Subcoracoid dislocation of the distal clavicle: A case report with eight-year follow-up

Subcoracoid dislocation of the distal clavicle is an exceedingly rare injury that is typically the result of high-energy trauma, is often associated with concurrent injuries, and can easily be missed in the acute setting. Early open reduction with fixation of the acomioclavicular joint in these cases is recommended to optimise shoulder function and to avoid recurrent acomioclavicular instability and degenerative change. We present the unusual case of subcoracoid dislocation of the distal clavicle that did not require internal fixation or reconstruction following reduction, with satisfactory shoulder function maintained eight years after injury.     

Proximal tibiofibular dislocation: a case report and review of literature

An isolated dislocation of the proximal tibiofibular joint is uncommon. The mechanism of this injury is usually sports related. We present a case where initial X-rays did not show the tibiofibular joint dislocation conclusively. It was diagnosed after comparative bilateral AP X-rays of the knees were obtained. A closed reduction was performed and followed by unrestricted mobilization after 1 week of rest. A review of the literature was conducted on PubMed MEDLINE. Thirty cases of isolated acute proximal tibiofibular joint dislocations were identified in a search from 1974. The most common direction of the dislocation was anterolateral, and common causes were sports injury or high velocity accident related. More than 75 % of the cases were successfully treated by closed reduction. Complaints, if any, at the last follow-up (averaging 10 months, range 0–108) were, in the worst cases, pain during sporting activities. We advise comparative knee X-rays if there is a presentation of lateral knee pain after injury and diagnosis is uncertain. Closed reduction is usually successful if a dislocation of the proximal tibiofibular joint is diagnosed. There is no standard for after-care, but early mobilization appears safe if there are no other knee injuries.     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位

目的探讨锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位的临床疗效。方法从2002年5月至2006年2月,应用AO锁骨钩钢板内固定及韧带修复术治疗锁骨远端骨折(NeerⅡ型)16例和肩锁关节脱位(TossyⅢ型)11例的患者。结果25例获得随访,随访时间6个月～35个月,平均18个月。按照Lazzcano标准评定疗效,优18例,良6例。术后无伤口感染、钢板断裂、螺钉松动,骨折全部愈合,无肩锁关节再脱位。结论AO锁骨钩钢板内固定治疗锁骨远端骨折(NeerⅡ型)和肩锁关节脱位(TossyⅢ型)具有操作简单,固定牢靠,恢复快,疗效好等优点,是一种较好的手术方法。     

Superior sternoclavicular joint dislocation presented with shoulder motion limitation: A case report and literature review

Introduction and importanceSternoclavicular joint dislocation accounts for 1 percent of the human joint dislocations. Sternoclavicular joint dislocation most commonly occurs in anterior or posterior dislocation. To the best of the authors knowledge, only six cases of superior sternoclavicular joint dislocation are reported in the literature. The injury is commonly missed.Case presentationWe present a 28-year-old athlete with upper chest pain and right shoulder range of motion limitation. On imaging, it was revealed that he had a superior sternoclavicular dislocation. He was managed with arm sling, analgesics and physiotherapy. After 3 months, he was asymptomatic and returned to his sport activity successfully.Clinical discussionWe searched the published related studies and summarized the signs and symptoms of patients presented with sternoclavicular dislocation. Chest pain is one of the most common symptom while sternoclavicular tenderness and restriction of shoulder movement are among the most common signs of sternoclavicular dislocations. Conservative, close reduction, and open reduction and internal fixation with fiber wire have been applied for cases with superior sternoclavicular dislocation with acceptable results.ConclusionA high index of suspicion is needed in order not to miss sternoclavicular dislocation. In cases with no evidence of mediastinal structure compression it may be managed conservatively successfully. However, some degree of cosmetic deformity may remain at the sternoclavicular joint in those treated with conservative therapy.     

Sternoclavicular joint dislocation and its management: A review of the literature

Dislocations of the sternoclavicular joint(SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as x-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.     

