Irreducible isolated dislocation of the radial head

Isolated dislocation of the radial head in adults is a rare injury. A 20-year-old man received a direct blow to his elbow and sustained an isolated anterior dislocation of the radial head. Open reduction was required because soft tissue interposition prevented reduction by closed manipulation. At operation the annular ligament was found to be ruptured and interposed between the articular surfaces, preventing reduction. A satisfactory result was obtained 1 year after surgery.     

The relationship between inert gas wash-out and radioactive tracer microspheres in measurement of bone blood flow: effect of decreased arterial supply and venous congestion on bone blood flow in an animal model

Twenty cases of carpal bone dislocation were encountered during a 7-year period, with an average of 27 months of follow-up. There were ten types of dislocation in this series; the most common type was transscaphoid perilunate dislocation which was seen in nine cases. In addition, there were two scaphoid subluxations; one volar lunate dislocation; one dorsal perilunate dislocation; one scaphoid perilunate dislocation; one hamate and pisiform dislocation; one transhamate pisiform dislocation; one trapezoid dislocation with dislocation of carpometacarpal joints two to five; one dislocation of the trapezium, trapezoid, and carpometacarpal joints two to four; and two trapezium periscapholunate dislocations. Methods of treatment included open reduction, closed reduction, proximal row carpectomy, total wrist arthrodesis, and excision of the lunate. In this series, the patterns of dislocation were different for crushing injuries and dorsiflexion injuries. The clinical results associated with the soft-tissue injuries of the ipsilateral hand were mostly caused by crushing forces. Although carpal instabilities were noted, there was no significant correlation between the clinical and roentgenographic results in some of our cases. Best results invariably relied on a stable anatomic reduction and an adequate period of immobilization. Poor results were demonstrated in the cases with incomplete initial reduction, secondary degenerative arthrosis, or nonunion.     

Do not forget to listen to the ambulance crew and the spouse...

Dislocation of the testes is an uncommon sequela of trauma. In contemporary times, it is usually associated with motorcycle accidents. We present 2 cases of unilateral traumatic testicular dislocation and 1 case of bilateral dislocation, all involving motorcyclists. Spontaneous reduction is rare. Early reduction is recommended because of histological changes seen in dislocated testes. Surgical reduction is often required. The significance of this condition must be emphasised to doctors managing trauma patients and early urological consultation obtained.     

Closed reduction of a rare type III dislocation of the first metatarsophalangeal joint

OBJECTIVE: To discuss a rare Type III dislocation of the first metatarsophalangeal (MP) joint, without fracture, that used a closed reduction technique for correction. CLINICAL FEATURES: A 43-yr-old man suffered from an acute severe dislocation of his great toe as the result of acute forceful motion applied to the toe as his foot was depressed onto a brake pedal to avoid a motor vehicle accident. Physical examination and X-rays revealed the dislocation, muscle spasm, edema and severely restricted range of motion. INTERVENTION AND OUTCOME: The dislocation was corrected using a closed reduction technique, in this case a chiropractic manipulation. Fourteen months after reduction, the joint was intact, muscle strength was graded +5 normal, ranges of motion were within normal limits and no crepitation was noted. X-rays revealed normal intact joint congruency. The patient experienced full weight bearing, range of motion and function of the joint. CONCLUSION: Although a Type III dislocation of the great toe has only once been cited briefly in the literature, this classification carries a recommended surgical treatment protocol for correction. No literature describes a closed reduction of a Type III dislocation as described in this case report. It is apparent that a closed reduction technique using a chiropractic manipulation may be considered a valid alternative correction technique for Type III dislocations of the great toe.     

Opportunities and potential treatment in renal diseases: from research to bedside

Dislocation of the scapula is a rare event, usually associated with massive trauma and injury. We report a case of a patient for whom dislocation was the sole presentation. The possibility of voluntary dislocation for secondary gain was suspected, but because of perceived progressive brachial plexus involvement, urgent closed reduction was undertaken and led to resolution of the neurologic symptoms. The patient returned 1 year later with similar complaints and findings, but declined another closed reduction attempt when offered only an interscalene regional block as pain relief. The diagnosis of voluntary dislocation should be considered in a patient presenting with superior and lateral migration of the scapula, without a history of trauma.     

Intradural drop metastases in oligodendrogliomas

OBJECTIVE: To observe the developmental changes of the acetabulum after reduction of developmental dislocation of the hip and require evolutionary regularity of acetabular dysplasia. METHODS: A follow-up in an average of 7.4 years was carried out in 117 patients (161 hips) with developmental dislocation of the hip after reduction. By the series of X-ray films, acetabular index, acetabular-head index, Sharp's angle, ACM angle (Idelberger's angle) and anteversion were observed. At the same time, centre-head distance discrepancy was measured. RESULTS: Acetabular index returned to normal gradually as the time went by and significantly within one year after the reduction of developmental dislocation of the hip. The process of recovery was nearly stable three years later. Acetabular index in the dysplasia group was above 39 degrees before reduction and decreased slowly after the reduction. However, it was still up to 30 degrees after 3 years observation. The value of centre-head distance discrepancy decreased gradually as the years went by after reduction. CONCLUSIONS: If acetabular index before reduction is above 39 degrees and is still up to 30 degrees three years after reduction, acetabular dysplasia can be diagnosed.     

Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study

Twelve children with obstetric paralysis were diagnosed as having a posterior dislocation of the humeral head. The diagnosis was suspected on clinical grounds and confirmed by computed tomography (CT) scans in all cases. All 12 patients were treated with open reduction via an anterior approach. The age range at the time of surgery was from 7 months to 7 years (average, 2 years and 3 months). All patients were immobilized in a shoulder spica for 6 weeks and a further 6 weeks in an orthosis. All patients were examined by CT scans in the postoperative period, which confirmed a satisfactory reduction in all cases. With a minimal follow-up of 12 months, there have been no redislocations. This article demonstrates that dislocation of the shoulder in association with obstetric paralysis is not rare, as previously described, and shows that once diagnosed, the dislocation can be satisfactorily treated by a single anterior open reduction of the shoulder.     

Ductile fracture initiation in pure α-Fe: Part I. Macroscopic observations of the deformation history and failure of crystals

Single crystalα-Fe whiskers, grown by the reduction of ferrous chloride by hydrogen have been strained to fracture in an Instron tensile testing machine and in a bench straining device at various elongation rates at room temperature. Whiskers were found to exhibit macroscopic slip behavior strongly dependent upon elongation rate while the geometric reduction in area and the fracture mode remained in all cases identical. Ductile rupture of iron whiskers produces a characteristically shaped chisel-edge fracture whose geometry is sensitive to crystal orientation, due to the geometry of active slip systems, but which isnot a function of strain rate. The micromechanisms of ductile rupture of these single crystals are strongly affected by dislocation dynamics. The development of dislocations necessary to accomodate an extensive reduction in area appears to be independent of the nature of surface slip observed. Dislocation structures form small volume elements which are separated from one another by dislocation cell walls. The accommodation of large strains as well as the reduction in area is determined by the movement of dislocations on the order of a distance equal to that of the dislocation cell size. The boundaries of the cell and/or the cell volume could then be expected to be specifically related to the site where the initiation of fracture occurs.     

Posterolateral dislocation of the elbow with concomitant fracture of the lateral humeral condyle: case report

We describe a case of a 6-year-old girl with a posterolateral elbow dislocation and a concomitant fracture of the lateral humeral condyle. After reduction of the dislocation, the fracture was diagnosed and treated by open reduction and fixation, with a good functional result. In doubtful cases, oblique, heterolateral, and varus stress films, or even arthrography may be necessary.     

Open complex metacarpophalangeal joint dislocation. Two cases: index finger and long finger

Two patients with open complex dislocation of a metacarpophalangeal joint were treated by cleansing of the wound, open reduction, primary wound closure, and early motion. One dislocation occurred in the index finger, the other in the long finger which is only the second such case to be described. Antibiotics were given before and continued for 5 days after operation. There were no infections, and both patients regained an excellent range of motion without pain.     

Metacarpophalangeal joint dislocation: indications for open surgical reduction

In complex dislocations of the metacarpophalangeal joint, the volar plate is separated from the proximal phalanx and the metacarpal head is entrapped within surrounding tissue structures. These complex dislocations must be managed by open surgical reduction to reduce the dislocation and realign the volar plate. A 58-year-old male presented to the emergency department with a complex dislocation of the metacarpophalangeal joint of the left little finger, which was successfully treated by open reduction in the operating room. The indications for open reduction of metacarpophalangeal joint dislocations are reviewed.     

Arthroscopy of a dislocated hip replacement: a case report

A 55-year-old woman had a dislocation of a total hip arthroplasty that could not be reduced by closed manipulation because of an obstructing cement fragment. The use of percutaneous arthroscopic instrumentation allowed reduction by successful manipulation of the fragment out of the joint.     

Causes of and treatment protocol for instability of total hip replacement

Dislocation of the total hip replacement is a devastating complication, physically and mentally. It was determined whether there are radiographic or operative findings predictive of repeat dislocation and whether there are causes of dislocation that require immediate reoperation. A previously published classification of dislocations was used which evaluates (1) positional (no radiographic abnormality); (2) component malposition (femur or acetabulum), which is inadequate version or position of the acetabular or femoral component; (3) soft tissue imbalance (change in the length or displacement of the hip), which is a change in the muscle functional length of the hip; and (4) component malposition and soft tissue imbalance. Categories of treatment of dislocations were established that could be correlated to the cause of the dislocation: (1) Category I is a successful closed reduction; (2) Category II is a successful reoperation; (3) Category III is a reoperation with subsequent repeat dislocations successfully treated with closed reduction; and (4) Category IV is comprised of hips that require multiple reoperations for treatment of dislocations. The results are that any dislocation of any origin may be treated successfully with closed reduction so that this should be the first choice of treatment. To avoid multiple treatments, immediate reoperation should be performed if the hip is unstable when the patient is examined under anesthesia after the closed reduction. Hips with soft tissue imbalance and weakness of the abductor musculature, with or without component malposition, are most at risk for multiple operations. These hips may be considered for mechanical stability (constraint in the acetabular replacement) at reoperation.     

