Post-traumatic heterotopic ossification in front of the ankle joint for 23 years:A case report and review of literature

BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.However,anterior HO of the ankle is rarely reported.CASE SUMMARY We report a patient with massive HO in front of the ankle joint for 23 years.In 1998,the patient was injured by a falling object on the right lower extremity,which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot.The patient did not develop gradual ankle function limitations until nearly 36 mo ago,and underwent resection of HO.Even after 23 years and resection of HO,the ankle joint was still able to move.CONCLUSION It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.

Incidence of sports-related sternoclavicular joint dislocations in the United States over the last two decades

BACKGROUND Epidemiological understanding of acute sternoclavicular(SC)dislocations secondary to sports across the United States is poorly defined.AIM To identify and assess epidemiological trends of SC dislocations occurring secondary to sports-related mechanisms across United States over the past two decades.METHODS This cross-sectional,descriptive epidemiological study evaluates epidemiological trends of SC dislocations from sports that present to emergency departments(EDs)across the United States.Data were obtained from the National Electronic Injury Surveillance System database spanning two decades.Data on incidence,patient demographics,mechanisms of injury,dislocation types,incident locales,and patient dispositions were collected.RESULTS 1622 SC dislocations occurred nationwide from 2001 to 2020[incidence=0.262/1000000 people,confidence interval(CI)=0.250-0.275],comprising 0.1%of shoulder/upper trunk dislocations.Most patients were male(91%,n=1480)and aged 5-17(61%,n=982).Football,wrestling,and biking were the most frequently implicated sports,with contact sports responsible for 59%of athletic injuries(n=961).Recreational vehicle-related sports injuries,such as all-terrain vehicles,dirt bikes,and mopeds accounted for 7.8%of all injuries(n=126),with dirt bikes specifically comprising 3.7%(n=61).Ultimately,82%were discharged from the ED(n=1337),12%were admitted(n=194),and 6%were transferred(n=90).All recorded posterior dislocations were admitted or transferred from the ED.Patients sustaining SC dislocations from contact sports had a significantly increased risk of hospital admission or transfer rather than discharge from the ED as compared to patients whose injuries were from non-contact sports(incidence rate ratio=1.46,CI:=1.32-1.61,P<0.001).CONCLUSION SC dislocations from sports continue to be rare with a stably low incidence over the past two decades,likely comprising a smaller proportion of shoulder dislocations than previously thought.Contact sports are a frequent source of injury,especially among school-aged and teenage males.Most patients are discharged directly from the ED;however,a substantial number are hospitalized,many of which had documented posterior dislocations.Ultimately,understanding the epidemiology and mechanism-related trends of acute SC dislocations is important given the potential severity of these injuries,concentration in a specific population,and uncertainty linked to rare presentation.

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.

Sternoclavicular joint dislocation and its management: A review of the literature

Dislocations of the sternoclavicular joint(SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as x-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.

Surgical Repair of Dorsal Capsulo-Ligamentous Complex for Dislocation of the Thumb Carpometacarpal Joint

Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after surgical repair of the dorsal capsulo-ligamentous complex. Materials and methods: Eight patients with a mean age of 39.8 years (range, 23 - 56 years) treated for the thumb CMC joint were treated in our hospital between 2008 and 2018. The ruptured dorsal capsulo-ligamentous complex was repaired using suture anchors in all patients, and the joint was immobilized with a Kirschner wire pinning and splint for 3 weeks. The clinical outcome was assessed by measuring the range of motion of the thumb CMC joint and the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH-JSSH) score. Results: The mean radial abduction of the thumb CMC joint was 66°, and the volar abduction was 63°. The mean Q-DASH-JSSH score was 4.8 (range, 0 - 15.6). There were no cases of infection, nerve disturbance, or osteoarthritis. Anatomical reduction was observed in seven patients at the final follow-up and in a rugby football player at 6 months of follow-up;however, subluxation of the thumb CMC joint at 12 months of follow-up due to reinjury was observed. Conclusion: Surgical repair of the dorsal capsulo-ligamentous complex with suture anchors is a reliable and simple treatment for acute unstable dislocation of the thumb CMC joint.

