Subtalar dislocations:Mechanisms,clinical presentation and methods of reduction

Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints,without major fracture of the talus.They are usually classified as medial(most common),lateral,anterior and posterior dislocations,based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury.They are usually diagnosed by X rays,but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively.Majority being closed injuries,can be managed in ED by closed reduction and cast immobilisation,but if they are open,have poor outcomes.Complications that ensue open dislocations are post-traumatic arthritis,instability and avascular necrosis.

Clinical study on treatment of TOSSY type III acromioclavicular joint dislocation with clavicular hook plate combined with coracoclavicular ligament repair

Objective:To explore the treatment of TOSSY type III acromioclavicular joint dislocation with clavicular hook plate combined with coracoclavicular ligament repair and its clinical effect.Methods:80 patients with TOSSY type III acromioclavicular joint dislocation who were admitted to our hospital from January 2014 to January 2019 were selected.They were randomly divided into the control group(n=39,treated with clavicular hook plate)and the observation group(n=41,treated with clavicular hook plate combined with coracoclavicular ligament repair)by the random number table method.The clinical efficacy in 12 months after operation,related clinical indicators,12-month postoperative recovery and postoperative complications were compared between the two groups.Results:The excellent and good rate was 92.68%(38/41)in 12 months after operation in the observation group,which was higher than that(76.92%,30/39)in the control group(p<.05).There were no significant differences in the duration of surgery,intraoperative blood loss and HLOS between the observation group and the control group(p>.05).In 12 months after operation,abduction activity and forward flexion activity of the observation group were higher than those of the control group,and visual analogue score(VAS)was lower than that of the control group(p<.05).The incidence of complications in the observation group was slightly lower than that in the control group,but there was no statistically significant difference between the two groups(p>.05).Conclusions:For TOSSY type III acromioclavicular joint dislocation,clavicular hook plate combined with coracoclavicular ligament repair has a good clinical efficacy.It can improve shoulder joint function,alleviate shoulder pain and have fewer complications.It can provide a reference for clinical treatment of this type of acromioclavicular joint dislocation.

Utility of Spiral Computed Tomography in the Study of Dislocation of Cricoarytenoid Joint

The cricoarytenoid relationship presented with spiral computed tomography was demonstrated and the reconstruction of arytenoid dislocation was presented by using multiplanar reconstruction algorithms. Fifteen patients with arytenoid dislocation documented by fiberoptic laryngoscopy and strobovideolaryngoscopy and 10 normal persons were displayed by spiral computed tomography (CT). A making design of our own had been used to diagnose arytenoid dislocation on axial CT image. Results showed that dislocation of cricoarytenoid joint was consistently demonstrated on several of the overlapping thin axial reconstructions in each of the 15 patients, in whom asymmetry of the bilateral cricoarytenoid joints was noted on axial images. It was found that on the glottic-fissure level the basal angle on abnormal side was larger in 8 patients than that on the normal side and smaller in 7 patients in patient group, whereas right basal angle was equal to the left in 8 subjects, except 2 in control group. There was statistically significant difference in the number of the equal to two basal angles of glottic fissure between control group and patient group (P<0.025). High-quality sagittal and coronal reconstructive images often were helpful in confirming or clarifying the complex arytenoid orientations. The findings that two-side basal angle was not equal in triangle of glottic fissure can be used as an objective parameter to diagnose arytenoid dislocation. Spiral CT is a useful adjunct in the diagnosis and treatment of dislocation of cricoarytenoid joint.

Decompression via posterior-anterior approach and anterior fixation in treatment of fracturedislocation of the lower cervical spine with bilateral facet joints dislocation

Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This

Posterior pedicle screw fixation combined with local steroid injections for treating axial eosinophilic granulomas and atlantoaxial dislocation:A case report

BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simple to overlook and misdiagnose.Because of the disease's rarity,there is presently no standardized treatment principle.There are few accounts of such occurrences affecting the axis among children.We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone.CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation,a 6-year-old boy was brought to our hospital.Following a careful evaluation,the pathology indicated a strong likelihood of an axial EG.Ultimately,we decided to treat the boy with posterior pedicle screw fixation and local steroid injections.CONCLUSION EGs of the upper cervical spine are quite uncommon in children,and they are exceedingly easy to overlook or misdiagnose.Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.

