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Objectives In this study, we aimed to describe a new hook plate technique (HPT) and to compare our results with the conventional extension block technique (EBT) with a Kirschner wire (K-wire) for bony mallet finger treatment. Patients and methods Between April 2015 and January 2018, a total of 19 patients including 10 who were treated with EBT (7 males, 3 females; mean age: 30.1±7.3 years; range, 17 to 48 years) and nine who were treated with HPT (6 males, 3 females; mean age: 31.7±11.3 years; range, 19 to 42 years) for bony mallet finger with distal interphalangeal (DIP) joint subluxation and/or fracture fragment larger than one-third of distal phalanx (Wehbe-Schneider type 1/b, 2/a, 2/b, 3/a) joint were retrospectively analyzed. The DIP range of motion (ROM), Warren and Crawford scores, time to return to work/daily activity, operation time, the number of fluoroscopy shots, cost and complications were compared. Results No significant difference was found in the DIP ROM (p=0.708) and the Warren/Norris and Crawford scores (p=0.217 and p=0.175, respectively) between the two groups. Operation time and material cost were higher with HPT (p=0.006, p=0.001). There was no significant difference in the number of fluoroscopy shots (p=0.344). Although DIP joint motion was started at two weeks in the HPT group and at eight weeks in the EBT group, no significant difference was observed in the time of return to work and normal daily life in both groups (p=0.859). Complications were observed in two patients in the EBT group and in three patients in the HPT group. No significant difference in total complications was observed between the two groups (p=0.666). Conclusion Bony mallet finger treatment with a custom-made hook plate prepared from 1.3-mm AO plates appeared to be clinically and radiologically similar to EBT. Additionally, HPT had the advantages of allowing early ROM to DIP joint and eliminating the need for a secondary surgery such as K-wire removal. On the other hand, hardware cost with HPT was higher than EBT.

Carpometacarpal (CMC) joint instability may be caused by either joint trauma or systemic ligamentous laxity in a setting of connective tissue disorders. Bilateral CMC joint dislocation is extremely rare and has only been described in 2 cases, both resulting from high-energy mechanisms in adults. Here, we present a case of recurrent, bilateral CMC joint subluxation and dislocation resulting from low-energy mechanisms in a pediatric patient with no diagnosable connective tissue disorder. Over a course of 4 years, the patient underwent 10 procedures, including bilateral closed reduction and immobilization, bilateral closed reduction and percutaneous pinning, bilateral tightrope placement, and eventual bilateral tightrope revision with anterior oblique ligament reconstruction. To date, the optimal treatment options for bilateral, low-energy CMC dislocations have not been well described, and these depend on the time from injury to closed reduction as well as postreduction joint stability. Tightrope placement and ligamentous reconstruction may be required in a setting of long-term instability.

Introduction. Locked thumb metacarpophalangeal (MCP) joints due to entrapped radial sesamoids are rare injuries that commonly require open reduction, especially when the injury is delayed in presentation. Case Presentation. We present a case of a 24-year-old female with a subacute thumb MCP joint subluxation due to an incarcerated radial sesamoid. She underwent successful closed reduction but had persistent pain and difficulty gripping large objects necessitating eventual open volar plate repair despite therapy. She was able to achieve full motion, with little pain and disability, after undergoing delayed volar plate repair. Discussion. Delayed volar plate repair may be considered for those patients who fail to improve with conservative management and occupational therapy after a successful closed reduction for thumb MCP joint subluxation due to an incarcerated radial sesamoid.

The hip joint involvement in multiple hereditary exostoses (MHE) occurs in 30–90%, causing pain and limitation of motion by femoroacetabular impingement, coxa valga, acetabular dysplasia, hip joint subluxation, and osteoarthritis. The purpose of this study was to investigate the clinical and radiographic outcomes of ten hips in seven patients treated by surgical dislocation and corrective osteotomies between 2004 and 2009. Surgical dislocation and excision of the osteochondromas and varus intertrochanteric osteotomies were performed in all cases when the neck–shaft angle was &gt, 150°. Common sites of osteochondromas were medial, posterior, and anterior neck of the femur. Neck–shaft angle of the femur was improved from a mean of 157° to 139°, postoperatively. On an average, the center-edge angle improved from 20° to 30° postoperatively. We believe that Ganz’s safe surgical dislocation technique is the preferred treatment of MHE. This safeguards the circulation of the femoral head and the osteochondromas can be resected under direct vision. It can be combined with additional corrective osteotomies because the hip affected by MHE is frequently associated with dysplastic changes which can result in premature osteoarthritis.

