We present a case of lumbosacral fracture-dislocation, which was spontaneously reduced during radiological examination. Such rapid reduction is, however, not reliable for long-term stability. We would like to report this case briefly because spontaneous reduction of lumbosacral fracture-dislocation has not been reported previously.
Adult ; Dislocations/*physiopathology/surgery ; Humans ; Lumbar Vertebrae/*injuries ; Male ; Sacrum/*injuries ; Spinal Fractures/*physiopathology/surgery

OBJECTIVETo study diagnosis and treatment methods of terrible triad of elbow.

METHODSFrom June 2001 to June 2009, 7 patients with terrible triad of elbow were reviewed. Among the patients, 6 patients were male and 1 patient was female, ranging in age from 20 to 68 years, averaged 36.5 years. All the fractures were fresh. All the patients were treated through a single lateral approach. The general approach was used to repair the damaged structures sequentially from deep to superficial, from coronoid to anterior capsule, to radial head, lateral ligament complex, and common extensor origin. The coronoid fractures and the radial head fractures were fixed with different methods according to fragments. The curative effiency were evaluated by Mayo elbow performance score (MEPS).

RESULTSAll the patients were followed up, and the duration ranged from 5 to 36 months, with a mean of 16.3 months. All the fractures were healed, and the healing time ranged from 3 to 6 months after operation (averaged 4.5 months). Four patients had heterotopic ossificatio. According to evaluation criteria, 2 patients got an excellent result, 4 fair and 1 bad. The average range of motion in elbow flexion-extension were 106.5 degrees (from -20 to 130 degrees), and the range of motion in forearm pronation-supination were 121 degrees (from 70 to 140 degrees). The patient with bad results were treated with radial head excised, and Kirschner fixation from posterior to anterior after reduction, which was found separate dislocation of the coronoid fracture on the X-ray after operation, and subluxation and instability of the elbow joint.

CONCLUSIONThe patients with terrible triad of elbow should be treated with operation actively. Follows are key to get an excellent result: treatment of bone and soft tissues at the same time, early rehabilitation after operation.

Adult ; Aged ; Elbow Joint ; injuries ; physiopathology ; Female ; Humans ; Joint Dislocations ; diagnosis ; physiopathology ; surgery ; Male ; Middle Aged ; Radius Fractures ; diagnosis ; physiopathology ; surgery ; Ulna Fractures ; diagnosis ; physiopathology ; surgery

OBJECTIVETo evaluate the clinical outcome of surgical treatment of the posterior dislocation of the elbow with coroniod and radial head fractures.

METHODSFrom January 2004 to March 2009, 9 patients with terrible triad of the elbow were reviewed. There were 7 males and 2 females (4 left elbows and 5 right elbows), with an average age of 41.2 years, ranged from 21 to 67 years. The radial head fractures were classified according to the Schatzker-Tile criteria: 4 patients had the fractures of type I, 3 patients had type II and 2 patients had type III. The ulnar coronoid fractures were classified according to the Regan-Morrey criteria: 2 patients had the fractures of type I, 5 patients had type II and 2 patients had type III. The general approach was used to repair the damaged structures sequentially from deep to superficial, through coronoid, anterior capsule, radial head, and lateral ligament complex to common extensor origin. If there was valgus instability in the elbow after the operation, the medial collateral ligament should be repaired with nonabsorption sutures. The plaster was applied for 7 to 10 days with elbow flexion in 90 degrees and the forearm in full pronation. Unrestricted motions and rehabilitation began at the 8th week after operation. Recovery of regular occupation depended on the degree of physical activity required, and it typically took 3 months for heavy physical laborers to return to work.

RESULTSAll the patients were followed up from 6 months to 5 years, with a mean duration of (31 +/- 6) months. At the 3rd month after operation, the mean rang of motion in flexion and extension of the elbow was (102 +/- 3) degrees (ranged from 80 degrees to 110 degrees), and the mean range of motion in pronation and supination of the forearm was (135 +/- 6) degrees (100 degrees to 150 degrees). According to the criteria of the Mayo scoreing system, the results were excellent in 5 cases, good in 3 cases, and fair in 1 case. Three patients had heterotopic ossification at the 6th month after operation. Among them, 2 patients had no effects on elbow function and were not treated, 1 patient had effects on flexion-extension of the elbow and was treated with resection of heterotopic ossification through lateral approach combined with early rehabilitation, the MEP score of the patient improved from fair to good.

CONCLUSIONThe key points for treating the terrible triad of the elbow are to restore the elbow normal anatomy and early rehabilitation to avoid the elbow stiff.

Adult ; Aged ; Elbow Joint ; injuries ; physiopathology ; Female ; Humans ; Joint Dislocations ; complications ; physiopathology ; surgery ; Male ; Middle Aged ; Radius Fractures ; complications ; physiopathology ; surgery ; Ulna Fractures ; complications ; physiopathology ; surgery

OBJECTIVETo study therapeutic effects of anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow.

