Neglected congenital bilateral knee dislocation treated by quadricepsplasty with semitendinosus and sartorius transfer:A case report

BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.

High density dislocations enhance creep ageing response and mechanical properties in 2195 alloy sheet

The creep strain of conventionally treated 2195 alloy is very low,increasing the difficulty of manufacturing Al-Cu-Li alloy sheet parts by creep age forming.Therefore,finding a solution to improve the creep formability of Al-Cu-Li alloy is vital.A thorough comparison of the effects of cryo-deformation and ambient temperature large pre-deformation(LPD)on the creep ageing response in the 2195 alloy sheet at 160℃with different stresses has been made.The evolution of dislocations and precipitates during creep ageing of LPD alloys are revealed by X-ray diffraction and transmission electron microscopy.High-quality 2195 alloy sheet largely pre-deformed by 80%without edge-cracking is obtained by cryo-rolling at liquid nitrogen temperature,while severe edge-cracking occurs during room temperature rolling.The creep formability and strength of the 2195 alloy are both enhanced by introducing pre-existing dislocations with a density over 1.4×10^(15)m^(−2).At 160℃and 150 MPa,creep strain and creep-aged strength generally increases by 4−6 times and 30−50 MPa in the LPD sample,respectively,compared to conventional T3 alloy counterpart.The elongation of creep-aged LPD sample is low but remains relevant for application.The high-density dislocations,though existing in the form of dislocation tangles,promote the formation of refined T1 precipitates with a uniform dispersion.

Roughness characterization and shearing dislocation failure for rock-backfill interface

Shearing dislocation is a common failure type for rock–backfill interfaces because of backfill sedimentation and rock strata movement in backfill mining goaf.This paper designed a test method for rock–backfill shearing dislocation.Using digital image techno-logy and three-dimensional(3D)laser morphology scanning techniques,a set of 3D models with rough joint surfaces was established.Further,the mechanical behavior of rock–backfill shearing dislocation was investigated using a direct shear test.The effects of interface roughness on the shear–displacement curve and failure characteristics of rock–backfill specimens were considered.The 3D fractal dimen-sion,profile line joint roughness coefficient(JRC),profile line two-dimensional fractal dimension,and the surface curvature of the frac-tures were obtained.The correlation characterization of surface roughness was then analyzed,and the shear strength could be measured and calculated using JRC.The results showed the following:there were three failure threshold value points in rock–backfill shearing dis-location:30%–50%displacement before the peak,70%–90%displacement before the peak,and 100%displacement before the peak to post-peak,which could be a sign for rock–backfill shearing dislocation failure.The surface JRC could be used to judge the rock–backfill shearing dislocation failure,including post-peak sliding,uniform variations,and gradient change,corresponding to rock–backfill disloca-tion failure on the field site.The research reveals the damage mechanism for rock–backfill complexes based on the free joint surface,fills the gap of existing shearing theoretical systems for isomerism complexes,and provides a theoretical basis for the prevention and control of possible disasters in backfill mining.

Effects of interstitial cluster mobility on dislocation loops evolution under irradiation of austenitic steel

The evolution of dislocation loops in austenitic steels irradiated with Fe^(+)is investigated using cluster dynamics(CD)simulations by developing a CD model.The CD predictions are compared with experimental results in the literature.The number density and average diameter of the dislocation loops obtained from the CD simulations are in good agreement with the experimental data obtained from transmission electron microscopy(TEM)observations of Fe~+-irradiated Solution Annealed 304,Cold Worked 316,and HR3 austenitic steels in the literature.The CD simulation results demonstrate that the diffusion of in-cascade interstitial clusters plays a major role in the dislocation loop density and dislocation loop growth;in particular,for the HR3 austenitic steel,the CD model has verified the effect of temperature on the density and size of the dislocation loops.

Moiré superlattices arising from growth induced by screw dislocations in layered materials

Moiré superlattices(MSLs) are modulated structures produced from homogeneous or heterogeneous two-dimensional layers stacked with a twist angle and/or lattice mismatch. Enriching the methods for fabricating MSL and realizing the unique emergent properties are key challenges in its investigation. Here we recommend that the spiral dislocation driven growth is another optional method for the preparation of high quality MSL samples. The spiral structure stabilizes the constant out-of-plane lattice distance, causing the variations in electronic and optical properties. Taking SnS_(2) MSL as an example, we find prominent properties including large band gap reduction(~ 0.4 e V) and enhanced optical activity. Firstprinciples calculations reveal that these unusual properties can be ascribed to the locally enhanced interlayer interaction associated with the Moiré potential modulation. We believe that the spiral dislocation driven growth would be a powerful method to expand the MSL family and broaden their scope of application.

