Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
This video explains Lumbar Disc Replacement in Detail. When degenerative disc disease begins to affect the spine this is called degenerative disc disease. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Disc Replacement feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
This video explains Lumbar Disc Replacement in Detail. When degenerative disc disease begins to affect the spine this is called degenerative disc disease. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Disc Replacement feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
Shoulder dislocations are the most common joint dislocations, and only 2% of these are seen as posterior shoulder dislocations. The floating elbow was first described in children, after that shown in adults. Floating elbow cases are very rare, and usually seen with high-energy trauma. Classical definition is the coexistence of the humeral diaphyseal and forearm fracture, but there are other definitions as well.
Background:
The anterolateral ligament (ALL) is a true well-defined ligament in the knee first described in 1879 by Segond. After the work of Claes et al., several studies were conducted about biomechanics and its role in stability of the knee. The anatomical existence of the ALL has been studied by and various radiographic diagnostic modalities and in cadavers. It originates from lateral femoral epicondyle and is inserted between Gerdy’s tubercle and the fibular head. There has been controversy about the existence of ALL in pediatric patients. The aim of this work was to confirm the presence of ALL in pediatric patients by using MRI.
Materials and Methods:
We reviewed the knee MRI scans of 100 pediatric patients (ages between one and 12 yr) who had no knee injury or congenital deformity and had been evaluated by an expert radiologist.
Results:
The ALL was detected in 90% of the pediatric patients with the use of MRI.
Conclusions:
The main finding of this study was that ALL can be seen in pediatric patients using MRI. Despite numerous studies, additional research is needed to further define the role of the ALL in knee function.
Level of Evidence:
Level IV.
ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΜΕ ΜΟΝΗ ΔΕΣΜΗ ΣΕ ΑΝΑΤΟΜΙΚΗ ΘΕΣΗ. ...STAVROS ALEVROGIANNIS
(Παρουσίαση σε Διεθνές Συνέδριο Εταιρείας Αρθροσκόπησης & Χειρουργικής Γόνατος της Πολωνίας, POZNAN 2011).
FREE HAND NOVEL ANATOMIC SINGLE BAND TECHNIQUE FOR ACLR
(X/O BUTTON,CONMED,LINVATEC,USA).PRELIMINARY RESULTS.
(POZNAN 2011)
Spine Arthroplasty or Artificial Disc Replacement is a new term which is used more and more in international scientific meetings and publications starts to dominate the scenery. The last three decades have been the most revolutionary in the history of spine treatment. The 80’s were dominated by the development of modern implants for internal segmental fixation such as pedicle screw systems and others. In the 90’s „Mini-open“ as well as „closed“ endoscopic techniques replaced the majority of conventional surgical approaches . Progress in biological and biochemical research seems to open new perspectives in fusion technology. We must not forget that bony fusion of a functional spinal unit is non physiological and it is associated with a variety of proven and (yet) unproven undesired effects and sequelae. At the beginning of this century, the progress in implant technology open a new dimension for spinal reconstructive non-fusion surgery. A variety of new implants are used today for: nucleus pulposus, total disc replacement, dynamic posterior reconstruction systems, posterior shock absorbers and injectable intradiscal materials. Cervical Disc Replacement is a Motion preserving surgery, Treat painful / pathologic process while restoring/maintaining motion, Decreased stress in adjacent levels, May prevent problems of adjacent segment disease, secondary surgery, pseudoarthrosis.
Comparing arthroplasty (ACDR) vs fusion (ACDF) most of the studies are in favour of (ACDR) because of, Higher neurologic success, Earlier return to work, Degrees of maintained motion, Adjacent Segment Degeneration 5 yrs, Statistically significant better scores (NDI, Arm pain, VAS, and SF-36 scores), lower revision rate (Reoperation rate for ACDF – 11.3% vs 2.9% ACDR)
Biomechanical Properties of the AnteroLateral Ligament (ALL) of the Knee comp...KHALIFA ELMAJRI
Improvising is an established corner in orthopaedic surgery .But if we start handling healthy body tissues surgically we are actually disturbing nature. The lateral knee region is known by its complex functional anatomy. Injury to the integrity of biceps tendons components in this region or direct injury to the FCL could happen during surgery in this region. As the injuries of FCL augment ALRI of the knee it is worth to study the effect of passing the graft deep to the LCL in lateral extra-articular reconstructions , an injury could arise from fixing distal FCL to its tunnel which prevent FCL normal gliding within this tunnel.
To restore function of a structure in the lateral knee using another structure one should have sound comparable knowledge’s about exact nature of structures to be handled, their clinical anatomy and their material and structural properties is a must before their investment, this to minimise the risk of introducing imbalance to a sensitive ligamentous balance or alter the proprioceptive function or affect the stability of the lateral meniscus .That’s why the more work on the anterolateral knee would be invested, in addition to management of acute knee injury , in the study of graft placement isometry in ACL reconstruction , as well as isometry of lateral extra-articular reconstructions to control (ALRI) with ITT, when indicated .
A review of the reverse total shoulder replacement surgery and it's clinical implications for both physical rehabilitation and functional anatomy.
Objectives:
Understand basic anatomy of the shoulder complex and its implications for shoulder replacement
Understand indications for shoulder replacement
Understand differences between standard and reverse total shoulder replacements
Understand precautions following rTSA
Understand important concepts in rehabilitation following rTSA
this presentation focus on a specific problem for patients with multiple hereditary exostosis who suffered from forearm deformity . It introduce a new technique to correct the deformity while preserving the epipyseal plate to maintain the growth of the bone.It avoids the complex surgery of distraction osteogenesis.
