Knöcherne und ligamentäre Begleitverletzungen der traumatischen Schulterluxation und deren Bedeutung für die Pathogenese der habituellen Luxation

161 consecutive patients with traumatic shoulder luxation between 1975 and 1983 are followed, concerning their evolution to recurrent shoulder dislocation. In 26 patients there was a recurrent shoulder dislocation in a mean time of 19 months after the first luxation. In literature the common level of recurrent dislocation is higher than our 16.1%, despite of the shorter immobilising time after the first shoulder luxation in our center. When there is no evolution to recurrent dislocation, a stable shoulder and a normal shoulder function without pain can be expected in 95%. The compression fracture of the humeral head and the avulsion of the glenoid margin were made responsible for the recurrent dislocation, mostly appearing in adult men, younger than 35 (55% of all recurrent dislocations). Because avulsion fractures of the tuberculum majus don't lead to an unstable fracture neither the existence of a compression defect in the humeral head is pathognomonic for an unstable shoulder, nor a lack of such radiological appearance excludes a recurrent dislocation. In first instance rotatory cuff injuries could be responsible for the instability of the shoulder joint. All patients with this invalidating injuries should be stimulated to an operative procedure, because after correction of an unstable shoulder by a derotation osteotomy of Weber or the elevation of the anterior margin of glenoid in the technique of Trillat good results with normal functional capacities of the shoulder can be expected.     

Clinical aspects and treatment of arthrogryposis multiplex congenita. Lower extremity

This is a report about 25 patients of 28 AMC patients with affected lower limbs. From distal to proximal the joints are less attacked. The club-foot is most frequent. It nearly always needs operative treatment. The best results can be obtained by bony operations (exstirpation of the talus, lateral resection of the cuboid, subtalar arthrodesis). In knee joints the frequent flexion-gryposis is functionaly disturbing. It can be eliminated in most of the cases only by operation. The supracondylar extension-osteotomy has to be rejected in children in favour of a dorsal arthrolysis. Flexion-gryposis preponderate in hip joints. Conservative treatment is most often successful, when flexion is not supported by flexion-gryposis of the knee. Frog like contractures are very obstinate and need operative treatment. There exist different opinions whether open reduction of bilateral complete luxation of the hip is necessary or not. Our 3 patients with complete luxation of both hips had a satisfying function of hips after false external rotation was eliminated by osteotomy of the femur. Unilateral luxation of a hip needs open reduction even if a live in sitting position has to be expected. Our own experience is compared with reports of other authors and guiding principles for treatment are presented.     

Zur konservativen Therapie der Schulterluxation

There is no undivided agreement in how long a shoulder ought to be fixed after a luxation. Having made a distinction between the terms of habitual and posttraumatic recidivous luxation of the shoulder, the results of a retrospective analysis of 118 luxations of the shoulder are shown, with 75 outpatients after a primary luxation. In most cases the fixation in the Desault-dressing was maintained for three to four days and was followed by early-functional physiotherapeutical after-treatment. Ten patients=14.9% developed posttraumatic recidivous, and eight patients=10.4% habitual luxations. In comparison with other analyses, these results show that with a short time of fixation of three to four days there is no higher tendency to reluxation than with a longer time of fixation. If a habitual or a posttraumatic recidivous luxation occurs, operative treatment is required.     

Die isolierte luxation ies proximalen tibiofibulargelenks als seltene sportverletzung

The authors present three cases of the rare isolated luxation of the fibular head. Anatomy, injuring mechanism and classification are described. The dignosis is established by clinical examination and comparative X-ray radiograp hy. If a luxation is irreposible under general anesthesia (two of our cases), open reposition has to be performed with subsequent temporary nail or screw fixation. A postoperative immobilization with plastercaston the thigh overaperiod of sixmonths is necessary. After removal of the plaster cast, the material must immediately be removed in order to avoid complications such as fatigue fractures of the material. If this therapy scheme is observed, surgical treatment can be performed without problems and good functional therapy results will be achieved.     

Stem displacement during reduction of a dislocated cemented total hip arthroplasty with a polished tapered stem

Displacement of the polished stem of a total hip arthroplasty from its cemented mantle occurred as a complication of an attempted closed reduction after luxation. No cement fractures were seen during subsequent reoperation. The complication can be avoided if cement is placed over the shoulder of the prosthesis.     

