Ipsilateral hip and knee dislocation: Case report and review of literature

Hip and knee dislocations are not uncommon but simultaneous ipsilateral dislocation of the hip and knee joint is rare; consequently, there is an inadequate amount of literature on the subject. We identified only 11 such cases reported in English literature. In the present report, we describe the case of a 23-year-old male patient who presented with ipsilateral hip and knee dislocation on the right side after being involved in a road traffic accident. The hip dislocation was associated with a posterior wall acetabular fracture. The hip as well as the knee joints was reduced in the emergency bay. The patient underwent an urgent fixation of the posterior wall acetabular fracture with delayed ligament reconstruction for the knee dislocation. At one-year follow-up, he had no pain in the hip or knee. There was grade 1 posterior sag but no symptoms of knee instability. Radiographs revealed no evidence of avascular necrosis or arthritis of the femoral head. The normal treatment protocol for individual injury is affected by the simultaneous occurrence of hip and knee dislocation.     

A case of pathological fracture caused by vitamin D insufficiency in a young athlete and a review of the literature

Our patient is a 16-year-old boy basketballer with no significant medical history or previous injuries. He fell on his right hip during jogging and sustained a right superior-posterior hip dislocation with a Pipkin type 2 fracture of the femoral head. Manipulation and reduction under sedation then general anaesthesia was unsuccessful he underwent open reduction and internal fixation.Because his fall was of low energy, an endocrinologist was consulted to rule out primary contributing factors to his fracture dislocation. He was found to have insufficient levels of vitamin D (22.4 μg/l) which was replaced subsequently. Other hormonal investigations were unremarkable. The Bone Mineral Density of his left femoral neck measured 1.098, corresponding to a Z-score of 1.1 (normal). At 2 months post operation, our patient was pain free and able to ambulate without aid. Follow up Xrays showed satisfactory alignment with no evidence of osteonecrosis.We conducted a literature search on pubmed with keywords: Hip, dislocation, fracture, minimal trauma, atraumatic, vitamin D deficiency. We then excluded post-operative dislocations and found 4 articles reporting minimal or atraumatic hip dislocations.Posterior hip dislocations have been reported in literature to be a high energy trauma, usually due to an axial load on the femur, typically with hip flexed and adducted. Complex posterior fracture-dislocation of the native hip joint in adults is usually caused by road traffic accidents or falls from heights.Native hip dislocations in adults associated with minimal or no trauma are rarely reported in literature, and are mostly due to hip dysplasia, arthritis, connective tissue disorders or spastic muscular paralysis. Of note there are no reports of vitamin D deficiency causing a hip fracture dislocation.This is the first known case of an athlete sustaining a vitamin D insufficiency fracture. In patients presenting with posterior hip dislocations after minimal or no trauma, underlying causes must be excluded. More research is necessary to investigate the relationship between vitamin D insufficiency and hip dislocations.     

Acetabular depression fracture accompanying posterior fracture dislocation of the hip

The acetabular depression fracture is defined as a rotated, impacted, osteocartilaginous fragment of the posteromedial acetabulum that occurs in conjunction with a posterior fracture dislocation of the hip. Displacement of this fracture fragment creates incongruity of the posterior acetabular articular surface and the potential for hip joint instability. A retrospective review of hip dislocations over a 3-year period disclosed 75 posterior fracture dislocations of the hip. A total of 71 hips had computerized tomography (CT) scanning after successful closed reduction of the dislocation. Of the 75 dislocations, 58 were treated with open reduction and internal fixation for reproducible posterior subluxation or redislocation upon clinical examination, non-concentric closed reduction, and/or unacceptable articular fracture displacement. The acetabular depression fracture was identified in 17 cases (23%). A total of 16 were found on preoperative CT scans, and one was discovered at the time of open reduction. Preoperatively, each of these injuries demonstrated posterior instability with hip flexion less than 90 degrees. Treatment consisted of disimpaction of the fragment with elevation to the level of the concentrically reduced femoral head. The fragment was stabilized with packed cancellous bone graft obtained from the greater trochanter. The separate posterior lip fragment was then reduced and internally stabilized to ensure reduction of the acetabular depression fragment. We conclude that this variant of the posterior fracture dislocation of the hip occurs in a significant percentage of these injuries. Preoperative recognition of this fracture may correlate with posterior hip instability, and its presence may be an indication for open reduction and internal fixation of the fracture. Long-term studies of this lesion are still needed.     

