The Biomechanical Consequences of Arthroscopic Hip Capsulotomy and Repair in Positions at Risk for Dislocation

Background: The effect of interportal (IP) capsulotomy, short T-capsulotomy, and long T-capsulotomy, and their repairs, on resistance to anterior and posterior “at risk for dislocation” positions has not been quantified. Hypotheses: Our primary hypothesis was that an IP capsulotomy would have a minimal effect on hip resistive torque compared with both short and long T-capsulotomies in the at-risk dislocation positions. Our secondary hypothesis was that capsule repair would significantly increase hip resistive torque for all capsulotomies. Study Design Controlled laboratory study. Methods: We mounted 10 cadaveric hips on a biaxial test frame in an anterior dislocation high-risk position (20° of hip extension and external rotation) and posterior dislocation high-risk position (90° of hip flexion and internal rotation). An axial force of 100 N was applied to the intact hip while the femur was internally or externally rotated at 15° per second to a torque of 5 N·m. The rotatory position at 5 N·m was recorded and set as a target for each subsequent condition. Hips were then sequentially tested with IP, short T-, and long T-capsulotomies and with corresponding repairs randomized within each condition. Peak resistive torques were compared using generalized estimating equation modeling and post hoc Bonferroni-adjusted tests. Results: For the anterior position, the IP and long T-capsulotomies demonstrated significantly lower resistive torques compared with intact. For the posterior position, both the short and long T-capsulotomies resulted in significantly lower resistive torques compared with intact. Repairs for all 3 capsulotomy types were not significantly different from the intact condition at anterior and posterior positions. Conclusion: An IP incision resulted in a decrease in capsular resistive torque in the anterior but not the posterior at-risk dislocation position, in which direction only T-capsulotomies led to a significant decrease. All capsulotomy repair conditions resulted in hip resistive torques that were similar to the intact hip in both dislocation positions. Clinical Relevance Our results suggest that it is biomechanically advantageous to repair IP, short T-, and long T-capsulotomies, particularly for at-risk anterior dislocation positions.

Brachial plexus paralysis in anterior dislocation of the shoulder : about 03 cases

Les luxations de l’épaule peuvent s'associer à une paralysie du plexus brachial. Cette association lésionnelle a été décrite pour la première fois en 1910 par Delbet et Cauchoix. Elles surviennent souvent lors des accidents de la voie publique par des traumatismes violents de la ceinture scapulaire mais peuvent aussi survenir suite à des chutes banales sur le moignon de l’épaule. La paralysie du plexus brachial est rarement totale. Il s’agit souvent d’une atteinte partielle touchant essentiellement le tronc secondaire postérieur et les branches terminales. La prise en charge de ces lésions n’est pas unanime. L’abstention thérapeutique est majoritairement adoptée et le traitement chirurgical en urgence ne se conçoit que s’il existe une lésion vasculaire associée. Ces atteintes neurologiques sont de bon pronostic car il s’agit souvent d’une neurapraxie qui récupère dans quelques mois. L’indication chirurgicale en l’absence de récupération clinique ou électrique doit être posée avant le sixième mois. Nous rapportons les cas de 03 patients adultes ayant présenté des troubles neurologiques de gravité variable suite à des luxations antérieures de l’épaule. L’objectif est de discuter les particularités de cette association lésionnelle.

Clinical Analysis of Dry Eye Syndrome According to Anterior Displacement of the Marx Line

Purpose: To evaluate the clinical characteristics of patients with dry eye syndrome according to anterior displacement of the Marx line.Methods: This retrospective study involved 127 eyes in 127 patients with dry eye, who were divided into three groups: group 1, aqueous-deficient, including Sjögren syndrome; group 2, meibomian gland dysfunction (MGD) dry eye; and group 3, other tear layer instability. A detailed assessment was conducted, involving the Ocular Surface Disease Index, corneal fluorescein staining (score: 0-15), conjunctival Lissamine green staining (score: 0-12), measurement of tear breakup time, and Schirmer’s test.Results: The proportion of patients with MGD was highest in the group with anterior displacement of the Marx line (p < 0.05). The correlation between anterior dislocation of the Marx line and Schirmer’s test, an objective indicator of dry eye syndrome, was significantly weaker when there was anterior displacement of the Marx line.Conclusions: Anterior dislocation of the Marx line was more common in patients with MGD. The Marx line is a useful marker for diagnosing MGD.