Micropillar compression using discrete dislocation dynamics and machine learning

Discrete dislocation dynamics(DDD)simulations reveal the evolution of dislocation structures and the interaction of dislocations.This study investigated the compression behavior of single-crystal copper micropillars using fewshot machine learning with data provided by DDD simulations.Two types of features are considered:external features comprising specimen size and loading orientation and internal features involving dislocation source length,Schmid factor,the orientation of the most easily activated dislocations and their distance from the free boundary.The yielding stress and stress-strain curves of single-crystal copper micropillar are predicted well by incorporating both external and internal features of the sample as separate or combined inputs.It is found that the machine learning accuracy predictions for single-crystal micropillar compression can be improved by incorporating easily activated dislocation features with external features.However,the effect of easily activated dislocation on yielding is less important compared to the effects of specimen size and Schmid factor which includes information of orientation but becomes more evident in small-sized micropillars.Overall,incorporating internal features,especially the information of most easily activated dislocations,improves predictive capabilities across diverse sample sizes and orientations.

Quantification of grain boundary effects on the geometrically necessary dislocation density evolution and strain hardening of polycrystalline Mg-4Al using in situ tensile testing in scanning electron microscope and HR-EBSD

In situ tensile testing in a scanning electron microscope(SEM)in conjunction with high-resolution electron backscatter diffraction(HR-EBSD)under load was used to characterize the evolution of geometrically necessary dislocation(GND)densities at individual grain boundaries as a function of applied strain in a polycrystalline Mg-4Al alloy.The increase in GND density was investigated at plastic strains of 0%,0.6%,2.2%,3.3% from the area including 76 grains and correlated with(i)geometric compatibility between slip systems across grain boundaries,and(ii)plastic incompatibility.We develop expressions for the grain boundary GND density evolution as a function of plastic strain and plastic incompatibility,from which uniaxial tensile stress-strain response of polycrystalline Mg-4Al are computed and compared with experimental measurement.The findings in this study contribute to understanding the mechanisms governing the strain hardening response of single-phase polycrystalline alloys and more reliable prediction of mechanical behaviors in diverse microstructures.

Dislocation of primary total hip arthroplasty:Analysis of risk factors and preventive options

Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.

Testicular dislocation:A rare complication of scrotal trauma

Scrotal trauma,though uncommon,can have severe consequences,and one such complication is testicular dislocation.This occurs when the testicle is displaced from its normal anatomical position within the scrotum due to a traumatic event.Understanding the mechanisms,diagnosis,and management of testicular dislocation is paramount in providing optimal care for affected individuals[1].Traumatic incidents,such as sports injuries,motor vehicle accidents,or direct blows to the scrotum,can result in testicular trauma[2].The condition demands immediate medical attention to prevent further complications,including vascular compromise and testicular ischemia.Diagnosing testicular dislocation involves a thorough physical examination and often necessitates imaging studies,such as ultrasound,to precisely determine the extent of the displacement and assess potential vascular compromise.Once diagnosed,prompt intervention is crucial to reposition the dislocated testicle and restore blood flow.Treatment options may include manual reduction or surgical intervention,depending on the severity of the dislocation and associated injuries[3].Close monitoring in the post-treatment period is essential to identify and manage any complications promptly.

C1C2 Wiring and Posttraumatic Atlantoaxial Dislocation: An Effective and Cheap Surgical Procedure in a Developing Country

Objectives: Atlantoaxial dislocation remains a rare and serious condition with a high preoperative and postoperative morbidity and mortality. Its successful surgical management is still challenging and gratifying for neurosurgeons. Several technics have been described such as wiring, trans articular screwing, C1C2 screwing with plate and screw introduced by Goel et al., and modified by insertion of polyaxially screw and rod many years later by Harms. Unavailability and expensiveness of upper cervical spine instrumentation device led us to C1C2 Wiring resulting in a good outcome. Finally, a quadriplegic patient with a more comfortable financial condition had ordered devices from abroad and benefit for Goel and Harms screwing technique and improved dramatically from ASIA A to ASIA E. Material and methods: This is a retrospective study of patients managed in our department by a same neurosurgeon from January 2019 to April 2024. Results: We defined 6 men and 1 woman with an average age of 33 years. Unrestrained driver in a rollover motor vehicle accident was most common. Only one patient was neurologically intact on admission. Neurovegetative disorders were noticed in one patient. Dislocation was associated to a fracture of the dens in two patients. Three patients have been successfully operated with remarkable outcome, mostly from ASIA A to E. Conclusion: C1C2 dislocation is a serious condition and C1C2 Wiring represents an effective and cheaper technic. Therefore, this technic should deserve consideration above all in low incomes countries when screwing devices are not available. Seatbelt should be demanded for motor vehicle drivers and passengers.