THERAPEUTIC EFFECTS OF ELECTROACUPUNCTURE PLUS POINT-PENETRATION FOR CHRONIC ANKLE JOINT SPRAIN

Objective: To observe clinical therapeutic effects of electroacupuncture plus point-penetration for chronic ankle joint sprain. Methods: 76 patients were randomly divided into treatment group (n=43) and control group (n=33).In teatment group, penetration needling from Qiuxu (丘墟 GB 40) to Zhaohai (照海 KI 6) was performed, combined with electrical stimulation for 30 min. Patients of control group were ordered to take Antinfan (50 mg,b.i.d.),supplemented with local external application of Votalin cream (b.i.d.).After 14 treatments (two courses), the therapeutic effect was assessed. Results: Following two courses of treatment, of the 43 cases and 33 cases in treatment and control groups,33 (76.7%) and 15 (45.5%) were cured, 4 (9.3%) and 7 (21.2%) had marked improvement in their symptoms, 3 (7.0%) and 2 (6.1%) had improvement, and 3 (7.0%) and 9(27.3%) failed, with the effective rates being 93.0% and 72.7% respectively. The therapeutic effect of treatment group was significantly superior to that of control group (P<0.05). Conclusion: Penetrative needling plus EA is significantly superior to medication in relieving chronic ankle spain patient’s clinical symptoms and signs.

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.

TREATMENT OF DISLOCATION OF THE FRESH ACROMIOCLAVICULAR JOINT USING INTERNAL FIXATION OF CLOSED REDUCTION AND CANNULATED LAG SCREW

Objective Introduce a new method to treat fresh acromioclavicular joint dtslocations-close reduction and percutaneous internal lixatlon using guide cannulated lag screw. Methods 12 cases of acute acromioclavicular joint dislocations were treated and followed. Results 11 cases succeeded and one failed with technical mistakes. Conclusion Because no important nerve or vessel passing between coracoid process and clavicle, close reduction and percutaneous coracoclavicular cannulated lag screw fixation treatment is safe, effective and affords early rehabilitation.

RESEARCH ON THE BIOMECHANICS OF ANKLE JOINT AFTER PARTIAL FIBULAECTOMY

patients undergoing upper-medial partial fibulaectomy were followed up for 1￣ 8 years.Clinical functions of bilateral ankle joints and plantor arches were evaluated and X-ray examination was carried out in these patients.Moving range and myodynamia of active muscle in bilateral ankle joints were evaluated by ankle joint function-evaluating instrument designed by the authors themselves and compared.The data from the examination demonstrated that partial fibulaectomy on the upper and middle part had no influence on the function of ankle joint.The authors suggest that it would be an applicable approach to take fibula as donor.

Management of Traumatic Joint Dislocations in Irrua

Aim:?To elucidate the pattern of presentation and management of traumatic major joint dislocations as seen in Irrua Specialist Teaching Hospital. Method: A five-year retrospective review of 44 cases in 43 patients. Data were retrieved from the Medical Records Department of the hospital. Results:?Forty-four cases of traumatic dislocations were reviewed in 43 patients. Male to female ratio was 7.6:1. Median age was 33 years. The majority of patients were in the 3rd?decade of life. Patients below 40 years accounted for 62.79% of cases. Twenty-four (55.81%) patients had hip dislocation. Knee dislocations were the least, accounting for 2.32% of cases. All cases except three resulted from road traffic accidents (RTAs). None had neurologic deficits. Nineteen (44.23%) patients had isolated injuries. 76.7% cases presented in less than 6 hours. All shoulder dislocations were anterior while all elbow dislocations were posterior. All except 3 cases were managed by closed manipulation under general anaesthesia. Two patients died from associated head injury. Fourteen patients discharged against medical advice while recuperating in the ward. Follow-up was however difficult as a significant number did not turn up. Conclusion: Hip dislocation is the commonest variety of traumatic dislocation in our setting. A majority of cases were amenable to closed manipulation and immobilization. Road traffic accidents accounted for the majority.

Posterior Positioning of a Clavicle Hook Plate Is a Risk Factor for Acromial Fractures after Acromioclavicular Joint Dislocation

Purpose: Acromioclavicular (AC) joint dislocation is commonly treated using a clavicle hook plate (HP). However, previous reports have indicated that acromial fractures may occur after HP fixation. The purpose of this study was to identify risk factors for acromial fractures. Methods: A retrospective study was conducted on 39 patients with AC joint dislocation who were treated using clavicle HP fixation in our hospital between 2006 and 2017. Related parameters, including Rockwood classification, hook angle, the degree of reduction, the coverage of the hook under the acromion, and the anteroposterior position of the hook under the acromion, were evaluated to identify risk factors for acromial fractures. Results: The mean age of the participants was 51.7 (range 19 - 81) years;34 were men and 5 were women. Injury occurred on the right side in 18 patients and on the left side in 21. Injuries were categorized as follows: 24 were Rockwood type III, one was type IV, and 14 were type V. Four of the 39 patients (10%) experienced acromial fractures. Statistical analyses indicated that the degree of reduction at the final follow-up was moderately correlated with the Constant score. Posterior positioning of the hook was the only identified risk factor for acromial fractures. Hook angle and the degree of reduction at the time of surgery were not significantly associated with acromial fractures. Conclusions: Postoperative shoulder function was associated with the degree of reduction at the final follow-up, suggesting that anatomical reduction is recommended for AC joint dislocation. Posterior positioning of the hook is a risk factor for acromial fractures;however, clavicle HP fixation provides a positive outcome for AC joint dislocation. Therefore, careful positioning of the hook is required for preventing acromial fractures.