Physiotherapie nach operativer Stabilisierung von Wirbelsäulenverletzungen

Shoulder luxation occurs mainly as anterior, inferior and/or axillary, and less frequently as posterior, luxation. Diagnosis of the former generally presents no clinical or radiological challenge; the latter, however, remains initially undetected in 50%--80% of cases, delaying diagnosis. Basic diagnostic imaging of shoulder luxation provides X-rays of the affected shoulder in at least two planes. Ultrasound can be used for orientation, while computer tomography or magnetic resonance imaging are not least valuable in terms of an expert opinion, while appropriate arthrography-assisted procedures offer advantages over native techniques. These methods make measures available enabling a reasonable choice between primary conservative procedures and arthroscopic diagnosis with subsequent arthroscopic surgical therapy.     

Reconstruction of humeral head retroversion in the treatment of anterior shoulder instability]

Reduction of the physiologic retroversion of the humeral head can lead to shoulder luxation. After shoulder luxation it can also lead to shoulder instability. The aim of the paper was to check the level of humeral head retroversion in patients with anterior shoulder instability and to estimate the effectiveness of treatment of this instability with the derotational Weber osteotomy. The study included 38 patients, 34 males and 4 females, ranged 16-48 yr. (mean 31) treated in our Clinic. Every patient was done CT in order to estimate the level of humeral head retroversion. Patients with reduced humeral head retroversion qualified for operational treatment with Weber method derotational osteotomy. The outcomes were estimated according to the Rowe and Zarins score. 34 patients had excellent or good results. Pain was retreated, patients could come back to their normal activities, before the first luxation. Only 4 patients had another luxation in spite of our treatment. The control CT showed that the humeral head retroversion was 30 or more degrees. The arthroscopy was performed, the Bankart lesion was found and the patients were qualified for treatment this lesion. Weber osteotomy could be the satisfactory method of treatment of anterior shoulder instability in patients with physiologic reduction of humeral head retroversion.     

Volar scaphotrapezial dislocation.

We present a case of volar luxation of the scaphotrapezial bone, in which radiographs suggested luxation of the scaphoid, but unclear relations to the other carpal bones. Computer tomographic reconstruction showed an isolated scaphotrapezial luxation. This was treated by closed reduction and a plaster cast, after which the patient regained normal function of her wrist.     

Volar scaphotrapezial dislocation

We present a case of volar luxation of the scaphotrapezial bone, in which radiographs suggested luxation of the scaphoid, but unclear relations to the other carpal bones. Computer tomographic reconstruction showed an isolated scaphotrapezial luxation. This was treated by closed reduction and a plaster cast, after which the patient regained normal function of her wrist.     

Diagnostik und Therapie der Luxation nach Hüfttotalprothesenimplantation

Background

Luxation following endoprosthetic hip replacement represents a frequent and severe complication and is the reason for a relevant number of hip arthroplasty revision interventions. The probability of occurrence of luxation of a total hip arthroplasty is associated with the indications, patient and operation-specific risk factors. Approximately 50 % of luxations after total hip arthroplasty occur within 3 months of the operation (early luxation).

Diagnostics

The diagnostics of luxation of total hip arthroplasty are carried out by clinical and radiological methods. The causative assignment is made by assessment of joint stability, the bony situation (e.g. loosening, periprosthetic fracture and defects) and the soft tissue (e.g. pelvitrochanterian musculature). In cases of clinical and paraclinical signs of infection and of late luxations, a joint puncture is indicated.

Therapy

Therapy decisions are made depending on the cause (e.g. implant malpositioning, pelvitrochanterian insufficiency, impingement, incongruence between head and inlay and combinations of causes). Therapy of acute total hip prosthesis luxation begins with imaging controlled repositioning carried out with the patient under adequate analgesia and sedation. Conservative therapy is carried out by immobilization with a hip joint orthesis or pelvis-leg cast for 6 weeks. Operative therapy strategies for recurrent luxation are restoration of the correct implant position and sufficient soft tissue tension. Larger hip heads, bipolar heads and tripolar cups are more commonly used due to the geometrically lower probability of dislocation (higher jumping distance). Luxation of total hip prostheses due to infection is treated according to the principles of periprosthetic infection therapy. The rate of recurrence of luxation of 30 % is high so that in cases of unsuccessful therapy treatment should best be carried out in a center for revision arthroplasty.

