Anterior hip dislocation: A current concepts review and proposal of management algorithm

Anterior hip dislocations as compared to posterior, rarely occurs. Nevertheless, it is important to be prepared to manage it. Physical examination and imaging are crucial in detecting this type of dislocation and ruling out any associated fractures. The most important thing is not delaying reduction which is done in a closed manner preferably in the operating room and under general anesthesia. Post-operative complications should be monitored. As for rehabilitation it is still debated and no consensus was reached.

Evaluation of clinical and diagnostic imaging findings of bilateral superficial digital flexor tendon luxation in the tarsus of a gelding

Superficial digital flexor tendon (SDFT) plays an important role in the locomotion of the horses with flexion of the limbs. In the hind limb, it passes over the calcaneal bone and attaches to medial and lateral surfaces of calcaneous by two bands of connective tissue; while, the medial band is weaker than the lateral one. Occasionally, severe trauma, over-extension or fracture of the calcaneous may cause rupture of the supportive bands leading to tendon luxation. An 11-year-old Thoroughbred jumping gelding with symptoms of lameness in both legs, after examination by an internal specialist veterinarian in equine practice field was referred to the Teaching and Research Hospital of the Faculty of Veterinary Medicine of the University of Tehran, Tehran, Iran. Clinical examination showed lateral luxation of SDFT in the right and left tarsal joints. Radiography revealed no sign of calcaneal involvement, except soft tissue swelling. In the radiography of the tarsal joints, the calcaneus bones did not show significant changes, but among the bones of the central and 3rd tarsal bone (distal intertarsal joint) of the tarsus, osteophyte formation was observed to a mild extent, indicating mild bone spavin in both tarsal joints. In ultrasonography, SDFT thickenings accompanied by hypoechoic regions in tendons were seen, confirming the signs of tendonitis. Moreover, fibrous tissue formation was diagnosed. In the left leg, anechoic fluid in the calcaneous bursa was seen. Evaluation of diagnostic imaging findings enables veterinarians to diagnose the site and extent of the lesions, choosing the appropriate therapeutic approach in addition to clinical symptoms.

Wide awake surgery for rupture of the lateral expansion of the long-finger extensor tendon: A case report

Spontaneous extensor digitorum communis (EDC) tendon rupture is uncommon but easily confusing injury that lead to functional impairment. There is no any strict first-line treatment for nonrheumatoid EDC tendon rupture. We report a kidney transplant recipient with spontaneous rupture of the lateral expansion of the long-finger extensor tendon treated by wide awake surgery. Surgical repair with wide-awake local anesthesia was performed to realign the tendon for the patient. Three months following surgery, the patient obtained a full pain-free range of motion of the hand without recurrent dislocation.

Lens-related ocular emergencies (LROE) in dogs: treatment and visual outcome after late presentation of 90 eyes

BACKGROUND

Lens-related emergencies need immediate medical intervention to reduce complications, minimize pain, and improve the chances of retaining vision. The present study aimed to demonstrate the common lens-related ocular emergencies in dogs and evaluate the short-term outcomes after the treatment of these cases. Sixty dogs (90 eyes) of different breeds were presented with unilateral (30 eyes, OD = 18, OS = 12) and bilateral (60 eyes) ocular abnormalities related to crystalline lens injury. Clinical, ultrasonographic, and laboratory examinations were achieved. Different treatment protocols were conducted after a complete ophthalmic examination and the associated clinical outcomes were evaluated.

RESULTS

Mean (± SD) age of dogs at initial evaluation was 3.65 (± 2.4) years (range, 1-12 years). Lens luxation and subluxation were diagnosed in 45 eyes (25 with anterior lens luxation, 15 with subluxation, and 5 with posterior lens luxation). Lens-induced anterior uveitis without ocular hypertension (n = 25 eyes), lens-induced uveitis with secondary glaucoma (uveitic glaucoma) (n = 15 eyes), and lens capsule disruption (n = 5 eyes) were also diagnosed. The vision was lost in all 5 eyes with posterior lens luxation and secondary glaucoma (100%), 18/25 eyes with anterior lens luxation (72%), and 5/15 eyes with lens subluxation (33.3%). Vision impairment was also identified in 10/25 eyes (40%) with unresponsive lens-induced anterior uveitis and in 5/5 eyes (100%) with traumatic rupture of the anterior lens capsule.

