinaculum on MRI images, functional scores, pain interference scores, and ankle eversion muscle strength. These assessments are conducted respectively before the surgery, 1 month after the surgery, 3 months after the surgery, and at the final follow-up for each group of patients (at least 6 months post-surgery). Demographics and intergroup comparisons of the two groups of data were analyzed by t-test or the Mann-Whitney U test. Intragroup comparisons of the two groups of data were analyzed by one-way analysis of variance (ANOVA) or the Kruskal-Wallis test, followed by post hoc multiple comparisons. RESULTS: In the intragroup comparisons, both the arthroscopic surgery and the open surgery group demonstrated significant improvement in functional scores, pain interference scores, muscle strength, and MRI findings at the final follow-up postoperatively (p < 0.01). However, the open surgery group exhibited significant improvements in these outcomes at the final follow-up, while the arthroscopic surgery group showed significant improvement at 3 months postoperatively. In intergroup comparisons, the arthroscopic surgery group outperformed the open surgery group in functional scores, pain interference scores, and muscle strength 3 months after the surgery, with statistically significant differences (p < 0.01). CONCLUSION: Arthroscopic surgery offers advantages in early clinical outcomes, such as pain relief, function, and muscle strength improvement. However, over time, both approaches provide similar results regarding effectiveness.

The utilization of decision trees on orthopantomographic and lateral panoramic graphs for the diagnosis of unilateral anterior disc displacement of the temporomandibular joint.

BACKGROUND: Investigation is to utilize decision trees in conjunction with orthopantomography (OPT) and lateral panoramic graphy (LPG) to diagnose unilateral anterior disc displacement (ADD) of the temporomandibular joint. METHODS: In this study, 161 patients with images obtained through all three imaging methods, MRI, OPT, and LPG, were selected from the archives. The participants were categorized into two groups: the study group, comprising 89 patients with unilateral anterior disc displacement, and the control group, consisting of 72 healthy individuals. Measurements, including 2 angles (antero-posterior angle and superior-inferior angle) and 3 distance parameters (anterior joint space distance, superior joint space distance, and posterior joint space distance), were conducted on each imaging modality dataset. To assess the obtained measurement data within each patient, the differences from each measurement were calculated. Statistical analysis of the measurement differences between the control and study groups was carried out with independent t test, and decision trees were generated using the SPSS 25 decision tree module 5.0. RESULTS: In ADD patients, it was statistically significantly found that the APA increased while the SIA decreased for angle measurements. But for linear measurements, AS increased while the SS and PS decreased in MRI, OPT, and LPG. CONCLUSION: ADD can be diagnosed in OPT and LPG. The identification of the specific type of ADD that occurs in the temporomandibular joint is not feasible.

Clinical Features and Classification of Proximal Carpal Fracture Dislocation Through the Radiocarpal Joint.

Background: The most common types of wrist dislocation are trans-scaphoid lunate dislocation (TLD) and trans-scaphoid perilunate dislocation, in which the lunate and proximal scaphoid are dislocated through the midcarpal joint. There is another rare type of dislocation in which the proximal carpi are dislocated through the radiocarpal joint. The purpose of this study is to examine the clinical features of this type of dislocation. Methods: Six cases of the proximal carpal fracture dislocation via the radiocarpal joint were retrospectively reviewed. All patients underwent open reduction and internal fixation with the ligament reconstruction. A Mayo wrist score was assigned to each patient based on the assessment of pain, functional status, range of motion and grip strength at the last follow-up. Clinical subjective evaluation of function and pain was assessed using the patient-rated wrist evaluation (PRWE) method. Results: All patients were male and injured with a median age of 33.5 years. The median follow-up period was 10 months. There were three types of dislocations: Scaphoid fracture dislocation, TLD and scaphoid-lunate dislocation. All patients had satisfactory results with an average PRWE of 7.2 ± 4.7. The preoperative VAS was 6.7 ± 1.0 and the postoperative VAS was 0.7 ± 0.7 (p < 0.01). Postoperative grip strength accounted for 89.2% ± 9.8% of the contralateral side; the Mayo wrist score averaged 90.0 ± 6.5, with four patients obtaining excellent and two good results. Conclusions: Fracture dislocation of the proximal carpal bones through the radiocarpal joint is an independent type of wrist dislocation that tends to occur in young men with high-energy impact. The wrist is most often injured in a pronation hyperextension position. If treatment is timely and appropriate, the prognosis is quite good. Level of Evidence: Level IV (Therapeutic).

