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Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To investigate the risk factors for unsuccessful radial head reduction (RHR) in children with chronic Monteggia fractures (CMFs) treated surgically. Methods: A total of 209 children (mean age 6.84 years (SD 2.87)), who underwent surgical treatment for CMFs between March 2015 and March 2023 at six institutions, were retrospectively reviewed. Assessed risk factors included age, sex, laterality, dislocation direction and distance, preoperative proximal radial metaphysis width, time from injury to surgery, reduction method, annular ligament reconstruction, radiocapitellar joint fixation, ulnar osteotomy, site of ulnar osteotomy, preoperative and postoperative ulnar angulation, ulnar fixation method, progressive ulnar distraction, and postoperative cast immobilization. Independent-samples t-test, chi-squared test, and logistic regression analysis were used to identify the risk factors associated with unsuccessful RHR. Results: Redislocation occurred during surgery in 48 patients (23%), and during follow-up in 44 (21.1%). The mean follow-up of patients with successful RHR was 13.25 months (6 to 78). According to the univariable analysis, time from injury to surgery (p = 0.002) and preoperative dislocation distance (p = 0.042) were identified as potential risk factors for unsuccessful RHR. However, only time from injury to surgery (p = 0.007) was confirmed as a risk factor by logistic regression analysis. Receiver operating characteristic curve analysis and chi-squared test confirmed that a time from injury to surgery greater than 1.75 months increased the rate of unsuccessful RHR above the cutoff (p = 0.002). Conclusion: Time from injury to surgery is the primary independent risk factor for unsuccessful RHR in surgically treated children with CMFs, particularly in those with a time from injury to surgery of more than 1.75 months. No other factors were found to influence the incidence of unsuccessful RHR. Surgical reduction of paediatric CMFs should be performed within the first two months of injury whenever possible. Cite this article: Bone Jt Open 2024;5(7):581–591.

Our objective was to scrutinize the risk factors related to bilateral involvement in the developmental dysplasia of the hip (DDH) and to inspect the impact of bilaterality on the enduring results of the DDH. All patients, aged between 6 and 18 months, who underwent surgery using the limited posteromedial approach (734 hips from 561 patients), were included in this study. The number of births, birth type, history of consanguineous marriage, family history, and swaddling were analyzed. Physical examination and complaints of the patients were evaluated, and direct radiographs were examined in terms of the redislocation, avascular necrosis, and residual acetabular dysplasia. Among the 561 patients, bilateral DDH was observed in 173 patients (30.8%). The use of swaddling was found to be statistically significant between groups (p = 0.012). The use of swaddling for more than one month was associated with a higher odds ratio for bilaterality (p = 0.001, OR = 1.56, 95% CI: 1.2–2.0). Furthermore, bilaterality was associated with a higher risk for redislocation in DDH (p = 0.001, OR = 4.25, 95% CI: 1.6–11.2). The study concludes that swaddling for over a month is strongly linked with the bilateral involvement in DDH. It is important to note that bilaterality plays a crucial role in the development of redislocation after open reduction in DDH. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effect of isolated medial patellofemoral ligament reconstruction (MPFLR) versus concomitant MPFLR and tibial-tubercle osteotomy (TTO) on patient-reported functional outcomes, rate of patellar redislocation, and rate of return to sport in skeletally mature patients with recurrent patellar instability and lateralization as defined by elevated tibial-tubercle trochlear groove (TT-TG) distance. Methods: Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 10th, 2022 for literature outlining the management of patients with TT-TG indices greater than 15 mm with either isolated MPFLR or concomitant MPFLR and TTO procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on functional outcomes via the Kujala anterior knee pain score, redislocation rates, return to sport rates, and complications were recorded. The MINORS score was used for all studies to perform a quality assessment of included studies. Results: A total of 31 studies comprising 1405 patients (1452 knees) were included in this review. The mean Kujala score in 13 studies comprising 848 total patients in the isolated MPFLR group was 85.0 (range 80.9–97.5) compared to a score of 83.7 (range 77.2–94.0) in 14 studies comprising 459 patients in the concomitant group. The mean pooled redislocation rate in 19 studies examining isolated MPFLR procedures comprising 948 patients was 3.1% (95% CI 2.1–4.4%, I2 = 7%) as opposed to 3.2% (95% CI 1.9–5.0%, I2 = 0%) in 15 studies comprising 486 patients in the concomitant group. The mean pooled return to sport rate in seven studies with 472 total patients in the isolated MPFLR group was 82% (95% CI 78–86%, I2 = 16%) compared to a score of 92% (95% CI 78–99%, I2 = 58%) in four studies comprising 54 patients in the concomitant group. There were similar complication rates between both treatment groups, including range of motion deficits, fractures, infections, and graft failures. Conclusion: Isolated MPFLR leads to similar anterior knee pain, similar redislocation rates and lower return to sport rates than concomitant MPFLR and TTO procedures in patients with TT-TG distances greater than 15 mm. Information from this review can aid surgeons in their decision to choose MPFLR versus concomitant procedures for this patient population, and can also guide future studies on this topic. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Medial patellofemoral ligament reconstruction (MPFLR) is an excellent surgical option for patients with recurrent patellar instability. This technique has demonstrated significant improvements in patient-reported outcomes, high rates of return to sport, and low rates of failure. However, there is debate regarding the use of isolated MPFLR in the setting of concomitant pathoanatomic features such as patella alta, trochlear dysplasia, or a lateralized tibial tubercle.To estimate the overall relative effect sizes as well as strength of evidence supporting described risk factors for recurrent instability after isolated MPFLR.Systematic review and meta-analysis.A systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, Cochrane, and Ovid/MEDLINE databases were queried. Clinical studies for outcomes of isolated MPFLR reporting recurrent instability and associated risk factors were included. Data for each risk factor analyzed by at least 2 studies were extracted, and the heterogeneity of studies was determined by I2 value. For variables evaluated in studies determined to have fair homogeneity, defined as I2 <25%, DerSimonian-Laird random-effects models were generated and effect sizes were represented as mean differences or odds ratios.Nine studies examining risk for recurrent instability after isolated MPFLR were identified, with 5 overlapping risk factors with low heterogeneity between studies: age, sex, tibial tubercle to trochlear groove (TT-TG) distance, Caton-Deschamps Index (CDI), and trochlear dysplasia. There was strong evidence to support the risk of recurrent instability associated with CDI >1.3 (OR, 2.72; P = .02) and dysplasia with a trochlear bump (DeJour type B or D; OR, 3.28; P <.001). Age, sex, and TT-TG distance did not cause an increased risk of recurrent instability with currently available aggregate data.There are signs of increased risk of failure of isolated MPFLR in the setting of DeJour type B and D trochlear dysplasia and patella alta (CDI, >1.3). Currently available data suggest that age, sex, and TT-TG distance do not cause a higher risk of recurrence for patients undergoing isolated MPFLR. [ABSTRACT FROM AUTHOR]