Elbow Dislocation in Children: About Two Cases and Review of the Literature

Background: Elbow dislocations in pediatric patients are rare injuries. This is a therapeutic emergency because a delay in treatment can have disastrous consequences on the functional level of the upper limb. Objective: To present the management of elbow dislocation in children in cases of limited resources. Presentation of the Cases: These were 2 older male children aged 7 and 9 years old, admitted to the emergency room for painful functional impotence of the right elbow after a fall and landing on the right hand. Clinical and radiological examinations were in favor of posterior elbow dislocations. The reductions were carried out under sedation and immobilization in Jersey. According to Robert’s criteria, the functional result was excellent in both patients. Conclusion: Emergency reduction and immobilization whatever the means ensure an excellent functional prognosis even in cases of limited resources.

Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.

Evaluation of Functional and Radiological Outcome of Arthroscopic-Assisted Anatomical Coracoclavicular (CC) and Acromioclavicular (AC) Ligament Reconstruction in Chronic AC Joint Dislocation

Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockwood classification system. Controversies surround grade III injuries, necessitating further classification. Non-operative treatment has shown favorable outcomes, while surgical interventions vary. Anatomical coracoclavicular reconstruction (ACCR) has demonstrated biomechanical advantages over traditional methods. Arthroscopic techniques offer advantages, minimizing deltoid detachment and allowing concurrent pathology identification. This study evaluates the outcomes of arthroscopic-assisted ACCR in chronic AC joint dislocation. Surgical Technique: Arthroscopic-assisted ACCR involves meticulous portal placement, tendon graft harvesting, diagnostic arthroscopy, and coracoid exposure. The clavicle tunnels were made to mimic the conoid and trapezoid ligament positions, using FibreTape#2 loop and Dog Bone Button for correct placement against the coracoid base, and passing the semitendinosus graft through to reconstruct the conoid ligament, reduction done and graft follow through for anatomical reconstruction. Methods: A retrospective cohort study at Hospital Kuala Lumpur analyzed 35 patients undergoing arthroscopic-assisted ACCR for Rockwood grade III - V AC joint dislocations. Inclusion criteria encompassed trauma ≥ 3 weeks prior, no prior shoulder injuries, and ≥12-month follow-up. Functional and radiological assessments utilized ASES scores and coracoclavicular distances, respectively. Statistical analysis employed descriptive statistics and logistic regression. Results: The mean age was 38.9 years (SD 11.26), and 34 of 35 patients were male. Grade IV injuries were predominant (37.1%). Waiting time for surgery averaged 234.9 days. Functional improvement was substantial postoperatively (ASES: 55.5 to 88.9). Radiological outcomes demonstrated reduced coracoclavicular distances and maintained reduction. No significant correlation was observed between injury grade and outcomes. Conclusion: Arthroscopic-assisted ACCR for chronic AC joint dislocation yields significant functional and radiological improvement, irrespective of injury grade. Waiting time for surgery exhibits minor impact on outcomes, emphasizing the procedure’s efficacy. Concomitant injuries do not impede success, highlighting the versatility of this approach in managing shoulder instability. The study contributes valuable insights into the nuanced management of chronic AC joint dislocations and supports the adoption of arthroscopic-assisted ACCR as a viable treatment option.

Traumatic Neglected Antero-Medial Knee Dislocation: Case Report

Introduction: Neglected knee dislocation is an unusual injury, only a few cases have been reported in the literature. The circumstances of onset are generally an unnoticed knee dislocation in a polytrauma context or a delay in consultation after the initial trauma. Presentation of case: We report the case of a 48-year-old female patient who sustained a knee injury during a domestic accident. Initial treatment was traditional and was followed for 3 years. She then consulted hospital, where a neglected knee dislocation was identified and treated with femorotibial arthrodesis. Discussion and conclusion: The treatment options of neglected knee dislocation include open reduction and fixation, arthrodesis and total knee arthroplasty. That the choice depends on the old unreduced of dislocation.

Epidemiology of shoulder dislocations presenting to United States emergency departments:An updated ten-year study

BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.

Horizontal Inferior Patellar Dislocation in an Elderly Patient: A Case Report and Review of Literature

Intra-articular patellar dislocation due to acute trauma is considered a rare presentation and is less commonly encountered in practice than extra-articular patellar dislocation. This case study presents a rare type 2 inferior dislocation of the patella in an elderly patient which was successfully reduced and managed non-operatively.