Axial-Radial-Ulnar Carpal Dislocation with Divergent Intermetacarpal Dislocations, Peritrapezoid and Scaphotrapezial Dislocations: A Case Report.

We report a patient with a severe axial-radial-ulnar (ARU) fracture dislocation of the carpus, involving multiple intermetacarpal dislocations as well as divergent carpometacarpal dislocations involving the index, long, ring and small fingers and peritrapezoid and scaphotrapezial dislocations. She also had a degloving injury involving the dorsal hand. Emergent debridement followed by open reduction and internal fixation of all injuries was performed, followed by soft tissue management. At 6-year follow-up, the patient had adequate active range of motion with the ability to make a full fist and was able to use her wrist and hand for most activities of daily living. Disabilities of the arm, shoulder and hand (DASH) score was 47.5. Michigan hand outcomes questionnaire (MHQ) score was 66.8. Mayo wrist score was 65. Patient-rated wrist evaluation (PRWE) score was 42. Severe ARU fracture dislocations of the carpus can result in adequate functional recovery on long-term follow-up. Level of Evidence: Level V (Therapeutic).

Corrective Osteotomy and Ligamentous Reconstruction in a Neglected Elbow Dislocation with Radial Neck Malunion: A Case Report.

CASE: Neglected elbow dislocation and radial neck malunion frequently result in chronic pain, instability, and early arthrosis. These complications are best prevented by early treatment with open reduction, corrective osteotomy, and ligament reconstruction, followed by early supervised physiotherapy. We present a peculiar case with neglected complex elbow dislocation and radial head malunion. In this case, we performed an open reduction of the elbow joint and radial neck corrective osteotomy, medial collateral ligament, annular ligament reconstruction, and lateral collateral ligament repair. CONCLUSION: Neglected complex elbow dislocations require reconstruction of both ligamentous and osseous structures to achieve a good functional outcome.

Primary total talus arthroplasty for Hawkins type IV talar neck fracture dislocation.

A woman in her 40s was involved in a motor vehicle collision and sustained a closed Hawkins type IV talar neck fracture dislocation. The injury was treated with reduction, percutaneous pinning and spanning external fixation, followed by definitive treatment with total talus arthroplasty (TTA) 2 months following injury. This is a unique example of definitive management for a severe talar neck fracture dislocation with arthroplasty in the subacute setting. TTA is perhaps a primary option for these injuries at high risk for avascular necrosis, non-union, malunion and post-traumatic arthritis.

Clinical characteristics of upper cervical spine injuries in children: a retrospective case series.

OBJECTIVE: Pediatric cervical spine injuries (CSI) can be devastating, and children < 8 years are particularly at risk for upper CSI given unique anatomical differences. Diagnosis of these injuries can be delayed due to variable clinical presentations and a paucity of existing literature. The authors aimed to characterize the spectrum of pediatric upper CSI. METHODS: This was a retrospective, single-center case series of trauma patients aged < 16 years who were assessed at a level I pediatric trauma center and diagnosed with upper CSI between 2000 and 2020. Patients were included if they had evidence of bony or ligamentous injury from the occiput to C2 on imaging or autopsy. Data were obtained from manual chart review and analyzed using descriptive statistics. RESULTS: In total, 502 patients were screened and 202 met inclusion criteria. Of these, 31 (15%) had atlanto-occipital (AO) joint distractions, 10 (5%) had atlanto-axial (AA) joint distractions, 31 (15%) had fractures of C1-2, and 130 (64%) had ligamentous injury without joint distraction. Of the patients with AO injury, 15 patients had complete dislocation. They presented as hemodynamically unstable with signs of herniation and 14 died (93%). In contrast, 16 had incomplete dislocation (subluxation). They usually had stable presentations and survived with good outcomes. Of the patients with AA injury, 2 had complete dislocation, presented with arrest and signs of herniation, and died. In contrast, 8 patients with subluxation mostly presented as clinically stable and all survived with little residual disability. The most common fractures of C1 were linear fractures of the lateral masses and of the anterior and posterior arches. The most common fractures of C2 were synchondrosis, hangman, and odontoid fractures. Overall, these patients had excellent outcomes. Ligamentous injuries frequently accompanied other brain or spine injuries. When these injuries were isolated, patients recovered well. CONCLUSIONS: Among upper CSI, AO and AA joint injuries emerged as particularly severe with high mortality rates. Both could be divided into complete dislocations or incomplete subluxations, with clear clinical differences and the former presenting with much more severe injuries. Lateral cervical spine radiography should be considered during resuscitation of unstable trauma patients to assess for these CSI subtypes. Fractures and ligamentous injuries were clinically heterogeneous, with presentations and outcomes depending on severity and associated injuries.

