Neglected irreducible posterolateral knee dislocation

Knee dislocations are rare injuries. Posterolateral knee dislocations are only a small subset of them. There is a paucity of literature regarding the management of such neglected cases. We report here, a case of neglected irreducible posterolateral knee dislocation treated with open reduction and isolated posterior cruciate ligament reconstruction followed by gradual rehabilitation with good outcome at 3 years followup.     

先天性膝关节脱位1例

1病例资料患儿,男,足月产,1月龄。产后即发现右膝关节过伸畸形,于2006年8月就诊。查体:被动屈曲明显受限,膝前部皮肤皱褶明显,腘窝皮肤皱褶消失,可触及髌骨,髌骨形态大小均正常;股骨髁向后,胫骨向前移位,被动屈膝时有弹性反抗,被动活动膝关节可达过伸30°以上,胫骨可以前后推移,股四头肌无挛缩,髌上囊触不清,无其他畸形。X线片示:胫骨向前移位。无家族史,其母亲无致畸药物服用史。治疗:经手法整复,右膝关节可恢复至屈曲80°左右,但有一定张力。用自制的铝板固定膝关节,每日按摩并加大关节屈曲角度,及时调节铝板屈曲度。28 d后摄X线片示:双…     

Quadricepsplasty for congenital dislocation of the knee and congenital quadriceps contracture

Purpose

We encountered problems with the Curtis and Fisher technique of quadricepsplasty for congenital quadriceps contracture, including wound dehiscence, insufficient lengthening of the quadriceps and instability of the knee. We modified the operative technique to address these three problems. We undertook this study to evaluate the results of the modified technique of quadricepsplasty to determine if we succeeded in overcoming these limitations of the original technique.

Methods

Twenty children (33 knees) underwent the modified Curtis and Fisher quadricepsplasty through a lateral incision; a long tongue of the rectus femoris was raised and the vasti mobilised without dividing the lateral retinaculae till the collateral ligaments. The children were followed up for a mean period of 63 months and evaluated. The healing of the wound, active and passive range of motion (ROM) of the knee, the stability of the knee, quadriceps power and knee function were assessed.

Results

Primary wound healing occurred in 32 of 33 knees. Adequate lengthening of the quadriceps sufficient to facilitate knee flexion to 90° was possible. Considerable improvement in the ROM was noted. In non-syndromic congenital dislocation of the knee (CDK), the quadriceps power was Grade 5, but minor degrees of extensor lag was noted. In a proportion of patients, minor degrees of joint instability was present. The majority of children were community walkers. The overall results were better in non-syndromic CDK than in children with arthrogryposis, but differences of some variables were not significant.

Conclusion

The modifications to the original Curtis and Fisher technique overcame the specific problems they were expected to avoid.     

Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee

Traumatic knee dislocations are uncommon yet serious injuries that historically have had variable prognosis. The evaluation and management of traumatic knee dislocations remains controversial. Appropriate early management has been shown to have a significant impact on long term functional outcome. A comprehensive review of the recent literature is presented alongside our current approach to management.The dislocated knee is an under diagnosed injury which relies on a high index of clinical suspicion on presentation of any knee injury. There is now a degree of consensus regarding need for surgery, timing of surgery, vascular investigations, surgical techniques and rehabilitation protocols.Vigilant monitoring for neurovascular complications, appropriate investigations and early involvement of surgeons with a specialist interest in knee ligament surgeries is the key to successful management of these difficult injuries.     

Congenital dislocation of the knee: a protocol for management based on degree of knee flexion

Purpose  

Congenital dislocation of the knee (CDK) is a relatively rare condition. It may occur as an isolated deformity, it may be associated with musculoskeletal anomalies such as developmental dysplasia of the hip and clubfoot, or it may occur as part of a syndrome such as arthrogryposis multiplex congenita or Larsen syndrome, or it may occur in paralytic conditions such as meningomyelocele. Treatment options include serial casting, percutaneous quadriceps recession (PQR) and V–Y quadricepsplasty (VYQ). The aim of this study is to evaluate the medium-term results of PQR and VYQ, and to set a protocol of management for CDK based on a modified grading system.     

膝关节前外侧脱位1例

1病例资料 患者,女,38岁。于2007年4月9日因“左小腿砸伤后膝关节疼痛伴活动受限4h”入院。受伤原因：患者左肩背10kg硬物,行走时不慎滑倒,左膝半屈状态下左小腿近端后侧被肩部滑落硬物砸伤,随即出现膝关节疼痛伴活动受限。     

全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位

目的评估全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位患者的临床疗效。方法对6例膝骨关节炎合并固定性髌骨脱位的患者(8膝)行全膝关节置换术。采用标准内侧髌旁入路,并行“+”形松解外侧支持带,常规髌骨置换,使用非限制性后稳定假体。比较手术前后的HSS评分和疼痛VAS评分,测量股骨胫骨角(FTA)和伸膝迟滞。结果患者均获得随访,时间1~8年。HSS评分从术前25~63分提高到术后1年75~94分。VAS评分从术前5~8分下降至术后1年0~3分。FTA从术前161°~173°改善至术后1年173°~175°。术前有10°~25°的伸膝迟滞,术后基本消失。结论采用标准内侧髌旁入路结合外侧结构的松解作全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位可获得良好的临床疗效。     