Our objective was to scrutinize the risk factors related to bilateral involvement in the developmental dysplasia of the hip (DDH) and to inspect the impact of bilaterality on the enduring results of the DDH. All patients, aged between 6 and 18 months, who underwent surgery using the limited posteromedial approach (734 hips from 561 patients), were included in this study. The number of births, birth type, history of consanguineous marriage, family history, and swaddling were analyzed. Physical examination and complaints of the patients were evaluated, and direct radiographs were examined in terms of the redislocation, avascular necrosis, and residual acetabular dysplasia. Among the 561 patients, bilateral DDH was observed in 173 patients (30.8%). The use of swaddling was found to be statistically significant between groups (p = 0.012). The use of swaddling for more than one month was associated with a higher odds ratio for bilaterality (p = 0.001, OR = 1.56, 95% CI: 1.2–2.0). Furthermore, bilaterality was associated with a higher risk for redislocation in DDH (p = 0.001, OR = 4.25, 95% CI: 1.6–11.2). The study concludes that swaddling for over a month is strongly linked with the bilateral involvement in DDH. It is important to note that bilaterality plays a crucial role in the development of redislocation after open reduction in DDH.

Purpose: To compare the outcomes of arthroscopic anterior Bankart repair with and without associated postero-inferior capsulolabral repair as treatment of anterior glenohumeral instabiliy at minimun 10 year follow-up. Methods: A retrospective comparative study including patients who underwent arthroscopic anterior Bankart repair to treat anterior glenohumeral instability with glenoid bone-loss < 15% between January 2000 and February 2010 was performed. Outcomes were reported as recurrence rate, type of recurrence (dislocation or subluxation), need for revision surgery, range of motion, complications, and functional status. Outcomes were compared depending on whether a postero-inferior capsulolabral repair was added to the anterior Bankart repair. Results: 70 shoulders [59 males, mean age 28.2 (range 14–56), mean follow-up 146.1 (range 120–208) months] were included. Recurrence occurred in 9 cases (12.8%), including 3 dislocations and 6 subluxations. Revision surgery was needed in 8 (11.4%). Mean Rowe score improved from 29.7 (11.6) preoperatively to 87.1 (12.3) postoperatively. 83.3% returned to previous sports activities. Mean forward flexion changed from 173.5° (19.2) to 168.4º(10.4) (P < 0.01), external rotation from 81.4° (18) to 75.7° (10.5) (P < 0.01), and internal rotation decreased from 66.2% reaching T12 to 14.1% (P < 0.01). Addition of postero-inferior capsulolabral repair did not influence any of the outcomes significantly. Conclusion: Postero-inferior capsulolabral repair added to anterior Bankart repair as treatment of anterior glenohumeral instability in abscence of significant glenoid bone-loss did not influence the outcomes in terms of recurrence, range of motion, return to sports, or functional status, compared to isolated anterior Bankart repair at 12.2 year follow-up. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Introduction: Monteggia fracture-dislocation refers to traumatic ulnar fractures and dislocation of the radial head, which is one of the most frequently missed injuries, especially in children. The most widespread attitude towards chronic Monteggia lesion is the open reduction of the radial head associated with ulnar osteotomy with or without annular ligament reconstruction. Our study aimed to analyze the risk factors for redislocation after surgical management of chronic Monteggia lesion and the benefits of annular ligament reconstruction and radiocapitellar pinning in paediatric.Materials and Methods: We retrospectively reviewed patients treated with reconstruction surgery for chronic Monteggia fracture-dislocation in our department between 2005 and 2017, with a minimum two years' follow-up. The reconstruction surgery included ulnar osteotomy performed in all patients, annular ligament repair or reconstruction or fixation of radiocapitellar joint, or radial osteotomy in some patients. We collected the related clinical data and evaluated the risk factors of redislocation using logistic regression analyses and a two-piecewise linear regression model with a smoothing function, after reconstruction.Results: Throughout a mean six years' follow-up (range, 2-14 years), 62 patients (42 males, 20 females; average age 6.49 years range, 2-13 years) were reviewed. Of the radiocapitellar joints, 16.1% was noted to have redislocation. Univariate risk analysis showed age, time from injury to surgery, and radial osteotomy were risk factors for a recurrent radiocapitellar redislocation. Time from injury to surgery was found to be independent predictor of redislocation in multivariate analysis. However, there were significant nonlinear associations between time from injury to surgery and redislocation in multivariate logistic regression analysis after multivariate adjustment (p for nonlinear = 0.023). Every one month increase was associated with a 1.37-fold increase in redislocation, in participants within one year after injury.Conclusion: In conclusion, the surgery of chronic Monteggia fracture-dislocation should be done as quickly as possible within one year after injury. Associated annular ligament reconstruction or fixation of radiocapitellar joint does not seem to be helpful. [ABSTRACT FROM AUTHOR]

Objective. To study the influence of thoracic inlet angle (TIA) and the fracture of the articular process on the initial strength of the fixation of the spinal segment during its anterior and circular instrumental surgical stabilization in an experiment on a model of the lower cervical spinal segment. Material and Methods. The material of the study was assembled models of C6–C7 spinal segments made using addictive technologies by 3D printing. After preliminary instrumentation, spinal segments were installed on the stand testing machine using specially manufactured equipment. A metered axial load simulating the native one was applied along the axis of the parameters SVA COG–C7 and C2–C7 SVA, which values were close to the value of 20 mm, at a rate of 1 mm/min until the shear strain was reached. The system’s resistance to dis- placement was measured, and the resulting load was evaluated. Four study groups were formed depending on the modeling of the T1 slope parameter, the integrity of the facets, and the type of instrumentation. Three tests were conducted in each group. The graphical curves were analyzed, and the values of the parameters of the neutral and elastic zones, the yield point, time to yield point, and the value of the applied load for the implementation of shear displacement were recorded. The data were subjected to comparative analysis. Results. In Group 1, anterior shear displacement of the C6 vertebra could not be induced in all series. In groups 2, 3, and 4 a shear dis- placement of ≥4 mm was noted in all series. In Group 3 where a fracture of the articular process was additionally modeled, the average value of the yield point was 423.5 ± 46.8 N. Elastic zone, the time to the onset of the yield point, the time at the end point or at a shear of C6 ≥4 mm did not differ significantly. In Group 4, a translational displacement of ≥4 mm was observed, though the average yield point was 1536.0 ± 40.0 N. Conclusion. The direction of the load applied to the fixed spinal segment, as well as the presence of damage to the articular processes, play a crucial role in maintaining resistance to shear deformation of the spinal segment during its instrumental stabilization. At high values of TIA (T1 slope) and the presence of fractures of the articular processes, the isolated anterior stabilization is less effective, circular fixation of 360° under these conditions gives a high initial stability to the spinal segment.

