The dorsal dislocation inferior radio-ulnar joint was treated by the shortening operation of the pronator quadratus muscle by moving the muscle origin to its dorsum, so that the pronator quadratus muscle was always under tension whether the muscle was contracted or relaxed. Thus the anatomic position and stress distribution were improved. We had treated 11 patients in the past four years.The patients were followed from four months to four and half years and the results were 9 patients excellent and 2 good.
From 1974 to 1993, 20 patients with dislocation of patella in 26 knees were treated by surgical technique, including 11 males and 9 females, aged from 10 to 67,averaged 31 year old. Thirteen cases (16 knees) were available for followup with an average period of 6.4 years. Using the criteria of Insall, the result were excellent in 5 knees, good in 5 knees, fair in 3 knees and poor in 3 knees with a success rate of 62%. Based on the biomechanism of patella movement and the findings in this study, the mechanism of dislocation of patella and its biomechanical reconstruction principle as well as the factors influencing the operative results were discussed.
ObjectiveTo explore the cause of prosthesis dislocation after primary artificial hip replacement (AHR) and propose preventive measures. MethodsA total of 221 patients underwent artificial hip replacement from 2000 to 2012, among whom 8 developed dislocation. These cases were retrospectively analyzed to summarize the causes of dislocation and preventive measures were proposed. ResultsAmong 221 cases of hip replacement, 8 suffered from postoperative dislocation. All of them underwent posterolateral-approach total hip arthroplasty. The causes of dislocation included coexisting decreased muscle strength before operation, improper placement of the prosthesis during operation, inappropriate postural changes after operation, improper nursing and health education. Of the 8 dislocation cases, 2 were cured after reoperation and revision, 6 were cured through close reduction under anesthesia, and 7 were followed up for 1-5 years without relapse. ConclusionPreoperative assessment of the patients' soft tissue tension of affected hip and comorbid conditions, selection of proper design of prostheses and the components, removal of tissues possibly causing joint impact, correct placement of artificial prosthesis and components and instructing the patients for the correct movement mode of the affected hip after operation are all crucial for the prevention of postoperative hip dislocation.
Sixty-one cases of fracture or dislocation were treated with France-made biopolyester ligament. They consisted of 18 cases of fracture of patella, 13 cases of fracture of olecranon, 8 cases of fracture of distal clavicle, 10 cases of dislocation of acromino-clavicular joint, 6 cases of separation of lower tibio-fibular joint, 3 cases of rapture of cruciate ligament and 3 cases of fracture of upper third of ulna with dislolcation of radial head. The follow-up period lasted from 3 to 12 months with an average of 7.3 months. The result showed that of the 56 follow-up cases, 49 were excellent and 7 were satisfactory. There was no redisplacement occured in this group. The Biopolyester ligament was believed to be a good and safe material for fractures or dislocations and was of good strength of extension and easy to use.
ObjectiveTo explore the clinical effect of open reduction and internal fixation with hollow screw fixation in the treatment of difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus.MethodsFrom January 2011 to March 2014, 15 patients with difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus were treated with open reduction and hollow screw fixation. There were 9 males and 6 females, aged from 45 to 77 years with an average of 63.5 years. The causes of injury included 7 cases of falls, 5 cases of high falling injury, and 3 cases of traffic accident injury. The injury-to-admission time was 2 hours to 5 days with an average of 1.5 days. The shoulder joint was the initial dislocation. The types of dislocation showed 14 cases of anterior dislocation and 1 case of posterior dislocation. There were 9 cases of simple avulsion fracture of greater tuberosity of humerus, 5 cases of comminuted fracture, 1 case of both greater tuberosity of humeru with small tuberosity of humerus fracture, and 2 cases of incomplete nerve injury; no exploration was carried out in operation.ResultsThere were 14 patients with wound healing at first intention; 1 suffered superficial infection of the wound, which healed by anti infection treatment. Fifteen cases were followed up for 6 to 18 months with an average of 12.2 months, with 1 case of shoulder joint re-dislocation 1 month after operation, and 2 cases of tuberosity of humerus defect absorption. One year after operation, the shoulder joint function were evaluated according to Neer Scoring System, and the results were excellent in 9 cases, good in 3 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 80.0%.ConclusionThe curative effect of open reduction and internal fixation with hollow screw fixation on difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus is remarkable, which can obtain satisfactory shoulder joint function.
