Posterolateral rotatory instability of the elbow describes a condition that radial head subluxation or dislocation occurs when forearm rotates externally in relation to humerus. It is difficult to diagnose and treat. We reported a typical case which was confirmed by physical examination and MR images. Ligamentous insufficiency was confirmed under direct vision, and was reconstructed with triceps fascia as described by Gong et al with slight modification. Regain of full function was achieved one year after surgery.
Adult ; Elbow Joint ; physiopathology ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Magnetic Resonance Imaging ; Shoulder Dislocation ; complications

Adult ; Aged ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Lumbar Vertebrae ; pathology ; physiopathology ; Male ; Middle Aged ; Spinal Canal ; pathology ; physiopathology ; Spinal Stenosis ; complications ; diagnosis ; physiopathology ; surgery

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

INTRODUCTIONThis study aimed to evaluate the two-year clinical outcomes of arthroscopic Bankart repair augmented by plication of the inferior glenohumeral ligament (IGHL) via horizontal mattress suturing.

METHODSThis study was a retrospective analysis of 76 arthroscopic Bankart repairs by a single surgeon from 2004 to 2008. Bioabsorbable suture anchors were used, with anchors placed at the 5:30, 4 and 3 o'clock positions of the right shoulder (correspondingly at the 6:30, 8 and 9 o'clock positions for the left shoulder). The lower most anchor was tied via horizontal mattress suture with plication of the IGHL, while the remaining two anchors were tied using simple sutures. The patients were postoperatively assessed, clinically and using the University of California Los Angeles (UCLA) shoulder rating scale.

RESULTSThe mean age of the patients at the time of presentation was 24.09 ± 7.98 years, and the mean duration of follow-up was 28.7 months. The postoperative recurrence rate of dislocation was 7.89% (six shoulders), of which five shoulders required revision surgeries. Excluding the revision cases, clinical assessment of the strength of the supraspinatus and the range of motion of the operated shoulders at two years post operation were either maintained or full in all patients. Analysis of the UCLA results showed pre- and postoperative mean scores of 25.94 ± 3.43 and 33.77 ± 3.07, respectively (p < 0.05).

CONCLUSIONArthroscopic Bankart repair augmented by plication of the IGHL and anchored via horizontal mattress suturing is a safe and reliable treatment for shoulder instability, with good clinical outcomes and low recurrence rates.

Adult ; Arthroscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Joint Instability ; etiology ; physiopathology ; surgery ; Male ; Range of Motion, Articular ; Retrospective Studies ; Shoulder Dislocation ; complications ; physiopathology ; surgery ; Shoulder Joint ; injuries ; physiopathology ; surgery ; Suture Anchors ; Suture Techniques ; instrumentation ; Treatment Outcome ; Young Adult

OBJECTIVESTo compare the paravertebral muscle (such as multifidus, erector spinae, psoas muscle) changes between the patients with degenerative lumbar instability and normal person by MRI and to observe the degeneration of paravertebral muscles. To analyze the relationship between paravertebral muscle degeneration and lumbar curvature of degenerative lumbar instability.

METHODSSixty patients with degenerative lumbar instability were retrospectively enrolled from December 2011 to July 2013 as degeneration group, meanwhile 60 health persons with no degenerative lumbar instability were selected as control group. No significant differences were found in the gender, age and body mass index between the two groups. The cross-sectional area(CSA) and percentage of fat infiltration area (FIA) of the paravertebral muscles at the L4-S1 levels were measured using T2-weighted axial MRI and Image J soft ware. And the lumbar curvature(expressed as lumbar lordosis angle) of all the patients in lumbar X-ray were measured in the two groups. The measured data were analyzed with independent samples t-test.

RESULTSThe difference of multifidus cross-sectional area and the percentage of fat infiltration in the patients of degenerative lumbar instability at the L4-L5, L5-S1 level, compared with the control group, was statistically significant (t = 2.768, t = 6.216, P < 0.05). Between the two groups, the percentage of fatty infiltration in erector spinae showed significant differences (t = 5.862, P < 0.05). The cross-sectional area of erector spinae and the degeneration of the psoas muscle between the two groups was not statistically significant. The lumbar lordsis angle in the patients with degenerative lumbar instability was (43.9 ± 15.6)°, which was higher than the (39.3 ± 14.2)° in control group (t = 2.915, P < 0.05).

