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Plantar dislocation of the first metatarsophalangeal joint is a possible, albeit rare, injury to the foot. The mechanism has been attributed to a hyperflexion motion, with the hallux situated plantar to the first metatarsal head. In this article, we provide a case example of an open, plantar dislocation of the first metatarsophalangeal and perform a literature review of this rare injury. Based on x-ray analysis of the published cases, the sesamoids may or may not dislocate with the phalanx based off of the local capsuloligamentous anatomy. As a result, a modified Jahss classification (type 3A and type 3B) has been proposed to amend the existing system, adding plantar dislocations of the first metatarsophalangeal without (type 3A) and with (type 3B) sesamoid dislocation., (Copyright © 2018 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Dislocation of the first metatarsophalangeal joint is a relatively rare and still poorly known injury. The current classification includes only the dorsal variety of this lesion; thus, as further cases of other varieties are reported, a larger understanding of this entity is required. We report the case of a young male with dorsal dislocation of the first metatarsophalangeal joint treated by closed reduction. The clinical outcome at the 2-year follow-up point is reported. A review of the published data of the variations of this injury reported to date is included, and a new summarizing classification is suggested., (Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

There is significant heterogeneity in the literature related to the causes and treatment of patellar instability. To address the multifactorial issue of patellar instability, the first task is to classify the instability pattern. Once a classification system is developed, future studies can differentiate between treatment recommendations and outcomes for each instability pattern. Existing classification systems do not include the entire spectrum of patellar instability patterns. The aim of this article is to review the nomenclature and existing patellar instability classification systems and analyze the different patterns into a comprehensive system., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Monteggia fractures and olecranon fracture dislocations represent complex injuries with distinct patterns of bony and soft tissue involvement. Fractures of the proximal ulna and olecranon process may lead to disruption of the proximal radioulnar joint and/or ulnohumeral joint. The keys to treatment are recognition of the pattern of injury and formation of an algorithmic surgical plan to address all components of the injury process. Complications are common and may be related to the injury spectrum itself and/or inadequate fracture alignment or fixation., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described., (Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Unfortunately, the literature has little guidance for revision elbow surgery. This article attempts to supplement what is known in the literature with the author's anecdotal experience. With this article, it is the author's hope that the reader may learn from his or her successes and his or her failures without having to discover them first hand. There is good reason for angst to overcome surgeons looking at radiographs depicting a traumatized proximal ulna or radius. Surgeons know that there is a good chance they will be seeing these patients for a long time., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Monteggia described a fracture of the proximal third of the ulna with anterior dislocation of the radial head from both the proximal radioulnar and radiocapitellar joints. Application of this eponym to all injuries with radiocapitellar subluxation or dislocation has led to some confusion. In addition, there are substantial differences between Monteggia injuries in children and adults. With careful definition, specific subsets of patients may benefit from consideration as a separate type of Monteggia injury., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Despite the highly constrained nature of the elbow joint, dislocation is not uncommon. Uncomplicated (simple) dislocations are those that occur without fracture and usually can be managed successfully with closed reduction and early motion. Precise attention, however, should be given to the stability of the elbow immediately after reduction. Instability can persist in full extension and require modification in forearm rotation and limitation of full extension to maintain stability. Soft tissue injury can be severe, at times requiring surgical repair to maintain stability.

In 1934, fractures of the middle and distal third of the radius associated with instability of the distal radial ulnar joint (DRUJ) were described by Galeazzi. This type of lesion is characterized by its unstable nature and the need for open reduction and internal fixation to achieve a satisfactory functional outcome. A high index of suspicion should be maintained by the surgeon, and a thorough examination for instability of the DRUJ must be conducted. The marked instability of this fracture-dislocation complex is further enhanced by the disruption of the triangular fibrocartilage complex, either with or without ulna styloid fracture. Treatment in adults is surgical, and both bone and soft tissue injuries should be addressed.

Monteggia fracture-dislocations remain a relatively uncommon injury. Prompt recognition of this injury is imperative. The character of the ulnar fracture is useful in determining optimal treatment. It is imperative to look for associated injuries of the radial head and coronoid, which alter the management and lead to altered outcomes.

In this article we describe the fundamental concepts that were established by Essex-Lopresti over 50 years ago and explore the current concepts in anatomy, biomechanics, diagnosis, and treatment for longitudinal radioulnar dissociation. Moreover, we present encouraging results for treating chronic injuries to the IOM achieved by bone-ligament-bone (BLB) reconstruction using a patellar tendon graft, giving hope for this seemingly unforgiving injury. A treatment algorithm is also provided to aid in the management of acute and chronic longitudinal radioulnar dissociation.