Ehlers–Danlos syndrome is an umbrella term for a group of heritable soft connective tissue disorders which is characterized by joint hypermobility, skin texture and elasticity abnormalities, and visceral and vascular fragility or dysfunctions. As the syndrome is rare, it is often underdiagnosed. Patients usually present late, with chronic moderate to severe pain which is attributed to the joint hypermobility and joint subluxations. If the clinician is aware of the syndrome, he/she can identify affected patients in order to prevent complications. We report a 60-year-old woman with arthralgia and back pain lasting for several months and recent metatarsophalangeal luxation of the left toe who was discovered to have Ehlers–Danlos syndrome.

Objective Ehlers–Danlos syndrome frequently causes acute and chronic pain because of joint subluxations and dislocations secondary to hypermobility. Current treatments for pain related to Ehlers–Danlos syndrome and central pain syndrome are inadequate. This case report discusses the therapeutic use of ketamine intravenous infusion as an alternative. Case report A 27-year-old Caucasian female with a history of Ehlers–Danlos syndrome and spinal cord ischemic myelopathy resulting in central pain syndrome, presented with severe generalized body pain refractory to multiple pharmacological interventions. After a 7-day course of ketamine intravenous infusion under controlled generalized sedation in the intensive care unit, the patient reported a dramatic reduction in pain levels from 7–8 out of 10 to 0–3 out of 10 on a numeric rating scale and had a significant functional improvement. The patient tolerated a reduction in her pain medication regimen, which originally included opioids, gabapentin, pregabalin, tricyclic antidepressants, and nonsteroidal anti-inflammatory drugs. Conclusion Ketamine infusion treatment has been used in various pain syndromes, including central neuropathic pain, ischemic pain, and regional pain syndrome. Reports have suggested that ketamine modulates pain by the regression of N-methyl-D-aspartate receptor to a resting state. As such, propagation of nociceptive signal to brain is interrupted allowing for the restoration of physiological balance between pain inhibition and facilitation. The present report shows that this treatment option can be used in patients with refractory central pain syndrome in the setting of spinal cord myelopathy secondary to Ehlers–Danlos syndrome. In addition, as seen in this case, this protocol can potentially decrease the chronic use of pain medication, such as opioids.

ObjectiveTo provide certified athletic trainers (ATs) with recommendations and guidelines for the immediate management of patients with joint dislocations.BackgroundOne of the primary responsibilities of ATs is to provide immediate injury care for active individuals. Although ATs are confronted with managing patients who have many kinds of injuries, the onsite management of a joint dislocation presents challenges in evaluation and immediate treatment. The critical concern in managing a dislocation is deciding when a joint can be reduced onsite and when the patient should be splinted and transported for reduction to be performed in the hospital or medical setting. Factors that influence the decision-making process include the following: whether the AT possesses a documented protocol that is supported by his or her supervising physician(s), employer documents, and respective state regulations; the AT's qualifications and experience; the dislocated joint; whether the dislocation is first time or recurrent; the patient's age and general health; and whether associated injuries are present.RecommendationsThese guidelines are intended to provide considerations for the initial care of specific joint dislocations. They are not intended to represent the standard of care and should not be interpreted as a standard of care for therapeutic or legal discussion.

© 2019 Journal of Shoulder and Elbow Surgery Board of Trustees Background: The Walch type B glenoid has the hallmark features of retroversion, joint subluxation, and bony erosion. Although the type B glenoid has been well described, the morphology of the corresponding type B humerus is poorly understood. As such, the aim of this imaging-based anthropometric study was to investigate humeral torsion in Walch type B shoulders. Methods: Three-dimensional models of the full-length humerus were generated from computed tomography data for the Walch type B group (n = 59) and for a control group of normal nonarthritic shoulders (n = 59). An anatomic humeral head-neck plane was created and used to determine humeral torsion relative to the epicondylar axis. Measurements were repeated, and intraclass correlation coefficients were calculated. Results: The type B humeri had significantly (P