Open Posteromedial Dislocation of the Tibiotalar Joint without Associated Malleolar Fracture: A Case Report

Background: Open pure tibiotalar dislocations with an associated superficial fibular nerve injury are rarely reported. Case presentation: The authors report a case of open tibiotalar dislocation without any associated fracture and an associated injury of superficial fibular nerve after a motorcycle accident. A debridement plus an open reduction and casting were performed sixteen hours after the trauma. After twenty-six months, the outcome was good without any infection and a sensitivity recovery of the foot. Conclusion: A delayed management of an open tibiotalar dislocation with an associated superficial fibular nerve injury led to a good mid-term outcome.

Fracture-Dislocations of Lisfranc Joint in Lomé(Togo)

Introduction: The purpose of this prospective study was to describe the clinic pathological varieties of fracture-dislocations of Lisfranc joint and outcome of treatment. Patients and Methods: This study was conducted on 21 cases of fracture-dislocations of the Lisfranc joint treated in our orthopedics trauma unit from 2010 to 2013. We selected middle foot pure dislocations or associated with Lisfranc joint bone fractures. Classification of Myerson was used to characterize the lesions. The results assessment criteria were clinical and radiological for foot and Massari score. Results: Fourteen (14) patients were male. The average age was 34.7 years. Five (5) clinic pathological forms were met by relying on the classification of Myerson;4 cases of type A;5 cases of type B1;B2, 6 cases;4 cases of type C1 and 2 cases of type C2. There were eight cases of pure dislocation and 13 dislocations were associated with fractures (metatarsal in 11 patients, cuneiform in 5 patients, cuboid bone in 2 patients and enucleation fracture of the medial cuneiform in 2 patients). It was noted 10 cases of skin openings. Treatment consisted on open reduction in all patients and stabilization by pin complemented by a foot plaster for 6 weeks. Four (4) immediately arthrodeses were made. All patients were followed up 7 month to 4 years (mean, 30 month). According to the criteria of Massiri, treatment outcomes were excellent in 19% of cases, good in 28%, fair in 30% and poor in 23%. Conclusion: In our context, these lesions are often open and associated with fractures of Lisfranc joint skeleton and treated after a period more or less long and sometimes, we face lesions totally old. Immediately arthrodesis can be a lasting solution and should not be overlooked.

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.

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.

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.

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

Numerical analysis of dislocations of the face slabs of the Zipingpu Concrete Faced Rockfill Dam during the Wenchuan earthquake

The Zipingpu Concrete Faced Rockfill Dam （CFRD） was obviously damaged during the Wenchuan earthquake in 2008. A wide range of dislocations occurred along the horizontal construction joints at EL. 845m, between the face slabs constructed in the second and third stages. The maximum displacement of the dislocations reached 17cm. In this study, the slab dislocations were investigated using finite element （FE） analysis. The method based on strain potential was applied to compute the permanent deformation of the Zipingpu Dam during the Wenchuan earthquake. The calculated magnitude of the slab dislocation showed good agreements with the field measurements. The dislocation mechanism was discussed. The results show that the dislocation of the concrete slab is a subsequent damage after the permanent deformation of the rockfill materials. The effects of the shear strength and the direction of the construction joints, the reservoir water level and the seismic waves were studied. The shear strength and the direction of the construction joints, reservoir water level and have a significant effect on the dislocation displacement. The dislocation can be effectively reduced by measures such as changing the direction of the construction joints or improving the shear strength at the horizontal joints.

Lateral subtalar dislocation: Case report and review of the literature

A case of complicated lateral subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis requiring arthrodesis and chronic subtalar instability. Negative prognostic factors include lateral and complicated dislocations, total talar extrusions, and associated fractures. A literature search was performed to identify studies describing outcome after lateral subtalar joint dislocation. Eight studies including fifty patients could be included, thirty out of 50 patients suffered a complicated injury. Mean follow-up was fifty-five months. Ankle function was reported as good in all patients with closed lateral subtalar dislocation.Thirteen out of thirty patients with complicated lateral subtalar joint dislocation developed a complication.Avascular necrosis was present in nine patients with complicated injury. Four patients with complicated lateral subtalar dislocation suffered deep infection requiring treatment with antibiotics. In case of uncomplicated lateral subtalar joint dislocation, excellent functional outcome after closed reduction and immobilization can be expected. In case of complicated lateral subtalar joint dislocation immediate reduction, wound debridement and if necessary(external) stabilisation are critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular talar necrosis and infection.