Recurrent dislocation of total knee arthroplasty: an unusual cause

We report an unusual case of recurrent dislocation of posterior stabilized total knee arthroplasty (TKA) secondary to fracture of the polyethylene insert. Recurrent dislocation occurred 21 months after primary TKA. Fractured polyethylene insert was noted as an abnormal radiolucent shadow on postoperative radiographs and was confirmed by an arthrogram. At revision surgery, disintegration of the insert, including the tibial post, was found. We recommend careful scrutiny of the integrity of the polyethylene insert at the time of follow-up evaluation in cases of TKA dislocation.     

Treatment of congenital dislocation of the hip after neonatal diagnosis

During 1966-1975, 920 infants with a congenital dislocation of the hip diagnosed neonatally were born in Uusimaa county in southern Finland. The first examination of the hips was made by a pediatrician, but the diagnosis was generally confirmed by a pediatric surgeon before treatment was started. The mean age of beginning treatment was 7 days. An abduction pillow was the only treatment in 852 cases, six of whom later developed complications, notably two with avascular necrosis. The duration of the pillow treatment shortened noticeably during the time under review but this caused no increase in the number of failures. In 64 cases the routine pillow treatment could not be carried through, mostly because the hip dislocated on the pillow. The most apparent reason for this was inappropriate control of the pillow by the parents. In this group bilateral dislocations and associated calcaneovalgus feet were found more often than in the rest of the neonatal group. Non-operative treatment was successful in 96 per cent of the 920 cases.     

Irreducible dislocation of the knee joint

Posterolateral knee dislocations are very rare and generally irreducible by closed reduction. It is due to interposition of various portions of medial capsule-ligamentous structure in the knee joint space. In such cases, open reduction is recommended. Only a few cases have been reported in the literature. This article presents an unusual case of irreducible knee dislocation, in which the medial femoral condyle buttonholed through the medial retinaculum and capsular structure. Closed reduction attempt was unsuccessful. Open joint reduction was performed. Direct repair of the medial collateral ligament and retinaculum, and arthroscopic assisted posterior cruciate ligament reconstruction were also performed. Arthroscopic-assisted anterior cruciate ligament reconstruction was carried out in staged operation.     

Biomechanical and hormonal factors in the etiology of congenital dislocation of the hip joint

Summary Perinatal dislocation of the hip — C. D. H. — is influenced by mechanical and hormonal factors. The authors' experiments on rats confirm that persistent knee extension, ovariectomy and administration of progesterone increased the rate of dislocation, whereas division of either iliopsoas or the hamstring muscles or administration of oestrogen had a protective effect. The hormonal changes greatly influenced the collagen and elastin content of the joint capsule.

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Résumé La luxation congénitale de la hanche (C. D. H.) survient sous l'influence de facteurs mécaniques et hormonaux. L'expérimentation pratiquée par les auteurs sur le rat confirme que l'extension prolongée du genou, l'ovariectomie et l'administration de progestérone augmentent la fréquence des luxations tandis que la section de l'iliopsoas ou des ischiojambiers ainsi que l'administration d'oestrogènes ont un effet protecteur. Les modifications hormonales ontune influence considérable sur la proportion de fibres collagènes et élastiques de la capsule articulaire.

     

Neglected congenital dislocation of the hip: Role of computed tomography and computer-aided design for total hip arthroplasty

Computed tomography (CT) provides important three-dimensional anatomic details in congenital dislocation of the hip that are useful for total hip arthroplasty (THR) and are not obtainable with conventional radiographic evaluation. In this study, 84 patients (119 hips) with congenital dislocation of the hip were evaluated with CT before surgery. Specifically, both the acetabulum and the femur were analyzed to make the best selection of the prosthesis. The average anteversion of the acetabulum was 23°, with an opening of 30.9 mm and a depth of 14.7 mm. The bone stock of the true acetabulum was calculated and the average available diameter for the acetabular implant was 44.9 mm. The CT topogram revealed the true leg-length discrepancy (average, 0.5–1.9 cm), and the amount of a shortening osteotomy when necessary was determined. Finally, to determine the stem with optimum fit and fill, a three-dimensional reconstruction of the femoral canal using CT data and computer-aided design (CAD) was matched with a three-dimensional geometry of several stem designs and sizes obtained from a CAD system.     