Molecular dynamics study of interactions between edge dislocation and irradiation-induced defects in Fe–10Ni–20Cr alloy

Irradiation-induced defects frequently impede the slip of dislocations, resulting in a sharp decline in the performance of nuclear reactor structural materials, particularly core structural materials. In the present work, molecular dynamics method is used to investigate the interactions between edge dislocations and three typical irradiation-induced defects(void,Frank loop, and stacking fault tetrahedron) with the sizes of 3 nm, 5 nm, and 7 nm at different temperatures in Fe–10Ni–20Cr alloy. The critical resolved shear stresses(CRSSs) are compared among different defect types after interacting with edge dislocations. The results show that the CRSS decreases with temperature increasing and defect size decreasing for each defect type during the interaction with edge dislocations, except for the case of 3-nm Frank loops at 900 K. According to a comparison, the CRSS in Frank loop is significantly higher than that of others of the same size, which is due to the occurrence of unfaulting and formation of superjog or stacking-fault complex during the interaction. The atomic evolution of irradiation-induced defects after interacting with dislocations can provide a novel insight into the design of new structural materials.

Modified Model of Crack Tip Stress Field Considering Dislocation Slip Accumulation and Crack Tip Blunting

This study uses the digital image correlation technique to measure the crack tip displacement field at various crack lengths in U71MnG rail steel,and the interpolated continuous displacement field was obtained by fitting with a back propagation(BP)neural network.The slip and stacking of dislocations affect crack initiation and growth,leading to changes in the crack tip field and the fatigue characteristics of crack growth.The Christopher-James-Patterson(CJP)model describes the elastic stress field around a growing fatigue crack that experiences plasticity-induced shielding.In the present work,this model is modified by including the effect of the dislocation field on the plastic zone of the crack tip and hence on the elastic field by introducing a plastic flow factorρ,which represents the amount of blunting of the crack tip.The Levenberg-Marquardt(L-M)nonlinear least squares method was used to solve for the stress intensity factors.To verify the accuracy of this modified CJP model,the theoretical and experimental plastic zone errors before and after modification were compared,and the variation trends of the stress intensity factors and the plastic flow factorρwere analysed.The results show that the CJP model,with the introduction ofρ,exhibits a good blunting trend.In the low plasticity state,the modified model can accurately describe the experimental plastic zone,and the modified stress intensity factors are more accurate,which proves the effectiveness of dislocation correction.This plastic flow correction provides a more accurate crack tip field model and improves the CJP crack growth relationship.

Dislocation configuration evolution during extension twinning and its influence on precipitation behavior in AZ80 wrought magnesium alloy

Thermomechanical treatment T10(extension twinning+aging treatment)can largely enhance the precipitation strengthening effect of magnesium alloys.In this study,dislocation structure evolution and precipitation behavior during T10 treatment of an AZ80 extruded bar were analyzed mainly by two-beam diffraction in TEM.At a compressive strain of 1%in the extrusion direction(ED),a typical dislocation configuration,including basal I1 stacking faults(SFs)and<c+a>dislocations,has been established in extension twins.As the strain reaches 7%,the volume fraction of extension twins increases to more than 90%at which point high dense I1 SFs and<c+a>dislocations occur.After aging for 2 h at 150℃for the 7%strained sample,masses of basal I1 SFs and<c+a>dislocations remain in the extension twins and can act as effective nucleation sites and solute fast-diffusion channels for continuous precipitates.Consequently,the precipitates in extension twins become highly dense.

Dislocation mechanism of Ni_(47)Co_(53) alloy during rapid solidification

Dislocations and other atomic-level defects play a crucial role in determining the macroscopic properties of crystalline materials,but it is extremely difficult to observe the evolution of dislocations due to the limitations of the most advanced experimental techniques.Therefore,in this work,the rapid solidification processes of Ni_(47)Co_(53) alloy at five cooling rates are studied by molecular dynamics simulation,and the evolutions of their microstructures and dislocations are investigated as well.The results show that face-centered cubic(FCC) structures are formed at the low cooling rate,and the crystalline and amorphous mixture appear at the critical cooling rate,and the amorphous are generated at the high cooling rate.The crystallization temperature and crystallinity decrease with cooling rate increasing.Dislocations are few at the cooling rates of 1×10^(11) K/s,5×10^(12) K/s,and 1×10^(13) K/s,and they are most abundant at the cooling rates of 5×10^(11) K/s and1 × 10^(12) K/s,in which their dislocation line lengths are both almost identical.There appear a large number of dislocation reactions at both cooling rates,in which the interconversion between perfect and partial dislocations is primary.The dislocation reactions are more intense at the cooling rate of 5×10^(11) K/s,and the slip of some dislocations leads to the interconversion between FCC structure and hexagonal close packed(HCP) structure,which causes the twin boundaries(TBs) to disappear.The FCC and HCP are in the same atomic layer,and dislocations are formed at the junction due to the existence of TBs at the cooling rate of 1 ×10^(12) K/s.The present research is important in understanding the dislocation mechanism and its influence on crystal structure at atomic scales.