Complete dislocation of the eye globe into the maxillary sinus: a rare case

Blowout fracture with entrapped orbital contents within the maxillary sinus is common due to the fragility of the inferior wall, but complete herniation of the eye globe is extremely rare and emergent. Dealing with such a case appears to be a real challenge for any ophthalmologist. We herein present a case of a 31-year-old woman with the entire eyeball missing from the orbit following a road traffic accident. Imaging revealed a complete herniation of the globe into the maxillary sinus. The patient underwent surgery for repositioning the herniated orbital contents and reconstructing the orbital walls. The outcome was satisfactory in terms of aesthetic effect, although the patient’s vision could not be restored as it still depends on various factors, especially the survival of ganglion cells after trauma.

Retrospective study on the impact of ulnar nerve dislocation on the pathophysiology of ulnar neuropathy at the elbow

Introduction High resolution ultrasonography (US) has been used for diagnosis and evaluation of entrapment peripheral neuropathy. Ulnar neuropathy at the elbow (UNE) is the second most common focal entrapment neuropathy. The ulnar nerve tends to move to the anteromedial side and sometimes subluxates or dislocates over the medial epicondyle as the elbow is flexed. Dislocation of the ulnar nerve during elbow flexion may contribute to friction injury. We aimed to investigate the effects which the dislocation of ulnar nerve at the elbow could have on the electrophysiologic pathology of UNE. Materials We retrospectively reviewed 71 arms of UNE. The demographic data, electrodiagnosis findings and US findings of ulnar nerve were analyzed. We classified the electrodiagnosis findings of UNE into three pathologic types; demyelinating, sensory axonal loss, and mixed sensorimotor axonal loss. The arms were grouped into non-dislocation, partial dislocation, and complete dislocation groups according to the findings of nerve dislocation in US examination. We compared the electrodiagnosis findings, ulnar nerve cross sectional areas in US and electrodiagnosis pathology types among the groups. Results A total of 18 (25.3%) arms showed partial dislocation, and 15 (21.1%) arms showed complete dislocation of ulnar nerve in US. In the comparison of electrodiagnosis findings, the partial and complete dislocation groups showed significantly slower conduction velocities and lower amplitudes than non-dislocation group in motor conduction study. In the sensory conduction study, the conduction velocity was significantly slower in partial dislocation group and the amplitude was significantly lower in complete dislocation group than non-dislocation group. In the comparison of US findings, patients in partial and complete dislocation groups showed significantly larger cross sectional areas of the ulnar nerve. The comparison of electrodiagnosis pathologic types among the groups revealed that there were significantly larger proportions of the axonal loss (sensory axonal loss or mixed sensorimotor axonal loss) in partial and complete dislocation groups than non-dislocation group. Conclusion The ulnar nerve dislocation could influence on the more severe damage of the ulnar nerve in patients with UNE. It might be important to evaluate the dislocation of the ulnar nerve using US in diagnosing ulnar neuropathy for predicting the prognosis and determining the treatment direction of UNE.

Management of complete dislocation of tarsal scaphoid without fracture

<p class="abstract"><strong>Background:</strong> Injuries to the mid tarsal joints usually occur in the form of various combinations such as fracture, fracture subluxation, and fracture dislocation. Dislocations of navicular without fracture are rare injuries, minimal literatures exist, which describe the probable mechanism of injury and optimal treatment<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Four patients with complete dislocation of navicular without fracture presented to us following a history of trauma. The diagnosis was confirmed by radiology and further details were studied by CT scans. One injury was open and the rest were closed. One had associated fracture of talus and two had metatarsal fracture and one was purely isolated navicular dislocation without any associated injury. All were initially stabilized in a below knee plaster of paris slab and foot end elevated. All were successfully treated surgically under spinal anesthesia with open reduction and internal fixation with Kirschner wires through a dorsomedial approach. Postoperative immobilization was continued for twelve weeks then gradual mobilization begun followed by physiotherapy.<strong></strong></p><p class="abstract"><strong>Results:</strong> All patients had good clinical results with two patients resuming their work within twelve weeks and the one with open wound took twenty weeks for resuming his original work. One with associated talar fracture later had to undergo subtalar arthrodesis for pain in the foot while weight bearing after one year of surgery for navicular dislocation<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Open reduction and internal fixation with Kirschner wire is an effective way of managing patients with complete dislocation of tarsal navicular for early resuming of the functions and return to work<span lang="EN-IN">.</span></p>