1/197. Spontaneous regression of periodontoid pannus mass in psoriatic atlantoaxial subluxation. Case report.STUDY DESIGN: A case report of a 41-year-old man with psoriasis who had cervical myelopathy caused by atlantoaxial subluxation and periodontoid pannus mass. OBJECTIVE: To describe the possible mechanism underlying the periodontoid pannus formation and the optimal treatment for such cases. SUMMARY OF BACKGROUND DATA: Atlantoaxial subluxation causing spinal cord compression at the craniocervical junction may develop in patients with rheumatoid or psoriatic arthritis. Periodontoid pannus formation plays an important role in compromising the anteroposterior diameter of the spinal canal and in causing neurologic deficits. Transoral transpharyngeal excision of the pannus is sometimes thought necessary for anterior decompression of the spinal cord. Spontaneous resolution of the periodontoid pannus after posterior atlantoaxial fusion and fixation has been documented in rheumatoid arthritis, but not in psoriatic arthritis. methods: The patient underwent posterior atlantoaxial fusion and Halifax fixation. RESULTS: The patient experienced clinical improvement. Regression of the periodontoid pannus mass was observed on magnetic resonance imaging. CONCLUSIONS: Posterior fusion and instrumentation resulted in spontaneous regression of the pannus mass and symptomatic relief. This report provides evidence that atlantoaxial instability may be the sine qua non for the formation of periodontoid pannus, and that amelioration of such instability leads to spontaneous resolution of the pannus mass.- - - - - - - - - - ranking = 1keywords = instability (Clic here for more details about this article) |
2/197. Inferomedial (subsustentacular) dislocation of the navicular: a case report.A unique case of subsustentacular dislocation of the navicular is presented. The authors propose that such a severe displacement cannot occur until there is complete instability across the whole midfoot. The mechanism of injury and the treatment options are discussed. In the present case, there was late collapse of the foot into abduction because the lateral column was not primarily stabilized. Avascular necrosis is a common complication which leads to navicular collapse. A midfoot arthrodesis gave a good result in our patient.- - - - - - - - - - ranking = 0.5keywords = instability (Clic here for more details about this article) |
3/197. Management of chronic posttraumatic radial head dislocation in children.We describe a new procedure for the management of chronic posttraumatic radial head dislocation, which uses two drill holes in the proximal ulna. The holes are placed at the original attachments of the annular ligament and thereby allow repair of the annular ligament (frequently avulsed from one attachment and impinged within the joint) or reconstruction of the annular ligament with whatever tissue or material desired (triceps tendon is convenient). It secures the radial head in its normal position from any dislocated position. It also allows for osteotomy of any accompanying deformity of the ulna or radius. This operation developed gradually between 1967 and 1995 while we treated seven female patients. The average age at time of injury was 5 years 10 months (range, 3 years 4 months to 8 years 11 months). The interval between injury and operation averaged 30 months (range, 3 months to 7 years). The age at time of surgery averaged 8 years 4 months (range, 5 years 4 months to 13 years 5 months). The only criterion for surgery was a normal concave proximal radial articular surface. Follow-up averaged 48 months. At final follow-up, all patients were fully active and had no elbow pain or instability. Analysis of these cases suggests that the criteria for surgical repair should be based on two features: (a) normal concave radial head articular surface, and (b) normal shape and contour of the ulna and radius (deformity of either should be corrected by osteotomy). The age of the patient and duration of the dislocation are unimportant.- - - - - - - - - - ranking = 0.5keywords = instability (Clic here for more details about this article) |
4/197. Posterior interosseous nerve palsy following placement of the compass elbow hinge for acute instability: a case report.We describe a case of posterior interosseous nerve palsy that developed after application of a hinged elbow external fixation device. Our hypothesis that forearm pronation during ulnar half pin insertion may have been causative is supported by anatomic findings noted during subsequent cadaveric dissection. Based on our observations we recommend that the ulnar half pins required with this device be inserted with the forearm in supination.- - - - - - - - - - ranking = 2keywords = instability (Clic here for more details about this article) |
5/197. An irreducible knee dislocation: a case report.An 8-year-old man presented after sustaining an injury during a fall. A closed reduction attempt failed, and after several tests, an open reduction was performed. With posterolateral dislocation of the knee, there can be anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament disruption. At the 6-month (final) follow-up, the patient had no subjective pain or instability. With this type of injury, the approach can be conservative monitoring or repair of all of the ligaments. Because of the age and activity level of our patient, we opted for repair of the medial collateral ligament initially with the possibility of late anterior cruciate ligament and/or posterior cruciate ligament reconstruction.- - - - - - - - - - ranking = 0.5keywords = instability (Clic here for more details about this article) |
6/197. Atlantoaxial rotatory subluxation in patients with marfan syndrome. A report of three cases.STUDY DESIGN: This is a retrospective case series of three patients, ages 9 1/2, 13, and 20 years old, with marfan syndrome treated for atlantoaxial rotatory subluxation. In the first two cases, acute torticollis was noted postoperatively, following pectus excavatum repair. The diagnosis was made in the third patient after she presented to the emergency room with a week-long history of unresolved neck pain following minor trauma. OBJECTIVE: To report and discuss the courses and clinical sequelae of atlantoaxial subluxation in patients with marfan syndrome. SUMMARY OF BACKGROUND DATA: Radiographic analysis of patients with marfan syndrome has shown that increased atlantoaxial translation, larger odontoid height, and basilar impression are more prevalent in this population compared to age-matched controls. Despite these findings, there are sparse data on injuries secondary to cervical spine instability