A new atraumatic temporomandibular joint dislocation reduction technique. Note preview

In light of the new coronavirus pandemic, emotional temporomandibular joint disorders have become more common. As a result, abnormal wear of the bones and cartilages in this joint may favor the triggering of temporomandibular dislocations. This technical note describes a new atraumatic method for reducing temporomandibular dislocation, with advantages over the traditional Nelaton maneuver. The corresponding author states that he has been using this technique for over 20 years in Brazilian public hospitals with absolute success. The note is original and has never been submitted, in full or in part, to any journal. This work aims to present an innovative technique, easy to perform and free of cost, in order to facilitate the reduction of temporomandibular dislocations.

Traumatic Hip Dislocation: Lecture

Traumatic hip dislocations occupy the fourth place among dislocations of various localizations and, as a rule, are the result of exposure to a high-energy traumatic agent. Such injuries are more often observed in young and middle-aged males. The main cause of hip dislocations is road accidents. The femoral head is more often dislocated posteriorly, but anterior dislocations are not casuistic and account for approximately 10%. Hip dislocations are often combined with acetabular fractures, while their fairly clear clinical picture in the presence of fractures can be leveled. Traumatic hip dislocations require urgent diagnosis and treatment. After the clinical examination of the patient, an x-ray of the pelvis and hip joints are performed. Radiographic diagnosis of hip dislocation remains relevant, but modern imaging methods allows to study the hip joint in more detail and identify concomitant injuries. The main treatment for hip dislocation is closed reduction. Early dislocation reduction and the absence of damage to the structures forming the hip joint are important for the treatment results prognosis. The further patient management tactics after the dislocation reduction is determined by the results of stress tests and the CT data. When confirming the instability and associated injuries of the hip joint anatomical structures, surgical treatment is indicated. Among the complications of hip dislocation: sciatic nerve damage, post-traumatic coxarthrosis, the femoral head avascular necrosis, heterotopic ossification. Current literature data indicates the importance of early diagnosis of dislocation-associated injuries of the hip joint and periarticular tissues. Early and comprehensive repair of all existing injuries is crucial for favorable outcomes. A number of therapeutic and diagnostic methods, primarily arthroscopy, show optimistic results, but need further study.

The TOAST (Traction on Ankle Stress Test): A Supplemental Clinical and Dynamic Ultrasound Examination Approach for Focal Assessment of Axial Ankle Joint Instability.

Ankle drawer and varus-valgus stress tests have evolved to examine for excessive joint displacement in the sagittal and coronal planes which may correlate to ligament instability. However, there appear to be no formal manual test(s) assessing for axial plane (longitudinal) instability of the mortise joint. In keeping with Cartesian and Cyriax principles, The TOAST (Traction On Ankle Stress Test) was developed to dynamically assess for 3rd vector axial strain pain generation and long-axis mortise joint gapping. The test is easy to learn as longitudinal manual traction of the mortise joint and applied counterforce hand positions are similar to emergent ankle fracture dislocation reduction technique. The TOAST may also be performed under dynamic ultrasound control.

900 An Audit of Effectiveness of Inhaled Methoxyflurane (Penthrox) Use for Reduction of Shoulder Dislocation

Introduction Shoulder dislocation is a painful injury best treated by early closed reduction. Patients often require intravenous sedation, with airway monitoring in a safe setting. We implemented methoxyflurane inhalational analgesia (Penthrox) to aid shoulder dislocation reduction without the need for sedation and evaluated the effectiveness and adverse events. Method Patients presenting to the minor injury’s unit at Wrexham Maelor Hospital between 01/04/2020 and 26/05/2020 with only shoulder dislocation were included. Patients had Penthrox and underwent closed reduction. Pre and post reduction shoulder radiographs were reviewed to determine reduction success and time between radiographs was evaluated. Adverse events were recorded. Reduction success and times between radiographs were compared to a consecutive retrospective cohort of patients who underwent closed shoulder dislocation reduction with sedation before implementing Penthrox. Results 22 patients were included. Mean patient age was 44.6 years. Majority were male (72%). Penthrox was used in 11 patients. All patients had their shoulder dislocation reduced successfully. Mean time between reduction radiographs for the Penthrox group was 40.8 min (95%CI 27.4 to 54.3). This was shorter than the intravenous sedation group mean 157.7 minutes (95%CI 92.3 to 223.2, p = 0.0026). No documented adverse events with Penthrox. Conclusions Simple shoulder dislocations can be reduced safely, quickly, and effectively using Penthrox.

105 The Mustaq Method: Could This be The Simplest Shoulder Dislocation Reduction Method?

Introduction The Mushtaq Method is a new shoulder reduction technique. It is a simple, reliable, and less traumatic time modulated procedure. Method Patients are placed in the supine position if plausible. Fully adducting the affected arm with the elbow at right angle. The practitioner applies gentle traction above the elbow with the other hand placed deep into the axilla, palpation of the humeral head is followed by lateral pressure resulting in a successful relocation. Internal rotation and a broad arm sling complete the technique. No assistants are needed, and simple analgesia was often enough. Results 95% had a successful reduction within 5 minutes. 75% required analgesia alone, and no periprocedural complications were observed. Conclusions With so many options already, available it is essential to understand what dictates the success and failures of these methods. We have a new, safe, easy to use method requiring minimal force. We hope to increase our cohort size in the future to draw firm conclusions.