METHODSFrom November 2009 to March 2013,17 patients with terrible triad of elbow were treated through anteromedial approach combined with lateral approach. There were 11 males and 6 females, with an average age of 36.6 years old, ranging from 22 to 68 years old. Ten patients had fractures in the left side and 7 patients had fractures in the right side. All of which were close fractures. Coronoid process fractures were reduced and treated with internal fixation through the anteromedial approach, and the incision was located between radiocarpus and cubitalis grailis. In order to expose the lateral collateral ligament joint capsule and capitulum radii, Kocher approach was used with the incision between triceps brachii muscle and brachioradialis muscle along condylus lateralis humeri, down to posterior side between anconeus muscle and extensor carpi ulnaris muscle. Then capitulum radii fractures were treated with internal fixation using miniature plates and screws, and lateral collateral ligament complexes were repaired using fasciole rivets. Mayo elbow performance score (MEPS) was used to evaluate clinical effects at the latest follow-up.

RESULTSAll the patients were followed up, and the duration ranged from 13 to 24 months,with a mean of 12.4 months. At the latest follow-up, the average flexion angle of all patients was (134.0 ± 8.8) degrees; the average extension angle was (6.4 ± 2.3) degrees. According to the Mayo criteria system, the average total score was 91.8 ± 7.9, including pain score 42.4 ± 5.9, range of motion score 17.6 ± 2.6, joint stability score 9.7 ± 1.2, and functional score 22.1 ± 2.5; 13 patients got an excellent result and 4 good. Two patients had transient ulnar nerve palsy, and 1 patient had heterotopic ossification. There were no complications such as infection, nonunion, elbow residual instability, dislocation and elbow stiffness.

CONCLUSIONThe operation through anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow has advantages of providing both bone and soft-tissue stability simultaneously, allowing early exercise and improving early functional recovery.

Adult ; Aged ; Elbow Joint ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; physiopathology ; surgery ; Male ; Middle Aged ; Radius Fractures ; physiopathology ; surgery ; Ulna Fractures ; physiopathology ; surgery

Adult ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Male ; Metatarsophalangeal Joint ; injuries ; physiopathology ; Radiography ; Range of Motion, Articular

OBJECTIVETo assess the application of three-dimensional jaw model in treatment of superolateral dislocation of condyle.

METHODSNine patients with superolateral dislocation of condyle and symphyseal fractures were admitted in hospital from June 2008 to June 2013. Spiral CT scan on maxilla and mandible was performed，and three-dimensional jaw model was constructed with rapid prototyping technology. According to conditions of condylar superolateral dislocation model，the operation scheme was designed. The symphyseal fracture line was made and fracture was reduced on three-dimensional jaw model. Individualized prefabricated reconstructive titanium plate was made on symphyseal fracture model. Symphyseal fracture was replaced with individualized prefabricated mandibular reconstruction titanium plate according to occlusal relationship. At the same time，reduction of condylar superolateral dislocation was accomplished.

RESULTSOperations were successfully completed in 9 cases under guidance of three dimensional jaw model surgery. Operative incision was primarily healed，and occlusal relationship was restored. Postoperative CT scan showed that the locations of condyle in 9 cases were completely restored. Patients were followed-up for 6-28 months with a median of 18 months. The maximum of mouth opening was 3.1- 4.2 cm with a medians of 3.3 cm，and the occlusal relationship of all patients was normal after surgery.

CONCLUSIONThree-dimensional jaw model can show complete status of condylar superolateral dislocation and symphyseal fracture. The model can accurately shape symphyseal reconstructive titanium plate and restore condylar superolateral dislocation during reductive surgery.

Humans ; Joint Dislocations ; Mandibular Condyle ; physiopathology ; surgery ; Mandibular Fractures ; surgery ; Models, Anatomic ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinical effects of anterior transpediclar screw (ATPS) fixation in treating lower cervical spine fracture and dislocation.

METHODSFrom January 2009 to December 2011, 18 patients with lower cervical spine fracture and dislocation were treated with ATPS technique, including 12 males and 6 females, aged from 17 to 47 years old with an average of 38.2 years. Severity score of lower cervical spine injuries (SLIC) ranged from 6 to 9 points with an average of 7.5 points. According to ASIA grade of spinal cord injury, 2 cases were classified in grade A, 8 cases in grade B, 6 cases in grade C and 2 cases in grade D. X-ray and CT scan were done after surgery in order to evaluate the safety of ATPS and observe the stability and fusion of injured segment. Spinal cord function was evaluated according to ASIA grade at 3 months after operation and last follow-up.

RESULTSAll patients were followed up for 6 to 15 months with an average of 9.5 months. Three months after operation, in aspect of spinal cord function, 8 cases improved 1 grade, 2 cases improved 2 grades; and at final follow-up, 7 cases improved 1 grade, 4 cases improved 2 grades. All patients obtained bony fusion 6 to 8 months after operation with an average of 6.5 months. After operation, 1 case had transient hoarseness and recovered 2 months later;2 cases felt swallowing discomfort, but the symptoms disappeared after about 3 weeks by inhalation. No internal fixation breakage and loosening as well as nerve, blood vessel and esophageal injuries were found.

