Surgical management of medial and lateral elbow instability secondary to acute atypical complex elbow dislocation: Case report and literature review

Introduction and importanceElbow dislocation is common in adults, and complex elbow dislocations are generally associated with bone fractures. Anteromedial coronoid fracture, in association with lateral collateral ligament (LCL) disruption, often results from varus posteromedial forces. “Terrible triad” injuries are more likely to result from valgus posterolateral forces. However, our case presentation has combined medial and lateral elbow instability in addition to “terrible triad” injury of the elbow with no radial head injury.Case presentationThe patient was a 38-year-old man with an atypical complex elbow dislocation. He was successfully treated by stabilizing the medial epicondyle and coronoid anterolateral facet fractures, in addition to LCL repair and medial collateral ligament (MCL) reconstruction. A radial head fracture was unnoted. The procedure yielded satisfactory functional outcome, with a stable and painless full elbow range of motion.Clinical discussionMulti-ligament injuries with coronoid fractures result in highly unstable elbow joints, forming a variant of the “terrible triad” injury. Surgical options vary according to the surgeon’s experience and equipment availability. In this case, direct LCL repair and MCL reconstruction were performed and were well tolerated. Elbow stability improved and the patient experienced improved functionality with minimal pain. However, it may be premature to report a definite outcome in this case because of short follow-up time postoperatively.ConclusionThe injury described in this case has a unique presentation as a multi-ligamentous injury will make the elbow very unstable. Thus, careful clinical judgment, knowledge, and experience are needed to identify the underlying injury and for optimal management.     

关节镜辅助手术治疗发育性髋关节脱位患儿效果观察

目的探讨分析关节镜辅助手术治疗发育性髋关节脱位患儿效果。方法以柘城县中医院2010年7月—2013年8月收治的发育性髋关节脱位患儿中选取48例作为研究对象,采用随机数字表法将所有研究对象分为观察组和对照组,每组各24例。对照组采用Ferguson手术法,观察组采用关节镜辅助手术治疗,观察两组两种治疗方法的治疗效果以及手术切开后妨碍骨头复位的因素。结果观察组的总有效为95.83%,明显高于对照组的87.50%,组间比较差异有统计学意义(P0.05);妨碍骨头复位因素有盂唇内翻、圆韧带拉长和髋臼横韧带肥厚盂唇增厚等,采用关节镜辅助的观察组妨碍骨头复位因素显著优于对照组,差异有统计学意义(P0.05)。结论采用关节镜辅助手术治疗发育性髋关节脱位可以清楚看见妨碍骨头复位因素并给予及时清除,达到有效复位成形关节,治疗效果较为理想,值得临床上推广应用。     

Usefulness of a Three‐Dimensional‐Printed Model in the Treatment of Irreducible Atlantoaxial Dislocation with Transoral Atlantoaxial Reduction Plate

ObjectiveTo evaluate the usefulness of a 3D‐printed model for transoral atlantoaxial reduction plate (TARP) surgery in the treatment of irreducible atlantoaxial dislocation (IAAD).MethodsA retrospective review was conducted of 23 patients (13 men, 10 women; mean age 58.17 ± 5.27 years) with IAAD who underwent TARP from January 2015 to July 2017. Patients were divided into a 3D group (12 patients) and a non‐3D group (11 patients). A preoperative simulation process was undertaken for the patients in the 3D group, with preselection of the TARP system using a 3D‐printed 1:1 scale model, while only imaging data was used for the non‐3D group. Complications, clinical outcomes (Japanese Orthopaedic Association [JOA] and visual analogue score [VAS]), and image measurements (atlas–dens interval [ADI], cervicomedullary angle [CMA], and clivus‐canal angle [CCA]) were noted preoperatively and at the last follow up.ResultsA total of 23 patients with a follow‐up time of 16.26 ± 4.27 months were included in the present study. The surgery duration, intraoperative blood loss, and fluoroscopy times in the 3D group were found to be shorter than those in non‐3D group, with statistical significance. The surgery duration was 3.29 ± 0.45 h in the 3D group and 4.68 ± 0.90 h in the non‐3D group, and the estimated intraoperative blood loss was 131.67 ± 43.03 mL in the 3D group and 185.45 ± 42.28 mL in the non‐3D group. No patients received blood transfusions. The intraoperative fluoroscopy times were 5.67 ± 0.89 in the 3D group and 7.91 ± 1.45 in the non‐3D group. Preoperatively and at last follow up, JOA and VAS scores and ADI, CCA, and CMA were improved significantly within the two groups. However, no statistical difference was observed between the two groups. However, surgical site infection occurred in 1 patient in the 3D group, who underwent an emergency revision operation of the removal of TARP device and posterior occipitocervical fixation; the patient recovered 2 weeks after the surgery. In 2 patients in the traditional group, a mistake occurred in the placement of screws, with no neurological symptoms related to the misplacement.ConclusionPreoperative surgical simulation using a 3D‐printed real‐size model is an intuitive and effective aid for TARP surgery for treating IAAD. The 3D‐printed biomodel precisely replicated patient‐specific anatomy for use in complicated craniovertebral junction surgery. The information was more useful than that available with 3D reconstructed images.     