Pipkin's骨折的治疗及并发症分析

[目的]通过治疗随访21例髋关节后脱位合并股骨头骨折（Pipkin＇s骨折），探讨治疗方法及并发症。[方法]1998～2004年，共收治21例此类病人。据Pipkin分型，Ⅰ型5例，Ⅱ型8例，Ⅲ型2例，Ⅳ型6例。据分型、年龄、术前影像及术中探查综合考虑治疗方法。闭合复位2例，取出游离小骨块4例，可吸收螺钉及可吸收缝线固定骨折块16例，全髋置换术2例。[结果]随访6个月～6a，疗效优3例，良10例，可4例，差4例，优良率62％。[结论]治疗效果的关键是早期诊断，据个体化原则选用手术切口及固定，适当扩大手术指征。     

Posterior dislocation of the hip joint with fracture of both the femoral head and neck

Fracture of both the femoral head and neck associated with posterior hip dislocation is a rare injury. This report describes a rare case of fracture-dislocation of the hip joint with a separated femoral head with a residual fragment in the acetabulum, and a subcapital fracture. We performed open reduction with internal fixation immediately after the injury. Osteonecrosis of the femoral head was detected one year after the surgery, however this patient had no symptoms related to the hip joint.     

The open femoral fracture in war--173 external fixators applied to the femur (Afghanistan war)]

During the three years 1988 through 1990, more than 700 external skeletal fixations (AO/ASIF Tubular System) were utilized at the ICRC Hospital for Afghan War Wounded in Peshawar, Pakistan, 173 of which were for femoral fractures. 13% of the fractures were open grade II, and 71% open grade III, mostly due to high velocity gunshot or shrapnel injuries. Usually, the external fixator was left in place until consolidation of the fracture. The average time of external fixation was 128 days. Three major groups of complications have been observed: fracture complications, implant complications, and residual loss of function of the knee joint, probably the most significant permanent complication to the patient. In order to improve the functional results in treating open fractures of the femur, three measures are recommended: unilateral frame with posterolateral insertion of Schanz screws, postoperative positioning of the patient with 90 degrees of flexion of hip and knee joints and mobilization of the patient as soon as possible (on the first or second postoperative day).     

外固定架结合骨段滑移治疗胫骨骨折

目的探讨利用外固定架结合骨段滑移治疗胫骨骨折的方法。方法应用外固定架结合骨段滑移的方法治疗11例胫骨骨折合并骨缺损和软组织缺损的患者。胫骨缺损长度4～12 cm;软组织缺损面积4 cm×5cm～8 cm×16 cm。使用单边重建外固定架,经过扩创、清除死骨、骨膜下截骨、骨段滑移、骨接触端植骨等步骤完成骨段滑移。结果 11例均获随访,时间18～48个月。胫骨骨折均获得愈合。骨段滑移5～12(8±1.9)cm。4例出现钉道浅表感染。2例膝关节屈伸活动度较健侧减少15°,1例踝关节屈伸减少10°,但是不影响生活。2例进行了浅表创面游离植皮。无经历第二次深部扩创、无进行皮瓣转移。结论外固定架结合骨段滑移是治疗胫骨骨折、骨缺损的有效办法,具有创伤小、疗效确切的优点。     

Three part posterior fracture dislocation of the hip without fracture of the femoral head: review of literature and a case report

This case report describes a rare posterior dislocation of the hip with fractures of the ipsilateral femoral neck and greater trochanter, without fracture of the femoral head, in a young adult male following a railway accident. This patient was managed within 6h of injury by open reconstruction. This unusual injury has not been reported previously. Cases of posterior fracture dislocation of the hip with a fracture of the femoral neck without fracture of the femoral head were reviewed from the literature. Mechanism of injury, controversies regarding operative procedures and appropriate surgical approach are discussed. The authors also believe that this injury pattern merits inclusion in the existing classification system of fracture dislocation of hip for management and prediction of outcome.     