Abstract Background There has been no gold standard of the initial treatment strategy for acute patellar dislocation (APD) with osteochondral fracture (OCF). Hence the study aim is firstly, to review and compare clinical outcomes of patients who underwent conservative treatment for APD with or without OCF. Secondly, to characterize the location and size of fracture fragment. Methods Sixty-nine consecutive patients who were retrospectively evaluated after first-time APD over a 2- year period were divided into two groups (group 1 (n = 24): APD with OCF and group 2 (n = 45): APD only). Magnetic resonance imaging (MRI) was used to assess patients with APD and OCF from the medial patella. All patients were treated with a supervised course of immobilization followed by progressive range of motion and strength exercise protocol. History of a recurrent dislocation, radiologic and functional scores were analyzed. Results Redislocation rate was 31.2% in group 1 and 26.6% in group 2, showing no significant difference between the two groups (p = 0.690). Intergroup differences in terms of final Kujala and IKDC scores were not significant (p = 0.117 and p = 0.283, respectively). Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). In the subgroup of patient with OCF of the inferomedial facet of the patella, the fragments were found in the lateral gutter and did not cause pain or mechanical symptoms. Thus, loose body removal was not performed. However, all five patients with large OCF involving the central ridge of the patella failed non-operative treatment with recurrent dislocations, ultimately requiring fragment refixation and medial retinacular imbrication. Conclusions First, APD patients with OCFs of medial margin or inferomedial facet showed similar redislocation rates and functional knee scores with those without OCFs after conservative treatment. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. Surgery should be considered with this type.

Purpose: The 'Spaarne soft tissue procedure', is a 4-in-1 soft tissue procedure that treats recurrent patellar dislocations in the young and active population. The procedure has not yet described elsewhere. The purpose of this study is to analyse the redislocation rate and to evaluate the postoperative knee function and patient satisfaction. Methods: Twenty-seven patients (34 knees) underwent the four-in-one SST-procedure. The 4-step technique required a minor change in 2010, including the use of a smaller strip of the patellar tendon for transposition. After a median follow-up of 10.4 years, the redislocation rate was evaluated as the primary outcome measure. Secondary outcome measures were functional outcome (IKDC, Kujala, Lysholm and Tegner activity scale) and Numeric Rating Scales for satisfaction and pain. Results: Redislocation occurred in 8 cases (23.5%) and subluxation occurred in 13 cases (38.2%) post-surgery. A significant higher number of redislocations and subluxations were seen before 2010 (p = 0.04, p = 0.03). The median postoperative IKDC, Lysholm and Kujala scores for the total group were 54, 76 and 81 respectively. Pre- and postoperative Tegner activity scale were both level 3. Median NRS scores during rest, walking and sports were 1, 3 and 5 respectively. Satisfaction with the procedure was reported as 'excellent' or 'good' by 79% of the patients. Conclusion: Despite the high overall redislocation rate and increased pain scores, the SST-procedure shows to be a safe procedure in patients with recurrent patellar dislocations based on the cases after 2010. Mid- and long-term results show moderate to good functional outcomes and satisfaction. Level of evidence: Therapeutic retrospective cohort study, LEVEL III [ABSTRACT FROM AUTHOR]