CONCLUSION

Crystalline lens pathology can cause a wide variety of ocular emergencies that may result in blindness. Early diagnosis and appropriate treatment are crucial for handling lens-related emergencies in dogs.

Ligamentum teres reconstruction using autogenous semitendinosus tendon with toggle technique in rabbits

Background

Ligamentum teres (LT) has traditionally been considered a vestigial or redundant structure in humans; however, based on new studies and the evolution of hip arthroscopy, the LT injury has been viewed as a source of hip pain. Therefore, LT reconstruction can be beneficial in some cases. Rabbits have been frequently used as a model for cranial cruciate ligament reconstruction but few studies are available for ligamentum teres reconstruction.

Objective

To evaluate the semitendinosus tendon to replace ligamentum teres with the toggle technique, using rabbits as an experimental model.

Methods

Twenty-six female Norfolk rabbits with approximately 3 months of age were divided into two equal groups after excision of ligamentum teres (LT) from the right hip joint: G1-no reconstruction of LT and capsulorrhaphy; G2-double-bundle reconstruction of the LT using semitendinosus tendon autograft. In both groups, the LT was removed from the right hip joint. In G2 the autograft was harvested from the left hind limb of the same rabbit. The rabbits were evaluated clinically at different time intervals; before surgery (M1), 48 h (M2), 15 days (M3), 30 days (M4) and 90 days (M5) after surgery.

Results

The rabbits supported their limbs on the ground in both the groups. As complications of the procedure, four hip joints showed subluxations in the radiographic evaluation of G1; three at M4 and one at M5. In G2; two luxations of hip joints at M3 and one subluxation at M4 were seen. On ultrasound, irregular articular surface was seen in 30.8% of the rabbits that had subluxation of hip joints. Gross evaluation identified tendon graft integrity in 76.92% of the rabbits. Histological analysis revealed graft adhesion to the bone in the early phase comprised of sharpey-like collagen fibers.

Conclusion

The double-bundle reconstruction of the LT using autologous semitendinosus tendon associated with the toggle rod shows an early phase of tendon graft ligamentization at 90 days post-operatively in young rabbits, but biomechanical bias suffered by the tendon during gait must be considered.

[Open metacarpophalangeal dislocation]

Open metacarpophalangeal dislocation Abstract. Dislocation of a finger is a pathology often encountered in emergency centers. The following case example provides a reminder of its management and the situations in which the patient should be referred to the specialist.

Dental Trauma and Alveolar Fractures

A dentoalveolar fracture requires thorough clinical and radiographic examination for an accurate diagnosis to guide appropriate treatment. Dentoalveolar fractures can be classified into the following 4 groups: (1) crown/root fractures, (2) luxation/displacement of teeth, (3) avulsion, and (4) alveolar fractures. Treatment can be divided into nonrigid fixation (splinting with wires and composite) and/or rigid fixation (Erich arch bars, Risdon cable wires) depending on the extent of dentoalveolar fractures. Special considerations must be made for primary teeth and mixed dentition to avoid injuring tooth buds and arising permanent dentition.

Late Breakage of a Dual-Mobility Polyethylene Insert in a Revision Total Hip Arthroplasty: An Unusual Failure Mode

The use of dual-mobility cups has gained popularity in recent years. Thus, surgeons can expect an increase in known and new causes of failure. We report a previously undescribed form of a late intraprosthetic dislocation consisting of a complete breakage of a polyethylene mobile bearing that suffered a dislocation 3 months after its implantation. Two years later, he began feeling anterior groin pain and suffered gait changes. Computed tomography scan revealed an eccentric alignment of the mobile polyethylene bearing suggestive of poly wear. During the revision surgery, the polyethylene was found to be split in 2. Possible causes of this complication are proposed. Our case shows a previously unreported implant-specific complication, so surgeons can identify it.

Equine Oral Extraction Techniques

This article serves as a template for equine veterinarians to become proficient in basic intraoral premolar and molar extraction techniques of Equidae. Indications, equipment, and methodology are described. Numerous photos and videos are included to achieve a more immersive learning experience than can be accomplished with the written word alone. Clinicians performing these techniques will continue to improve their skillsets to achieve positive outcomes as case specifics become more challenging.