Type I atlanto-occipital dislocation complicated by non-communicating hydrocephalus – A case report

Hydrocephalus, an extremely rare complication of craniocervical junction injuries, is postulated to result from compression of the fourth ventricular cerebrospinal fluid (CSF) outlets by fractured and displaced bone fragments, a swollen upper spinal cord or adhesions formed after a traumatic subarachnoid haemorrhage. We present the case of a 21-year-old woman for whom an injury to the cervical spine complicated by a type I atlanto-occipital dislocation contributed to the development of non-communicating hydrocephalus. The hydrocephalus was probably a consequence of impaired CSF circulation at the fourth ventricular outlets (the foramina of Luschka and Magendie), caused by post-haemorrhagic adhesions formed after severe injury to the craniocervical junction. (AU)

La hidrocefalia, una complicación extremadamente rara de las lesiones de la unión craneocervical se considera resultado del bloqueo de las salidas del líquido cefalorraquídeo (LCR) del cuarto ventrículo por los fragmentos óseos fracturados y desplazados, la inflamación de la médula espinal superior o las adherencias formadas después de una hemorragia subaracnoidea traumática. Se reporta caso clínico de una mujer de 21 años en el que la lesión de la columna cervical complicada por una luxación atlanto-occipital de tipo I contribuyó al desarrollo de una hidrocefalia no comunicante. La hidrocefalia probablemente fue consecuencia de una obstrucción del flujo del LCR fuera del cuarto ventrículo (agujeros de Luschka y Magendie), debida a las adherencias post-hemorrágicas formadas después de la grave lesión de la unión craneocervical. (AU)

C1–C2 intraarticular distraction with anterior cervical cages for basilar invagination realignment: Operative technique nuances and review of literature

Neurosurgical management of basilar invagination (BI) has traditionally been aimed at direct cervicomedullary decompression through transoral dens resection or suboccipital decompression with supplemental instrumented fixation. Dr. Goel introduced chronic atlantoaxial dislocation (AAD) as the etiology in most cases of BI and described a technique for distracting the C1–C2 joint with interfacet spacers to achieve reduction and anatomic realignment. We present our modification to Goel’s surgical technique, in which we utilize anterior cervical discectomy (ACD) cages as C1–C2 interfacet implants. A young adult male presented to our institution with BI, cervicomedullary compression, occipitalization of C1, and Chiari 1 malformation. There was AAD of C1 over the C2 lateral masses. This reduced some with preoperative traction. He underwent successful C1–C2 interfacet joint reduction and arthrodesis with anterior cervical discectomy (ACD) cages and concomittant occiput to C2 instrumented fusion. BI can be effectively treated through reduction of AAD and by utilizing ACD cages as interfacet spacers. (AU)

El tratamiento neuroquirúrgico tradicional para la impresión basilar es principalmente a través de un abordaje trans-oral para la resección del proceso odontoide, seguido de una descompresión suboccipital con instrumentación posterior cervical. Dr. Goel presenta la dislocación atlanto-axial (AA) como una de las etiologías principales en los casos de impresión basilar. A su vez, describió la técnica quirúrgica que incluye la distracción de la articulación AA con cajas para fusión permitiendo la reducción y reajuste anatómico cervical. En este artículo presentamos una variación a la técnica quirúrgica del Dr. Goel en el cual utilizamos implantes utilizados en la discectomía y fusión cervical anterior (DFCA) para la articulación facetaria de C1–C2. Presentamos un paciente adulto masculino que evaluamos en nuestra institución con impresión basilar, compresión cérvico-medular, fusión occipital con el atlas y malformación de Chiari tipo 1. En adición, el paciente tenía evidencia radiográfica de dislocación AA. Se logro obtener reducción mínima de la impresión basilar con tracción cervical pre-operatoria. Luego, se sometió al tratamiento quirúrgico que consistió en el uso de implantes cervicales para la reducción y fusión de la articulación facetaria de C1–C2 complementado por instrumentación y fusión craneocervical. Esta técnica presentada sugiere que la reducción y reajuste anatómico cervical de la dislocación AA con implantes utilizados para DFCA puede ser efectivo para el tratamiento de impresión basilar. (AU)

