Traumatic dislocation of the hip joint in children.

Between 1949 and 1972, 24 children under the age of 16 years were admitted to Middlemore Hospital with traumatic dislocation of a hip. Half of these were between 12 and 15 years of age, and there was a predominance of boys in the ratio of 7:1. A survey of these children supports the view that the hip joint of a child becomes dislocated more readily than that of an adult.     

Classification of glenohumeral joint instability

Shoulder instabilities have been classified according to the etiology, the direction of instability, or on combinations thereof. The current authors describe a classification system, which distinguishes between static instabilities, dynamic instabilities, and voluntary dislocation. Static instabilities are defined by the absence of classic symptoms of instability and are associated with rotator cuff or degenerative joint disease. The diagnosis is radiologic, not clinical. Dynamic instabilities are initiated by a trauma and may be associated with capsulolabral lesions, defined glenoid rim lesions, or with hyperlaxity. They may be unidirectional or multidirectional. Voluntary dislocation is classified separately because dislocations do not occur inadvertently but under voluntary control of the patient.     

Traumatic anterior dislocation of hip joint with vascular damage.

Closed reduction of an anterior dislocation of the hip joint in a 15-year-old boy failed because of interposition of capsule, iliopsoas and rectus femoris muscles. The immediate complications were compression of the common femoral artery, tear of the femoral vein, and fat embolism 24 hours after the injury. The sequelae were periarticular ossification and avascular necrosis of the femoral head. The definitive treatment was a Charnley total hip arthroplasty.     

Immobilisation following traumatic anterior glenohumeral joint dislocation: a literature review

Traumatic anterior dislocations of the shoulder are common and disabling injuries, in young and old alike. For centuries, the means of managing this injury has been to immobilise the affected shoulder after reduction, for up to 8 weeks, in an adducted and internally rotated position. The aim of this literature review is to assess whether traumatic anterior shoulder dislocations should be immobilised; for how long should they be immobilised; and whether the position of immobilisation affects outcomes. An electronic literature search was performed of the databases AMED, Cinahl, Embase, Medline (using Ovid), PEDro and Pubmed, from their inceptions to February 2005. Human clinical trials, written in English, which could assist in answering the research questions, were included. Sixteen (of 168) papers met the inclusion criteria and were reviewed. The review suggests that it remains unclear whether patients with traumatic primary anterior shoulder dislocations should be immobilised, or for how long. Similarly, it remains uncertain whether patients should be immobilised in internal, or external rotation. Much of this uncertainty is due to the limited size of the evidence base, which exhibited numerous methodological weaknesses (e.g. small sample sizes, no control groups, not evaluating findings against statistical tests). Recommendations are made to develop the evidence base.     

Multidirectional instability of the glenohumeral joint

The concept of multidirectional instability (MDI) was introduced as an important clinical entity in 1980. Previously, it had received little mention in the literature and was not considered to be clinically relevant. MDI is a symptomatic glenohumeral subluxation or dislocation occurring in more than one direction. The basic pathology of this condition is a loose and redundant joint capsule. Most patients with MDI can be treated successfully by conservative methods, such as patient education, a shoulder girdle strengthening program, or modification of the patient's routine activity.     

创伤性髋关节前上方脱位

因创伤导致股骨头脱出于髋臼的病理改变称创伤性髋关节脱位,我们治疗４例前上方脱位,其损伤机制、临床体征和Ｘ线表现均有别于经典的脱位类型。１　临床资料１－１　病例资料　１９９１年９月～１９９４年４月收治髋关节前上方脱位４例,男、女各２例,年龄１９～５２岁。右髋３例,左髋１例。洗澡滑跌伤１例,土石塌方砸伤２例,摩托车撞伤１例。４例均表现患肢外旋、内收、短缩畸形,髋部压痛、弹性固定,髂前上棘前下方或腹股沟部可触及骨性隆起。１－２　Ｘ线表现　Ｘ线片（图１）示股骨头脱出髋臼于髂前上棘前下方、髋臼上缘上方,股…     