Effect of inciso-cervical position of wire-composite splint on the mobility of an avulsed permanent tooth: A cadaveric model study

Introduction

The wire composite splint as a general rule is placed on the middle third of labial surface of the tooth. This is due to ease of application, better isolation, and fewer chances of contamination. However, these assumptions are opinion-based, with no scientific evidence to support them. In addition, to best of our knowledge no research has been carried out to evaluate the effect of position of wire splints on the mobility of the affected tooth and anchor teeth.

Aim

The aim of this study was to evaluate the effect of the cervico-incisal position of splinting wire on the mobility of a replanted tooth and anchor teeth in a cadaveric model.

Methodology

Three cadavers (one female, 45 years old and two males, each 40 years old) were included in the study. periotest S was used to assess physiologic-tooth-mobility in three cadavers at baseline and after "extraction-replantation-wire-composite" splinting-protocol.

Results

Greatest splint effect for horizontal-mobility was found to be 9.33 ± 0.57 for Cadaver-I (incisal-third), whereas it was highest (3.66 ± 2.51) for vertical-mobility in Cadaver-II (cervical third).

Conclusion

Middle third position of wire composite splint have lowest splint effect on both horizontal and vertical mobility of replanted teeth, thus rendering the most favorable position for the establishment of physiologic mobility.

Long-term outcome following cranial biceps brachii tendon transposition in a dog with a traumatic cranial scapulohumeral luxation

Background:

Cranial luxation of the scapulohumeral has been rarely reported in dogs and there is limited information available regarding surgical management of this condition, particularly with respect to long-term functional outcomes.

Case Description:

This report describes the successful resolution of a chronic traumatic cranial scapulohumeral joint luxation in a dog that was stabilized by cranial transposition of the biceps brachii tendon of origin. At surgery, an osteotomy of the greater tubercle was performed and a trough was made in the exposed bed of the osteotomy. The transverse humeral ligament was incised, and the bicipital tendon was levered into the trough and secured in that location by reattachment of the greater tubercle using multiple Kirschner wires and a figure-of-eight tension band wire. Postoperatively, the dog was maintained in a Spica splint for 2 weeks. Although surgical reduction was performed 4 months after the original injury, the luxation did not recur and the dog did not have appreciable lameness 14 months following the surgery.

Conclusion:

Although cranial transposition of the bicipital tendon is an invasive procedure, this dog’s scapulohumeral luxation did not recur and the procedure yielded an excellent long-term functional outcome.

Zinn's zonule

The Zonule of Zinn, or ciliary zonule, is the elaborate system of extracellular fibers that centers the lens in the eye. In humans, the fibers transmit forces that flatten the lens during the process of disaccommodation, thereby bringing distant objects into focus. Zonular fibers are composed almost entirely of 10-12 nm-wide microfibrils, of which polymerized fibrillin is the most abundant component. The thickest fibers have a fascicular organization, where hundreds or thousands of microfibrils are gathered into micrometer-wide bundles. Many such bundles are aggregated to form a fiber. Dozens of proteins comprise the zonule. Most are derived from cells of the non-pigmented ciliary epithelium in the pars plana region, although some are probably contributed by the lens and perhaps other tissues of the anterior segment. Zonular fibers are viscoelastic cables but their component microfibrils are rather stiff structures. Thus, the elastic properties of the fibers likely stem from lateral interactions between microfibrils. Rupture of zonular fibers and subsequent lens dislocation (ectopia lentis) can result from blunt force trauma or be a sequela of other eye diseases, notably exfoliation syndrome. Ectopia lentis is also a feature of syndromic conditions caused typically by mutations in microfibril-associated genes. The resulting ocular phenotypes raise the possibility that the zonule regulates lens size and shape, globe size, and even corneal topology, in addition to its well-recognized role in accommodation.

Chronic Atlantoaxial Luxation Imaging Features in a Pony with Intermittent Neck Stiffness

A 17-year-old mixed breed pony was presented with intermittent neck stiffness during regular training rides in the six months preceding its admission. All parameters were within the normal range, except for an increase in heart rate (48 bpm) during the examination. Concave areas were observed at the level between the atlas and axis vertebrae (C1-C2) on both the left and right sides of the neck. Radiographs were taken of the laterolateral, left ventrodorsal oblique, and right ventrodorsal oblique projections in the cranial cervical region. The images revealed severe structural disorders, including trauma with luxation of the atlantoaxial joint, a fusion of the atlas and axis vertebrae, and evidence of a false joint in the axis bone. Subsequent ultrasonography showed hyperechoic areas in the rectus capitis caudalis and obliquus capitis caudalis muscles. Neck mobility was improved after two weeks of stall rest, administration of oral phenylbutazone (4.4 mg/kg), and topical cold gel treatment. The overstretching of surrounding soft tissues accompanying chronic injury of cranial cervical area may result in neck stiffness in the aging pony. Radiographic and ultrasonographic findings were consistent with the presence of cranial cervical trauma leading to neck stiffness. These findings emphasized the essential role of imaging diagnostics in treating a pony with intermittent neck stiffness.