CONCLUSIONSCompared with the control group, patients with degenerative lumbar instability exists erector spinae and multifidus muscle degeneration, and erector spinae is more obvious. The degeneration among psoas muscle, erector spinae and multifidus muscle are inconsistent, which may be related to the increasing of the lumbar lordosis angle in the patients with degenerative lumbar instability.

Aged ; Case-Control Studies ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; pathology ; Lumbosacral Region ; physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle, Skeletal ; pathology ; Muscular Atrophy ; complications ; diagnosis ; pathology

OBJECTIVESTo investigate the influence of wrist joint stability of patients with diversified fracture of the distal radius, and to find out the difference of the clinical effect between the patients with surgical treatment and non-surgical treatment.

METHODSFrom January 1999 to September 2006 a total of 200 cases with the fracture of the distal radius were reviewed according to the AO classification, the radiolunate angle, scapholunate angle, palmar tilt angle and the length of the radial shorting and step-off of the articular surface were measured by the standard X-ray. Gartland and Werley as modified by Sarmiento evaluation system was used, and the results were statistically analyzed.

RESULTSThe average follow-up period was 5 years and 2 months. The follow-ups revealed 5 types of carpal instability: scapholunate dissociation, volar intercalated segment instability, dorsal intercalated segment instability and palmar or dorsal shift of the carpus. Functional results were excellent and good in 78% of the total patients. The increasing of the length of the radial shorting and step-off of the articular surface was found to be associated with greater risk of carpal instability.

CONCLUSIONSBased on the results of the study, wrist articular surface and radial shortening and palmar tilt angle should be considered as the most important factors of the healing effect after the fracture of the distal radius. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Carpal instability wound leads to significantly effect on the wrist. And surgery was necessary to severe intra-articular fracture of the distal radius.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Joint Instability ; diagnostic imaging ; etiology ; physiopathology ; Male ; Middle Aged ; Radiography ; Radius Fractures ; complications ; Retrospective Studies ; Treatment Outcome ; Wrist Joint ; diagnostic imaging ; physiopathology ; Young Adult

OBJECTIVETo investigate the results and indication of differently internal fixation for intertrochanteric fracture and prevent for complication.

METHODSOne hundred and two patients of intertrochanteric fracture of femur from January 1997 to December 2007 were reviewed and analysed. There were 46 males and 56 females, with an average age of 76.5 years ranging from 60 to 93 years. There were 34 cases of stability fractures and 68 of instability fractures. The methods of internal fixation included dynamic hip screw in 82 cases, proximal interlocking nail in 5, multi-screw fixation in 9, dynamic codylar screw in 6.

RESULTSThese patients were followed up for 6 to 72 months (36 months in average). The time of fracture healing was from 8 to 12 weeks. According to evaluation criterion of effect, the results were excellent in 72 cases, good in 20, fair in 10. After operation, there were 3 cases of coax vara, 2 cases of lag screws cutting out, 1 case of breakage of screw, 2 cases of avascular necrosis of the femoral head, 1 case of postoperative infection, 1 case of delayed union.

CONCLUSIONSuitable implant selection according the type of fracture, health condition is an important factor to reduce the incidence of complication for unstable fracture in aged patients. DHS is a main treatment of intertrochanteric fracture. PFN is recommended for serious osteoporosis or unstable intertrochanteric fracture. Compression screws is a choice for the fixation of type I and type II fracture of bad health condition.

Aged ; Aged, 80 and over ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; physiology ; Hip Fractures ; complications ; surgery ; Humans ; Joint Instability ; physiopathology ; Male ; Middle Aged ; Postoperative Complications ; prevention & control

Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.
Anterior Cruciate Ligament/*injuries/*surgery ; Bone Transplantation/methods ; Bone-Patellar Tendon-Bone Graft/methods ; Humans ; Joint Instability/*complications/physiopathology ; Range of Motion, Articular ; *Reconstructive Surgical Procedures ; Risk Factors ; Tendons/transplantation ; Treatment Outcome