Cases reported "Dislocations"

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11/134. Avascular necrosis after minimally displaced talus fracture in a child.

    This is a case report of a delayed diagnosis in a 5 year old child who sustained a minimally displaced fracture of the proximal or posterior aspect of the talar neck of the left foot with no subluxation at the subtalar or ankle joint of his left talus. Avascular necrosis (AVN) appeared 6 months after the injury. The further course was protracted with another 12 months of non-weight bearing. The case was followed until 36 months after the injury with nearly full functional recovery. An extensive literature review revealed a calculated incidence of AVN after reportedly non-displaced talus fractures in children of 16 per cent which is considerably more than is reported in adults. Nearly half of all reported cases occurred after the fracture had been missed initially. 8 of 11 cases with reported age occurred between 1 and 5 years. No child was older than 9 years, which indicates that the immature talus may be more prone to AVN. Some possible causes for the higher incidence of AVN in children with non-displaced talus fractures are discussed. Prolonged non weight-bearing cannot be recommended, since it reportedly does not alter the course of the disease.
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ranking = 1
keywords = neck
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12/134. Atlantoaxial subluxation in an adult secondary to retropharyngeal abscess.

    Atlantoaxial subluxation secondary to a retropharyngeal abscess is well described in children, but very rare in adults. Only two adult cases have been reported in the literature. We present a case of severe atlantoaxial subluxation in an adult secondary to retropharyngeal abscess. His atlas-dens interval was very large, up to 10 mm in flexion. We tried external fixation with a neck collar initially, but for remaining instability, surgical fusion was performed. The mechanism of subluxation is attributed to softening of the ligament allowing greater mobility at the joint. The etiology of this process is speculative.
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keywords = neck
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13/134. Retro-odontoid soft tissue mass associated with atlantoaxial subluxation in an elderly patient: a case report.

    BACKGROUND: We present the case of an elderly patient with a retro-odontoid soft tissue mass associated with atlanto-axial subluxation. CASE DESCRIPTION: A 74-year-old man was admitted to our hospital with progressive motor weakness in his right arm and neck pain. Radiological examinations revealed atlantoaxial subluxation and diffuse degenerative changes. Cervical MRI revealed a syrinx at the C1 level and a retro-odontoid soft tissue mass that severely compressed the spinal cord. The mass was of low signal intensity on both T1- and T2-weighted images. Conservative therapy could not stop the progression of his symptoms, so posterior decompression via a laminectomy of C1 and occipitocervical fixation was performed. These procedures resulted in an improvement of his neurological condition and in reduction of the mass and the compression of the spinal cord. CONCLUSION: The patient lacked any specific conditions that might have caused chronic atlantoaxial subluxation. The degenerative changes alone might have provoked chronic atlantoaxial subluxation and a subsequent retro-odontoid soft tissue mass. In patients with this condition, posterior fixation without direct removal of the mass should be the first choice for surgical intervention.
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ranking = 1
keywords = neck
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14/134. La maladie de Grisel: spontaneous atlantoaxial subluxation.

    Objective: "La maladie de Grisel" (Grisel's syndrome) is a spontaneously occurring atlantoaxial subluxation with torticollis. We present a case of atlantoaxial subluxation occurring in a 20-year period of pharyngoplasty surgery. The occurrence of a "spontaneous" atlantoaxial subluxation after oral cavity or pharynx operations is rare. Because some neck pain and stiffness are commonly seen after these kinds of operations, we would like to draw attention to this unusual complication. Symptoms associated with a torticollis after an operation in the oral cavity or pharynx requires additional investigation to exclude this rare complication. A review of the available literature concerning etiology and treatment of la maladie de Grisel is presented.
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ranking = 1
keywords = neck
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15/134. Evaluation of persistent torticollis following adenoidectomy.

    Post-operative neck complaints are not an uncommon finding following adenotonsillectomy. However, non-traumatic subluxation of the atlantoaxial joint (Grisel's syndrome) should be considered in cases of persistent neck pain and stiffness. An early diagnosis and adequate treatment of this rare condition is mandatory to prevent potentially serious complications. We describe three cases with persistent torticollis in the post-operative period, discuss the pathogenesis and evaluate the clinical management of these patients.
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ranking = 2
keywords = neck
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16/134. chiropractic care of a patient with vertebral subluxations and unsuccessful surgery of the cervical spine.

    OBJECTIVE: The chiropractic care of a patient with vertebral subluxations, neck pain, and cervical radiculopathy after a cervical diskectomy is described. CLINICAL FEATURES: A 55-year-old man had neck pain and left upper extremity radiculopathy after unsuccessful cervical spine surgery. INTERVENTION AND OUTCOME: Contact-specific, high-velocity, low-amplitude adjustments (i.e., Gonstead technique) were applied to sites of vertebral subluxations. rehabilitation exercises were also used as adjunct to care. The patient reported a decrease in neck pain and left arm pain after chiropractic intervention. The patient also demonstrated a marked increase in range of motion (ROM) of the left glenohumeral articulation. CONCLUSION: The chiropractic care of a patient with neck pain and left upper extremity radiculopathy after cervical diskectomy is presented. Marked resolution of the patient's symptoms was obtained concomitant with a reduction in subluxation findings at multiple levels despite the complicating history of an unsuccessful cervical spine surgery. This is the first report in the indexed literature of chiropractic care after an unsuccessful cervical spine surgery.
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ranking = 4
keywords = neck
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17/134. Simultaneous noncontiguous cervical spine injuries in a pediatric patient: case report.