Background: Therapy programs to treat thumb carpometacarpal (CMC) arthritis may engage selective activation and reeducation of thenar muscles, particularly the first dorsal interosseous (FDI) and opponens pollicis (OP) to reduce subluxation of the joint. We describe the effect of simulated selective activation of the FDI and OP muscles upon radiographic subluxation of the thumb CMC joint. Methods: In a cadaver model of CMC subluxation, loads were applied to the FDI, the OP, and then concomitantly at 0%, 25%, 50%, 75%, and 100% maximal loads and radial subluxation of the joint and reduction in subluxation was measured. Results: Selective activation of the OP, alone, improved the subluxation ratio (SR) in a dose-dependent manner. Selective activation of FDI, alone, demonstrated minimal effects on SR. Concomitant activation of OP and FDI improved the SR across all loading states, and activation of 75% and greater, when compared with FDI activation alone, resulted in a statistically significant improvement in SR to within 10% of the presubluxed joint. Conclusions: Concomitant activation of the FDI and OP acts to reduce subluxation of the thumb CMC joint in a dose-dependent fashion. The OP is likely the predominant reducing force. Hand therapy programs that focus on selective strengthening programs likely function in part to encourage patients to activate the easily palpable and easily understood FDI. Concomitant coactivation of the OP may be the major reducing force to elicit clinical and radiographic reduction of subluxation, improved thumb positioning, and reduction of pain and arthritic symptoms.

Mallet finger is inability to fully extend a finger due to the disruption of the extensor mechanism integrity at the distal interphalangeal (DIP) joint level. Cases with DIP joint subluxation, and avulsion fractures involving more than 30% of the DIP joint surface are candidates for surgery. Subacute/late cases have poor outcomes. Investigating the success of extension block pinning in subacute/late bony mallet finger cases is aimed. Patient demographics, the rate of DIP joint involvement in plain X-rays, subluxation status of DIP joint, the time between injury and operation, the duration of the operation, complications in post-operative follow-up, extensor lag and healing status of bone were reviewed. Patient outcomes and relation with operative delay and joint subluxation were analyzed. Mean rate of DIP joint involvement of study group was 43.4 ± 6.12%. Half of the study group (n=7) had DIP joint subluxation. Mean time from injury to operation was 29.78±20.4 days. Six patients time from injury to operation was longer than 5 weeks. Study group had statistically significant improvement after surgery. Preoperative mean extensor lag was 15.71° ± 7.30° and postoperative mean extensor lag was 5.57° ± 8.89°(p5 weeks) and presence of subluxation did not alter the outcome (p=0.353 and p=0.149, respectively). Extension block pinning technique is a fast, easy-to-apply technique with minimal morbidity. Although it has more limited results in chronic cases, it can be used safely in the majority of cases requiring surgery. [Hand Microsurg 2020; 9(3.000): 146-152]

Objectives: We analyzed the clinical and radiological outcomes of percutaneos extension block technique for treatment of osseous mallet injury. Methods: We included 36 patients who had osseous mallet finger ≥ 20% articular surface involvement. We controlled 29 men, 7 women followed mean 18,5 ( Range 8 – 24) months.Radiologic evaluation was made according to the Doyle classification and 25 injuries were classified type IVb, 11 injuries were classified type IVc. Final evaluation were made according to Crawford evaluation criteria and distal interphalangeal joint motion.Results: The preoperative avarage articular surface involvement was 39,7% ( Range 20 – 60 ). The DIP joint subluxation was seen in 6 patients who had ≥50% articular surface involvement. Clinical results, according to the Crawford criteria, were excellent in 30 ( 83,3% ) patients, good in 4 patients ( 11,1% ), moderate in 2 patients ( 5,5% ). The average extension lag was 3,1° (0°to 17°), and the average final active flexion of DIP joint was 75,1° (50° to 80°). Bone union was showed in all cases radiographically at the final control. Conclusion: The extension block technique is a minimal invasive treatment technique. This technique has decreased the complications of the open surgical treatments. This technique when properly applied has been given functionally satisfactory results. The experience of the surgeon is very effective over the result of the patients.