Using shape-memory alloy staples to treat comminuted manubrium sterni fractures: A case report

BACKGROUND Comminuted manubrium sterni fractures are rare,and internal fixation methods are limited.This report explored a practical and feasible method of internal fixation for comminuted manubrium sterni fractures.CASE SUMMARY A 17-year-old female was injured in a car accident for which she underwent debridement and suturing of her head and anterior chest wounds in another hospital.Eight days later,the patient was transferred to our hospital for surgical treatment.The manubrium sterni was found intraoperatively to be split into three irregular fragments with obvious overlap and separation displacement.Meanwhile,a manubriosternal joint dislocation and left first rib cartilage fracture were observed.The retraction force of the shape-memory alloy staples was used to pull the fracture fragments together.Two more titanium locking plates were then used to fix the manubrium sterni and corpus sterni longitudinally,and the left first rib cartilage fracture was repositioned and fixed with a titanium locking plate.A postoperative computed tomography scan showed reduced and rigid fixation of the comminuted manubrium sterni fractures.The patient recovered well with no significant complaints of discomfort.The patient was discharged 10 days postoperatively after the stitches had been removed.CONCLUSION Shape-memory alloy staples had the advantage of being safe and effective during the repositioning and internal fixation of comminuted manubrium sterni fractures.Therefore,they provided a new surgical option for comminuted manubrium sterni fractures.

A Comparative Study on the Close Reduction of Arytenoid Dislocation under Indirectand Direct Laryngoscope

To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation,indirect laryngoscope (IL ) and direct laryngoscope (DL ) were utilized for the closed reduction of the displaced arytenoid under local anesthesia.2 3patients who underwent the reduction for dislocated arytenoid under IL or DL from January1991to June 2 0 0 1were reviewed.The data were collected on the duration of the laryngeal injury,tim es of re- ceiving reduction,side- effects after the treatment and the period for voice to return to normal. The relationship between the duration of the laryngeal lesion and the period of the voice rehabilita- tion was examined.13patients received the reduction under IL and 10 patients under DL .Except the tim es of the reduction,which showed significant difference,no differences were found between IL group and DL group in the course and the period of voice rehabilitation,as well as sore throat after the manipulation.The patients'voice recovery was positively related to their course of dis- ease in both IL and DL group.Itis concluded thatthe recovery of normal voice is obviously affect- ed by the duration of arytenoid dislocation.The reduction under IL is as effective as under DL in the treatment of arytenoid dislocation.Reduction by DL is better suit the patients with long tim e course of disease.

Clinical observation of needling gluteus medius muscle trigger point plus chiropractic for sacroiliac joint subluxation

Objective:To observe the clinical effect of needling gluteus medius muscle trigger point (TrP) plus chiropractic for sacroiliac joint subluxation.Methods:A total of 124 cases conforming to the inclusion criteria of sacroiliac joint subluxation were classified by anterior subluxation and posterior subluxation,and randomized into a TrP group and a conventional group respectively.There were 63 patients with anterior subluxation who were randomized into a TrP group of 32 cases (including 4 dropped out cases) and a conventional group of 31 cases (including 3 dropped out cases);and 61 patients with posterior subluxation who were randomized into a TrP group of 31 cases (including 3 dropped out cases) and a conventional group of 30 cases (including 3 dropped out cases).Patients in the TrP group received the treatment of needling gluteus medius muscle TrP plus chiropractic,while patients in the conventional group received conventional acupuncture treatment plus chiropractic.The treatment was done twice a week for a succession of 8 weeks.Then,the pain visual analog scale (VAS),Oswestry disability index (ODI) and therapeutic efficacy were evaluated.Results:After treatment,the total effective rate of TrP group with anterior subluxation was 96.9%,higher than 77.4% in the conventional group,the difference showed a statistical significance (P<0.05);the total effective rate was 93.5% in the TrP group with posterior subluxation,higher than 73.3% in the conventional group.After treatment,the VAS and ODI scores in both groups dropped obviously,the differences showed statistical significance (all P<0.05);the scores of VAS and ODI in the TrP group were obviously lower than those in the conventional group (all P<0.05).Conclusion:Needling gluteus medius muscle TrP plus chiropractic had a better therapeutic effect than conventional acupuncture plus chiropractic for sacroiliac joint subluxation.