    OBJECTIVE AND IMPORTANCE: Noncontiguous traumatic injuries of the cervical spine in children are rare. We present the case of a child who simultaneously sustained a separation of the odontoid synchondrosis and a C6-C7 dislocation with a complete spinal cord injury. The management of simultaneous cervical spine injuries is discussed. CLINICAL PRESENTATION: A boy aged 4 years and 2 months was a restrained back-seat passenger involved in a head-on motor vehicle accident. The patient lacked neurological function below C7. Imaging studies revealed a separation of the odontoid synchondrosis as well as a traumatic dislocation of the spine at C6-C7. INTERVENTION: The patient was placed in a halo vest shortly after admission. Four days after his injury, he underwent a posterior wiring and fusion of C6 to C7. As the C6-C7 dislocation was reduced by posterior element wiring, intraoperative x-rays showed a gradual increase in the subluxation of C1 on C2. This increase in C1-C2 subluxation required intraoperative repositioning of the halo crown on the ventral halo vest posts to maintain acceptable C1-C2 alignment. Postoperatively, ideal alignment of the odontoid peg on the body of C2 could not be achieved by halo adjustments alone. The patient required a custom-made posterior neck cushion attached to the halo vest to maintain cervical lordosis and good alignment of the odontoid peg on the body of C2. CONCLUSION: Simultaneous traumatic cervical spine injuries in pediatric patients are rare. The intraoperative reduction of one spine injury can affect the alignment at the location of the second injury. In this case, a custom adjustment of the halo vest improved the alignment of the odontoid peg on the body of C2.
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ranking = 1
keywords = neck
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18/134. Irreducible dislocations of the cervical spine with a prolapsed disc: preliminary results from a treatment technique.

    STUDY DESIGN: The preliminary results from a treatment technique for irreducible dislocations of the cervical spine with prolapsed disk are reported. OBJECTIVE: To report the success of a technique for grafting and instrumentation of the anterior cervical spine before reduction. This technique is useful in cervical fracture-dislocations irreducible through the anterior approach that must be approached first from the front because of a prolapsed disc. SUMMARY OF BACKGROUND DATA: In the treatment of cervical facet dislocations, a third anterior procedure often is necessary to accomplish the anterior instrumentation and fusion. The reported technique describes a method that eliminates this third procedure by using a cervical buttress plate. methods: Between August of 1996 and October 1998, four patients had dislocation of the cervical spine with a prolapsed disc that could not be reduced using the anterior approach. After discectomy and endplate preparation, a tricortical bone graft was harvested from the iliac crest, placed in the interspace, and held with a buttress plate screwed in two places into the superior vertebral body. The anterior wound then was closed. The posterior elements were exposed and the facets reduced by flexing the neck and posteriorly translating the superior segment. fluoroscopy was used during the reduction to ensure that the graft was pulled into the interspace, that the screws in the buttress plate did not pull out of the superior vertebral body, and that the reduced graft did not impinge on the spinal cord. A posterior fusion was performed and the posterior wound closed. RESULTS: All the patients had consolidation of both anterior and posterior fusions. No cases of instrument failure occurred, either anteriorly or posteriorly. No cases of neurologic deterioration occurred, and no complications were attributable to the use of this technique. CONCLUSION: The reported technique was used successfully in the treatment of four patients with irreducible dislocations of the cervical spine.
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ranking = 1
keywords = neck
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19/134. Irreducible elbow dislocation associated with a radial neck fracture: a case report.

    A rare case of an irreducible elbow dislocation is described. We discuss the causes of irreducibility and the treatment options. Intraoperative assessment of joint stability, repair of the lateral collateral ligament and appropriate postoperative management led to an excellent 5-year outcome, obviating the need for an external fixator or a radial head replacement.
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ranking = 4
keywords = neck
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20/134. Grisel's syndrome.

    Summary Atlantoaxial subluxation is a rare complication of the upper neck inflammatory processes of head and neck region. Grisel's syndrome is a non-traumatic subluxation of the atlanto axial joint. It is not associated with trauma or bone disease. It typically occurs in children after serious infection in the head and neck region. Several theories have been proposed to explain the pathogenesis of inflammatory subluxation. The primary treatment of Grisel's syndrome is medical. We report a case of atlantoaxial rotatory subluxation treated with external fixation and antibiotic therapy.
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ranking = 3
keywords = neck
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