The Application of Sesamoid Position in Diagnosing Thumb Metacarpophalangeal Joint Dorsal Dislocation: A Retrospective Study.

OBJECTIVES: The position of sesamoid of thumb metacarpophalangeal (MCP) joint changed clearly when the joint was dislocated dorsally. However, the significance of sesamoid location in diagnosing joint dislocation was unclear. The present study aimed to explore the positional relationship between sesamoid bone and thumb metacarpophalangeal joint in normal and dorsal dislocation joints. METHODS: Between January 2018 and August 2023, we collected 60 isometric plain films from sixty outpatients and reviewed 56 anisometric plain films from twenty-eight emergency patients with dorsal dislocation of thumb MCP joint at Tianjin Hospital, then took measurements on the hand X-ray images. The sesamoid length on its longitudinal axis was defined as DP, the distance between the distal edge of sesamoid and thumb MCP joint was defined as DJ, and the ratio of DJ and DP was R. An independent-samples t-test and paired-samples t-test was utilized to analyze difference among data groups. RESULTS: The 60 isometric images were from 30 male and 30 female outpatients with normal bone structure in their hands, and the 56 anisometric images of the 28 emergency patients included both preoperative and postoperative materials. Among the outpatients, the actual distance between the distal edge of sesamoid and thumb MCP joint space (DJ) was 2.09 mm and 1.40 mm in males and females, respectively. The authentic average length of sesamoid (DP) was 4.46 mm in males and 4.22 mm in females. The average value of R (the ratio of DJ and DP) in males and females was 0.49 and 0.34, respectively. There were gender-related statistical differences in DJ (p < 0.01) and R (p=0.01), but no statistical difference in DP (p > 0.05). For the 28 emergency patients, the mean value of R was -0.47 before joint reduction and 0.58 after joint reduction, with statistical difference between them (p < 0.01). CONCLUSIONS: There was significant difference in the relative position between sesamoid and thumb MCP joint when joint dislocation and joint reduction. The distal edge of sesamoid beyond thumb MCP joint could be an evidence in diagnosing joint dorsal dislocation. The distal edge of sesamoid below thumb MCP joint could be an evidence of joint reduction.

Technical note: Traumatic atlanto-occipital dislocation and severe subaxial cervical distraction injury in an infant.

INTRODUCTION: Traumatic injuries of the spine requiring surgery are rare in infancy. Fusion procedures in the very young are not well-described at the atlanto-occipital junction or subaxial spine. Here we describe novel segmental posterior instrumentation in a severe spinal column disruption in an infant. CASE PRESENTATION: A 13-month-old male with atlanto-occipital dislocation and severe C6-7 distraction (ASIA impairment scale A) presented after a motor vehicle accident. He underwent instrumented fusion (occiput-C2 and C6-7) and halo placement. Postoperative imaging demonstrated reduction of the C6-7 vertebral bodies. Physical examination showed lower limb paraplegia and preserved upper extremity strength except for mild weakness in hand grip (3/5 on the MRC grading scale). Occiput-C2 instrumentation was performed using occipital keel and C2 pedicle screws with sublaminar C1 polyester tape. C6-7 reduction and fixation was performed with laminar hooks. Arthrodesis was promoted with lineage-committed cellular bone matrix allograft and suboccipital autograft. Anterior column stabilization was deferred secondary to a CSF leak. Intraoperative monitoring was performed throughout the procedure. Within 1 month after surgery the patient was able to manipulate objects against gravity. CT imaging revealed bony fusion and spontaneous reduction of C6-7. DISCUSSION: Spinal instrumentation is technically challenging in infants, regardless of injury mechanism, particularly in cases with complete spinal column disruption, but an anterior fusion may be avoided in infants and small children with posterior stabilization and halo placement.