Outcome of revascularization therapy in traumatized immature incisors

Background

The aim of this retrospective analysis was to evaluate the clinical and radiological outcome of revascularization therapy in traumatized permanent incisors to determine whether this approach could be implemented into clinical routine.

Methods

A total of 16 traumatized incisors (either avulsion or severe luxation/intrusion) with open apices (> 1 mm) that underwent revascularization following a standardized protocol were analyzed with a mean follow-up of 22 months. Radiographs and clinical parameters (such as root length, pulp space, dentin wall width, apical foramen, alveolar bone loss, ankylosis/mobility, supra−/infraposition, discoloration, probing depth) were compared pre- and postoperatively and statistically analyzed.

Results

Over the follow-up period, 81.3% of the teeth survived revascularization and regained sensitivity, while 18.7% failed, as they had to be extracted due to serious root resorption. Regarding radiographic outcomes a significant difference could only be found in the decrease of apical foramina (p = 0.04). The other parameters showed no significant difference between pre- and postoperative measurements. More than half of the teeth (56.3%) developed root resorptions and 31.3% displayed signs of ankylosis and 92.9% developed discolorations during follow-up. However, 85.7% of the teeth maintained the bone level and outcomes of mobility showed a significant solidification.

Conclusions

Revascularization is a promising approach for the treatment of immature incisors to regain sensitivity and to enhance apical closure and at least to maintain alveolar bone in terms of a socket preservation. Further studies have to be performed to determine ideal conditions (type of trauma, age, width of apical foramen) for a revascularization.

Trapeziometacarpal total joint arthroplasty: The effect of capsular release on range of motion

It has been suggested that trapeziometacarpal total joint arthroplasty be combined with complete release of the joint capsule to prevent ligament tethering and implant dislocation. Our goal was to evaluate the consequences of capsular release on range of motion. Trapeziometacarpal joint motion was measured with a 3D motion tracking system in seven fresh frozen human cadaver hands before and after capsular release and total joint arthroplasty with subsequently longer neck lengths. Relative to the native trapeziometacarpal joint with intact joint capsule, mean flexion-extension was significantly increased after the arthroplasty with released capsule and lengthening up to 6 mm. Mean abduction-adduction did not increase significantly. Total joint replacement combined with capsular release increases the trapeziometacarpal joint's range of motion, but not beyond the limits of most trapeziometacarpal implant designs. Lengthening of the implant neck progressively decreases the excess motion.

Non-operative treatment of peroneal tendon dislocations: A systematic review

Purpose

This study evaluated the clinical outcome of non-operative treatment of peroneal tendon dislocations.

Methods

A systematic review of literature was performed.

Results

Six studies were included. Redislocation rates differed between treatments: taping ≥ 3 weeks; 18/30 (60%) patients. Plaster cast ≥ 4 weeks; 5/13 (32%) plaster cast ≥ 6 weeks; 1/6 (17%). Strapping or taping treatment indicated a higher rate of pain and instability and a lower rate of ability to return to former activity.

Conclusions

A non-weight bearing cast ≥ 6 weeks was successful in 5/6 patients. A non-weight bearing cast might be a good alternative for surgical intervention.Level of Clinical Evidence: Level IV, systematic review of level IV studies.

Traumatic caudal elbow luxation in two cats

Background

Traumatic caudal elbow luxation is an uncommon injury and it is rarely reported in the cat. Closed reduction is considered in early instance but open reduction and stabilization should be evaluated if the joint cannot be reduced or if gross instability persist.