PIP joint volar rotatory dislocation: An anatomical study to explore extensor system lesions and the Stener effect

Volar rotatory dislocation of the proximal interphalangeal joint results from volar rotation of the condyle around an intact opposite collateral ligament. A cadaveric study was preformed to better understand the mechanisms of this injury. Thirty-two long fingers (II to V) were studied. After partial section of the triangular ligament, the radial collateral ligament was cut (partly or completely, at proximal or distal insertion) and volar rotatory dislocation was induced. We studied the incidence of a fixed dislocation, the distal extension of the triangular ligament lesion, and the Stener lesion of the radial collateral ligament. A buttonhole lesion was produced by a dislocated lateral band in all cases with complete section of the collateral ligament. When the lesion of the triangular ligament extended distally, dislocation became irreducible. A Stener effect (interposition of the lateral band between the condyle and the collateral ligament) was observed after reduction in 21% of cases with proximal lesions of the radial collateral ligament.     

Isolated radial palmar dislocation of the fifth carpometacarpal joint with ulnar neuropathy associated: successful treatment with closed reduction and internal fixation

Carpometacarpal dislocations may be dorsal, volar or divergent type but most are dorsal with involvement of fourth and fifth metacarpal. Isolated volar dislocation of the fifth carpometacarpal joint is an uncommon injury specially when there is no associated fracture. We report a case of radial palmar dislocation of the base of fifth carpometacarpal joint associated to compression of the fourth interdigital nerve in the hand.     

锁骨钩钢板治疗锁骨远端骨折脱位的并发症分析

目的：探讨锁骨钩钢板治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折术后并发症的原因及其防治方法。方法：2001年1月至2011年12月,采用锁骨钩钢板分别治疗TossyⅢ型肩锁关节脱位246例和NeerⅡ型锁骨远端骨折222例。其中男348例,女120例;年龄21～80岁,平均45．4岁;受伤至手术时间1h-15d,平均30．8h。所有患者受伤前肩关节活动正常。根据Karlsson评定标准,将肩关节功能恢复优良者归为正常组、肩关节功能差者为异常组,对两组肩关节的前屈、后伸、内收、外展和上举进行比较,总结钢板钩撞击肩峰、肩峰下骨质磨损、肩锁关节炎、锁骨应力骨折、肩锁关节向下半脱位、脱钩和断钩的情况。结果：468例均获随访,时间8-48个月,平均12．5个月。按照Karlsson评定标准,优308例,良76例,差84例。两组肩关节前屈、后伸、内收、外展和上举的差异均有统计学意义（P〈0．01）。异常组患者中,41例（8．76％）钢板钩撞击肩峰或位置不佳,12例（2．56％）肩峰下骨质磨损或肩峰下滑囊炎,10例（2．14％）肩锁关节炎和锻炼太晚引起肩痛不适,7例（1．50％）锁骨应力性骨折或钢板内侧端翘起,6例（1．28％）肩锁关节向下半脱位,5例（1．07％）脱钩,3例（0．64％）断钩。结论：锁骨钩钢板是治疗Tossym型肩锁关节脱位和NeerⅡ型锁骨远端骨折的较好方法,术中正确放置钢板钩的位置、适当将钢板钩预弯、修复肩锁关节周围纤维结构以及合理功能锻炼有助于减少并发症的发生。     

The anterior dislocation of the sacroiliac joint: a report of four cases and review of the literature and treatment algorism

Pelvic fractures are an uncommon injury in pediatric trauma patients, but the morbidity and mortality associated with these injuries can be profound. Of the posterior pelvic ring disruptions, the posterior dislocation of sacroiliac joint, which is the traditional dislocation of the sacroiliac joint, occurs in most incidences of pediatric trauma patients. There are few reports, however, on the “anterior” dislocation of sacroiliac joint, in which the ilium dislocates anterior to the sacrum and often combines with symphyseal diastasis and fractures of pubic rami and ilia. The distinct fracture-dislocation of sacroiliac joint is a subtype of completed posterior pelvic fracture. Literature review contains little information about such type of dislocation. We present four cases of pediatric trauma patients with the “anterior” dislocation of sacroiliac joint. After a thorough literature review of existing classification of pelvic fractures, we name it as the anterior dislocation of sacroiliac joint. Q. Zhang and W. Chen contributed equally to this work.     

Acute dislocations of the distal radioulnar joint and distal ulna fractures

This article reviews acute dislocations of the distal radioulnar joint (DRUJ) and distal ulna fractures. Acute dislocations can occur in isolation or in association with a fracture to the distal radius, radial metadiaphysis (Galeazzi fracture), or radial head (Essex-Lopresti injury). Distal ulna fractures may occur in isolation or in combination with a distal radius fracture. Both injury patterns are associated with high energy. Outcomes are predicated on anatomic reduction and restoration of the stability of the DRUJ.     

