Volar radiocarpal dislocation with ulnar translocation

The first known reported case of volar radiocarpal dislocation with ulnar translocation is described with a review of previous literature on the isolated components of these injuries. Radiographic criteria for their diagnosis are presented with recommendations for early operative intervention to minimize the risk of subsequent carpal instability and provide an optimum functional result. An awareness of the possible coexistence of these injuries leading to early diagnosis and expedient treatment is essential to a good functional result.     

Isolated ulnar radiocarpal dislocation

Isolated radiocarpal dislocation is quite rare. A patient with an isolated ulnar radiocarpal dislocation was treated with closed reduction and external fixator. The patient was followed-up for 20 months. The functional results were successful,but a secondary ulnar translation of the corpus developed.     

Palmar dislocation of the radiocarpal joint

Radiocarpal dislocation, with or without damage to the radial styloid process or to the distal radial rim, is extremely rare. Review of the literature reveals much confusion on the proper classification of radiocarpal dislocations or fracture-dislocations. A case of radiocarpal dislocation is reported, the classification is discussed, and a critical review of earlier reports is presented.     

Isolated posttraumatic ulnar translocation of the radiocarpal joint

An isolated posttraumatic ulnar translocation of the carpus is unusual. In cases in which the translocation occurs without accompanying injury to distal radius, ulna, or carpal bones, the diagnosis is often delayed due to the unfamiliarity of the treating physician with this rare radiographical finding. By presenting two patients with such an injury, we hope to increase awareness of this injury.     

Ulnar translocation instability of the carpus after a dorsal radiocarpal dislocation: a case report

An unusual case of ulnar translocation of the carpus after a radiocarpal dislocation is described. Persistent instability was noted despite attempted reattachment of the avulsed palmar capsuloligamentous structures. A successful outcome occurred after radiolunate arthrodesis and external fixation of the wrist.     

Shoulder electromyography in multidirectional instability

We studied shoulder muscle activity in multidirectional instability (MDI) and multidirectional laxity (MDL) of the shoulder, our hypothesis being that altered muscle activity plays a role in their pathogenesis. Six muscles (supraspinatus, infraspinatus, subscapularis, anterior deltoid, middle deltoid, and posterior deltoid) were investigated by use of intramuscular dual fine-wire electrodes in 7 normal shoulders, 5 MDL shoulders, and 6 MDI shoulders. Each subject performed 5 types of exercise (rotation in neutral, 45 degrees of abduction, 90 degrees of abduction, flexion/extension, and abduction/adduction) on an isokinetic muscle dynamometer at two rates, 90 degrees /s and 180 degrees /s. After filtering, rectification, and smoothing, the electromyography signal was normalized by using the peak voltage of the movement cycle. In subjects with MDI, compared with normal subjects, activity patterns of the anterior deltoid were different during rotation in neutral and 90 degrees of abduction, whereas those of the middle and posterior deltoid were different during rotation in 90 degrees of abduction. In subjects with MDL, the posterior deltoid showed increased activity compared with normal subjects during adduction. Activity patterns of the supraspinatus, infraspinatus, and subscapularis appeared similar in both groups. Dual fine-wire electromyography offers insight into the complex role of shoulder girdle muscle function in normal movement and in instability. Altered patterns of shoulder girdle muscle activity and imbalances in muscle forces support the theory that impaired coordination of shoulder girdle muscle activity and inefficiency of the dynamic stabilizers of the glenohumeral joint are involved in the etiology of MDI. Interestingly, the abnormalities are in the deltoid rather than the muscles of the rotator cuff.     

Palmar dislocation of the scaphoid and lunate

A case of palmar dislocation of the scaphoid and lunate was complicated by a delay in the diagnosis and avascular necrosis of the lunate. Anatomic reduction was obtained 34 days after the injury. At 2 1/2 years follow-up the patient had good return of hand function and radiologic evidence of resolution of the avascular necrosis without evidence of collapse or intercarpal arthritis.     

肘关节复合畸形并多发性脱位、关节不稳的手术治疗

骨折导致的肘关节畸形、关节不稳临床处理较为棘手[1].肘关节是人体结构最稳定的关节之一,其稳定性的维持有赖于组成关节结构的完整性,其最大屈伸度可达160°,旋前可达85°,旋后约80°,滑车与肱骨长轴成6°的外翻角、与髁间轴成5°～7°的内旋角,肘关节屈伸运动轴位于肱骨中线的前面与肱骨干构成40°夹角[2].     

创伤性腕骨轴向尺侧脱位

例1 女,36岁.左腕部碾压伤.临床检查:左腕明显肿胀,开放性损伤,左腕掌尺侧至中、环指指蹼处斜行创口,左手掌变扁、宽.腕横韧带完全断裂,正中神经外露,腕关节活动受限.     