Background: Adductor tenotomy is needed for clinically complex hips with soft-tissue contractures. It may be proposed that the patients who need adductor tenotomy during closed reduction would have poorer prognosis than the ones without need for adductor tenotomy. The main purposes were to compare the normalization of acetabular index angle (AI), to determine the incidence of femoral head avascular necrosis (AVN), and to predict the need for any secondary surgical intervention between the patients who need adductor tenotomy and those who do not during closed reduction for developmental dysplasia of the hip. Materials and Methods: The study group consisted of 65 hips treated between 6 and 12 months of age. The mean age at the time of surgery was 8.1 ± 1.4 (6–12) months and the mean follow-up was 4.2 ± 1.5 years. Improvement of AI, rate and severity of AVN, and need for secondary surgery with its predictors were evaluated. Results: Adductor tenotomy was performed in 22 hips (Group 1), but not in 43 hips (Group 2). Normalization of the AI was − 14.8° ± 3.5° versus − 14.3° ± 3.2°. The overall incidence of AVN was 18.4%. The rate of secondary surgical intervention was higher in Group 1 (63.1% versus 36.9%) (p = 0.014). Conclusions: No significant difference was detected regarding the improvement of AI as well as the incidence of AVN between the groups. The need for adductor tenotomy during closed reduction was one of the main predictors of the possible secondary surgery. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic labral repair combined with capsular plication decreases joint volume and restores glenoid labral bumper height; thus, the procedure helps decrease capsular redundancy. However, the decreased volume and restored glenoid labral bumper height could change over time, which could influence the outcome of the operation. Purpose: To (1) measure glenoid labral bumper height and capsular volume quantitatively in serial computed tomography arthrography (CTA) and evaluate the relationship between bumper height and joint volume and (2) compare the difference in bumper height and joint volume between groups with and without apprehension after arthroscopic Bankart repair. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who had undergone arthroscopic Bankart repair between January 2012 and June 2016, and were assessed by CTA 3 to 6 months and 12 to 18 months after the operation were included. An image reconstruction program (3-dimensional slicer) was used to calculate inferior, anterior-inferior, and posterior-inferior joint volumes; the ratio of the anterior-inferior volume to the inferior volume was defined as the anterior-inferior volume fraction (VFAI). We also measured glenoid labral bumper height at the 5-, 4-, and 3-o'clock positions. Results: A total of 50 patients were enrolled as study participants (mean age, 25.2 ± 9.29 years). Of these, 10 patients had either redislocation or apprehension, and 40 patients had neither. A significant correlation was observed between 5-o'clock glenoid labral bumper height and VFAI on early CTA (3-6 months) and late CTA (12-18 months) (early CTA: Pearson coefficient, –0.335, P =.040; late CTA: Pearson coefficient, –0.468, P =.003). VFAI at the early CTA was 42.20 ± 10.15 in the group with apprehension and 33.49 ± 9.66 in the group without apprehension; a significant difference was observed. VFAI at the late CTA was 45.84 ± 11.97 in the group with apprehension and 37.65 ± 9.70 in the group without apprehension and thus showed a significant difference between the 2 groups. However, the 3-, 4-, and 5-o'clock glenoid labral bumper heights on early and late CTAs did not show a statistically significant difference between the 2 groups. Conclusion: Early postoperative VFAI is related to postoperative apprehension and redislocation and might be reduced by increasing the 5-o'clock glenoid labral bumper height. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Surgery & Medicine (JOSAM) is the property of Journal of Surgery & Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: There is little data regarding timing of index dislocation in patients who undergo primary total hip arthroplasty (THA) and subsequent risk of redislocation and revision. Methods: Between 1992 and 2013, 21,490 primary THAs were performed at a single institution. 189 patients (190 hips) had a first episode of dislocation within one year of index surgery (0.9 %). 32 patients (32 hips) were excluded for the following reasons: complex THA secondary to fracture malunion, Crowe III/IV developmental hip dysplasia, periprosthetic fracture, prior hip surgery, incomplete information, and hip abductor avulsion. The final cohort consisted of 157 patients (158 hips) who experienced dislocation within 1 year of primary non-complex THA. 88 patients were female (56%), mean age was 61 years (SD = 14), and mean follow-up was 76 months (range 0–229). Multivariable Cox proportional-hazards regression models with fractional polynomial models were used to estimate the association between timing of index dislocation and subsequent redislocation and revision surgery. Results: 69 patients (44%) redislocated at final follow-up. Revision for any cause occurred in 26 out of 157 hips (17%). Time lapse from index THA to first dislocation was significantly associated with the risk of redislocation (p = 0.004) and with the risk of revision (p = 0.04). For every additional 7 days from surgery, risk of redislocation increased by a factor of 1.1 and risk of revision was increased by a factor of 1.13. Conclusion: This study demonstrates there is a lower risk of redislocation and revision in patients who have a first episode of dislocation closer to primary THA. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the radiographic outcomes, rate of redislocation, and avascular necrosis of proximal femoral epiphysis (AVN) in patients aged 24 to 36 months with developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization in human position.Material and Methods: We reviewed the medical records of 39 patients (51 hips) aged 24 to 36 months with DDH treated by CR and spica cast immobilization in human position. The Tönnis grade, rate of redislocation and AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs.Results: Among the included 39 patients (51 hips), 15 hips (29.4%) were Tönnis grade II, 24 hips (47.1%) were grade III, and 12 hips (23.5%) were grade IV. In 47 hips (92.2%), the ossific nucleus was present at the time of CR. Stable reduction was achieved by CR in 39/51 hips (76.5%) and redislocation occurred in 12/51 hips (23.5%). Among the 12 hips that redislocated, 11 underwent open reduction and one repeated CR. Two out of 40 hips (5%) treated by CR developed AVN. Overall, 54.6% of the hips had satisfactory outcomes (39.2% Severin type I and 17.6% type II), while 45.4% had unsatisfactory outcomes (39.2% Severin type III and 3.9% type IV). Of the 40 hips treated by CR, 57.5% and 42.5% of cases had satisfactory outcomes and residual acetabular dysplasia, respectively. Six out of 11 hips (54.6%) treated by open reduction and pelvic osteotomy had satisfactory outcomes.Conclusions: Our study showed that stable CR could be achieved in 76.5% of patients aged 24 to 36 months with DDH at the time of index procedure. Satisfactory outcomes can be expected in 56.4% of the cases (5.0% AVN rate), although late acetabular dysplasia may develop in 43.6% of the hips. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to investigate the clinical outcomes of a combined anterior and posterior approach for the surgical treatment of chronic Monteggia fractures in children.Materials and Methods: From November 2010 to January 2018, 33 patients (27 boys and 6 girls) with chronic Monteggia fracture who were treated surgically by one surgeon of our department were retrospectively analyzed. In the surgical procedure, open reduction and excision of fibrous scar were performed with the anterior Henry's approach, while ulnar osteotomy was carried out with a posterior approach. In cases of unstable radial head reduction, a trans-capitellar K wire was applied. Repair or reconstruction of the annular ligament (ALR) was not undertaken.Results: The average follow-up of the patients was 33.8 months (range 8-87 months). At the last follow-up, Mayor Score and function of flexion and extension showed significant improvement compared to preoperative condition (p < 0.05). Two patients with palsy of the deep branch of the radial nerve with neurolysis recovered to normal over a 3-month follow-up. Redislocation occurred in two patients while subluxation occurred in one. One patient suffered a mild ischemic contracture but gradually recovered. Other severe complications, nerve injuries, heterotopic ossification, or synostosis, were not noted in the follow-up.Conclusion: A combined anterior and posterior approach for surgery resulted in a satisfactory outcome due to the advantages of better exposure, more convenient intraoperative management, and facilitate for radial nerve exploration. Our study provided a new approach for the surgery of chronic Monteggia fractures. [ABSTRACT FROM AUTHOR]

Background: The precise location of unlar osteotomy remains a subject of ongoing controversy in chronic Monteggia fracture (CMF). The purpose of this study was to analyze the influence of different levels of ulnar osteotomy on redislocation in CMF., Methods: We retrospectively reviewed 18 children following our previous series. Except the baseline characteristics and radiographic parameters such as ulnar osteotomy angle, maximum interosseous distance (MID) and proportional ulnar length (PUL), we introduced a new parameter: proportional ulnar osteotomy (PUO) which represents the quantitative level of proximal ulnar osteotomy. Based on the value of PUO, we divided it into two intervals: appropriate PUO range (1/5< PUO <1/3) and inappropriate PUO range (PUO >1/3; PUO <1/5). The relationship between these indexes and redislocation was analyzed., Results: According to the reduction state of radial head, patients were divided in two groups: reduced (15/18) and redislocation (3/18). Only PUO range differed significantly (P=0.043) between the two groups, with a notably higher number of patients showed an osteotomy between 1/5 and 1/3 of ulna in reduced group. Combining PUO range with radiographic parameters (osteotomy angle and post-PUL) improved the accuracy and specificity over using osteotomy angle and post-PUL (accuracy, 94.44% vs. 83.33%) (specificity, 93.33% vs. 86.67%, P=0.008). This combination further enhanced the predictive capability for detecting the risk of redislocation in CMFs., Conclusions: Ulnar osteotomy between the proximal 1/3 and 1/5 appears to provide a much safer and more stable radiocapitellar joint in CMF., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-23-477/coif). The authors have no conflicts of interest to declare., (2024 Translational Pediatrics. All rights reserved.)

Background: Closed reduction and spica cast is still the preferred treatment option for children presenting with developmental dysplasia of the hip (DDH) after the age of 6 months. This study aims to investigate the outcomes of patients with DDH treated by closed reduction and dynamic cast immobilization.Methods: In total, 159 patients (mean age 15.6 ± 4.2 months; 172 hips) were treated with a dynamic cast immobilization for 3 months, followed by an abduction brace until a stable concentric reduction was achieved. Radiological examination was performed at each follow-up visit to assess reduction, redislocation rate and presence of avascular necrosis (AVN) of the femoral epiphysis. Final radiographic results were evaluated with the Severin classification.Results: The redislocation rate was 4.1% (7/172); the overall AVN rate was 14.5% (grade II: 16 hips; grade III: 5 hips; grade IV: 3 hips). At last follow-up visit, the mean age of patients was 61.6 ± 21.3 months (range 30.8-141), and the mean acetabular index was 22.6° ± 5.6°; 67.3% of the hips had Severin type I radiographic criteria, 8.5% had type II, 23.6% had type III, and 0.6% had type IV.Conclusions: Dynamic cast is an alternative to spica cast immobilization in DDH patients undergoing closed reduction. It has similar redislocation and AVN rates compared to standard spica cast immobilization, as reported by previous studies. [ABSTRACT FROM AUTHOR]