Case Description

This case report described two Domestic Shorthaired cats referred for monolateral forelimb non-weight bearing lameness caused by trauma. Clinical and radiographic examinations revealed a caudal elbow luxation in both patients. The cats were treated with closed reduction and the elbow joints stabilized at 40° of flexion by a transarticular external skeletal fixation for 18-22 days. The follow-up examinations at 2 months and at 3 years showed mild and moderate radiographic evidence of osteoarthritis, respectively, but good elbow function in both patients.

Conclusion

This technique, for the treatment of the traumatic caudal elbow luxation, is easy and straightforward with few complications and to the authors' knowledge was not previously reported in cats.

Exotic Mammal Orthopedics

Orthopedic disorders are a common clinical presentation for the exotic clinician. Before treating the fracture it is vital to stabilize the patient. Small exotic mammals are characterized by relatively thinner bones, adding to the difficulty the small size already represents. A combination of conservative and surgical treatment options are available. The principles of orthopedic surgery and ideas behind the treatment options remain the same as for small mammals, but not all techniques can be directly extrapolated. Historically, the tie-in fixator has been the preferred surgical choice whenever feasible, but further development in bone plates represents a promising advancement.

Avian Articular Orthopedics

In most avian species, luxations occur infrequently compared with other orthopedic conditions. A comprehensive review about avian luxations was published 4 years ago. The aim of this article was to review and describe from an orthopedic point of view the different types of luxations and subluxations reported in birds, their surgical treatment, and, whenever possible, the potential limitations and complications related with these procedures.

Volar dislocation of the second and third carpometacarpal joints - the Lisfranc injury of the hand?

A case of an isolated volar dislocation of the second and third carpometacarpal (CMC) joints in an 18-year-old man is described. He presented following a game of rugby unable to move his hand or wrist. He was managed by manipulation and K-Wire fixation. Hand function was excellent following wire removal and mobilization. This is an extremely rare injury, easily missed. The mechanism of injury described leads to comparison with the Lisfranc injury of the foot.

[Study of the results scleral-fixated intraocular lenses in the absence of capsular support]

INTRODUCTION

In the absence of sufficient capsular support, scleral fixation of the intraocular lens is an interesting alternative. The goal is to evaluate this implantation technique when traditional implantation is impossible.

PATIENTS AND METHODS

This is an observational, retrospective, monocentric study at the Amiens university medical center between August 2013 and March 2016. Patients all underwent scleral fixation of a three-piece implant without suturing of the haptics, after posterior vitrectomy. All patients requiring implantation in the absence of stable capsular support were included. Patients with adequate iris or capsular support were excluded from our study.

RESULTS

Eighteen patients were included, with an average age of 69.3±16.9 years. The surgical indications were: complicated surgery, trauma and endothelial decompensation. The preoperative mean corrected visual acuity was 1.2±0.4 LogMAR while the postoperative acuity was 0.7±0.5 LogMAR. The mean postoperative corneal astigmatism was 1.9±1.9 diopters. The main complications observed were ocular hypertension, macular edema, retinal detachment, iris incarceration and exteriorization of the haptic.

DISCUSSION

There are two alternatives when faced with lack of a sufficient capsular support: scleral fixation or iris fixation. Our technique is the only one achievable in the presence of iris atrophy. Furthermore, it induces less astigmatism and enables the repositioning of a three-piece implant dislocated into the vitreous.

CONCLUSION

Scleral fixation is a technique allowing both a satisfactory and a lasting functional result and is to be considered when faced with a lack of sufficient capsular support.

Alveolar Bone Fracture: Pathognomonic Sign for Clinical Diagnosis

Aim:

Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other tooth trauma is detected. Any suggestion of alveolar fractures should be further investigated with an appropriate radiograph.

Summary:

This case report shows a pathognomonic sign that detects and diagnosis single tooth alveolar bone fractures, i.e., a localized hematoma crossing the attached gingiva from the free gingival margin to the vestibular mucosa. This should serve as a warning for localized alveolar bone fracture.

A visualized hematoma and gentle, careful palpation may help detect covered fractures when the overlying mucosa is not perforated.

Lateral patellar luxation in nine small breed dogs

The objective of this paper was to describe the clinical features, the management and the outcome of nine small breed dogs affected with lateral patella luxation referred during the period between January 2010 and December 2014. Patellar luxations were classified according to: breed, age, sex, weight, and grade of patellar luxation, as well as if unilateral or bilateral, and concurrent cranial cruciate ligament lesion. In affected dogs, surgical correction consisted in the combination of tibial tuberosity transposition and soft tissue procedure. Adjunctive condroplasty or trochleoplasty was performed as needing. The outcome was found positive after surgical management with low complication rate and complications have been easily managed with high success rate.