Fracture dislocations/subluxations of the tarsometatarsal joint are complex injuries that are often misdiagnosed. Prompt recognition and treatment of Lisfranc injuries decrease the likelihood of long-term sequelae. The original (1909) classification system was modified in 1982 and again in 1986. The 1986 classification system, developed by Hardcastle et al, is used most widely in clinical practice and is cited most often in the biomedical literature. For this-or any-classification system to be beneficial, however, multiple observers must be able to use it in a consistent manner, and a high level of interrater agreement should exist. This study examined interrater reliability among clinicians using the modified Hardcastle classification system for Lisfranc fracture dislocations. Thirteen Lisfranc injury radiographs were evaluated by 21 independent observers consisting of surgeons and residents (podiatric and orthopedic) as well as musculoskeletal radiologists, who classified radiographs according to the modified Hardcastle classification system. We used kappa statistics to evaluate the degree of interrater reliability for the entire group. A mean weighted kappa value of 0.54 was found for the group. Moderate interrater agreement was observed among clinicians interpreting the modified Hardcastle classification system for Lisfranc fracture dislocations.

Elbow instability may occur secondary to soft tissue or bony injuries. Predictable patterns of instability do occur. Identification of disrupted osseous or ligamentous constraints allows for an algorithmic and predictable treatment plan. Maintaining a high index of suspicion allows early recognition and treatment of elbow instability. Treatment based on recognized principles is the key to preventing recurrent instability and late arthrosis while maintaining functional elbow motion.

Recognition of the pattern of an elbow fracture-dislocation allows immediate knowledge of the treatment principles, pitfalls, and prognosis of the injury. Specific techniques for each injury component increase the surgeon's ability to restore stability to the elbow. When complications are anticipated and avoided or addressed expediently, it is possible to restore elbow function in spite of the complexity of these injuries.

Proximal interphalangeal joint fracture dislocations are complex, potentially disabling injuries for any patient, especially the competitive athlete. Dorsal fracture dislocations are fairly common and volar fracture dislocations are rare. Stable injuries often heal with minimal functional deficit, whereas unstable injuries can result in limitation in range of motion, joint incongruity, and degenerative joint disease. A number of surgical procedures have been described to treat the unstable dorsal fracture dislocation, including ORIF, extension block pinning, external fixation, dynamic traction, and volar plate arthroplasty. Volar fracture dislocations are usually amenable to closed or open reduction and internal fixation. The results of treatment of both volar and dorsal fracture dislocations can be unpredictable.

The SL ligament complex and volar radiocarpal ligaments provide scaphoid stability both at the SL joint and, more importantly, at its distal radius articulation. With disruption or attenuation of these ligaments, rotational displacement of the scaphoid occurs about its longitudinal axis. This results in distal scaphoid flexion and proximal pole subluxation dorsally, toward the distal radius rim. Rotary subluxation of the scaphoid accurately describes this condition, and represents a spectrum of radioscaphoid instability based upon the severity and chronicity of ligamentous disruption. Diagnosis is based upon identification of specific clinical and radiographic features. Recognition of this entity provides for a more rational basis for treatment of ligamentous injuries of the wrist.

The elbow is the second most common joint dislocated in adults. Up to 20% of dislocations are associated with fractures. Treatment principles are reduction of the joint, stabilization of associated fractures, and early motion. Ligament repairs or reconstruction and hinged external fixators are necessary in some cases to restore stability for early motion. In general, simple dislocations have a better prognosis than complex dislocations (fracture-dislocations).

Successful management of traumatic injuries of the thoracolumbar spine requires understanding of the concepts of spinal stability and instability. There are numerous classifications of injury patterns based on fracture type and the probable forces involved. This article focuses on Denis's three-column theory of spinal stability and its utility in categorizing five injury patterns and the forces involved: specifically, wedge compression fractures, burst fractures, flexion distraction injuries, fracture dislocations, and miscellaneous injuries. The authors also highlight the acute management and evaluation of patients suspected to have these types of injuries.

