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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.

According to Chinese medicine, the atlantoaxial joint is a composite joint composed of tendons and bones, and the stability of the joint depends on the ‘tendon-bone balance’ involving tendons, ligaments, atlas and axis. Multiple causes of ‘tendon off-position, joint subluxation’ will lead to joint ‘tendon-bone imbalance’, which will evolve into atlantoaxial subluxation (AAS), endangering human health. Chinese therapeutic massage (tuina) is a very effective treatment for AAS in adults, but conventional manipulations are prone to ineffectiveness or accidents due to neglect of the causal relationship of the ‘tendon-bone imbalance’ and inappropriate manipulations. Compared with conventional manipulations, the rational choice of modified manipulations under the guidance of ‘tendon-bone balance’ theory is more effective and less risky, and more worthy of clinical promotion. From the ‘tendon-bone balance’ theory, we considered the shortcomings of conventional manipulations, and introduced several modified manipulations that have their own strengths in ‘tendon smoothing’ and ‘bone setting’, in order to provide new ideas for treatment of AAS in adults.

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.

Background Elbow chronic instability is a disable complication, presenting as recurrent joint subluxations or dislocations. This systematic review aims to assess (1) the clinical outcome and (2) the complication rates of the surgical techniques currently used in the management of posterolateral rotatory elbow instability. Methods OVID-MEDLINE®, SCOPUS, and PubMed were searched from January 2009 to February 2019 to identify relevant studies. The search terms used were "LUCL", "Posterolateral dislocation", "Elbow Docking technique", "Elbow Jobe technique" and "Elbow single strand technique". The methodological qualities of the studies were evaluated, relevant data were extracted. Results Three studies, published between 2012 and 2015, were included in this review. No studies concerning the single strand technique met the inclusion criteria. The included studies had a level of evidence IV and recruited 33 patients undergoing a Jobe technique reconstruction and 8 patients undergoing a Docking technique. Jobe procedure registered better clinical and functional outcome, assessed using the Mayo Clinic Elbow Performance Scale (MEPS), compared with patients managed with Docking technique. Nonetheless, this difference is not significant. There was not a significantly different complication rate (p = 0.57) between patients treated with these two different techniques. Conclusion This systematic review showed that both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability. However, future studies with larger sample size and a longer follow-up interval are needed to draw stronger conclusions on the efficacy of the different LUCL surgical reconstruction techniques.

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.

CASE Vertically unstable pelvic ring injuries are often associated with sacroiliac (SI) joint subluxations or dislocations. The following report describes an irreducible SI joint dislocation where the ilium was locked in a position superior to the sacrum. This injury was refractory to initial closed reduction techniques and ultimately required an open reduction. CONCLUSIONS This report demonstrates the limitations of closed manipulation for some vertically unstable pelvic ring injuries. It is critical to have a strong understanding of the anatomy and typical manipulations to succeed in both closed and open SI joint reduction attempts.

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.

Mallet finger is a common athletic injury. It may occur due to a tendinous lesion or due to a bony avulsion at the level of the extensor tendon’s insertion at the base of the distal phalanx. In all cases, the result is variable loss of the active extension of the distal phalanx. The initial treatment involves immobilising the distal interphalangeal joint in neutral position, followed by X-ray examination to check for any fracture and joint subluxation. When surgery is indicated, extension blocking technique is preferred. Careful follow-up is necessary to minimise the risk of complications.

The hip joint is a common site of symptoms in Multiple Osteochondromatosis (MO), but is infrequently involved by solitary exostoses. In young children with MO, coxa valga is characteristic; features of hip dysplasia occurs in less than 50% of individuals and are usually mild. In older children, hip impingement - either extracapsular or intracapsular - is a common feature and is managed according to symptoms, anatomical location and the extent of osteochondromatosis. Hip joint subluxation is an urgent problem requiring surgical intervention. Malignant change is very rare in the first two decades of life.

© 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]

Surgical fixation is recommended when a mallet fracture involves more than one-third of the articular surface of the distal phalanx. This recommendation originates from the idea that involvement of more than one-third of the base of the distal phalanx causes subluxation of the distal interphalangeal (DIP) joint. Eighty-six fingers of 85 patients with a mallet fracture involving more than one-third of the articular surface of the distal phalanx were enrolled in this study. Patients were allocated on the basis of subluxation of the DIP joint into a group with no subluxation or a group with subluxation. These two groups were compared with respect to age, sex, fracture size, fracture displacement, time to finger immobilizer application, and initial extensor lag of the DIP joint. Backward stepwise multiple logistic regression analysis was performed to identify the risk factors of DIP joint subluxation, and receiver operating curve analysis was used to calculate the optimal cut-off point for the risk factors. Half of our patients with a mallet fracture involving > one-third of the articular surface of the distal phalanx showed subluxation of the DIP joint. A significant intergroup difference was found for fracture size and time to application of a finger immobilizer, but no significant difference was observed for other parameters. The risk factors of DIP joint subluxation were fracture size and time to application of finger immobilizer. The optimal cut-off values for the development of DIP joint subluxation were 48% for the fracture size and 12.5 days for time to finger immobilizer application. Level of Evidence: Prognosis, II

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.