Background The reported incidence of shoulder redislocation varies among different reports. This was a nationwide study to investigate the recurrence rate of shoulder dislocation after closed reduction. Methods We performed a cohort study to analyze the incidence of first dislocation as well as second and third repeated dislocations in a nationwide dataset from the National Health Insurance Research Database of Taiwan. Patients who had any shoulder dislocation event and received closed reduction from 2000 to 2013 were included. Results From this dataset of 1 million persons, we identified 1074 patients who had a shoulder dislocation. Of these, 210 had a second shoulder dislocation and 93 had a third shoulder dislocation. The shoulder redislocation rates were 9.4%, 12.7%, and 17.0% at 1 year, 2 years, and 5 years, respectively, after the first shoulder dislocation and 19.6% at overall follow-up. Patients in the youngest age group and male patients had higher risks of redislocation (adjusted hazard ratios, 3.28 and 1.41, respectively). The mean time to recurrence was 13.1 months. However, the patients who had a second shoulder dislocation had a shorter time to recurrence and a higher risk of redislocation (44%), with no statistical differences in risk among any age or sex groups. Conclusions After the first shoulder dislocation, male patients and younger patients had higher shoulder redislocation rates. However, after the second shoulder dislocation, all groups shared a similar high shoulder redislocation rate regardless of age or sex. Surgical treatment should be considered for patients with multiple episodes of shoulder dislocation. [ABSTRACT FROM AUTHOR]

Introduction: The goal in the treatment of developmental dysplasia of the hip (DDH) is to achieve a stable and concentric reduction and to create a congruent relationship between the femoral head and the acetabulum. This study discusses the causes of loss of reduction in DDH patients who had a concentrically reduced hip at the time of removal of the hip spica cast and cessation of brace use and who later appeared with hip redislocation after mobilisation and ambulation. In addition, the possible interventions in such cases are also discussed. Material and method: A retrospective evaluation was made of 13 patients diagnosed with DDH who developed redislocation following primary surgery. 6 of them had undergone the 1st surgery in our department between 2008 and 2016 and 7 had udergone surgery in another centre. For comparison reasons a 2nd group was formed of 13 demographically and clinically matched patients who had no loss of reduction. The groups were compared in terms of acetabular index, pelvic length, pelvic width, abduction degree of plaster, ossifying nucleus diameter, acetabular depth, and acetabular volume parameters. Results: The average age of the patients was 23 months at initial surgery and 29 months at the time of revision surgery. No significant difference was found between the groups in terms of acetabular inclination angle, ossifying nucleus diameter, pelvic size, pelvic width, centre edge angle, acetabular volume, and depth. Contracted inferomedial capsule was found in 1 patient who underwent revision surgery and intact transverse acetabular ligament was seen in 1 patient. The loss of reduction in the remaining 11 patients was associated with high total anteversion of the femoral head and acetabulum. Conclusions: Correction of increased combined anteversion by femoral osteotomy can create a safe zone in terms of redislocation and can significantly contribute to the stability provided by capsulorrhaphy and pelvic osteotomy. [ABSTRACT FROM AUTHOR]

Introduction: The late detection of developmental dysplasia of the hip (DDH) will remain a major concern in some parts of the world until effective screening programs become available. With late diagnosis comes the need for open surgical reduction. Surgery is invariably followed by a period of immobilisation in a spica cast to prevent postoperative displacement. The goal of this study is to evaluate the effect of double-leg spica as compared to single-leg spica, on the risk of displacement after unilateral open reduction of the hip.Materials and Methods: This was a retrospective review of DDH patients from 2012 to 2016 and younger than 4 years of age, who had unilateral anterior open reduction. Patients who had one of the following were excluded: neuromuscular diagnosis, the addition of K-wire, and simultaneous bilateral open reductions. Demographic data were collected along with related clinical and radiographic variables. A total of 128 patients (162 hips) met the inclusion criteria; 93 were in the double-leg spica group, and 69 were in the single-leg spica group.Results: The mean age was 25.4 ± 8.1 months and the mean follow-up was 18.6 ± 11.6 months. Baseline characteristics were balanced between the two groups. There were three events of redislocation in the double-leg spica group as compared to one redislocation in the single-leg spica group. The difference did not reach statistical significance (p = 0.637, risk ratio 1.317, CI 0.736-2.356). The difference in subsequent disruption of Shenton's line and hip migration of more than 29% was (p = 0.395, risk ratio 1.411, CI 0.892-2.234) and (p = 0.087, risk ratio 0.67, CI 0.417-1.078), respectively. Three patients had a greenstick distal femur fracture after double-leg spica and one after single-leg spica.Conclusion: These data suggest that including the contralateral hip in the cast after open reduction is not essential as it does not seem to improve stability. [ABSTRACT FROM AUTHOR]