or abnormalities in this population. To the authors' best knowledge, no report of atlantoaxial rotatory subluxation in patients with marfan syndrome exists in the literature. methods: Case records of rotatory instability of the atlanto-axial level were reviewed and are presented in the following report. RESULTS: The first two patients described in this report were noted to have "cock robin" posturing of their necks following pectus excavatum repairs. The first patient's subluxation was partially reduced with halo traction, and he subsequently underwent posterior spinal fusion of C1-C2 with internal fixation. The patient was well aligned postoperatively, and had no neurologic deficits. The second patient's subluxation reduced after 20 days of halter and traction; he was immobilized in a collar following discharge and reduction was maintained. The third patient's subluxation failed to reduce with halo traction; further imaging studies revealed odontoid prominence in the foramen magnum. She underwent posterior spinal fusion, occiput to C3, with satisfactory result. CONCLUSIONS: The cervical bony and ligamentous abnormalities seen in patients with marfan syndrome may slightly increase their risk for atlantoaxial rotatory instability. Special attention to intubation and positioning, both intraoperatively and postoperatively, may be necessary in patients with marfan syndrome. Additionally, rotatory subluxation should be included in the differential diagnosis for Marfan patients with neck pain after injury.- - - - - - - - - - ranking = 1.5keywords = instability (Clic here for more details about this article) |
7/197. Transarticular fixation with the capacity for motion in fracture dislocations of the elbow.Post-traumatic stiffness of the elbow joint is a frequent result of immobilisation leading to severe disability in the use of the upper extremity. Recognition of the tendency to stiffness leads to the assumption that the strong self-healing forces of the capsule and ligament apparatus converts the initial instability of the joint after ligament disrupture, into a high-grade undirected stability following immobilisation. Directed stability as it is produced by the natural ligament apparatus of the joint on the other hand produces a guided movement of the joint in one direction. These theoretical considerations lead to the idea that the self-healing forces of the ligament apparatus under continuous guided movement of the joint will result in a stable and movable joint to allow healing of the compromised soft tissue envelope and moreover to maintain free soft tissue access without compromising the stability. For this a unilateral fixator with motion capacity was developed. The joint bridging application approaches the humerus and ulna from the lateral side. The proximal pin group is inserted into the proximal region of the humerus respecting the radial nerve. The distal pin group is implanted from the dorsal side into the middle third of the ulna. The fixator has a hinge joint. The design of the fixator clamps, bars and the hinge joint allows simple alignment with the rotational axis of the elbow. Pro- and supination of the forearm is unhindered. Flexion and extension can be permitted according to the soft tissue situation.- - - - - - - - - - ranking = 0.5keywords = instability (Clic here for more details about this article) |
8/197. Sevoflurane mask anesthesia for urgent tracheostomy in an uncooperative trauma patient with a difficult airway.PURPOSE: Proper care of the trauma patient often includes tracheal intubation to insure adequate ventilation and oxygenation, protect the airway from aspiration, and facilitate surgery. airway management can be particularly complex when there are facial bone fractures, head injury and cervical spine instability. CLINICAL FEATURES: A 29-yr-old intoxicated woman suffered a motor vehicle accident. Injuries consisted of multiple abrasions to her head, forehead, and face, right temporal lobe hemorrhage, and complex mandibular fractures with displacement. mouth opening was <10 mm. blood pressure was 106/71 mm Hg, pulse 109, respirations 18, temperature 37.3 degrees C, SpO2 100%. Chest and pelvic radiographs were normal and the there was increased anterior angulation of C4-C5 on the cervical spine film. Drug screen was positive for cocaine and alcohol. The initial plan was to perform awake tracheostomy with local anesthesia. However, the patient was uncooperative despite sedation and infiltration of local anesthesia. Sevoflurane, 1%, inspired in oxygen 100%, was administered via face mask. The concentration of sevoflurane was gradually increased to 4%, and loss of consciousness occurred within one minute. The patient breathed spontaneously and required gentle chin lift and jaw thrust. A cuffed tracheostomy tube was surgically inserted without complication. Blood gas showed pH 7.40, PCO2 35 mm Hg, PO2 396 mm Hg, hematocrit 33.6%. Diagnostic peritoneal lavage was negative. Pulmonary aspiration did not occur. Oxygenation and ventilation were maintained throughout the procedure. CONCLUSION: Continuous mask ventilation with sevoflurane is an appropriate technique when confronted with an uncooperative trauma patient with a difficult airway.- - - - - - - - - - ranking = 0.5keywords = instability (Clic here for more details about this article) |
9/197. Recurrent posterior dislocation following primary posterior-stabilized total knee arthroplasty.In our series of 136 patients with primary total knee arthroplasty using posterior-stabilized prosthesis, a female patient with parkinson disease developed posterior dislocation of the knee 9 months after surgery. Eventually, the dislocation became recurrent, occurring several times a day. The patient made the reposition always by herself. Two months after the first dislocation, we performed the revision of the polyethylene tibial insert and found wearing of the tibial insert's cam as an hitherto unreported cause of the mechanical instability of the total knee prosthesis.- - - - - - - - - - ranking = 0.5keywords = instability (Clic here for more details about this article) |
10/197. Ulnar translocation instability of the carpus after a dorsal radiocarpal dislocation: a case report.An unusual case of ulnar translocation of the carpus after a radiocarpal dislocation is described. Persistent instability was noted despite attempted reattachment of the avulsed palmar capsuloligamentous structures. A successful outcome occurred after radiolunate arthrodesis and external fixation of the wrist.- - - - - - - - - - ranking = 2.5keywords = instability (Clic here for more details about this article) |
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