Many studies indicate that spinal canal decompression and stabilization lead to improved neurologic recovery in patients with incomplete neurologic deficits. It is recognized that surgical stabilization of unstable thoracolumbar injuries with complete neurologic deficit or without deficit reduces hospital stay, improves spinal alignment, shortens rehabilitation, and results in fewer medical complications. Unfortunately, many aspects of management remain controversial. For many injuries, more than one treatment method has been shown to be efficacious, although certain injuries have improved outcome with specific treatment modalities. This article is an overview of indications for surgery, operative approaches, types of instrumentation, and treatment options for specific thoracolumbar injuries.

Traumatic dislocation of the first metatarsophalangeal joint is a rare clinical finding. Ability to reduce the dislocation by nonoperative measures depends largely on the type of dislocation and involvement of the sesamoid complex. A brief description of the incidence, anatomy, and pathomechanics of dorsal dislocation of the first metatarsophalangeal joint is given. A report of a 33-year-old female with complete dorsal dislocation of the first metatarsophalangeal joint and anatomically preserved sesamoid complex is provided.

The mechanics involved in Danis-Weber-types B and C ankle fractures may allow the fibula to seek a shortened and externally rotated position following injury. Residual talar instability secondary to fibular malalignment may ensue if proper anatomic restoration is not achieved at the time of reduction. Evaluation of ankle incongruity may take the form of clinical, radiographic, and diagnostic techniques. Three case studies are presented in which fibular osteotomies were utilized to restore proper anatomic alignment and function to the ankle mortise.

The tibial pilon fracture is a severe injury that can result in disastrous complications. Articulated unilateral external fixation provides an alternate method for the surgical treatment of intra-articular fractures of the distal tibia. This technique provides early mobilization of the ankle joint, stabilizes the fracture site, and through distraction prevents collapse and displacement of the fracture fragments.

Detailed categorization of fractures and fracture-dislocations of the proximal interphalangeal joint should be done for all patients with these injuries. Fractures of the proximal portion of the middle phalanx and fractures of the condyles of the proximal phalanx vary greatly in their presentation, severity, prognosis, and treatment. Fractures of the condyles can be categorized simply by noting whether they are unicondylar or bicondylar, and with or without displacement. For the middle phalanx, I propose the grading system listed in Table 1. Universal acceptance and application of this classification system will advance our understanding and treatment of these difficult fractures.

We have contrasted 161 patients with Down's syndrome admitted to three acute care centers with 107 patients in an institutional setting, outlining their major orthopedic problems and suggesting methods of management based on acute care experience. Severe hallux valgus, metatarsus primus varus, subluxation an dislocation of the patella, severe pes planus, atlantoaxial subluxation, femoral head epiphysiolysis, and dislocation or subluxation of the hips remain the most critical problems against a background of other less common orthopedic abnormalities.

This article presents a practical classification of acute cervical spine injuries based on terminology with generally accepted and understood definitions, published results of experimentally produced acute injuries of the cervical spine, and the correlation of the radiographic and pathologic characteristics of the laboratory models with acute clinical injuries.

Significant advances have been made over the past 40 years in the understanding of the pathoanatomy, biomechanics, and neurophysiology of thoracolumbar injuries. These improvements are reflected in the sophisticated classifications currently in use. Yet, we remain in a transitional phase of our classification of these fractures. Future schemes will probably offer two precise classifications--one neurologic and one structural--for every injury.

Although MCP joint dislocations are much less common than PIP dislocations, they present a unique set of problems. MCP dislocations usually require open reduction. The obstructions to reduction include the volar plate, interposed ligaments, and the finger-trap effect of intrinsics and flexor tendons. The key to management of such injuries is proper identification of the dislocation type, use of open reduction where necessary, and an aggressive postinjury rehabilitation program. Complications of these injuries do occur, and they must be identified and managed properly.

Identification of the mechanism of injury is the hallmark of dislocation management. If the mechanism can be established by history, anatomic disruptions can be logically explained and identified. Conversely, the injury pattern clinically may help deduce the mechanism. Once the mechanism is established, either historically or clinically, relocation maneuvers can be planned and executed. A review of pedal dislocations has been presented with emphasis on anatomic relationships and mechanism of injury. These principles encompass diagnosis, treatment, and management. They must be understood to manage not only the acute emergency situation but the chronic disability of post-traumatic arthritis.

Dorsal fracture dislocations of the proximal interphalangeal joint with or without subsequent instability require a careful initial clinical examination followed by appropriate operative or nonoperative treatment. Attention to detail is crucial in achieving a successful outcome, regardless of the treatment selected. This article outlines the various classification systems available for dorsal fracture dislocation of the proximal interphalangeal joint and the appropriate treatment. It further describes management of cases that present late and require secondary reconstructive procedures.