Lateral subtalar dislocation: Case report and review of the literature

A case of complicated lateral subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis requiring arthrodesis and chronic subtalar instability. Negative prognostic factors include lateral and complicated dislocations, total talar extrusions, and associated fractures. A literature search was performed to identify studies describing outcome after lateral subtalar joint dislocation. Eight studies including fifty patients could be included, thirty out of 50 patients suffered a complicated injury. Mean follow-up was fifty-five months. Ankle function was reported as good in all patients with closed lateral subtalar dislocation.Thirteen out of thirty patients with complicated lateral subtalar joint dislocation developed a complication.Avascular necrosis was present in nine patients with complicated injury. Four patients with complicated lateral subtalar dislocation suffered deep infection requiring treatment with antibiotics. In case of uncomplicated lateral subtalar joint dislocation, excellent functional outcome after closed reduction and immobilization can be expected. In case of complicated lateral subtalar joint dislocation immediate reduction, wound debridement and if necessary(external) stabilisation are critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular talar necrosis and infection.     

A case report with review of literature of a rare variant of midfoot dislocations (mid-Chopart dislocation): Combined naviculo-cuneiform and calcaneo-cuboid dislocation

Closed midfoot and Chopart dislocations are uncommon injuries. Moreover, a combination of these dislocations is extremely rare. A 30-year-old male presented to our emergency department with mid-Chopart dislocation (combined naviculo-cuneiform and calcaneo-cuboid dislocation). Adequate open reduction with dual approach (dorsomedial and dorsolateral) and fixation with K-wires were achieved. Although the patient had satisfactory functional outcome postoperatively, he developed midfoot arthritis 12 months later. This type of dislocation is not yet classified, with only few cases reported in the literature.Level of clinical evidence4.     

Extension block pinning for the treatment of a dorsal fracture dislocation of the distal interphalangeal joint: case report

A relatively rare case of dorsal dislocation of the distal interphalangeal (DIP) joint associated with compression fracture of volar base of the distal phalanx is presented. An extension block pin was used to maintain the reduction of the DIP joint during active flexion and extension exercise after surgery. At 49-month follow-up, the clinical results and radiographic findings were satisfactory.     

锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折

目的探讨锁骨钩钢板（CHP）治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折的临床效果。方法应用锁骨钩钢板治疗肩锁关节脱位50例和锁骨远端骨折42例。结果88例获得随访,时间6～36（23．2±7．1）个月,复查X线片见骨折、脱位均复位满意。42例锁骨远端骨折均获得骨性愈合,时间6～18周,内固定物断裂3例,但骨折均愈合良好。46例肩锁关节脱位者中有36例取出CHP,1例术后4d再次受伤出现钢板近侧锁骨骨折,更换较长CHP固定后治愈,9例尚未取出CHP,但均无再脱位。按Karlsson疗效评定标准：优43．2％（38／88）,良50．0％（44／88）,差6．8％（6／88）,优良率达93．2％（82／88）。结论锁骨钩钢板设计合理,符合肩锁关节的解剖生理特点,具有固定确切和可早期功能锻炼的优点,是治疗TossyⅢ型肩锁关节脱位及NeerⅡ型锁骨远端骨折的较好选择。     

Traumatic atlantooccipital dislocation with survival: case report and review of the literature

Summary We present the case of a patient with traumatic atlantooccipital dislocation. The initial neurological examination showed no abnormalities. Dislocation was the result of rapid deceleration in a motor vehicle accident. The mechanism of injury was hyperextension/rotation, probably combined with a distraction force. Only a few cases of atlantooccipital dislocation without neurological involvement have been reported. Every report pointed out difficulties of initial diagnosis. Special attention should be directed toward the atlanto-odontoid-basion relationships as seen on lateral radiographs. Prompt recognition and surgical stabilization are essential to avoid further neurological injury.     

Shoulder dislocation in a very-low-birth-weight infant: case report and review of the literature

Shoulder dislocation in a preterm infant is very rare. We report a case of a preterm infant, with gestational age of 25 2/7 weeks and birth weight of 910 g, with anterior shoulder dislocation after breech delivery. The infant was successfully treated with closed reduction. In general, long-term outcome of shoulder dislocation in these infants is good. However, prompt recognition and treatment of the dislocated shoulder are essential to maintain normal shoulder girdle function and to prevent functional disability.