Ankle Injuries ; diagnosis ; surgery ; therapy ; Ankle Joint ; surgery ; Humans ; Joint Instability ; diagnosis ; surgery ; therapy

OBJECTIVESTo explore the clinical features of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury (CSCI), and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases.

METHODSFrom March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied.

RESULTSAll operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association (JOA) scores ranged from 10 to 16 one year postoperatively, 13.95+/-2.06 on average(improvement rate equal to 70.10%). X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants'position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed.

CONCLUSIONSTraumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal approach.

Aged ; Atlanto-Axial Joint ; injuries ; surgery ; Female ; Humans ; Joint Instability ; diagnosis ; surgery ; Male ; Middle Aged ; Spinal Cord Injuries ; diagnosis ; surgery

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

PURPOSE: The purpose of this study is to investigate and analyze accom-panying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time. Meterials and Methods: The study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy. RESULTS: There was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture. CONCLUSION: Under MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remar-kably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families.
Acute Disease ; Adolescent ; Adult ; Arthroscopy ; Female ; Humans ; Joint Instability/*diagnosis/*surgery ; Magnetic Resonance Angiography ; Male ; Shoulder Dislocation/*diagnosis/*surgery ; Shoulder Joint/*pathology/surgery ; Young Adult

Paralabral cyst of the shoulder joint can be observed in 2% to 4% of the general population, particularly in men during the third and fourth decade. On average, these cysts measure 10 mm to 20 mm in diameter and are located preferentially on the postero-superior aspect of the glenoid. The MRI has increased the frequency of the diagnosis of paralabral cysts of the shoulder joint. Paralabral cysts of the shoulder joint usually develop in the proximity of the labrum. The relationship between shoulder instability and labral tears is well known, however, the association of shoulder instability with a paralabral cyst is rare. Shoulder instability may cause labral injury or labral injury may cause shoulder instability, and then injured tear develops paralabral cyst. In our patient, the inferior paralabral cyst may be associated with inferior labral tears and instability MRI.
*Arthroscopy ; Cysts/complications/*diagnosis/surgery ; Humans ; Joint Instability/complications/surgery ; *Magnetic Resonance Imaging ; Male ; Shoulder Dislocation/complications/surgery ; *Shoulder Joint/pathology/surgery ; Young Adult

OBJECTIVETo investigate the feasibility of vibration test in evaluation of spinal stability after instrument fixation of thoracolumbar burst fracture in pigs.

METHODSTwenty-one porcine spines (T11 to L5) were impacted longitudinally with different energy levels to simulate thoracolumbar burst fracture. The fractures were fixed by Luque, Harrington, Steffee and Kaneda techniques, and the anterior-posterior, lateral and vertical spinal stability was analyzed using vibration test.

RESULTSIn the mild injury group, vibration test showed that only the first order frequency showed marked anterior shift in the vertical direction (P<0.05) but the main frequency did not, suggesting loosening between the vertebrae. In moderate- or high-energy impact groups, the main frequency markedly shifted forward in the vertical and anterior-posterior directions (P<0.05 or P<0.01), and obvious lateral shift was observed only in high-energy impact group.

CONCLUSIONThe dynamical characteristics of the spine indicate that the main frequency markedly shift after instrument fixation (except for Luque) of thoracolumbar burst fracture, suggesting the feasibility of vibration test for evaluating spinal injury severity and instrument fixation.

Animals ; Biomechanical Phenomena ; Fracture Fixation, Internal ; Joint Instability ; diagnosis ; Lumbar Vertebrae ; injuries ; surgery ; Spinal Fractures ; surgery ; Spinal Fusion ; methods ; Swine ; Thoracic Vertebrae ; injuries ; surgery ; Vibration

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: Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability. METHODS: MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study. RESULTS: Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%. CONCLUSIONS: MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.
Adolescent ; Adult ; *Ankle Joint/surgery ; Chronic Disease ; Female ; Humans ; Joint Instability/*complications/surgery ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Sensitivity and Specificity ; Tendinopathy/*diagnosis/etiology/surgery ; Tendon Injuries/complications/diagnosis ; Young Adult

INTRODUCTIONThe purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients.

MATERIALS AND METHODSWe undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy.

RESULTSOur results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists.

CONCLUSIONWe conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.

Adolescent ; Adult ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; surgery ; Magnetic Resonance Imaging ; Male ; Physical Examination ; methods ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder Dislocation ; complications ; diagnosis ; surgery ; Shoulder Joint ; surgery ; Young Adult

OBJECTIVETo study the examination,surgical opportunity and surgery methods of lost instability of traumatic dislocation of the knee joint.

METHODSSixty-three patients (48 males and 15 females,ranging in age from 16 to 75 years,with an average of 36.6 years) were checked, treated and followed up from January 2001 to April 2006. According to classification of Wascher for knee dislocation, there was 1 case of KD-I, 13 KD-II, 17 KD-III, 18 KD-IV, 14 KD-V. Stability of the knee was evaluated by physical and radiological examinations, of which 53 patients were treated with open surgery, 4 patients were treated with arthroscope, 4 patients were treated with arthroscope and open surgery, 1 patient was treated with amputation, 1 patient was treated with total knee arthroplasty.

RESULTSThe detection rate of MRI was 100% (39/39), stress radiography was 100% (19/19), arthroscpoe was 93.3% (14/15). According to Lysholm Criteria for knee joint function,the preoperative Lysholm score in old traumatic group was 37.17 +/- 5.33, fresh traumatic group was 37.41 +/- 5.38. The postoperative Lysholm score in old traumatic group was 67.33 +/- 14.72, fresh traumatic group was 82.45 +/- 12.13 (Z = -3.061, P = 0.002).

CONCLUSIONMRI stress radiography and arthroscope do well for the evaluation of stability of the knee. Instable traumatic dislocation of the knee joint must be operated promptly. Fresh instable dislocations of knee prefer repair,old instable dislocations of knee prefer reconstruction.

Adolescent ; Adult ; Aged ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; rehabilitation ; surgery ; therapy ; Knee Dislocation ; diagnosis ; rehabilitation ; surgery ; therapy ; Knee Joint ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Physical Examination ; Radiography