Popliteal Artery Injury Following Traumatic Knee Dislocation – Case Report

Knee dislocation is a devastating injury that can compromise the limb's viability. This trauma is associated with muscular and ligamentar extensive lesions. Obese patients can suffer of knee dislocation resultant from falls at the same level, and these “super-low” energy dislocations are associated with a surprising rate of neurovascular complications. The popliteal artery may be involved in up to 60% of cases, and the prognosis is considerably worse. In these cases an emergent approach is mandatory. Delayed diagnosis and treatment can result in up to 80% of amputations of the extremity. The authors present a patient that was admitted at the Emergency Room with knee pain and deformity after a fall at the same high. After the diagnose and reduction of the anterior dislocation, an echo-doppler and CT angiography were performed, and revealed a lesion in popliteal artery. After immobilized with a long leg plaster cast, the patient was transferred to a hospital with Vascular Surgery Department, and underwent revascularization of the limb. Despite the severity of the vascular injury the patient had a very good outcome.

Spontaneous globe subluxation: a case report and review of the literature

Background Spontaneous globe subluxation (SGS) is an atraumatic anterior dislocation of the eyeball. It is exceedingly rare. Understanding SGS predisposing factors may help uncover its etiology and undertake vision-saving management. Case presentation A 48-year-old female presented to the ED with her right eye out of its socket. She reported blurry vision, photophobia, and pain in the affected eye. She was unable to close her right eyelid and was in obvious distress. On arrival, her blood pressure was elevated. Her medical history was notable for hypertension and obesity. On physical examination, extraocular eye movements were not intact, and the globe appeared whole and round. She was also unable to count fingers with the affected eye. There was no visible trauma to the face. Multiple wet gauzes with sterile saline were placed over the displaced eyeball. Direct and even pressure was applied on the globe. Within 30 s, the globe was reduced back in. The patient was able to close her eyelids and reports substantial pain relief with reduction. A CT scan of the orbits was then obtained, demonstrating mild bilateral proptosis. The globes were normal and symmetric. No intraconal or extraconal abscess or infection was seen. There were no intraconal or extraconal masses. There was no acute orbital traumatic injury, no avulsion of the optic nerve, ocular rupture, or retrobulbar hematoma. After reviewing the case with an ophthalmologist, a follow-up appointment with the ophthalmologist was arranged. The patient was discharged on erythromycin ointment. Post-discharge investigation of the CT imaging revealed dilated optic nerve sheaths, tortuosity of the optic nerve, and empty sella. Conclusions In addition to causing distress and severe anxiety, SGS poses numerous immediate as well as long-term complications. Traction of the optic nerve and retinal vasculature may potentially cause retinal venous congestion and loss of visual acuity with potential vision loss. In the absence of known risk factors or disease processes, orbital imaging and serological studies for thyroid ophthalmopathy should be considered.

Anterior Dislocation After Total Hip Arthroplasty: A Rare Complication

Anterior dislocation after total hip arthroplasty (THA) is a rare event and its treatment protocol is controversial. The most important factor responsible for this complication is malposition of the components. We present a rare case of early anterior dislocation after THA in a 72-year female due to excessive anteverted position of the acetabulum socket as confirmed by radiological evaluation. Closed reduction was not successful. Revision surgery with correction of acetabulum cup version and inclination within the ‘safe zone’ resulted in excellent stability of prosthesis intra-op which even precluded the use of advanced implant designs such as constrained liners. At one-year follow-up, the patient is mobilized with a walking stick and has no recurrence of dislocation. This highlights the role of proper implant positioning which can reduce the complexity of the surgical procedure and provide good functional outcome in such catastrophic events.

Instability Severity Index Score Does Not Predict the Risk of Shoulder Dislocation after a First Episode Treated Conservatively

The first purpose of this study was to verify the association between Instability Severity Index Score (ISIS) and Recurrent Shoulder Dislocation (RSD) after a first episode treated conservatively. The second aim is to identify the risk factors associated with RSD after a primary acute shoulder anterior dislocation treated conservatively. A total of 111 patients with first traumatic anterior shoulder dislocation treated at a single trauma centre between January 2014 and March 2016 were enrolled. The main predictive variables of risk factors and the ISIS score were calculated. Among the 85 patients included, 26 cases of RSD were observed (30.6%). Considering the whole population, no significant association between ISIS and RSD were reported. Regarding other risk factors, high-risk working activities and rotator cuff injury had a significantly higher RSD risk. Sex, dominant limb, familiar history, hyperlaxity, contact or overhead sports, competitive sport, post-reduction physiokinesitherapy, return to sports activity time, Hill-Sachs lesion, bony Bankart lesion and great tuberosity fracture did not seem to influence the risk of RSD. No correlation between ISIS score and RSD in patients treated conservatively after a first episode of shoulder dislocation were reported. The only risk factors with a significant association to RSD were high-risk working activities and rotator cuff injury.