PURPOSE: To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures. METHODS: A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18 - 65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥ 2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American Orthopedic Foot and Ankle Society ankle hindfoot score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test. RESULTS: During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, diabetes, or smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American Orthopedic Foot and Ankle Society ankle hindfoot score revealed no significant difference between dislocation and no-dislocation patients. CONCLUSION Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.
Humans ; Ankle Fractures/physiopathology* ; Male ; Female ; Retrospective Studies ; Adult ; Middle Aged ; Supination ; Aged ; Young Adult ; Rotation ; Joint Dislocations/surgery* ; Fracture Fixation, Internal/methods* ; Adolescent ; Recovery of Function ; Treatment Outcome

BACKGROUND: Unstable simple elbow dislocation (USED) repair is challenged by the maintenance of joint reduction; hence, primary repair or reconstruction of disrupted ligaments is required to maintain the congruency and allow early motion of the elbow. We evaluated the effectiveness and the outcome of lateral collateral ligament (LCL) complex repair with additional medial collateral ligament (MCL) repair in cases of USED. METHODS: We retrospectively reviewed 21 cases of diagnosed USED without fractures around the elbow that were treated with primary ligament repair. In all cases, anatomical repair of LCL complex with or without common extensor origin was performed using suture anchor and the bone tunnel method. Next, the instability and congruency of elbow for a full range of motion were evaluated under the image intensifier. MCL was repaired only if unstable or incongruent elbow was observed. Clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and radiographic outcomes on last follow-up images. RESULTS: All cases achieved a stable elbow on radiographic and clinical results. LCL complex repair alone was sufficient to obtain the stable elbow in 17 of 21 cases. Four cases required additional MCL repair after restoration of the LCL complex. The overall mean MEPS was 91 (range, 70 to 100): excellent in 12 cases, good in 7 cases, and fair in 2 cases. All 17 cases with LCL complex repair only and 2 of 4 cases with additional MCL repair had excellent or good results by MEPS. CONCLUSIONS: USED requires surgical treatment to achieve a congruent and stable joint. If the repair of lateral stabilizer such as LCL complex acquires enough joint stability to maintain a full range of motion, it may not be necessary to repair the medial stabilizer in all cases of USED.
Adult ; Aged ; Collateral Ligaments/*surgery ; Dislocations/complications/physiopathology/*surgery ; Elbow Joint/*injuries/physiopathology/*surgery ; Female ; Humans ; Joint Instability/complications/physiopathology/*surgery ; Male ; Middle Aged ; Orthopedic Procedures/methods ; Range of Motion, Articular ; Retrospective Studies ; Young Adult

OBJECTIVETo study therapeutic effects of comprehensive traditional Chinese medicine therapy for preventing postsurgery stiffness after operation for terrible triad of the elbow.

METHODSFrom December 2008 to December 2013,32 patients with elbow triad were randomly divided into two groups: therapy group and control group. There were 17 patients in control group including 12 males and 5 females with a mean age of (41.0 ± 7.1) years old. The patients in control group were received the past procedure therapy. There were 15 patients in therapy group, including 10 males and 5 females with a mean age of (41.3 ± 7.6) years old. The patients in therapy group were received comprehensive traditional Chinese medicine therapy, including passive exercise training at early stage (0 to 2 weeks after operation), transition from passive to active exercise training at middle stage (3 to 4 weeks after operation), and active exercise training at late stage (5 to 12 weeks after operation). Other treatment methods, such as orally taking or externally use of Chinese herbal medicine, manipulation and physiotherapy, were used at all stages. The Mayo Elbow Performance Score, patient satisfaction and complications were evaluated and analyzed.

RESULTSAll the patients were followed up, and the mean duration was 7.5 months. There were no complications such as internal fixation loosing, obvious displacement fracture and heterotopic ossification occurred. The Mayo score and patient satisfaction in therapy group were higher than those in control group (t = 12.78, P = 0.00; χ2 = 8.719, P = 0.003). Seven patients needed reoperation in control group, compared with 1 patient in therapy group (χ2 = 4.626, P = 0.032).

CONCLUSIONThe comprehensive traditional Chinese medicine therapy is effective to prevent postoperative stiffness after operation for terrible triad of the elbow by using different methods at different stages, which is worthy of spread and application.

Adult ; Case-Control Studies ; Elbow Joint ; injuries ; physiopathology ; surgery ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Movement ; Postoperative Complications ; prevention & control ; Radius Fractures ; surgery ; Ulna Fractures ; 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

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 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 effects of external fixation combined with minimally invasive internal fixation for the treatment of distal radial fracture and dislocation of type IV based on Fernandez classification.

METHODSFrom January 2007 to October 2012,19 patients with the distal radius fracture and dislocation of type IV according to Fernandez classification were reviewed. There were 14 males and 5 females,ranging in age from 22 to 42 years old,with an average of 36.5 years old. All the patients were treated with minimally invasive reduction, and external fixation with finite internal fixation. The K-wire was used to fix radiolunate articular surface for correcting the instability of dorsal and volar intercalated segment. The radiolunate angle, scapholunate angle, and the length of the radial shorting were measured by the standard X-ray. Gartland and Werley evaluation system was used to evaluate recovery of function.

RESULTSNo complications such as injury of blood vessels and radial nerves and pin track infections occurred. After operation, the radiolunate angle, scapholunate angle and the length of the radial shorting time were (9.5 +/- 3.3) degrees, (51.3 +/- 11.2) degrees and (11.2 +/- 1.8) mm by the standard X-ray. On the 3rd month after operation, GW score was 3.02 +/- 3.05. There was no re-displacement and subluxation occurred during the follow-up period. Good functional recovery were improved wrist function significantly.