A complex interplay exists between the static and dynamic stabilizers in the glenohumeral joint, especially in overheard athletes who need a shoulder hypermobile enough to perform overhead activity yet stable enough to prevent joint subluxation. Concomitant shoulder pathologies commonly occur in the setting of microinstability and internal impingement. Before any surgical intervention, a 3- to 6-month course of conservative measures should first be attempted, with exercises focused on rotator cuff and scapular stabilizer strengthening combined with posterior capsule stretching. If surgery is needed, arthroscopic suture plication with treatment of concomitant lesions has been shown to provide the best clinical outcomes.

Background Shoulder hemiarthroplasty is a widely accepted method for treating complex proximal humeral fractures, and the deltopectoral approach is the most popular route for this procedure. The purpose of the current study was to define and compare outcomes of shoulder hemiarthroplasty when using deltopectoral or anterolateral deltoid-splitting approaches. Materials and methods Two cohorts of patients were compared for clinical and radiographic outcomes at the same postoperative follow-up periods: a deltopectoral group (DP group) of 15 patients, from November 2004 to April 2007, and an anterolateral deltoid-splitting group (DS group) of 17 patients, from May 2007 to December 2009. Pain scores, goniometric measurements of the range of motion, and Constant scores were recorded for clinical assessment. Radiographic evaluations were recorded for stem osteolysis, tuberosity absorption, joint subluxation, and acromiohumeral distance. Results The 2 groups did not differ significantly in demographic data, preoperative fracture classification, surgical timing, early postoperative radiographic findings, and 2-year radiographic results. The DS group had less immediate postoperative pain ( P = .025). At the 2-year follow-up assessment, the groups did not difference significantly in shoulder abduction and forward flexion. All prostheses survived until the 2-year assessment. Conclusion When performing shoulder hemiarthroplasty for complex proximal humeral fractures, we found that the anterolateral deltoid-splitting approach provides an easier route for assessing posterior fracture fragments and managing rotator cuff tissue. The anterolateral deltoid-splitting approach was shown to be an acceptable alternative route for shoulder hemiarthroplasty than the standard deltopectoral approach.

This chapter aims to analyze the state-of-the-art technology in quantifying the “feel” related to the pivot shift phenomenon. Therefore, the presented concepts are used to support this “feel” rationale, which is mainly associated with the sudden reduction that happens after joint subluxation. All of the presented methods are related to the possibility of measuring the “clunk” that can be felt within the knee joint associated to anterior cruciate ligament (ACL) injury. Scientific literature has reported the use of specific parameters – such as velocity and acceleration – that are related to the dynamic nature of the pivot shift phenomenon and also introduced the use of different devices and systems that are able to directly measure both velocity and acceleration. Due to the possibility of being used in a clinical setting, inertial sensors are playing an increasing role in this context.

Carpometacarpal (CMC) joint subluxation refers to the changes that occur in the CMC joint as seen on x-rays and observed during physical examination. The CMC joint is the most commonly involved arthritic joint in the hand, and arthritis may appear in localized or systemic forms. A diagnosis of thumb-CMC arthritis is based on symptoms of localized pain, tenderness, and instability on physical examination and radiographic evaluation. The AMA Guides to the Evaluation of Disease and Injury Causation provides a protocol for assessing causation and requires that all three of the following criteria must be met: 1) the patient has an illness compatible with a disease-producing agent or an injury; 2) the worker's exposure in the occupational environment potentially caused the disease or is a plausible mechanism of injury of sufficient magnitude to cause the condition; and 3) the preponderance of evidence supports the disease or injury as occupational in origin. If any one of the three is possible but not probable, causation has not been established. The authors review several published articles and conclude that, based on the clinical facts and current science, CMC joint subluxation is unrelated to work and instead is reflective of aging. The article concludes with a comparison of impairment ratings of CMC-related disability using the fifth and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment, both of which lead to identical impairment ratings but by different means.

Finger joint defects in 16 adults were treated with an autologous osteochondral graft from the base of the second metacarpal, the radial styloid, the base of the third metacarpal or the trapezoid and these patients were followed up from between 12 and 62 months. There was no donor site morbidity. One patient had resorption of the graft and developed pain. The joint was subsequently fused. The mean range of movement was 55.8% of the opposite normal joint. At follow up, 15 patients had no discomfort or mild discomfort. Three had mild narrowing of the joint space and two had slight joint subluxation. Only two patients with concomitant severe injury to the same limb had difficulty performing daily activities. Ten were open injuries and these had poorer outcomes. A hemicondylar defect of a finger joint can be treated using an osteochondral graft obtained from the same hand.

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.

Most doctors believe that water sports are save and harmless concerning foot and ankle injuries. However, analyzing injury patterns in Windsurf, Kitesurf and wave surf, foot and ankle injuries rate within the most frequent. Collision with the board, obstacles in the water close to the beach and rotation trauma with the foot fixed in foot straps and bindings are the causes. Superficial wounds may cause dangerous infections especially in tropical water. Midfoot injuries tend to be overlooked and may cause painful chronic instability and arthritis. Surfers must be instructed in self-management of open wounds. Lisfranc joint Subluxation and subtalar injuries must be excluded after a fall with the foot caught in the foot strap.