Traumatic Bilateral Knee Dislocations, Unilateral Hip Dislocation, and Contralateral Humeral Amputation: A Case Report

Bilateral traumatic knee dislocations are a rarity. We report a case of bilateral traumatic knee dislocations with concomitant right hip dislocation and complete traumatic amputation of the left, nondominant upper extremity at the level of the proximal one-third of the humerus. Angiograms revealed no evidence of popliteal artery injury. Orthopedic treatment consisted of immediate reduction of the dislocations and urgent revision amputation of the upper extremity. Staged, bilateral knee ligamentous reconstructions were performed on hospital days 24 and 29, respectively. Despite this constellation of devastating injuries, the patient had a satisfactory outcome. In patients with high-energy hip or knee dislocations, the bilateral hips and knees should be carefully examined to check for associated fractures and/or dislocations.     

Use of external fixator in the postoperative management of sciatic nerve injuries

Immobilization of lower limb following neurorrhaphy for sciatic nerve injuries poses a difficult clinical situation both for the surgeon and for the patient. In this article, we describe a new technique for maintenance of lower limb in desired position of extension at hip and flexion of knee without application of spica cast using an external fixator. In this method, a spanning external fixator across the knee and hip joint is applied in the desired position following neurorrhaphy, and both joints are sequentially brought back to normal position. Clinical follow-up of 2 cases is also presented with preservation of range of motion at hip and knee joint as well as good functional outcome of nerve repair.     

带髓腔内置物股骨骨折的环抱器治疗

目的观察环抱器治疗带髓腔内置物股骨骨折的疗效.方法对9例带髓腔内置物股骨骨折患者采用切开复位,形状记忆锯齿臂环抱内固定器(简称环抱器)治疗,其中5例股骨上段带人工股骨假体,4例股骨下端带逆行髓内钉.骨折位置分别位于股骨假体柄及尖端周围和髓内钉的尾端.1例股骨柄松动,予全髋翻修结合环抱器固定,其余内置物均稳定,术后随访1年.结果术后4月,X线片显示大部分骨折获骨性连接(6/9),术后1年,除1例行全髋翻修加环抱器固定,存在髋屈曲受限(45°)外,其余均得到良好的髋膝关节功能恢复,无感染、骨不连、再骨折等并发症.结论带内置物股骨骨折治疗困难.环抱器内固定提供了一种可靠、经济、实用的治疗选择.     

微型外固定架结合有限切开复位内固定治疗手部关节内骨折

目的 探讨微型外固定架结合有限切开复位内固定治疗手部关节内骨折的方法及疗效.方法 2002年5月至2007年5月,应用微型外固定架结合有限切开复位内固定治疗手部关节内骨折26例,男21例,女5例;年龄15～52岁,平均25.5岁.涉及近侧指间关节13例、拇指指间关节2例、掌指关节6例、拇指掌指关节5例.合并关节外掌骨骨折3例、舟骨骨折1例、前臂骨筋膜间室综合征1例.所有病例均采用Orthofix微型外固定架,内固定包括克氏针、细钢丝、可吸收缝线等.结果 全部病例随访6～30个月,平均11.5个月.术后骨折均愈合,愈合时间5～12周,平均7周.随访时X线片显示指骨短缩或旋转畸形2例,关节面不一致(1 mm以内)或关节间隙狭窄3例,其中1例于术后1年半因创伤性关节炎行人工关节置换术.所有损伤关节均无不稳定发生.以ATM标准评定手术后患指运动功能,优8例,良13例,可3例,差2例,优良率81%.结论 微型外固定架结合有限切开复位内固定治疗手部关节内骨折方法可靠、有效.指骨短缩或旋转畸形、关节间隙狭窄是主要并发症.     

Interprosthetic fracture of the femoral shaft

Experience in the management of a complication of ipsilateral hip and knee arthroplasty is described. The cases of four female patients who sustained a femoral shaft fracture after ipsilateral hip and knee arthroplasty are reported. All fractures were treated operatively, and in all cases internal fixation devices failed. This complication of multiple joint arthroplasty presents a difficult management problem. Rigid fixation has a high failure rate for this type of fracture. Surface knee arthroplasty provides a better opportunity for internal fixation than a knee arthroplasty with a stemmed femoral component.     