National incidence of joint dislocation in China:a retrospective survey of 512,187 individuals

Background:Joint dislocations significantly impact public health.However,a comprehensive study on the incidence,distribution,and risk factors for joint dislocations in China is lacking.We conducted the China National Joint Dislocation Study,which is a part of the China National Fracture Study conducted to obtain the national incidence and risk factors for traumatic fractures,and to investigate the incidence and risk factors for joint dislocations.Methods:For this national retrospective epidemiological study,512,187 participants were recruited using stratified random sampling and probability-proportional-to-size method from January 19 to May 16,2015.Participants who sustained joint dislocations of the trunk,arms,or legs(skull,sternum,and ribs being excluded)in 2014 were personally interviewed to obtain data on age,educational background,ethnic origin,occupation,geographic region,and urbanization degree.The joint-dislocation incidence was calculated based on age,sex,body site,and demographic factors.The risk factors for different groups were examined using multiple logistic regression.Results:One hundred and nineteen participants sustained 121 joint dislocations in 2014.The population-weighted incidence rate of joint dislocations of the trunk,arms,or legs was 0.22(95%confidence interval[CI]:0.16,0.27)per 1000 population in 2014(men,0.27[0.20,0.34];women,0.16[0.10,0.23]).For all ages,previous dislocation history(male:OR 42.33,95%confidence interval[CI]:12.03-148.90;female:OR 54.43,95%CI:17.37-170.50)and alcohol consumption(male:OR 3.50,95%CI:1.49-8.22;female:OR 2.65,95%CI:1.08-6.50)were risk factors for joint dislocation.Sleeping less than 7 h/day was a risk factor for men.Compared with children,women aged≥15 years(female 15-64 years:OR 0.16,95%CI:0.04-0.61;female≥65 years:OR 0.06,95%CI:0.01-0.41)were less likely to sustain joint dislocations.Women with more than three children were at higher dislocation risk than women without children(OR 6.92,95%CI:1.18-40.78).Conclusions:The up-to-date data on joint dislocation incidence,distribution,and risk factors can be used as a reference for national healthcare,prevention,and management in China.Specific strategies for decreasing alcohol consumption and encouraging adequate sleeping hours should be developed to prevent or reduce dislocation incidents.Trial Registration:Chinese Clinical Trial Registry,ChiCTR-EPR-15005878.

Study on the angle of needling Yamen (GV 15) in atlanto-axial dislocation patients

Objective: To compare the risk angle and safety angle of n eedli ng Ya me n (GV 15) betwee n the atla nto-axial dislocati on (AAD) patients and healthy subjects. Methods: A total of 177 AAD patients diagnosed and treated at the Center of Upper Cervical Vertebra of Beijing Chin a-Japa n Frie ndship Hospital betwee n January 2010 and January 2018 were in eluded in the AAD group. Ano ther 207 healthy subjects were included in the normal group. There were totally 191 males and 193 females. The MRI sean was performed for the cervical vertebrae to measure the risk angle and safety angle of acup un cture at Ya me n (GV 15) on the sagittal image. Results: In the AAD group, the risk angle was (13.14±3.99)° and the relative safety angle was (10.31±3.23)° for the perpendicular needling, while the oblique needling risk angle was (9.09±3.09)° for the male;the risk angle was (12.12±2.74)° and the relative safety angle was (10.56±2.09)° for the perpendicular needling, while the oblique needling risk angle was (9.70±2.95)° for the female. In the normal group, the risk angle was (7.89±1.59)° and the relative safety angle was (10.21±3.55)° for the perpendicular needling, while the oblique needling risk angle was (16.07±1.77)° for the male;the risk angle was (6.93±1.45)° and the relative safety angle was (10.70±2.94)° for the perpendicular needling, while the oblique needling risk angle was (14.89±2.18)° for the female. The perpendicular needling risk angles for the males and females in the AAD group were larger than those in the normal group, and the differences were statistically significant (both P<0.01);for the inner-group comparison, there was no sigrHficant difference in the perpendicular needling risk angle between the male and the female in the AAD group (P>0.05);however, the perpendicular needling risk angle for the male was larger than the female, and the differenee was statistically significant in the normal group (P<0.01). There were no sign讦icant differences in the relative safety angle for both the male and the female between the AAD group and the normal group (both P>0.05). For the inner-group comparison, there was no sign讦icant differenee in the relative safety angle between the male and the female (P>0.05). The oblique needling risk angles for both the males and females were smaller in the AAD group than those in the normal group, and the differences were statistically sign讦icant (both P<0.01);the oblique needling risk angle for the male was not significantly different from that for the female in the AAD group (P>0.05);in the normal group, the oblique needling risk angle for the male was larger than that for the female, and the differenee was statistically significant (P<0.01). Conclusion: Un der the AAD condition, the risk angle and safety angle of acup un cture at Ya me n (GV 15) cha nge significantly, perpe ndicular n eedli ng should be better if performed slightly lower tha n the horiz on tai di recti on, and the oblique needling should be safer across the occipital foramen toward the occipital bone.