Background The majority of simple elbow dislocations (no associated fractures) can be treated nonoperatively with a short period of immobilization followed by guided aftercare. This case series describes the soft tissue injuries in a rare subset of patients in whom the elbow redislocated despite adequate immobilization. Methods During a 6-year period, 8 patients were identified. They were all treated with reduction and casting in 90° of flexion or more. At 1 week of follow-up, redislocation had occurred in all patients and open soft tissue repair was performed. The injuries were documented and the patients were followed up clinically and with radiographs. Results Extensive soft tissue injuries, including both collateral ligament injuries and muscle origin avulsions from either or both sides, were found in all patients. The functional result at follow-up was satisfactory in all patients. Conclusion Vast soft tissue injuries including both collateral ligaments and muscle origins should be expected in the event of early severe instability of a dislocated elbow joint. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to systematically review the comparative studies in the literature to compare the outcomes of the Latarjet procedure in the setting of a previously failed Bankart repair versus those undergoing the Latarjet procedure as a primary surgery for anterior shoulder instability., Methods: A systematic search in Pubmed, EMBASE, and The Cochrane Library databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Cohort studies comparing outcomes in the Latarjet procedure as a primary surgery versus the Latarjet procedure in the setting of a previously failed Bankart repair were included., Results: Ten studies with 1913 patients were included. There was a significantly lower rate of recurrent instability in those with a Latarjet procedure as a primary surgery (4.8% vs 12.1%, p ​= ​0.007). There was also a significantly lower rate of complications with the Latarjet procedure as a primary surgery (6.2% vs 10.2%, p ​= ​0.03). Furthermore, there was a significant difference in the rate of revision surgery in favour of the Latarjet procedure as a primary surgery (4.8% vs 10.9%, p ​= ​0.02). However, there were similar rates of redislocations (2.8% vs 3.4%, p ​= ​0.82) and return to play (67.7% vs 78.5%, p ​= ​0.30) between the two cohorts., Conclusion: This study found that the Latarjet procedure as a revision procedure for a previously failed Bankart repair resulted in higher rates of complications, recurrent instability, and revisions than the Latarjet procedure performed as a primary procedure., Level of Evidence: Level III, Systematic Review & Meta-Analysis of Level III studies., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Re-dislocation after primary treatment of developmental dysplasia of the hip is a serious complication. We analyzed the various risk factors that contribute to re-dislocation, and whether the bony ossific nucleus (ON) confers increased stability against re-dislocation. Materials and Methods: Fifty-five children (60 hips) were classified into three treatment groups: Closed reduction (CR) in 15 children (17 hips), open reduction (OR) in 26 children (28 hips), and OR with bony surgery (ORB) in 14 children (15 hips). The mean age at initial treatment was 16 months (range 6-36 months). Fifty-one hips and 9 hips were Tonnis Grade 4 and 3, respectively. The mean preoperative acetabular index (AI) was 44.82° (range 32°-56°) for the study group. At initial treatment, bony ON was absent in 8 hips and present in 52 hips. Results: No hip developed stiffness and pain after primary treatment. Although the AI index, Tonnis grade, and absence of ossific nucleus were higher in the re-dislocated groups, this was not statistically significant. Excluding the re-dislocations, four children had a fair outcome, 11 had good outcome, and 36 had excellent outcome as per McKay's criteria. In the CR group (17 hips), two children (2 hips) with absent ON had re-dislocation. In the OR group (28 hips), three re-dislocations were seen (three children) at 3, 5, and 7 months, respectively. Two of these had an absent bony ON. In the ORB group (15 hips), one late subluxation occurred in a child with absent ON. The mean preoperative AI for the re-dislocated and located group was 44.66° (range 42°-48°) and 44.53° (range 39°-56°), respectively. The postoperative AI was 34.53. Conclusion: The experience of the treating surgeon and technical factors play an overwhelming role in preventing early dislocation. The absence of ON should perhaps alert the surgeon for enhanced spica care, postoperative splinting, and meticulous intra-operative management. [ABSTRACT FROM AUTHOR]

Background The purpose of this review was to determine the redislocation risk for collision athletes after an arthroscopic Bankart repair and to compare the redislocation rate between collision athletes and noncollision athletes after an arthroscopic Bankart repair. Methods A PubMed and Embase query was performed, screening all relevant literature of arthroscopic Bankart procedures mentioning redislocation rates in collision athletes. Studies with a follow-up <2 years or lacking information on redislocation rates in collision athletes were excluded. We used the modified Coleman Methodology Score to assess the quality of included studies. Finally, the data in all the studies were combined and analyzed. Results There were 1012 studies screened on title and abstract, of which 111 studies were full-text screened, and finally 20 studies were included. Four studies reported on collision athletes only, whereas 16 compared collision with noncollision athletes. Fourteen studies reported increased redislocation rates for collision athletes in comparison to noncollision athletes (absolute risk difference varying from 0.4% to 28.6%), whereas 2 studies reported decreased rates (absolute risk differences of −6% and −2.4%). A combined analysis revealed that collision athletes have an increased absolute risk of 8.09 with 95% CI from 3.61 to 12.57% for development of postoperative instability in comparison to noncollision athletes ( P = .001). Conclusion Collision athletes have an increased risk for redislocation in comparison to noncollision athletes after an arthroscopic Bankart repair, although there were no differences in return to sport. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic surgical repair is a better intervention than non-operative (conservative) treatment for patients with shoulder dislocations. This systematic review determined the numbers-needed-to-treat (NNT) and relative risk reduction (RRR) associated with arthroscopic surgical repair versus non-operative treatment in reducing recurrence rates among patients with first-time traumatic anterior shoulder dislocations. Methods: We searched Google Scholar, MEDLINE, SPORTDiscus, and CINAHL from inception in 2015. All articles had to compare arthroscopic surgical repair and non-operative treatment and be written in English. We used the total number of subjects and the number of recurrent dislocations within each treatment to calculate the NNT and RRR for each study and the pooled data. Results: Six articles were selected and all clearly demonstrated that the arthroscopic surgical repair was more effective than non-operative treatment in reducing the recurrence episodes. The pooled NNT was 1.76 (95% confidence interval [CI]=NNT to benefit 1.50-2.13) and the pooled RRR was 86.0% (95% CI=77.0%-92.0%) among individuals who underwent arthroscopic repair. The average follow-up time was 56 months. Conclusions: A Strength of Recommendation Taxonomy level of evidence of 1 with a grade A recommendation supports the use of arthroscopic surgical repair over non-operative treatment in prevention of first-time traumatic anterior shoulder dislocations. We suggest that sports medicine practitioners consider the patients' age, occupation, and physical activity level when making a clinical decision. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to demonstrate postoperative outcomes and return to regular physical and sports activities at average of 6 years after patellar stabilization with medial patellofemoral ligament (MPFL) reconstruction. Methods: Between November 2006 and January 2010, 31 isolated MPFL reconstructions in 29 patients with recurrent patellar dislocation were performed. Radiographs and magnetic resonance imaging were evaluated preoperatively. Knee function was assessed pre- and postoperative using Kujala score and the patient satisfaction, according to the International Knee Documentation Committee (IKDC) score. Tegner activity score was used for the evaluation of sports activity level. Results: The average follow-up was 6.4±1.2 years. All measured scores increased significantly at follow-up. The average Kujala score increased from 75±10 to 95±10, patient satisfaction according to IKDC score from 6.1±1.4 to 8.7±1.4 and Tegner activity score from 4.4±1.6 to 5.7±1.3. The Tegner activity score after surgery was significantly lower than the score before the patellar dislocation (6.7±1.3). There were no significant differences in Kujala postoperative score between women’s and men’s group (P=0.25). There was no significant correlation between body mass index and Kujala score postoperatively (P=0.11) and between age at surgery and Kujala scores postoperatively (P=0.56). Patients who were active in sports preoperatively had resumed sports activities in 88.5% after surgery, 69.6% of them returned to the same levels and 30.4% return to the lower levels. Conclusion: Patellar stabilization with MPFL reconstruction is a safe and effective treatment method for all patients with patellofemoral instability and allows most patients to return to regular physical and sports activities after surgical intervention. Although sports activity level increased significantly after surgery, the same level of sports activity before the patellar dislocation has not been achieved. [ABSTRACT FROM PUBLISHER]