Purpose Carpometacarpal (CMC) joint subluxations of the fifth finger are rare injuries and are notoriously difficult to diagnose due to severe swelling and overlapping of bones on radiographs. Various radiographic studies have been suggested to identify these injuries. We hypothesize that there will be no difference between various oblique radiographs for detection of a fifth finger CMC subluxation. Methods Using 4 cadaveric specimens, we took radiographs at various angles (0°, 30°, 45°, and 60°) with the fifth metacarpal in anatomic position, subluxated 25% and 50% dorsally. Radiology and orthopedic residents, fellows, and attending physicians viewed each image to determine whether a subluxation was present. Data were analyzed using area under the receiver operating curve, sensitivity, and specificity. Results A total of 36 responses were obtained from 9 radiologists (4 residents, 3 fellows, 2 attendings) and 27 orthopedic surgeons (16 residents, 8 fellows, 3 attendings). Radiographs taken at 60° were more sensitive and specific (Sn 85, Sp 60) than at 0° (Sn 64, Sp 33), 30° (Sn 84, Sp 47), or 45° (Sn 80, Sp 49). Area under the receiver operating curve was also higher for 60° (0.87) than 0° (0.59), 30° (0.75), and 45° (0.75). Conclusions Sensitivity, specificity, and area under the receiver operating curve were highest for 60° radiographs. We recommend obtaining radiographs of the hand in 60° of pronation from the lateral if there is suspicion for a fifth CMC subluxation or dislocation. Clinical relevance This study suggests a simple radiographic view to enhance the diagnosis of fifth CMC subluxations.

We present a framework to estimate the missing anatomical details from a partial CT scan with the help of statistical shape models. The motivating application is periacetabular osteotomy (PAO), a technique for treating developmental hip dysplasia, an abnormal condition of the hip socket that, if untreated, may lead to osteoarthritis. The common goals of PAO are to reduce pain, joint subluxation and improve contact pressure distribution by increasing the coverage of the femoral head by the hip socket. While current diagnosis and planning is based on radiological measurements, because of significant structural variations in dysplastic hips, a computer-assisted geometrical and biomechanical planning based on CT data is desirable to help the surgeon achieve optimal joint realignments. Most of the patients undergoing PAO are young females, hence it is usually desirable to minimize the radiation dose by scanning only the joint portion of the hip anatomy. These partial scans, however, do not provide enough information for biomechanical analysis due to missing iliac region. A statistical shape model of full pelvis anatomy is constructed from a database of CT scans. The partial volume is first aligned with the statistical atlas using an iterative affine registration, followed by a deformable registration step and the missing information is inferred from the atlas. The atlas inferences are further enhanced by the use of X-ray images of the patient, which are very common in an osteotomy procedure. The proposed method is validated with a leave-one-out analysis method. Osteotomy cuts are simulated and the effect of atlas predicted models on the actual procedure is evaluated.

Manual therapy, with its emphasis on joint movement and exercise, has become increasingly important for the treatment of pain and dysfunction of the musculoskeletal system. The rationale used to explain the success of manual therapy has changed radically in recent years. Early explanations, which included concepts such as adjusting joint subluxations, restoring bony alignment, and reducing nuclear protrusion, have been shown to have no basis in fact. Current biological research shows the value of movement in maintaining the health and strength of collagenous, muscular, and bony tissues and emphasizes the need for joint movement and for relatively high levels of activity throughout the life cycle. The musculoskeletal system thrives on stress and movement and reacts adversely to prolonged rest or immobilization. The problems associated with working or recreational postures involving prolonged loading at or near the limit of joint range of motion are considered together with a rationale for appropriate therapeutic management. Explanations are provided to enable an understanding of the success of intensive physical therapy for chronic back pain and for manipulation in the treatment of the acute painful locked back.