Avulsion fracture of the supinator crest as an indication for a sustained posterolateral (sub)luxation of the elbow. A case report, anatomical evaluation and review of the literature

The treatment of elbow injuries can be challenging because of the complexity of both anatomy and pathology. We present a rare traumatic avulsion fracture of the supinator crest of the ulna in a 37-year-old patient. Conservative treatment in a long arm cast for four weeks led to satisfactory results. Reproduction of the fracture on a cadaveric elbow clarified that the avulsed fragment holds the insertion of the lateral ulnar collateral ligament (LUCL). The mechanism of trauma that causes this fracture is a posterolateral (sub) luxation of the elbow, which usually causes the LUCL to rupture, but in rare cases the insertion of this ligament can be avulsed. A posterolateral (sub) luxation of the elbow can lead to chronic posterolateral rotational instability and therefore the stability of the elbow should be taken into account in the treatment of patients with such a fracture. A review of the literature concluded that this fracture often is associated with other injuries to the elbow and that it is easily missed on conventional AP and lateral radiographs. CT or MRI imaging and a radial head-capitellum view radiograph can be beneficial. Both conservative and operative treatments have been described with good clinical results.

Temporomandibular joint ankylosis after condylar dislocation into the middle cranial fossa: A case report

INTRODUCTION

Dislocation of the mandibular condyle into the middle cranial fossa after a trauma is a rare event. The lack of appropriate treatment can lead to ankylosis of the temporomandibular joint (TMJ). We report about a case of TMJ ankylosis following intracranial dislocation of the mandibular condyle through the roof of the articular fossa.

CASE REPORT

A 9-year-old patient was referred for a severe limitation of mouth opening that began progressively one year before. A history of chin injury due to an accidental fall was found. Preoperative CT scan showed a TMJ ankylosis on the right side combined with a dislocation of the mandibular condyle into the middle cranial fossa. Treatment consisted in an intracranial resection of the mandibular condyle, partial removal of the ankylosis block and TMJ arthroplasty.

DISCUSSION

Our case is the second case of TMJ ankylosis following intracranial dislocation of the mandibular condyle and treated with arthroplasty alone published in the English literature. There is no consensus regarding the pathophysiology of TMJ ankylosis and regarding the attitude towards the ankylosis block. In our case, no recurrence was noticed after a one-year follow-up. An interdisciplinary approach is needed, including maxillofacial surgeon, neurosurgeon, physiotherapist and orthodontist.

Transverse translunate fracture-dislocation: A rare injury

Perilunate fracture-dislocation is rare. We report the case of a 24-year-old male who fell from his motorcycle and presented with a transverse lunate fracture with perilunate ligament damage. The initial diagnosis based on X-rays was confirmed by CT scan. A dorsal approach was used to obtain good reduction, double screw fixation and ligament reinsertion protected by temporary K-wires. To the best of our knowledge, this is the first case of transverse lunate fracture within perilunate fracture-dislocation. The patient returned to normal activities after 6 months.

Trapeziometacarpal joint dislocation complicated by a trapezium fracture: A case report and literature review

The authors report and discuss the management of a 25-year-old male patient with a trapeziometacarpal joint dislocation complicated by a trapezium fracture. This injury combination is rare with only reported 15 cases. After closed reduction resulted in dorsal instability, anatomical reduction of the trapezium fracture and internal screw fixation were performed using an open approach. This fixation stabilized the joint but was fragile due to the small fragment size. For this reason, ligament reconstruction using half of the flexor carpi radialis tendon was added. At the last follow-up, 16 months later, the trapeziometacarpal joint was stable with a normal range of motion, but the patient had slight pain during physical effort and decreased pinch strength.

Floating thumb metacarpal in a motorcyclist: A case report

We present a case of simultaneous dislocation of the carpometacarpal and the metacarpophalangeal joints of the thumb (floating thumb metacarpal) in a 47-year-old motorcyclist. The treatment consisted of closed reduction of both joints with cast immobilization. After 24 months, the functional result was excellent. The mechanism of this rare injury and its therapeutic management are discussed.

