Articles: joint-instability-etiology.
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External rotation of the disrupted hemipelvis is a common deformity after pelvic ring trauma, especially in anteroposterior compression injury patterns. This displacement is associated with significant pelvic hemorrhage. ⋯ In such scenarios, circumferential pelvic area sheeting does not always achieve a complete reduction. We present a technique of internal rotation and taping of the lower extremities as an alternative or supplemental pelvic closed reduction method.
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In addition to tumor resection, a major goal of spine surgery involving tumors is the preservation or achievement of spinal stability. The criteria defining stability, originally developed for use in trauma, are not directly applicable in the setting of neoplasia. The authors discuss the most common patterns of tumor-related instability and deformity at all levels of the spinal column and review the surgical options for treatment.
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Review Case Reports
Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review.
Traumatic overdistraction between C1 and C2 may occur when all the ligaments connecting C2 to the skull are ruptured, and may be manifested when an attempt to reduce C1-C2 subluxation is made by means of traction. We describe here the case of a patient with traumatic anterior atlantoaxial dislocation, who developed atlantoaxial vertical dissociation after skull traction using a Gardner-Halo with lb 4.02 (1.5 kg) of weight. ⋯ In this case, it might have been prevented by avoiding spinal traction. The aim of this report was to show that vertical dissociation may occur in C -C2 anterior dislocation submitted to spinal traction, and that other forms of reduction must be considered to treat these pathologies and avoid this potentially fatal complication.
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Review
[Management of old neglected posttraumatic acromioclavicular joint instability and arthrosis].
Resection arthroplasty of the AC joint was performed in 42 cases of osteoarthrosis and residual instability of traumatic origin including 26 shoulders with horizontal instability of more than half of the width of the clavicula and lesions of the deltotrapezoid fascial complex (Rockwood type II: 7; type III: 9; type IV: 17; type V: 9). 23 cases were treated with a sole Weaver-Dunn procedure. 26 cases with horizontal instability and lesions of the deltotrapezoid fascia (Rockwood IV and V type) were treated in 7 cases with the standard Weaver-Dunn procedure and in 19 cases with a modified Weaver-Dunn procedure in combination with a coracoclavicular (3 x 1) and acromio-clavicular (1 x 1) 1 mm PDS string augmentation and double breasting fascioplasty of the deltotrapezoid complex. ⋯ Cases with horizontal instability (type Rockwood IV and V) seem to be over-represented among patients with failed conservative treatment. Resection arthroplasty with ligament transposition after Weaver/Dunn gives excellent results in posttraumatic osteoarthrosis with mainly vertical and moderate horizontal instability. In cases with advanced horizontal instability after Rockwood IV and V injuries, almost equal results can be reached by an additional coracoclavicular and acriomioclavicular PDS augmentation with deltotapezoid fascioplasty.
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Arch Orthop Trauma Surg · Jan 1991
ReviewKnee ligament injuries combined with ipsilateral tibial and femoral diaphyseal fractures: the "floating knee".
The incidence of rupture of the knee ligaments was retrospectively studied in 47 patients with ipsilateral fractures of the femoral and tibial diaphyseal shaft. Fifteen patients proved to have an instability of the knee at the time of follow up. Disruption of the knee ligaments had not been recognised initially. ⋯ After stabilisation of both fractures in these cases, the knee ligaments had been repaired; at re-examination these patients had no complaints and their knees were perfectly stable. In view of the high incidence of missed cases, the possibility of disruption of the knee ligaments should be considered in all patients with fractures of both the femoral and tibial shaft. Meticulous examination of the knee at the time of injury is strongly advocated.