Subtrochanteric stress fracture of the femur following total knee arthroplasty

This study reports the first case of a subtrochanteric stress fracture of the femur after total knee arthroplasty. A 61-year-old obese woman was treated by right total knee arthroplasty for osteoarthrosis. Four months after the surgery and 1 month after full weight bearing, she complained of tenderness in the right groin and proximal thigh. There was no history of trauma. Radiographs of the right hip and of the right proximal femur were interpreted as unremarkable, and nonsteroid anti-inflammatory drugs were administered. Three months later, she had a sudden onset of increased pain with instability and giving way of the right leg. Radiographs revealed a subtrochanteric transverse fracture of the right femur. Histologic workup of the bone and tissue specimen taken at open reduction, as well as the laboratory data were consistent with the radiologic and clinical diagnosis of a stress fracture. It is most likely that a decrease in the tension band effect of the iliotibial tract in combination with coxa vara and changes in static and dynamic forces of the femur and an increased level of activity after a period of relative inactivity secondary to the knee arthroplasty are responsible for this very uncommon fracture type.     

Simple dislocations of the elbow: evaluation and treatment

Simple dislocations of the elbow or dislocations occurring without an associated fracture are common injuries. Evaluation of these injuries must include an assessment of the entire involved upper extremity and a complete neurovascular examination. Principles of management include a prompt, controlled reduction, a determination of postreduction stability, and an immediate rehabilitation protocol that considers the stability of the joint following reduction. For those joints that are stable throughout the arc of motion, an unrestricted range of motion protocol can be started. When instability is present after reduction, the degree of instability determines the need for dynamic bracing, ligament repair or reconstruction, or the need for a hinged external fixator. The long-term results of these injuries are generally good, with nonoperative treatment producing equivalent or better results than operative treatment. Residual flexion contracture is the most common complication and can be diminished with the use of early range of motion. Other common complications include residual pain and heterotopic ossification, whereas recurrent instability occurs infrequently. Chronic dislocations of the elbow occur uncommonly in North America and Western Europe, but when they occur, reason-able results can be achieved with open reduction of the joint and the use of a hinged external fixator within I year following the dislocation.     

可活动外固定支架结合Anchor钉治疗腕关节脱位

目的探讨应用可活动外固定支架结合Anchor钉治疗腕关节脱位的可行性及治疗效果。方法对16例腕关节脱位患者进行腕关节可活动外固定支架固定,同时切开复位,加压空心钉固定骨折,Anchor钉修复腕骨间韧带和桡腕韧带,克氏针临时固定腕骨。结果随访3～6个月,16例患者均基本恢复腕关节功能,未出现再脱位、舟骨月骨坏死等。采用Cooney评价标准:优7例,良7例,可2例。结论可活动外固定支架结合Anchor钉治疗腕关节脱位可有效固定腕关节,韧带修复可靠,利于破损韧带愈合及促进早期逐步功能锻炼,疗效满意。     

老年浮膝损伤治疗的回顾分析

目的 :回顾收治的 3 1例老年浮膝损伤 ,探讨手术治疗的必要性和优越性以及膝关节功能恢复状况。方法 :综合考虑浮膝损伤时患者的全身情况 ,3 1例老年患者中 ,2 0例股骨和胫骨骨折 ,一次性切开复位内固定和 (或 )外固定器固定 ,8例行股骨骨折切开复位内固定、胫骨行牵引或石膏托固定 ,另外 3例行股骨小夹板固定、胫骨内固定或外固定器固定。按Karlstrom的标准评定治疗结果。结果 :本组病例除 1例意外身亡外 ,均获随访 6个月～ 4年 ,股骨骨折全部愈合 ,2例胫骨骨折出现延迟愈合 ,均无畸形愈合 ,膝关节功能恢复良好 ,无其他严重并发症。优良率 86.7%。结论 :浮膝损伤是一种重度不稳定骨折 ,尽早给予 1处或 2处骨折手术 ,使其达到稳定 ,可大大减少老年患者的并发症及有利于恢复膝关节功能     