[Bilateral chronic dislocation of the temporomandibular joints and Meige syndrome]

INTRODUCTION

Chronic dislocation of the temporo-mandibular joint (TMJ) is rare. It occurs when an acute dislocation is left untreated, in certain situations, including severe illness, neurologic or psychiatric diseases or prolonged oral intubation.

CASE REPORT

A 79 years old woman, with Meige syndrome, suffered from bilateral dislocation of the TMJ for over 1 year. Surgical repositioning of the mandibular condyles and temporal bone eminectomy were performed. At the 18 postoperative months control, no recurrence has been noted.

DISCUSSION

Treatment of chronic TMJ dislocations often requires a surgical procedure. Manual reduction, even under general anaesthesia, often fails because of severe muscular spasm and periarticular fibrotic changes. The management of this disorder is still controversial. We review available surgical procedures.

[Treatment of recurrent temporomandibular dislocation by displacement of the zygomatic arch: a modification of Gosserez and Dautrey's technique]

INTRODUCTION

Many methods have been reported for the surgical treatment of recurrent anterior temporomandibular dislocation. Most of these techniques are designed to limit the forward migration of the condylar head. The great number of surgical techniques experimented illustrates the difficulty to find a satisfactory method for the treatment of these recurrent dislocations.

TECHNICAL NOTE

We present a modification of Gosserez and Dautrey's surgical technique for the treatment of recurrent anterior temporomandibular joint dislocation.

DISCUSSION

The surgical technique is described and its indications are discussed.

[Dislocation of the thumb extensor tendons: an anatomical, clinical study and new classification]

The authors report on 11 cases of ulnar dislocation of the extensor pollicis longus (EPL) due to rupture of the dorsal aponeurosis at the thumb metacarpophalangeal (MCP) joint. This condition is rare. By performing a descriptive study of this injury, we were able to establish a classification system for thumb extensor tendon dislocation. The series included 11 patients with a mean age of 27years. All patients presented with either varus or rotational thumb injury. This resulted in an active extension deficit in the thumb MCP joint with EPL dislocation behind the MCP. Surgery was required in all cases. We defined three different injury presentations: 1) dissociated form with isolated EPL dislocation, but the EPB still in place; 2) complete form with dislocation of both tendons on the ulnar side of the MCP; 3) dissociated or complete form associated with a severe sprain of the lateral collateral ligament of the thumb MCP joint. The surgical treatment was adapted to each case. A classification into three types of dislocation of the extensor tendons at the MCP joint of the thumb was established. This rare condition must be identified at the time of thumb MCP joint injury and also when harvesting the EPB. This new classification system has a diagnostic and therapeutic role as it precisely describes the dislocation type and the resulting damage. Only a surgical treatment can produce good repairs.

Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases

Elbow dislocation associated with ipsilateral radial shaft fracture is an infrequent injury (nine cases reported in the literature). We present six new cases observed between 2006 and 2012, with an average age of 31 years and a mean follow-up of 18 months. The forearm fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. The dislocation was reduced by manipulation before open reduction and osteosynthesis of the forearm fracture. Four elbows were stable after reduction; two markedly unstable elbows necessitated temporary humero-ulnar external fixation; one case needed a ligamentoplasty several months later. Despite the complexity of the traumatic lesion, the clinical and radiological outcomes were acceptable.

[Finger bone and joint trauma of the hand in children]

The hand is the most commonly injured location of a child. Fractures of the digits are the most frequent lesions with two specific locations: 1) in the young child, the fracture is usually a crush injury, such as occurs when a hand gets caught in a door, with lesion of the distal phalanx; soft tissue associated injuries are the main problem in this location; 2) in the older child, the fracture is usually secondary to recreational sports, with lesion on the proximal phalanx of the second and fifth digits. Dislocations or sprains are less common. Most interphalangeal joint injuries occur at the proximal interphalangeal joint and are secondary to hyperextension with as results a volar plate injury. Most fingers injuries in children are treated non operatively with a favorable outcome. The treating physician should however identify those clinical situations that require surgery, as complications are most commonly due to a failure to identify and treat an injury requiring an operation acutely. These injuries include intra-articular fractures, displaced phalangeal neck fractures, and malrotated fractures. Malrotation or intra-articular malunion have no remodeling capacity. Non-union and stiff digits are uncommon but a significant trauma or a high-energy mechanism with severe soft tissues injuries appears to be a factor of risk.