非手术治疗小儿先天性髋关节脱位疗效评价

目的 提高小儿先天性髋关节脱位（ＣＤＨ）非手术治疗的治疗效果。方法 对３４０例３岁以下ＣＤＨ采用手法复位硅式石膏及上展支架治疗后进行１￣８年随访观察。结果 ３１２例非手术治疗成功，余２８例失败后改手术治疗，其中２岁以上占２６例。失败原因为股骨头前倾角过大或盂唇肥厚内翻，髋臼窝内充满瘢痕组织或关节周围软组织挛缩，髂腰肌卡压致关节囊呈亚铃状狭窄畸形，影响复位。结论 对２岁以上ＣＤＨ行手法复位治疗需谨慎     

Avascular necrosis complicating congenital dislocation of the hip

Summary This study reviews the course of avascular necrosis complicating treatment for congenital dislocation of the hip in forty-eight patients (fifty-four hips). Although good hip function generally persists for many years after avascular necrosis, a high percentage of affected patients develop severe changes which may lead predictably to degenerative arthritis and disability later in life. The wide variety of problems caused by avascular necrosis requires analysis of the specific factors operating to create the deformity in each case. Major problems can be anticipated at an early age by continuous observation and better results produced by judicious surgery.

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Résumé Etude de l'évolution de la nécrose ischémique ayant compliqué le traitement de la luxation congénitale de la hanche chez 48 malades (54 hanches). Bien que la fonction reste habituellement bonne long-temps après l'apparition de la nécrose, un pourcentage élevé de malades présentent d'importantes altérations qui aboutiront très vraisemblablement à une arthrose dégénérative et pourront entraîner tardivement une véritable infirmité. Les nombreux problèmes posés par la nécrose ischémique justifient une analyse des différents facteurs qui contribuent, dans chaque cas, à déterminer cette complication. La plupart de ces problèmes peuvent être reconnus précocément grâce à une observation rigoureuse et de meilleurs résultats seront obtenus grâce à un traitement chirurgical bien conduit.

     

先天性髋关节脱位手术治疗的探讨

目的 探讨先天性髋关节脱位手术治疗的有效方法。方法 采用开放复位、骨盆旋转截骨、髋臼成形或加盖、股骨上段旋转或短缩截骨的联合术式治疗先天性髋关节脱位106例，158髋。结果 全部病例经2～14年的随访，按照临床疗效评定标准，优良率达95．6％。结论 该方法根据病变的不同情况，采用联合的手术方式进行治疗，术后不用石膏固定，而采用牵引的方法，有利于髋关节功能的恢复；该手术方法可灵活运用，且并发症少。疗效满意。     

Unilateral joint laxity in unilateral congenital dislocation of the hip

Summary As a part of the clinical examination at a follow-up study on congenital dislocation of the hip (CDH) all patients were examined for general joint laxity. One patient, however, was found to have joint laxity only on the side of the originally dislocated hip.

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Résumé La recherche d'une hyperlaxité articulaire fait partie de l'examen clinique lors des révisions systématiques pour luxation congénitale de la hanche. Chez. une malade, on a mis en évidence cette hyperlaxité uniquement du côté de la hanche originellement luxée.

     

Complications of the treatment of congenital dislocation of the hip by the Pavlik harness

Summary The results of the treatment of congenital dislocation of the hip using the Pavlik harness were satisfactory, but lateral displacement and deformity of the femoral head were sometimes observed after treatment. The causes of these complications are discussed and the measures taken to avoid them are described.

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Résumé Les résultats du traitement de la luxation congénitale de la hanche ont été remarquablement améliorés grâce au bandage de Pavlik. Toutefois une excentration et une déformation de la tête fémorale sont parfois observées en fin de traitement. L'auteur discute les moyens d'éviter ces complications.

     

Posterior dislocation of the Oxford knee meniscal bearing: a treatment option

Unicompartmental knee replacement (UKR) is now established as a treatment for medial compartment arthritis. The Oxford UKR (Biomet Orthopedics, Inc, Warsaw, IN, USA) has a mobile-bearing system, which minimizes wear. This has been shown to provide excellent long-term results. Dislocation of the mobile-bearing device is rare with an incidence of 1 in 200 (0.5 %). The treatment usually involves exploration of the knee through the original anteromedial incision, removal of the dislocated bearing and rectification of the underlying cause for the dislocation. We describe two cases of a posterior dislocation in which the mobile bearing could not be retrieved and was left in situ. In both cases a good outcome was achieved. We conclude that in extremely rare cases where a dislocated bearing has migrated posteromedially and cannot be retrieved, it can be left in place rather than exploring the joint acutely through a separate posterior incision.     

先天性髋脱位的外科治疗

自 1995年 9月以来我院采用髋臼造盖[1] (Ｇｉｌｌ第一型 ) ,股骨粗隆下旋转短缩截骨 ,内收肌、髂腰肌切断综合手术治疗先天性髋关节脱位 35例 38髋 ,疗效满意。报告如下。1　临床资料　　本组 35例中男 6例 ,女 2 9例 ;双侧发病者 3例。年龄 3～ 14岁 ,平均 5岁。所有病例术前