Arthrodesis for chronic lateral subtalar joint dislocation caused by posterior tibial tendon dysfunction: A case report

IntroductionAdult acquired flatfoot deformity (AAFD) caused by posterior tibial tendon dysfunction (PTTD) can lead to the development of peritalar subluxation (PTS) and much more rarely to lateral subtalar dislocation.Presentation of caseA 75-year-old woman was referred to our hospital with an approximately 15-year history of pain in her right foot without obvious trauma. The lateral shifting foot deformity had worsened in the previous 5 years. On presentation, she had tenderness over the talonavicular joint, and the skin overlying the talar head on the medial foot was taut. Imaging revealed lateral displacement of the calcaneus with simultaneous dislocation of the talonavicular and talocalcaneal joints. We diagnosed lateral subtalar dislocation including the talonavicular and talocalcaneal joints caused by PTTD, which we treated by reduction and fusion of the subtalar joint complex. The foot and ankle were immobilized with a cast for 6 weeks.DiscussionAt the 1-year follow-up visit, the patient reported no pain during daily activities, although flatfoot persisted.ConclusionWe report a rare case of chronic lateral subtalar dislocation caused by PTTD that was treated by fusion of the talonavicular and talocalcaneal joints.     

高频超声与磁共振对急性外伤性髌骨外侧脱位的对比研究

目的比较分析高频超声与磁共振(MRI)对急性外伤性髌骨外侧脱位的诊断价值。方法对33例临床证实急性外伤性髌骨外侧脱位的高频超声和MRI资料,以手术结果为金标准,计算高频超声、MRI诊断各种伴随伤的敏感性、特异性和准确性,比较两种检查方法的有效性。结果与手术结果比较,高频超声、MRI诊断MPFL部分撕裂的敏感性、特异性、准确性分别为85.7%、85.7%,94.7%、89.5%,90.9%、87.9%;诊断MPFL完全撕裂的敏感性、特异性、准确性分别为94.7%、89.5%,85.7%、85.7%,90.9%、87.9%。高频超声、MRI诊断关节软骨Ⅱ级损伤的敏感性、特异性、准确性分别为36.4%、81.8%,85%、100%,67.7%、93.5%。高频超声、MRI诊断关节软骨Ⅲ级损伤的敏感性、特异性、准确性分别为81.8%、90.9%,85%、90%,83.9%、90.3%;高频超声、MRI诊断关节软骨Ⅳ级损伤的敏感性、特异性、准确性分别为100%、100%,90.9%、95.5%,93.5%、96.8%。高频超声对MPFL撕裂、关节软骨损伤的诊断与MRI比较差异无统计学意义(P>0.05)。结论高频超声检查与MRI检查同样能对急性外伤性髌骨外侧脱位的各种伴随损伤明确诊断和准确分级,是一种简单可靠、快捷并可重复的诊断方法,可作为急性外伤性髌骨外侧脱位的常规检查方法。     

Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation

We report a case of recurrent patellar dislocation with high-grade trochlear dysplasia which persisted despite two previous operations. We did a Dejour''s sulcus deepening trochleoplasty, medial patellofemoral ligament reconstruction, and lateral retinacular release. Trochleoplasty and medial patellofemoral ligament reconstruction is required in patients with high grade trochlear dysplasia.     

Clinical outcome after 36 months of treatment with injections of autologous blood for recurrent dislocation of the temporomandibular joint

We investigated the prognosis after three years of treatment for recurrent dislocation of the temporomandibular joint with autologous blood given intravenously in 21 patients with a mean (range) age 64 (17-92) years of whom 16 had coexisting systemic disease. The mean (range) follow up from the first injection was 64 (41-99) months. Eighteen patients had no recurrence during the first 36 months after their first injection, which showed that this minimally-invasive treatment was effective, particularly for those who had conditions that made a mouthpiece or operation unsuitable.     

Tethering technique using bone screws and wire for chronic mandibular dislocation: a preliminary study of refractory cases

A retrospective study was performed to determine the efficacy of a tethering procedure developed to achieve a more rigid fixation and more reliable outcome in patients with refractory dislocation of the temporomandibular joint. The cases of eight patients with dementia and systemic diseases who underwent this technique were reviewed. In these eight patients, the condyles of 13 joints were ligated using wire between screws placed in the eminence and condylar head. Additional screw–wire ligations were applied to reinforce the restraint of movement in five of the 13 joints with suspected uncontrolled dislocation. The procedure was performed successfully, and the patients were followed-up for an average of 25 months. In one patient, dislocation recurred 1 year postoperatively due to wire breakage. The five joints in which a double set of screw–wire tethering was applied showed no recurrence or wire disturbance. This technique may, therefore, have short-term efficacy in cases that are refractory to standard procedures, although the material used for ligation should be investigated further. This approach can contribute to the quality of life of patients, particularly those with a short life-expectancy.