Biomechanical evaluation of multidirectional glenohumeral instability and repair

The purpose of the current study was to create a multidirectional glenohumeral instability model and compare anterior capsulolabral reconstruction with inferior capsular shift with respect to their effects on glenohumeral translation and rotational range of motion. Ten fresh frozen cadaveric shoulders were used with a custom shoulder translation testing jig. To create the multidirectional instability model the capsule was stretched an additional 20% from the initial rotational range of motion in apprehension and neutral positions. Shoulders were repaired using anterior capsulolabral reconstruction (n = 5) or an inferior capsular shift (n = 5). Anterior, posterior, inferior, and superior translations were measured along with the rotational range of motion for intact, stretched, and repaired conditions. All specimens showed increased translations and rotations after stretching. Both repair techniques significantly reduced anterior, posterior, and inferior translation. The inferior capsular shift was more effective in reducing inferior translation in the apprehension position; however, postoperative rotational range of motion was restricted significantly when compared with anterior capsulolabral reconstruction, and posterior subluxation of the humeral head was seen in all specimens. These results indicate that a vertical capsulorrhaphy with a medial to lateral shift of the glenohumeral capsule, as in the inferior capsular shift repair, significantly reduces rotational range of motion when compared in vitro with the horizontal shift of the anterior capsulolabral reconstruction.     

Palmar carpal instability secondary to dislocation of scaphoid and lunate: Report of case and review of the literature

An isolated dislocation of scaphoid and lunate is presented. We believe that this injury was responsible for the later development of a palmar carpal instability pattern. Carpal kinematics and pertinent literature are reviewed to support this belief. In our patient, the scaphoid relationship to the trapezium and trapezoid had remained largely undisturbed. The separation of lunate and capitate, a frequent form of carpal dislocation, could be explained on an anatomical basis. The lunate remained attached to the scaphoid, but completely dissociated from the triquetrum. This provided a rare clinical model for the evaluation of the effects of triquetrolunate dissociations on carpal alignment.     

Dynamic upper limb proprioception in multidirectional shoulder instability

The ability of subjects with multidirectional shoulder instability to use proprioception to complete a series of upper limb repositioning tasks was investigated. Twelve subjects with multidirectional instability and 12 control subjects were blindfolded and instructed to use proprioception to reproduce a self-selected target position as accurately as possible. Subjects completed 10 repetitions for each limb using three distinct upper limb movements: overhead reaching, scapular plane pointing, and humeral external rotation with abduction. A three-dimensional video motion analysis system tracked limb position and determined spatial hand position error. Subjects with multidirectional shoulder instability showed significantly greater hand position error than control subjects. No hand position error differences were found between the symptomatic and the asymptomatic limbs of subjects in the instability group. Inter-repetition error for subjects in both groups improved significantly during the first three movement cycles. These results suggest that after movement initiation, dynamic proprioception was a factor in improving hand position accuracy in both groups, but to a lesser degree in subjects with multidirectional instability. Consequently, subjects with multidirectional instability may have a reduced capacity to use proprioception to refine and control the motor output of the upper limb.     

Transtriquetral perihamate ulnar axial dislocation and palmar lunate dislocation.

Transtriquetral perihamate ulnar axial dislocation associated with palmar lunate dislocation is a rare condition. We could find no other similar cases reported. The mechanism of injury was a combined anteroposterior crushing force that caused axial disruption of the carpus and the metacarpals and wrist hyperextension that caused the transtriquetral lunate dislocation. Our patient was treated with open reduction and internal fixation with good result.     

Palmar dislocation of scaphoid and lunate as a unit

A case of closed palmar dislocation of the scaphoid and lunate as a unit is described. This was treated by closed reduction and resulted in a good functional result as assessed at 1-year follow-up. No aseptic necrosis of the lunate or of the scaphoid developed. The only residual abnormality was an asymptomatic x-ray VISI pattern of the lunate. This is attributed to the disruption of the lunotriquetral joint. A functional analysis of the x-ray films with the wrist in radial and ulnar deviation indicated a normal arthrokinematic pattern.     

Wrist arthroscopy and dislocation of the radiocarpal joint without fracture.

The authors report a rare case of dorsal dislocation of the radiocarpal joint without any bony lesion associated. The traumatic cause was a high energy motorbike accident. Fractures of the other limbs were associated. The authors report the clinical, radiological, and arthroscopic features. Wrist arthroscopy showed a complete tear of all the extrinsic ligaments, a radial avulsion of the triangular fibrocartilage complex, and the integrity of the intracarpal ligaments, which guided the treatment. The dislocation was treated by closed reduction and radiocarpal pinning. The authors propose wrist arthroscopy in radiocarpal dislocation for diagnosis of soft tissue and cartilaginous lesions to guide the treatment (close or open).     

Palmar dislocation of scaphoid and lunate as a unit: case report with special reference to carpal instability and treatment

A case of palmar dislocation of scaphoid and lunate as a unit is reported with a 3 1/2-year follow-up. Closed reduction was followed by redislocation after a week. Secondary open reduction could not prevent a dorsiflexed intercalated segmental instability deformity, which ended with arthritic changes in the wrist. A plea is made for early open reduction and internal fixation.