Objective To explore the treatment of dislocation after total hip replacement. Methods From July 1997 to October 2004, 23 casesof dislocation after total hip replacement were treated,including 9 males and 14 females and aging 5379 years. The CT and serial X-ray films were taken to observe the position of prostheses. The strength of their hip abductor was also tested. In the patients without loosening, closed reduction was attempted at first. The stability of hip was tested. If closed reduction failed, the offset or/and parts of the components was adjusted, then the capsular was repaired. If instabilitystill existed, revision was adopted. Results In 23 cases of dislocation, 10 cases were treated successfully by closed reduction. In 12 patients who failed reduction, 5 were given open reduction combined with capsular repairing; the offset was adjusted by lengthening femoral head in 2 cases; rim liners were elevated in 2 cases; and larger offset was used and abnormal liner was adjusted in 1 case. Revision was used in 1 case having loosening and 2 cases having instability. Allpatients were followed up 1 year to 5 years (1.9 years on average). The Harrisscoring was 7294 (87 on average). Conclusion The treatment of dislocation after total hip replacement should use different ways according to the causes of dislocation and the stability of hip.
Objective To summarize the characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. Methods The clinical data of 4 patients with irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations between January 2010 and December 2019 were collected. There were 2 males and 2 females and the age ranged from 24 to 41 years, with an average age of 33.5 years. The cause of injury included traffic accident in 3 cases and falling in 1 case. Pipkin classification was 2 cases of type Ⅰ and 2 cases of type Ⅱ. The time from injury to operation was 1-2 days. The clinical features were that the hip joint of the affected limb was in a locked position, and the passive range of motion was poor. The affected limb was slightly flexed at the hip joint and shortened, in a state of neutral position or slight adduction and internal rotation. The imaging data suggested that the femoral head dislocated backward and upward, and the hard cortex of the posterior edge of the acetabulum was embedded in the cancellous bone of the femoral head, and the two were compressed and incarcerated. Patients of cases 1-3 underwent closed reduction of hip dislocation 1-2 times at 3, 1, and 3 hours after injury respectively, and femoral neck fracture occurred. The injury types changed to Pipkin type Ⅲ, and open reduction and internal fixation were performed. Patient of case 4 did not undergo closed reduction, but underwent open reduction and internal fixation directly. Results Patients of cases 1-3 were followed up 14, 17, and 12 months, respectively. They developed osteonecrosis of the femoral head at 9, 5, and 10 months after operation respectively, and all underwent total hip arthroplasty. Patient of case 4 was followed up 24 months and had no hip pain and limited mobility; the imaging data indicated that the internal fixator position was good and the fracture healed; no collapse or deformation of the femoral head was seen, and no osteonecrosis of the femoral head occurred. Conclusion Clinicians need to improve their understanding of the unique clinical features and imaging findings of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. It is suggested that open reduction and simultaneous fixation of femoral head fracture should be directly used to reduce the incidence of osteonecrosis of the femoral head.
Objective To investigate the treatment method and effectiveness of fresh closed fracture-dislocation of the midtarsal joint. Methods Between April 2004 and April 2011, 73 patients (75 feet) with fresh closed fracture-dislocation of the midtarsal joint were treated with closed reduction combined with open reduction and internal fixation. There were 56 males (58 feet) and 17 females (17 feet), aged from 19 to 62 years (mean, 35.8 years). Injuries were caused by falling from height in 35 cases, by sprain in 4 cases, by machine twist in 5 cases, by heavy pound in 9 cases, and by traffic accident in 20 cases. The time from injury to admission ranged from 1 hour and 30 minutes to 48 hours (mean, 4.5 hours). According to Main’s classification standard, 6 feet were rated as vertical compression injury, 33 feet as medial displacement injury, 17 feet as lateral displacement injury, 9 feet as flexion injury, and 10 feet as crush injury. Concomitant injuries included midfoot fracture-dislocation (34 feet), scaphoid fracture (6 feet), cuboid bone fracture (18 feet), calcaneal fracture (8 feet), talus fracture (7 feet), tibiotalar joint dislocation (2 feet), subtalar joint dislocation (2 feet), medial malleolus fracture (1 foot), and acute compartment syndrome (3 feet). Results Healing of incision by first intention was achieved in 65 cases (67 feet), by second intention in 8 cases (8 feet). Sixty-two cases (62 feet) were followed up from 11 months to 7 years and 11 months (mean, 3 years and 6 months). After operation, feet pain occurred in 26 cases, and stiffness or discomfort of the affected foot in 36 feet when walking. The X-ray examination showed good reduction of fracture-dislocation of the midtarsal joint and concomitant injuries with no re-dislocation or bone nonunion in 59 feet; 3 feet had flatfoot secondary to navicular necrosis, and underwent arthrodesis. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 77-90 (mean, 88.6) at last follow-up. Conclusion According to the preoperative evaluation of the damage, using the manual reduction combined with internal fixation (mini-plate or hollow screw with Kirschner wire) methods can obtain good effectiveness in the treatment of fracture-dislocation of the midtarsal joint.