CONCLUSIONExternal fixation combined with minimally invasive internal fixation can treat distal radial fracture and dislocation of type IV based on Fernandez classification. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Emphasis on the diagnosis and treatment of carpal instability, and postoperative functional rehabilitation can improve wrist function.

Adult ; Bone Nails ; Female ; Fracture Fixation, Internal ; Humans ; Joint Dislocations ; surgery ; Male ; Minimally Invasive Surgical Procedures ; Radius Fractures ; physiopathology ; surgery ; Range of Motion, Articular ; Treatment Outcome ; Wrist Injuries ; physiopathology ; surgery ; Wrist Joint ; physiopathology ; surgery ; Young Adult

OBJECTIVETo report a case series of six neglected cervical spine dislocations without neurological deficit, which were managed operatively.

METHODSThe study was conducted from August 2010 to December 2011 and cases were selected from the out-patient department of Postgraduate Institute of Medical Education and Research, India. The patients were in the age group of 30 to 50 years. All patients were operated via both anterior and posterior approaches.

RESULTSDuring the immediate postoperative period, five (83.33%) patients had normal neurological status. One (16.67%) patient who had C5-C6 subluxation developed neurological deficit with sensory loss below C6 level and motor power of 2/5 in the lower limb and 3/5 in the upper limb below C6 level.

CONCLUSIONThere is no role of skull traction in neglected distractive flexion injuries to cervical spine delayed for more than 3 weeks. Posterior followed by anterior approach saves much time. If both approaches are to be done in the same sitting, there is no need for instrumentation posteriorly. But if staged procedure is planed, posterior stabilization is recommended, as there is a risk of deterioration in neurological status.

Adult ; Cervical Vertebrae ; injuries ; Female ; Humans ; India ; Joint Dislocations ; physiopathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Spinal Injuries ; physiopathology ; surgery ; Treatment Outcome

OBJECTIVETo observe the basic characteristics of rats with subluxation, which was hypomobility of motion.

METHODSOne hundred and eight male SD rats (weighted, 350 to 450 g) were randomly divided into experimental group (simple fixation and rotatory fixation) and sham operation group. Each group was subdivided into four groups, including 2, 4, 8 and 12 weeks sub-groups. Simple fixation and rotatory fixation group were modeled by implanting external linked fixation system; Sham operation group was dealed with operation intervention. At the end of connection, X-ray films was used to observe posterier body angle (PBA); Spinal stiffness system for stiffness in simple fixation group and rotatory fixation group.

RESULTSRadiographic results showed that variation of PBA n experimental groups tended to decrease; and there was no significant difference between simple fixation group and rotatory fixation group at the end of linking time (P > 0.05). But there was significant difference between the experimental group and sham operation group (P < 0.05). The degree of stiffness showed that the stiffness in experimental group increased with the linking time, but no meaning between groups (P > 0.05).

CONCLUSIONRats with subluxation induced by external linked fixation system can effectively change biomechanical characteristics of spine, reduced the motion with linking time.

Animals ; External Fixators ; Fracture Fixation ; Humans ; Joint Dislocations ; physiopathology ; surgery ; Lumbosacral Region ; injuries ; physiopathology ; surgery ; Male ; Range of Motion, Articular ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo analyze appropriate strategy about treatment of rotatory dislocation of atlantoaxial articulation in children.

METHODSFrom March 2005 to February 2009, 36 patients with rotatory dislocation of atlantoaxial articulation were retrospectively analyzed, including 25 males and 11 females, with the average age of 7.8 years (ranged 3 - 14 years). According to Fielding-Hawkins clinical classification, type I 24 cases, type II 8 cases, type III 2 cases, type IV 2 cases. All of the patients were assessed rotatory dislocation of atlantoaxial articulation and whether or not upper cervical spine malformation by X-ray, MRI and CT scan and three-dimensional reconstruction. Thirty-two cases received observational treatments which were reduction after cervical traction, without appearance of the deformity, without neurological symptoms. And another 4 serious cases (irreducible atlantoaxial dislocation or with os odontoideum) received posterior atlantoaxial fixed autograft fusion.

RESULTSRotation of atlas decreased from 16.0° ± 4.4° (range, 5° to 26°) pre-therapy to 4.5° ± 1.5° (range, 0° to 8°) post-therapy in 35 cases, rotation of atlas had significant difference between pre-therapy and post-therapy (t = 14.75, P < 0.05). One patient pre-therapy rotation of atlas was 45°, post-therapy was 4°. All patients were followed up for 14 - 38 months (mean, 18 months), 32 cases who received cervical traction and external fixation resulted in satisfactory outcome in which all the ankylodeire were disappear, bilateral masses were symmetrical on anterior-posterior and good functional activities of cervical. All the 4 cases surgically treated obtained reduction, sound bony fusion and neural symptoms were improved obviously after operation.

CONCLUSIONSConservative treatment has been proved to be very effective in most of rotatory dislocation of atlantoaxial articulation in children. However, operative treatment should be considered in the following situations: irreducible atlantoaxial dislocation or patients with os odontoideum.

Adolescent ; Atlanto-Axial Joint ; abnormalities ; physiopathology ; Child ; Child, Preschool ; Congenital Abnormalities ; Female ; Humans ; Joint Dislocations ; surgery ; therapy ; Male ; Retrospective Studies