Effect of Temper Condition on Stress Relaxation Behavior of an Aluminum Copper Lithium Alloy

Deformation behavior of an Al-Cu-Li alloy in different temper conditions (solutionized and T8) is investigated using stress relaxation tests. Fundamental parameters such as the apparent and physical activation volume, strain rate sensitivity, effective stress, and exhaustion rate of mobile dislocation density are determined from single and multiple relaxation tests. It was found that dislocation–dislocation interaction controls the kinetics of plastic deformation in the solutionized sample, whereas dislocation–precipitate interaction is the overriding factor in the presence of T₁ precipitates. The apparent activation volume was found to be significantly lower in the presence of T₁ precipitates compared with solutionized samples. Strain rate sensitivity and effective stress were found to be higher in the presence of T₁ precipitates. In addition, multiple relaxation tests showed that irrespective of microstructural features (solutes, semi-coherent precipitates), the mobile dislocation density reduces during the relaxation period. Further evidence regarding reduction in mobile dislocation density is obtained from uniaxial tensile tests carried out after stress relaxation tests, where both solutionized and T8 samples show an increase in strength. Additional discussion on relaxation strain is included to provide a complete overview regarding the time-dependent deformation behavior of the Al-Cu-Li alloy in different temper conditions.     

Cervical facet dislocation: management following delayed diagnosis

This study examined the influence of early versus late initial presentation of patients with cervical spine facet dislocation on presentation, neurologic deficit, and the success of closed reduction. Thirty-four patients were studied, and approximately 35% presented at least 72 hours following their injury. Compared with patients who presented early, this late group demonstrated less neurologic deficit, and closed reduction was less likely to be successful. These findings suggest that a distinction should exist in the management algorithm between early versus late presentation of cervical facet dislocation.     

Prenatal ultrasound diagnosis of massive subchorionic thrombohematoma

We present a case report of a variation of a Bosworth fracture, which is a posterior dislocation of the proximal fragment of a distal fibula fracture. Our patient had a distal fibula dislocation without fracture. He was treated with an open reduction and internal fixation using syndesmotic screws. At his most recent follow-up, he was ambulating without pain.     

Adrenoceptors in the hepatic tissues in cirrhotic rats and cirrhotic patients with portal hypertension]

Phalangeal dislocations of toes are extremely rare in childhood and usually can be treated by closed reduction. We present a proximal interphalangeal dislocation of the fourth toe with an irreducible avulsion fracture of the middle phalanx requiring open reduction. To our knowledge concomitant avulsion fractures in this condition have not been reported thus far in pediatric patients. The pathological mechanism of this injury is discussed, and the significance of the plantar plate for joint stability is emphasized.     

Isolated volar carpometacarpal dislocation of the fifth digit

McWharter first described volar carpometacarpal dislocations of the fifth digit in 1918. Since then, 14 cases have been reported in the medical literature. Berg and Murphy were first to report a case of ulnopalmar dislocation that was successfully treated with closed reduction and immobilization. Previously reported cases required internal fixation with or without open reduction. We report a fifth carpometacarpal ulnopalmar dislocation, treated with closed reduction and casting.     

Influences of cell walls and grain boundaries on transient responses of an if steel to changes in strain path

The effects of changes in strain path on plastic behaviour in sheets of an interstitial-free steel with two widely different grain sizes were investigated. The sheets were prestrained in rolling and, apart from supplementary tests, they were tested in uniaxial tension at 90° to the rolling direction. The results support the following conclusions. The magnitude of the increase in reloading yield stress and amplitude of the subsequent reduction in work hardening depend on the strength of dislocation walls generated in the prestrain rather than the grain size. The walls are more effective barriers to dislocation glide in freshly activated slip systems than to glide in the original slip systems operating in the prestrain. The primary cause of the subsequent reduction in hardening rate is disruption and partial dissolution of the original dislocation substructure. The final recovery in hardening rate is caused by generation of a new substructure compatible with the new deformation mode.     

Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children

A one-stage, combined operative procedure for reduction of congenitally dislocated hips in older children consists of shortening of the femur; open reduction by an inferior approach to the joint; reconstruction of the acetabular roof; correction of anteversion of both the femoral neck and the neck-shaft angle; anterior transposition of the iliopsoas muscle. On 60 hips operated in children, ages 5 to 15 with a follow-up period, ranging from 5 to 9 years, the results were found to be excellent in 3 per cent, good in 60 per cent, fair in 30 per cent, and poor in 7 per cent. The procedure is indicated in children up to the time of early puberty. The primary indication is high bilateral dislocation. In unilateral dislocations some residual leg-length discrepancy frequently occurs. This procedure should be done only by orthopedic surgeons who have special training and experience in the treatment of congenital dislocation of the hip.