Conclusions

The search for the exact cause of total hip prosthesis luxation is extremely important. A classification is only possible when the exact cause is known and together with patient and implant-specific details the therapeutic approach can be ascertained. In revision operations the intraoperative functional diagnostics must be exactly documented. The reasons for delayed luxations could be prosthesis infections, abrasion and loosening.     

Ocular globe luxation under general anesthesia

We present a case of ocular globe luxation after general anesthesia. Upon completion of the surgery, the upper eyelid was retracted to examine for conjunctival edema, which resulted in globe luxation. The posterior aspect of the globe was visualized and a small tethering white structure ("check ligament") was observed. The upper lid was retracted, and the globe easily repositioned into the orbit. Ophthalmic sequelae would not be anticipated if the episode of globe luxation is brief. Anesthesiologists should be aware of the risk factors associated with globe luxation and know how to appropriately treat this complication.     

Fracture of the tibial head

Fractures of the tibial head are severe injuries, characterized by enormous variety. Fractures can be classified into fractures of the tibial plateau, luxation fractures, and comminuted fractures. Due to the mechanism of injury luxation fractures are frequently associated with lesions of the menisci and intra- and extra-articular ligaments. Multiple factors can be etiologic for post-traumatic gonarthrosis: nonanatomic reduction of the joint surface, malalignment, and unaddressed associated injuries. Therefore in addition to diagnostic steps such as X-ray, CT scan, and MRI a sophisticated therapeutic regime is necessary. In cases with severely damaged soft tissue or unstable patients, the fracture should initially be reduced and fixed with an external fixator and the definite fixation should be performed in a second setting. Arthroscopically assisted treatment is reserved for fractures of the tibial eminence, crack fractures, and impression fractures. Comminuted and bilateral fractures can be addressed via different incisions. New locking plates with angular stability allow avoidance of bilateral plating in most situations. In specific cases such as compound fractures and for patients with low compliance, a hybrid fixator may be a well-chosen alternative.     

Tibiakopffraktur

Fractures of the tibial head are severe injuries, characterized by enormous variety. Fractures can be classified into fractures of the tibial plateau, luxation fractures, and comminuted fractures. Due to the mechanism of injury luxation fractures are frequently associated with lesions of the menisci and intra- and extra-articular ligaments. Multiple factors can be etiologic for post-traumatic gonarthrosis: nonanatomic reduction of the joint surface, malalignment, and unaddressed associated injuries. Therefore in addition to diagnostic steps such as X-ray, CT scan, and MRI a sophisticated therapeutic regime is necessary. In cases with severely damaged soft tissue or unstable patients, the fracture should initially be reduced and fixed with an external fixator and the definite fixation should be performed in a second setting. Arthroscopically assisted treatment is reserved for fractures of the tibial eminence, crack fractures, and impression fractures. Comminuted and bilateral fractures can be addressed via different incisions. New locking plates with angular stability allow avoidance of bilateral plating in most situations. In specific cases such as compound fractures and for patients with low compliance, a hybrid fixator may be a well-chosen alternative.     

Manubriosternale Luxation durch indirektes Stauchungstrauma Fallbericht und Literaturübersicht

Manubriosternal dislocation caused by indirect flexion-compression trauma is an extremely rare condition. Two forms of manubriosternal luxation are distinguished: in type I the sternum is dislocated posterior and in type II anterior to the manubrium. Direct or indirect trauma may cause manubriosternal dislocation. Mode of injury in direct trauma is mostly a head-on collition in a motor accident resulting either in type I or type II luxation. The unusual origin of manubriosternal dislocation by indirect trauma is put down to flexion-compression injuries of the thoracic spine and results in a type II dislocation. Predisposition to manubriosternal dislocation by indirect trauma consists in rheumatoid arthritis or extreme forms of kyphosis. Outcome of many patients treated conservatively after initial reposition with adhesive tape, symptomatic pain therapy, cryotherapy and prohibition of any physical training over several weeks is subluxation or complete luxation of the manubriosternal joint. This condition may lead to chronic pain, periarticular calcification with ankylosis and progredient deformation. Lacking a controlled study for treatment of manubriosternal dislocation a standard therapeutic regime could not be established yet. In the literature only a few case-reports of patients undergoing operative therapy are published. We report a type II dislocation of the manubriosternal joint caused by indirect flexion-compression trauma. We achieved a very good long-term result using a 8-hole 1/3 tubular plate for fixation of the manubriosternal joint after reposition.     