Objectif Evaluer la frequence des complications de l\'epaule de l\'hemiplegique vasculaire et identifier les facteurs associes a ces complications Methodes C\'est une etude prospective realisee entre Juin et Octobre 2005 au Centre hospitalo-universitaire de Cocody (Abidjan, Cote d\'Ivoire). Elle concerne des patients admis en consultation de reeducation fonctionnelle (RF) ou en hospitalisation de neurologie. Resultats Cinquante patients âges en moyenne de 56,6 ± 13,4 ans (extremes de 29 et 85 ans) avec un sexe ratio de 1,17 en faveur des femmes, recrutes le plus souvent en RF (60%) ont ete inclus dans cette etude. Ils avaient un accident vasculaire cerebral (AVC) principalement ischemique (72%), qui evoluait en moyenne depuis 11,3 ± 12,9 semaines. Parmi eux 28 (56%) avaient une complication de l\'epaule qui etait : une douleur (DL, n=25), un syndrome epaule-main (SEM, n=10) ou une subluxation (SUB, n=18). Ces complications etaient associees dans 46,4% des cas. Ces patients etaient plus âges, avaient un AVC plus ancien, un index moteur du membre superieur plus faible mais un niveau d\'autonomie globale semblable a celui des patients sans complications. Ni l\'âge, ni la duree d\'evolution de l\'AVC n\'etait different selon le type de complication diagnostique. La fonctionnalite etait associe a la SUB (dans 72,2% des SUB le Frenchay arm test etait egal a 0 vs 37,5% chez les patients sans SUB p=0,02) tandis que le tonus des adducteurs du bras etait associe a la DL (dans 40% des DL le tonus des adducteurs etait egal a 1 vs 84% chez les patients ne presentant pas de DL p=0,006). Conclusion L\'epaule douloureuse de l\'hemiplegique est donc une complication frequemment retrouvee dans notre etude. Des etudes ulterieures seront utiles pour conforter la frequence de ces complications, l\'impact des differents facteurs qui semblent s\'y associer et analyser les possibilites de prise en charge tant curative que preventive dans notre milieu Objective To assess the frequency of shoulder complications among subjects with vascular hemiplegia and to identify factors associated with these complications. Methods Conducted between June and October 2005 at the teaching hospital of Cocody (Abidjan, Cote d\'Ivoire), this prospective survey concerned outpatients of rehabilitation unit (FS) and inpatients of neurology unit. Results Fifty patients with an average age of 56.6 ± 13, 4 years (ranged from 29 to 85), a sex ratio of 1.17 in favour of females, mainly recruited in the rehabilitation unit (60%) were included in this study. They had a stroke, mainly ischemic (72%), which progressed in average for 11, 3 ± 12.9 weeks. Among them 28 (56%) had a shoulder complication which was: a shoulder pain (SP, n=25), a shoulder-hand syndrome (n=10), or a glenohumeral joint subluxation (SUB, n=18). These complications were associated in 46.4% of cases. These patients were older, had a stroke progressing for a more long time, a lower pectoral limb motor index but a global self-sufficiency not different from the one of patients without shoulder complications. Neither age nor stroke progress duration was different according to the type of complication diagnosed. The functionality was associated with SUB (in 72,2% of SUB cases the Frenchay arm test was null vs 37,5% among patients without SUB p=0.02) while tonus was associated with pain (in 40% of SP cases the spasticity was scored 1 at the Aswhorth scale vs 84% among patients without SP p=0.006). Conclusion In our study hemiplegic shoulder pain were predominant. Further studies will be necessary in order to precise the prevalence of these complications, the relations with variable factors and to discuss the treatment best adapted to our social and professional environment. Keywords : Stroke ; Shoulder pain ; Shoulder-hand syndrome, Glenohumeral joint subluxation; Africa African Journal of Neurological Sciences Vol. 27 (1) 2008: pp. 11-15

Background The treatment of adults with pain from scoliosis is a complex and difficult task. The variety of structural pathologies with an adult de-novo degenerative conditions, include stenosis, joint subluxation,and disc degeneration. Mechanical pain is often associated with mal-alignment and deviations from the physiological neutral spine posture/ structure. The Side Shift approach has been used at the RNOH to treat Adolescent Scoliosis and Adults in pain. In order to optimize the management of adult scoliosis a decision making pathway was developed. The purpose of the pathway was to inform the clinicians, guide the management and protect the adult patients .Ultimately it was hoped that it would improve patient outcomes.

In this paper, we describe a case of retropharyneal abscess with atlantoaxial joint subluxation after an adenoidectomy. This is a rare complication of which the otolaryngologist must be aware because of its potential consequences.

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