Objective To retrospectively reviewed the operative therapy of the terrible triad of the elbow. Methods From October 2003 to September 2007, 10 cases of terrible triad were treated, with an elbow dislocation and an associated fracture of both the radial head and the coronoid process. There were 3 males and 7 females with the age of 18-66 years. The injury was caused by traffic accidents in 4 cases, fall ing from a height in 4 cases, and tumbl ing in 2 cases. The coronoid process fractures of the patients were 5 cases of type I, 3 cases of type II and 2 cases of type III according to Regan- Morrey classification. The radial head fractures of the patients were 1 case of type I, 6 cases of type II and 1 case of type IIIaccording to Mason classification, and their radial heads of the other 2 patiants were resected before they were in hospital. The general approach was to repair the damaged structures sequentially from deep to superficial, from coronoid to anterior capsule to radial head to lateral l igament complex to common extensor origin. And selected cases were repaired of the medial collateral l igaments and assisted mobile hinged external fixation to keep the forearm fixed in functional rotation position. The function of the elbows were evaluated with the criteria of the HSS2 score system. Results The other wounds healed by first intention except 1 case which had infection 7 days after operation and whose soft tissue defect in posterior elbow were repaired with the pedicle thoracoumbil ical flap. The patients were followed up 6 to 51 mouths (mean 24.9 mouths). The fracture heal ing time was 6 to 20 weeks (mean 9.6 weeks). Six mouths postoperatively, the mean flexion-extension arc of the elbow was 106.5° (85-130°), and the mean pronation-supination arc of the forearm was 138°( 100-160°) respectively. According to the criteria of the HSS2 score, the results were excellent in 4 cases, good in 4 cases, and fair in 2 cases. No compl ications such as stiffness and ulnohumeral arthrosis occurred. The radial nerve injury was found in 1 patient 1 day after operation who was treated with neurolysis, and the nerve function was recovered after 4-6 months. And heterotopic ossification occurred in 6 patients 6 months after operation and radiographic subluxation developed in 1 patient 36 months after operation, and conservative treatment weregiven. Conclusion The terrible triad of the elbow can lead to serious elbow instabil ity and should be treated with operationto restore the anatomic structures, to repair the articular capsule and the collateral l igament, using the adjuvant hinged external fixation and early exercise to avoid immobil ization and recover the articular function.
ObjectiveTo summarize the short-term effectiveness of TightRope system for the treatment of syndesmotic tibiofibular diastasis. MethodsBetween June 2013 and June 2015, 23 patients with syndesmotic tibiofibular diastasis were treated by TightRope system, including 15 males and 8 females with an average age of 32.3 years (range, 16-63 years). Injury was caused by sports in 13 cases, by traffic accident in 6 cases, and by falling from height in 4 cases. The locations were the left side in 13 cases and the right side in 10 cases. The time from injury to operation was 6 hours to 12 days (mean, 3.8 days). According to Lauge-Hansen classification, 13 cases were rated as supination-external rotation type, 7 cases as pronation-abduction type, and 3 cases as pronation-external rotation type; according to Weber classification, 5 cases were rated as type A, 11 cases as type B, and 7 cases as type C. ResultsThe mean operative time was 68.1 minutes (range, 48-93 minutes); the mean intraoperative blood loss was 70.3 mL (range, 20-150 mL); and the mean hospitalization days were 7 days (range, 5-13 days). Superficial local skin necrosis occurred in 6 cases, and primary healing of incision was obtained in the others. All patients were followed up 8-30 months (mean, 16.4 months). X-ray films showed bone union was achieved within 6-12 weeks (mean, 9.4 weeks). No related complications of reduction failure and re-fracture occurred. The internal fixators were removed at 10-18 months postoperatively (mean, 13.3 months). According to American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle function evaluation, the results were excellent in 19 cases and good in 4 cases at last follow-up. ConclusionTightRope system is a good method to treat syndesmotic tibiofibular diastasis, because of safety, convenient operation, and satisfactory short-term effectiveness.