Purpose: There is only one prospective randomized trial on acute primary patellar dislocation in adolescents comparing the long-term outcome after conservative versus operative procedures. Therefore, the long-term outcome, patellar redislocation rate, and functional outcome after conservative versus operative procedures were investigated in a prospective randomized study.Methods: Initially, 36 patients with acute primary patellar dislocation were prospectively randomized to conservative (n = 20) versus operative procedures (n = 16) and 30 of them (83%), 15/20 with conservative and 15/16 with operative procedures, were reached for a follow-up interview 6 years after primary procedure.Results: Baseline and clinical parameters were similar in the two groups. The prevalence of patellar redislocation rate at 3 and 6 years after primary procedure was higher in the conservative group (7/20, 35%, 3 years and 11/15, 73%, 6 years) versus in the operative group (0/16, 0%, 3 years and 5/15, 33%, 6 years) (p = 0.02). The knee function was slightly better 6 years after primary treatment in the operative group than in the conservative group. Most patients in both groups had excellent or good knee function at 6-year follow-up, but four patients (4/15, 27%) in conservative group and two patients (2/15, 13%) in operative group had poor knee function at 6-year follow-up. Four patients in conservative group (4/15, 27%) and two patients in the operative group (2/15, 13%) were unsatisfied with the procedure at 6-year follow-up.Conclusions: In conclusion, the results suggest that both conservative and operative procedures are feasible options for treatment of acute primary patellar dislocation in adolescents. A new finding with clinical relevance in the present work is a significantly higher redislocation rate in conservative group compared to operative group after 6-year follow-up in acute primary patellar dislocation in adolescents.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify the risk factors for recurrent lateral patellar dislocations and to incorporate those factors into a patellar instability severity score. Methods: Sixty-one patients [male/female 35/26; median age 19 years (range 9-51 years)] formed the study group for this investigation. Within the study group, 40 patients experienced a patellar redislocation within 24 months after the primary dislocation, whereas 21 patients, who were assessed after a median follow-up of 37 months (range 24-60 months), had not experienced a subsequent episode of lateral patellar instability. In all patients, age at the time of the primary dislocation, gender, the affected body side, body mass index, bilateral instability, physical activity according to Baecke's questionnaire, the grade of trochlear dysplasia, patellar height, tibial tuberosity-trochlear groove (TT-TG) distance, and patellar tilt were assessed. The odds ratio (OR) of each factor with regard to the patellar redislocation was calculated using contingency tables. Based on these data, a 'patellar instability severity score' was calculated. Results: The patellar instability severity score has six factors: age, bilateral instability, the severity of trochlear dysplasia, patella alta, TT-TG distance, and patellar tilt; the total possible score is seven. Reapplying this score to the study population revealed a median score of 4 points (range 2-7) for those patients with an early episode of patellar redislocation and a median score of 3 points (range 1-6) for those without a redislocation ( p = 0.0004). The OR for recurrent dislocations was 4.88 (95 % CI 1.57-15.17) for the patients who scored 4 or more points when compared with the patients who scored 3 or fewer points ( p = 0.0064). Conclusion: Based on the individual patient data, the patellar instability severity score allows an initial risk assessment for experiencing a recurrent patellar dislocation and might help differentiate between responders and non-responders to conservative treatment after primary lateral patellar instability. Level of evidence: Case-control study, Level III. [ABSTRACT FROM AUTHOR]

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Background: The macroscopic pathomorphology in recurrent shoulder instability has been described. However, less is known regarding the histopathologic details of the affected structures. This study evaluates different histopathologic stages of shoulder instability by assessing biopsy specimens of static stabilizers for possible correlations with clinical parameters. Our hypothesis was that clinical parameters of shoulder instability correlate with histopathologic findings. Materials and methods: Passive shoulder stabilizers (labrum, anterior bundle of the inferior glenohumeral ligament) were biopsied during arthroscopic shoulder stabilization. Samples were submitted to immunohistochemistry, in situ hybridization, and blinded evaluation. Clinical data, comprising age (<30 years or ≥30 years), total number of dislocations (1, 2-3, or >3), and period since initial dislocation (<6 months, 6 months to 6 years, or >6 years), were tested for statistical correlation with the following histopathologic parameters: inflammation, lipomatous changes, vascular proliferation, tissue fragmentation, and cellularity. Results: Standardized biopsies were performed in 30 consecutive patients (4 women and 26 men; mean age, 32.6 years) with anterior shoulder instability. Microscopic evaluation showed only small variations in histologic changes among all samples. Only limited variations in cell density, matrix swelling, and collagen fiber disruptions were found. Immunohistochemical analysis showed a similar expression of decorin in all samples. Clinical parameters (age, total number of dislocations, and period since initial dislocation) were statistically independent from histopathologic parameters (inflammation, lipomatous changes, vascular proliferation, tissue fragmentation, and cellularity). No correlation was found in patients with 1 dislocation versus those with more than 1 dislocation. Conclusions: In contrast to macroscopic findings among different grades of shoulder instability, this study detected no correlation between clinical items (age, total number of dislocations, and period since initial dislocation) and histopathologic parameters. These clinical items seem to be independent from the tissue status of static stabilizers of the shoulder. [Copyright &y& Elsevier]

Objectives: To investigate the incidence and the causes of redislocation after different operative corrections of the developmental dysplasia of the hip and its relations to age of the patients. Methodology: It was a prospective observational study during five year period between July 2000 to August 2005. Forty seven patients were admitted for corrective operation of the developmental dysplasia of the hip and a total of 59 hip surgeries have been done in our centre at Razi hospital, Ahwaz Jondishapour University of Medical Sciences, Iran.The rate and causes of redislocation in relation to the type of operation and age of these patients was recorded and analysis of the data was done by T-test and the P-values of less than 0.005 considered as a significant difference. Results: Nine out of 59 operations redislocated after beginning of weight bearing. It included mostly in those who had adductor tenotomy, femoral shortening, derotation and Salter innominate osteotomy (P<0.05). Conclusion: We conclude that if Salter innominate osteotomy is necessary after open reduction and femoral shortening in patients with developmental dysplasia of the hip, it is better not to perform femoral derotation. [ABSTRACT FROM AUTHOR]

From August 1998 to June 2005, we treated five children (age range 2–9 years) with traumatic dislocation of hip. The mean follow-up period was 4.1 years (range 1–8 years). There was acceptable reduction in all cases by single attempt at closed reduction. Two patients aged 2 and 3 years, respectively, had redislocation. Other complications like nerve injuries, avascular necrosis, growth disturbance, ectopic ossification and post-traumatic arthritis were not seen till the last follow-up (mean 4.1; range 1–8 years). Closed reduction is an effective treatment method for traumatic dislocation of hip in children, but adequate immobilization and protection from weight bearing is needed in children aged less than 10 years to prevent redislocation. [ABSTRACT FROM AUTHOR]