Arthrography is useful in the evaluation and treatment of developmental dysplasia of the hip. The authors describe the additional diagnostic value obtained from a "false profile" arthrogram. The "false profile" arthrogram allows assessment of anterior acetabulum cover, femoral neck anteversion and hip joint subluxation (instability), which may not be apparent on other views. (Hip International 2005; 15: 177-81).

An unusual case of irreducible volar metacarpophalangeal (MCP) joint subluxation of the thumb is described. The tendon of the extensor pollicis longus (EPL) was trapped palmar to the metacarpal head and open reduction was necessary.

One-third of all mallet fingers are associated with a fracture. Mallet fractures associated with large fracture fragments may result in volar subluxation of the distal phalanx. The management of mallet fractures varies based on injury pattern and surgeon preference. These treatment options include splinting regimens, closed reduction and percutaneous pinning and open reduction and internal fixation. Although numerous surgical techniques have been described, there is little clear consensus on operative treatment. Moreover, there is insufficient evidence to support operative over nonoperative treatment for mallet fractures. Level of evidence: Level V

SummaryAtlantoaxial subluxation was first reported in dogs nearly fifty years ago. Since that time a better understanding of the aetiologies pre-disposing to joint laxity and instability has been achieved. Surgeons however are still trying to address the problems associated with stabilizing this joint which by nature is often required in small juvenile dogs. This review describes the various techniques used, discussing the associated benefits and complications thereby allowing the clinician to make an informed decision on the best treatment for the individual patient.

Background: We investigated radiographic changes of calcaneocuboid (CC) joint subluxation following calcaneal lengthening procedure for the treatment of pediatric planovalgus foot deformities. Methods: This study included 44 cases of planovalgus foot deformities in 24 patients with mean age of 9.7 (range, 8 to 13) years who underwent calcaneal lengthening between 1999 and 2011. The mean follow-up period was 25 (range, 12 to 159) months. Anteroposterior (AP) and lateral radiographs of the weight-bearing view of the foot from immediate postoperative, 3-month postoperative, and last follow-up evaluations were reviewed and also used for trend analysis. Percentage of CC joint subluxations was measured on both AP and lateral view of the foot. Correlations between the percentage of CC joint subluxation and follow-up periods were assessed. Results: All of the feet showed dorsal subluxation of their CC joint on the immediate postoperative lateral plain radiographs. The median percentage of dorsal subluxation of the CC joint improved from 26.0% (range, 10.0 to 67.0) at the immediate postoperative evaluation to 16.5% (range, 7.0 to 47.0, P = .0001) at the 3-month postoperative evaluation and to 11% (range, 2.0 to 30.0, P = .0003) at last follow-up. The trend analysis over time indicated that the CC joint subluxation percentage with calcaneal lengthening generally decreased over time ( rs = −.67, P = .001). No patients showed osteoarthritic changes in the CC joint or nonunion at the calcaneal osteotomy site at last follow-up. Conclusion: At midterm follow-up, the CC joint subluxation was gradually resolving over time, with no evidence of osteoarthritic change in the CC joint. Level of Evidence: Level IV, case series.

✓ The authors describe transverse process hyperrotation and unilateral apophyseal joint subluxation as a novel mechanism of rotational vertebral artery (VA) occlusion. The patient, a 56-year-old man, complained of episodic bilateral blindness when rotating his head more than 90° to the right. Plain cervical x-ray films showed spondylotic osteophytes of the right C4–5 uncovertebral portion. Dynamic angiography revealed right VA occlusion at C4–5 and left VA occlusion at C1–2 with head rotation to the right. It was demonstrated on three-dimensional images constructed from computerized tomography scans that C-4 transverse process hyperrotation compressed the right VA against the apex of the C-5 subluxating superior articular process via the inner surface of the transverse process anterior root (processus costarius) rather than the osteophytes. It is also proposed that the true site of occlusion is different from that observed in angiographic studies.

Modern imaging techniques applied to the pediatric glenohumeral joint have advanced understanding of the anatomic changes that occur secondary to muscular imbalance after brachial plexus birth palsy. A better understanding of the progression and timing of glenohumeral dysplasia has also increased awareness and vigilance of this problem. Early detection of glenohumeral joint subluxation is now possible, allowing for prompt treatment with closed, arthroscopic, or open joint reduction with and without tendon transfers. Dynamic ultrasound imaging, Botox, and arthroscopic techniques have expanded treatment options, providing minimally invasive methods to successfully manage glenohumeral joint dysplasia.

Charcot neuroarthropathy may produce joint subluxation or dislocation, loss of the bone quality, and osseous malalignment, which produces abnormal osseous prominences that become potential areas for ulceration. The deformed Charcot foot position causes aberrant weight bearing forces and altered muscle-tendon balance that also increase the risk for infection and amputation. When treating the Charcot neuroarthropathic foot, the best results are achieved when intervention is initiated early and the treatment is performed accurately and efficiently.1,2

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.