Unusual combination of femoral head dislocation associated acetabular fracture with multipart femoral fractures: Case report

IntroductionTraumatic hip dislocation associated with femur intertrocanteric fracture is a rare and severe injury and it frequently occurs following a high energy trauma, Associated acetabular fractures with this injury are even more rare and potentially cause devastating consequences including avascular necrosis of the femoral head and subsequent early secondary osteoarthritis of the hip joint.Presentation of caseIn this case report, we present a 20 year old polytraumatized patient with traumatic hip dislocation associated with ipsilateral acetabulum fracture and simultaneous fractures of the ipsilateral femur.DiscussionTraumatic hip dislocation associated with femur intertrochanteric fracture is a rare and severe injury and it frequently occurs following a high energy trauma. In polytraumatized patients, musculoskeletal injuries are the most common lesions requiring surgical intervention frequently presenting challenging scenarios in terms of functional outcome and quality of life. Osteonecrosis of the femoral head is a serious and unpredictable complication that may occur after displaced femoral neck fracture and traumatic hip dislocation due to the disturbed blood supply of the femoral head.ConclusionA staged treatment strategy may be useful managing an unstable polytraumatized patient or a patient who requires prolonged transfer to receive definitive care.     

桡骨远端骨折合并同侧肘关节损伤的手术治疗体会

目的探讨桡骨远端骨折合并同侧肘关节周围骨折或脱位的治疗方法,提高临床治疗效果。 方法回顾性分析本院自2012年1月至2016年10月收治的桡骨远端骨折合并同侧肘关节脱位或骨折病例22例。22例桡骨远端骨折中13例伴尺骨茎突骨折,3例伴尺骨远端骨折,2例伴舟状骨骨折。22例肘关节周围损伤中5例为尺桡骨近端骨折,3例为肱骨远端骨折,14例发生肘关节后脱位。 结果所有患者均获得随访,术后平均随访时间为13.6个月（11~26个月）,所有骨折均愈合,未发生感染。Cooney腕关节评分平均为92.5分（55~100分）,其中优13例、良7例、中1例、差1例。Mayo肘关节功能评分平均为87.5分（50~100分）,其中优10例、良8例、中3例,差1例。其中1例就诊时已出现骨筋膜室综合征,尺神经、正中神经、桡神经均损伤,肌肉部分坏死切除,功能恢复较差。 结论桡骨远端骨折合并同侧肘关节损伤多为高能量损伤,早期积极而恰当的处理能为患者二次手术提供良好的条件,结合积极的康复锻炼,能取得良好的治疗效果。     

Results and experiences of conversion of hip arthrodesis

INTRODUCTION: With the predictably good outcome of total hip arthroplasty today (THA), hip arthrodesis currently has limited indications. Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and ipsilateral knee due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires conversion of a fused hip to a THA. The results and experiences of conversions of a hip arthrodesis into a THA are reported. INTRODUCTION: Between 1 January 1985 and 31 December 2001 conversion of a previously performed arthrodesis of the hip to THA was carried out in a total of 45 patients; 34 patients could be followed up after the conversion to THA after a mean of 77.5 months (min.: 24, max.: 208). The primary indications for the conversion were low back pain (n=21) and ipsilateral knee pain (n=13). RESULTS: The mean age at the time of THA was 75.3 years (min.: 32, max.: 74). The mean time interval between the arthrodesis and the conversion to THA was 30.4 years (min.: 5, max.: 66). Of 34 hips, 29 (85%) were either pain free or had minimal pain. Complications included one persisting sciatic nerve palsy, two superficial infections, two periprosthetic fractures, and two heterotopic ossifications IV degrees with one recurrence of ankylosis and one marked reduction of motion. Revision arthroplasty was performed in four hips. Postoperatively 7 patients showed no limping, 11 showed a slight limp, and 17 a pronounced limp. Recurrent dislocations occurred in one patient. CONCLUSION: We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. There is a high rate of complications after conversion of a hip arthrodesis to a total hip arthroplasty. These issues must be carefully considered and discussed with the patient before any conversion procedure.