Simple rotary luxation of the atlas

A case of simple rotation of the atlas is here reported and has not, to our knowledge, been previously described.Rotation of the atlas is an unusual injury.The clinical diagnosis of the atlanto-axial dislocation is made symptomatically but the recognition of the type of luxation can only be made radiographically.     

Über die Behandlungsmöglichkeiten des veralteten De Quervainschen Verrenkungsbruches

Zusammenfassung Es wird über Behandlungsverfahren und Nachuntersuchungsergebnisse bei veralteten De Quervainschen Verrenkungsbrüchen der Handwurzel berichtet. Die Erfolgsaussichten auf Ausheilung des Kahnbeinbruches bei den verschiedenen Behandlungsverfahren des veralteten De Quervainschen Verrenkungsbruches werden auf Grund der Nachuntersuchungsergebnisse dargelegt. Der Verfasser kommt durch die Auswertung des eigenen Krankengutes zu der Auffassung, daß die sofortige Verschraubung des Kahnbeinbruches im Anschluß an die operative Einrichtung des veralteten De Quervainschen Verrenkungsbruches die sichersten und schnellsten Ausheilungsergebnisse bringt.

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Summary The report covers the treatment and subsequent examination results of old De Quervain luxation fractures of the wrist. The chances of success of healing the fracture of the scaphoid bone by different methods used in the case of De Quervain luxation fractures is examined on the basis of results shown in subsequent examinations. By assessing the outcome of treatment given his own patients, the author comes to the conclusion that screwing the fracture of the scaphoid bone together immediately after operativ setting of the old De Quervain luxation fracture is the safest and quickest way of getting the fracture to heal.

     

Posterior luxation of the shoulder joint and contralateral shoulder joint fracture dislocation: a rare combination

Summary The posterior luxation of the shoulder joint is a rarely reported and often not recognized lesion in the clinical workday. The authors present the first case of a posterior luxation of the shoulder joint in combination with an contralateral anterior shoulder joint fracture dislocation. In that case the authors stress the importance of an exact clinical and radiology diagnostic and the right way to reduce a posterior luxation of the shoulder joint. Finally they draw the readers attention to operative steps to prevent a reluxation of the shoulder joint.      

Traumatic hip luxation associated with ipsilateral and contralateral femoral fracture in a child

In children, the association of traumatic luxation of the hip with homo- and heterolateral fracture of the upper extremity of both femurs, is extremely rare. In the case reported here, that association is present. Hip luxation can easily pass unrecognized. Orthopedic reduction is always recommended. Regarding the fracture of the upper portion of the femur in children under 10 years, when alignment of the fragments is not well achieved, surgical treatment should be considered. In this case, valgus osteotomy had to be performed in order to correct a post-traumatic coxa vara. After 4 1/2 years of follow up, the only sequel was a 1 cm leg-length discrepancy.     

Complete dislocation of the polyethylene inlay after internal hemipelvectomy and individually fitted tumor endoprosthesis

We report about an exceptional complication after internal hemipelvectomy and replacement of the defect with a custom-made endoprosthesis. A complete luxation of the PE-inlay out of the metal cup occurred. Radiologically we assumed a luxation of the femoral head in dorsal direction. Revision after a failed attempt of closed reposition showed a complete luxation of the inlay, which was caused by deficient fixation in the acetabular component. The absence of a contrast wire in the PE-inlay delayed the right diagnosis and made it difficult to find the dislocated inlay in the large wound.     

Possibilities for treating chronic radius head dislocations

Thirteen patients with neglected luxation of the proximal radius who were treated with different surgical procedures at the Orthopaedic Department of the Kantonsspital in St. Gallen (Switzerland) returned for evaluation at an average of 7 years postoperatively. The luxation was traumatic in 11 cases (7 Monteggia-fractures) and in 2 cases due to a dysplasia of the forearm. In 7 patients the deformity recurred and in 1 a synostosis between radius and ulna was noticed. In 4 cases the wrist showed a relative overlength of the ulna. Proximal osteotomy of the ulna in combination with open reduction of the proximal radius gave better results than the other procedures. Congenital luxation of the proximal radius does not cause much symptoms but surgical treatment often results in recurrence of the deformity. Therefore, we only occasionally advocate operative therapy in these cases.