Posterior dislocations of the glenohumeral joint are extremely rare (2–4% of all shoulder dislocations) and often associated with bone or ligamentary injuries. Though the reverse Hill-Sachs lesion is a common injury associated with posterior shoulder dislocation, there have been only few articles describing specific treatments for this type of humeral head defect. This article describes the successful operative treatment of an acute locked posterior shoulder dislocation by reconstructing the articular surface of the humeral head with the use of autologous bone graft taken from the iliac crest. The patient was doing quite well with no complaints, good range of shoulder motion and no recurrence of posterior shoulder dislocation despite several epileptic seizures, 1.5 years after surgical reconstruction of the anatomy of the humeral head. His right shoulder function revealed to be “excellent” or “good”, assessed with an absolute Constant Score of 76 points and a relative Score of 88% when compared with an age- and sex-matched normal population. [ABSTRACT FROM AUTHOR]

Summary: Dislocation of a Thompson hemiarthroplasty of the hip is a serious complication with a high mortality rate. Previous papers have focused on surgical techniques to try and prevent dislocation. There is little in the literature on how to manage a patient after a dislocation. Patients with a dislocated Thompson hemiarthroplasty over a 5-year period from 1997 to March 2002 were analysed. Attempts were made to identify factors which may contribute to redislocation. Our strategies for preventing redislocation were evaluated. Of the 612 patients who received a Thompson hemiarthroplasty 23 patients (4%) dislocated. The average number of dislocations per patient was 2.4. Thirteen patients (57%) redislocated their prosthesis. Ten patients (43%) dislocated at least twice. Seven patients (30%) had either a total hip replacement, Girdlestone''s procedure or the hip was left dislocated. Out of 15 patients fitted with an abduction brace 8 (60%) redislocated. Out of 8 patients treated with traction 6 (75%) redislocated. The 6-month mortality for patients suffering a dislocation was 7/23 (30%). If the prosthesis dislocates twice, the hip should be deemed unstable and consideration should be given to a revision procedure. Abduction braces and traction are ineffective in this condition and should be abandoned. [Copyright &y& Elsevier]

Copyright of Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The purpose of this study was to compare results of osteochondral fractures (OCF) after first-time lateral patella dislocation, when either refixation or debridement was performed in a mid- to long-term follow-up and to analyze redislocation and reintervention rates., Design: Fifty-three consecutive patients with OCF were included in this retrospective comparative study. Indication for refixation was presence of subchondral bone at the fragment. Thirty-six OCF were located at the patellar surface, and 17 at the lateral condyle of the distal femur. Refixation was performed in 28 patients while 25 patients underwent removal and debridement. Mean follow-up was 8.9 years (±4.4, range 2.0-16.7 years). For assessment of clinical outcome, the International Knee Documentation Committee (IKDC) Score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score were used. Redislocation rate and further surgical interventions within follow-up were evaluated., Results: All clinical scores in the refixation group yielded significantly better results at mid- to long term follow-up (IKDC P < 0.001, KOOS P = 0.006, Lysholm P = 0.001). Significantly more surgical reinterventions were necessary after debridement (48% vs. 7.1%, P = 0.001). The overall redislocation rate in cases with medial reefing as single stabilizing procedure was 43.3%., Conclusions: Refixation of OCF after lateral patella dislocation shows improved clinical outcome at mid- to long-term follow-up compared with debridement. Therefore, effort to try fragment refixation is recommended. Redislocation rate is high without proper restoration of patellofemoral instability.

Background: There has been no gold standard of the initial treatment strategy for acute patellar dislocation (APD) with osteochondral fracture (OCF). Hence the study aim is firstly, to review and compare clinical outcomes of patients who underwent conservative treatment for APD with or without OCF. Secondly, to characterize the location and size of fracture fragment.Methods: Sixty-nine consecutive patients who were retrospectively evaluated after first-time APD over a 2- year period were divided into two groups (group 1 (n = 24): APD with OCF and group 2 (n = 45): APD only). Magnetic resonance imaging (MRI) was used to assess patients with APD and OCF from the medial patella. All patients were treated with a supervised course of immobilization followed by progressive range of motion and strength exercise protocol. History of a recurrent dislocation, radiologic and functional scores were analyzed.Results: Redislocation rate was 31.2% in group 1 and 26.6% in group 2, showing no significant difference between the two groups (p = 0.690). Intergroup differences in terms of final Kujala and IKDC scores were not significant (p = 0.117 and p = 0.283, respectively). Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). In the subgroup of patient with OCF of the inferomedial facet of the patella, the fragments were found in the lateral gutter and did not cause pain or mechanical symptoms. Thus, loose body removal was not performed. However, all five patients with large OCF involving the central ridge of the patella failed non-operative treatment with recurrent dislocations, ultimately requiring fragment refixation and medial retinacular imbrication.Conclusions: First, APD patients with OCFs of medial margin or inferomedial facet showed similar redislocation rates and functional knee scores with those without OCFs after conservative treatment. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. Surgery should be considered with this type. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral instability is a common knee problem that is difficult to manage owing to its multifactorial etiology as well as the fact that predisposing pathoanatomic features vary from individual to individual. There is limited knowledge regarding the demographic and pathoanatomic risk factors or the relationship between these risk factors and the redislocation rate after surgical stabilization for this challenging condition., Purpose: To analyze the postoperative redislocation rates and the prevalence of demographic and pathoanatomic risk factors for patients undergoing a patellofemoral stabilization., Study Design: Case series; Level of evidence, 4., Methods: Patients with symptomatic recurrent patellofemoral instability underwent a soft tissue patellofemoral stabilization procedure. A total of 342 patellofemoral stabilization procedures (reconstruction, n = 256; imbrication, n = 86) were assessed at a mean follow-up of 24.3 months. Concomitant procedures were performed in accordance with the à la carte concept of addressing significant anatomic or biomechanical characteristics. Two surgical cohorts were analyzed separately for reconstruction or imbrication to address laxity of the medial patellofemoral ligament (MPFL). Failure of the patellofemoral stabilization procedure was defined as postoperative redislocation of the patella. Prevalence of demographic and pathoanatomic risk factors was determined for all patients. Disease-specific patient-reported outcomes were assessed with the Banff Patella Instability Instrument (BPII)., Results: A redislocation rate of 5.1% was identified for MPFL reconstruction and 20.9% for MPFL imbrication. For both MPFL procedures, age at time of surgery was significantly younger for the failed group as compared with the intact group. Postoperative BPII scores were significantly lower for patients who subsequently experienced a surgical failure as compared with intact surgery for both MPFL reconstruction ( P = .048) and MPFL imbrication ( P = .003)., Conclusion: Patellofemoral stabilization with an à la carte approach to surgical selection demonstrated a low postoperative redislocation rate and good clinical results. Younger age at time of surgery was associated with surgical failure. This information may be used to guide surgical decision making and patient education., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: L.A.H. is a consultant for ConMed Linvatec, Smith & Nephew, Pendopharm Canada, and Sanofi-Aventis. S.K. is a consultant for Pendopharm Canada. The Banff Sport Medicine Foundation has received research grants from LifeMark Health, Covenant Health, Sanofi-Aventis, ConMed Linvatec Canada, and Tribe Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.