CONCLUSIONAs for three columns injury caused by lower cervical spine fracture and dislocation, treatment with anterior transpediclar screw reconstruction can achieve the effect of decompression thoroughly and restore the cervical spine height and physiological curvature. Moreover, this kind of treatment has good stability and can create the favorable conditions for the recovery of spinal cord function.

Adolescent ; Adult ; Bone Screws ; Cervical Vertebrae ; injuries ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Recovery of Function ; Spinal Fractures ; physiopathology ; surgery

OBJECTIVETo evaluate the biomechanical personality of the sacroiliac anatomy type Bar-plate system (SABP), which was of fixation usage to the fracture or dislocation of the sacroliliac joint.

METHODSTwenty fresh and freeze cadaver pelvises were prepared with pelvic fracture model,compared with different internal fixation systems such as Galveston technique, transiliac rod fixation, reconstruction plate and sacroiliac joint screws using experimental stress analysis methods,and then the stability of the pelvic was obtained and evaluated.

RESULTSUsing new SABP system to treat pelvic sacroiliac joint fracture and dislocation was higher 10%, 11%, 16%, 21% in the strength; more 12%, 14%, 21%, 31% in rigidity; less 13%, 14%, 22%, 25% in straining;less 10%, 12%, 16%, 20% in shifting than the Galveston technique, transiliac rod fixation, reconstruction plate and sacroiliac joint screws, with remarkable statistic difference (P < 0.05), and it was even better than cadaver pelvis.

CONCLUSIONTo treat pelvic facture, the fixation with new SABP system is of better strength, rigidity and stability, and the SABP system is an ideal new application.

Adult ; Biomechanical Phenomena ; Bone Plates ; Fractures, Bone ; physiopathology ; surgery ; Humans ; Internal Fixators ; Joint Dislocations ; physiopathology ; surgery ; Middle Aged ; Sacroiliac Joint ; injuries ; surgery

OBJECTIVETo observe the clinical effect of a self-designed posterior STB thoracolumbar transpedicular screw-plate system in the treatment of spondylolysis and spondylolisthesis.

METHODSThis STB screw-plate system is developed with titanium alloy (TC4, Ti6Al4V). During December, 1999 and January, 2001, this system was applied in 51 cases, including lumbar spondylolysis and spondylolisthesis (36 cases), degenerative lumbar instability (15 cases). The patients were aged 22 - 78 years, mean age: 47.5 - years; among them there were 14 male cases, 37 female cases; There were 15 cases degenerative spondylolisthesis with grade I-II slip, 36 cases of spondylolysis and spondylolisthesis, including 34 cases with grade I-II slips and 2 cases with grade III slips; single level of 33 cases, two levels 3 cases. Decompression was performed for the 43 cases with interbody fusion using iliac crest or bilateral-lateral fusion using demineralized bone matrix and 8 cases were fixed with demineralized bone matrix fusion without decompression.

RESULTSAll the operations heeded about 60 - 120 minutes, and during the operations bleeding amounts were 200 - 500 ml. The cases completely recovered to work or normal action after 3 months of surgeries. 46 of all cases were achieved to satisfactorily reduction and clinical effect, 5 cases of grade II-III remained incomplete reduction (grade I slip).

CONCLUSIONThis STB system has advantages of biomechanical stability and reduction capability and its effect in clinical application is undoubtedly positive.

Adult ; Biomechanical Phenomena ; Bone Plates ; Bone Screws ; Humans ; Joint Dislocations ; surgery ; Lumbar Vertebrae ; Male ; Spinal Fusion ; instrumentation ; methods ; Spondylolisthesis ; physiopathology ; surgery ; Spondylolysis ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the effectiveness of open reduction and internal fixation and repair of palmar ligment in treating trans-scaphoid perilunate dislocation.

METHODSFrom June 1995 to June 2001,14 patients with trans-scaphoid perilunate dislocation were treated with open reduction and internal fixation and repair of palmar ligment. Among them,there were 13 males and 1 female,the ranging in age from 21 to 38 years,averaged 25.4 years. All patients were posterior dislocation and all operations were performed within 2 weeks after injury.

RESULTSAll patients were followed up from 24 to 60 months with an average of 28.3 months. Thirteen scaphoid fractures were primary healed and functions of wrist joint were good. Bone disunion was found in 1 case and part functions of wrist joint were limited. No found necrosis of lunate and scaphoid. According to clinical scoring system of Cooney, 9 case got excellent results, 3 good, 1 fair and 1 poor.

CONCLUSIONOpen reduction and internal fixation and repair of palmar ligament is effective in treating trans-scaphoid perilunate dislocation,which can early provide steady fixation for scaphoid,and profit to recover blood supply of lunatum and subterminal scaphoid.

Adult ; Early Diagnosis ; Female ; Humans ; Joint Dislocations ; diagnosis ; physiopathology ; surgery ; Lunate Bone ; injuries ; physiopathology ; Male ; Recovery of Function ; Scaphoid Bone ; injuries ; physiopathology ; Treatment Outcome ; Young Adult