Traumatic dislocation of the hip

Of 125 patients with traumatic dislocation of the hips treated, 96 were reviewed retrospectively; 80 were males and 16 females with an age range from seven to 81 years (mean, 33.5 years). Motorcycle accidents were the leading cause of traumatic dislocation in this series (40 cases, 42%). Associated injuries were found in 68 cases (70.8%). Seventy-seven hips (80%) were reduced within 24 hours. In follow-up periods ranging from 15 months to 18 years (mean, 7.5 years), 56 patients had excellent or good results (58.3%). Statistical analysis of the clinical results showed that those patients with simple dislocations had better functional recovery. The earlier the reduction, the better the results. Associated injuries affected prognoses. Good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods.     

Traumatic anterior dislocation of the hip joint with posterior acetabular wall fracture

The incidence of traumatic hip dislocation has increased in recent years as a result of high-energy trauma. Anterior hip dislocation forms less than 10-15% of all traumatic hip dislocations. Only a few case reports describe anterior dislocation along with acetabular fractures. The acetabular fracture involved the anterior wall or column in all such cases. We describe a rare case in which anterior superior dislocation of the hip was associated with a large fracture fragment of theposterior acetabular rim and adjacent wall.     

Traumatic hip dislocation in childhood

Traumatic dislocation of the hip in childhood is uncommon and can be a consequence of minor trauma. The authors report a series of 35 dislocations in skeletally immature patients. Most were isolated posterior dislocations without acetabular lesions. In 75% of cases, reduction of the dislocation was easy. Nine children required surgery to remove interposed joint capsule and/or osteochondral fragments to achieve anatomic reduction. Outcomes were generally good, except in one patient in whom a displaced fracture of the femoral physis was followed by total head avascular necrosis. One case of partial necrosis had a satisfactory outcome. Epiphyseal necrosis, though uncommon, appeared to be inconsistent to prevent and hard to predict. Bone scan seems to be more effective than MRI for the detection of necrosis.     

Traumatic hip dislocation in childhood

Twelve children with hip dislocation were recorded from 18 hospitals of the GDR in a collective study conducted on behalf of the Working Group on Paediatric Traumatology. The closed approach was exclusively taken to all reductions, and all of them were performed within the twelve-hour limit. Avascular necrosis of the femoral head or other growth disorders were not observed. Relief periods were conspicuously differentiated, which gave rise to the proposal of unitisation of the therapeutic approach.     

Shoulder kinesthesia after anterior glenohumeral joint dislocation

This article was presented in poster format at the Sixty-Third Annual Conference of the American Physical Therapy Association, San Antonio, TX, June 28-July 2,1987. The study was supported in part by the Montana Chapter of the American Physical Therapy Association and was submitted June 24, 1987; was with the authors for revision for 34 weeks; and was accepted June 9.1988. Reprinted from Physical Therapy with the permission of the American Physical Therapy Association. [Smith RL, Brunolli J: Shoulder kinesthesia after anterior glenohumeral joint dislocation. Phys Ther 69:106-112, 1989.]The purpose of this study was to examine kinesthesia in normal (uninjured) shoulders and in shoulders with a history of glenohumeral joint dislocations. Both shoulders of 10 healthy subjects and 8 subjects with a history of unilateral anterior dislocation were tested for accuracy of angular reproduction, threshold to sensation of movement, and end-range reproduction using a motor-driven shoulder-wheel apparatus. An analysis of variance revealed significant differences (p < 0.001) between the injured and uninjured shoulders for all three tests. Post hoc analysis showed significant differences (p < 0.02) between the involved shoulders and all uninvolved shoulders. No significant difference was found among the uninvolved shoulders. The results of this study indicate that kinesthetic deficits occur after glenohumeral dislocation and may result in abnormal neuromuscular coordination and subsequent reinjury of the shoulder. Clinicians should consider rehabilitation of shoulder kinesthesia using therapeutic activation of the shoulder joint and muscle receptors when treating patients with previous dislocations. J Orthop Sports Phys Ther 1990;11(11):507-513.