Diapositivas presentadas por Martina Massa, Marketing & Communications Manager Pragma Consultores, en el eCommerce IT Camp dentro del marco del eCommerce Day Buenos Aires 2016.
Diapositivas presentadas por Brian Gilbert, Jefe de Desarrollo Web & Mobile Grupo Logistico Andreani, en el eCommerce IT Camp dentro del marco del eCommerce Day Buenos Aires 2016.m
Shoulder dislocations are the most common joint dislocations, and only 2% of these are seen as posterior shoulder dislocations. The floating elbow was first described in children, after that shown in adults. Floating elbow cases are very rare, and usually seen with high-energy trauma. Classical definition is the coexistence of the humeral diaphyseal and forearm fracture, but there are other definitions as well.
Background:
The anterolateral ligament (ALL) is a true well-defined ligament in the knee first described in 1879 by Segond. After the work of Claes et al., several studies were conducted about biomechanics and its role in stability of the knee. The anatomical existence of the ALL has been studied by and various radiographic diagnostic modalities and in cadavers. It originates from lateral femoral epicondyle and is inserted between Gerdy’s tubercle and the fibular head. There has been controversy about the existence of ALL in pediatric patients. The aim of this work was to confirm the presence of ALL in pediatric patients by using MRI.
Materials and Methods:
We reviewed the knee MRI scans of 100 pediatric patients (ages between one and 12 yr) who had no knee injury or congenital deformity and had been evaluated by an expert radiologist.
Results:
The ALL was detected in 90% of the pediatric patients with the use of MRI.
Conclusions:
The main finding of this study was that ALL can be seen in pediatric patients using MRI. Despite numerous studies, additional research is needed to further define the role of the ALL in knee function.
Level of Evidence:
Level IV.
ΣΥΝΔΕΣΜΟΠΛΑΣΤΙΚΗ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΣΥΝΔΕΣΜΟΥ ΜΕ ΜΟΝΗ ΔΕΣΜΗ ΣΕ ΑΝΑΤΟΜΙΚΗ ΘΕΣΗ. ...STAVROS ALEVROGIANNIS
(Παρουσίαση σε Διεθνές Συνέδριο Εταιρείας Αρθροσκόπησης & Χειρουργικής Γόνατος της Πολωνίας, POZNAN 2011).
FREE HAND NOVEL ANATOMIC SINGLE BAND TECHNIQUE FOR ACLR
(X/O BUTTON,CONMED,LINVATEC,USA).PRELIMINARY RESULTS.
(POZNAN 2011)
Spine Arthroplasty or Artificial Disc Replacement is a new term which is used more and more in international scientific meetings and publications starts to dominate the scenery. The last three decades have been the most revolutionary in the history of spine treatment. The 80’s were dominated by the development of modern implants for internal segmental fixation such as pedicle screw systems and others. In the 90’s „Mini-open“ as well as „closed“ endoscopic techniques replaced the majority of conventional surgical approaches . Progress in biological and biochemical research seems to open new perspectives in fusion technology. We must not forget that bony fusion of a functional spinal unit is non physiological and it is associated with a variety of proven and (yet) unproven undesired effects and sequelae. At the beginning of this century, the progress in implant technology open a new dimension for spinal reconstructive non-fusion surgery. A variety of new implants are used today for: nucleus pulposus, total disc replacement, dynamic posterior reconstruction systems, posterior shock absorbers and injectable intradiscal materials. Cervical Disc Replacement is a Motion preserving surgery, Treat painful / pathologic process while restoring/maintaining motion, Decreased stress in adjacent levels, May prevent problems of adjacent segment disease, secondary surgery, pseudoarthrosis.
Comparing arthroplasty (ACDR) vs fusion (ACDF) most of the studies are in favour of (ACDR) because of, Higher neurologic success, Earlier return to work, Degrees of maintained motion, Adjacent Segment Degeneration 5 yrs, Statistically significant better scores (NDI, Arm pain, VAS, and SF-36 scores), lower revision rate (Reoperation rate for ACDF – 11.3% vs 2.9% ACDR)
Biomechanical Properties of the AnteroLateral Ligament (ALL) of the Knee comp...KHALIFA ELMAJRI
Improvising is an established corner in orthopaedic surgery .But if we start handling healthy body tissues surgically we are actually disturbing nature. The lateral knee region is known by its complex functional anatomy. Injury to the integrity of biceps tendons components in this region or direct injury to the FCL could happen during surgery in this region. As the injuries of FCL augment ALRI of the knee it is worth to study the effect of passing the graft deep to the LCL in lateral extra-articular reconstructions , an injury could arise from fixing distal FCL to its tunnel which prevent FCL normal gliding within this tunnel.
To restore function of a structure in the lateral knee using another structure one should have sound comparable knowledge’s about exact nature of structures to be handled, their clinical anatomy and their material and structural properties is a must before their investment, this to minimise the risk of introducing imbalance to a sensitive ligamentous balance or alter the proprioceptive function or affect the stability of the lateral meniscus .That’s why the more work on the anterolateral knee would be invested, in addition to management of acute knee injury , in the study of graft placement isometry in ACL reconstruction , as well as isometry of lateral extra-articular reconstructions to control (ALRI) with ITT, when indicated .
A review of the reverse total shoulder replacement surgery and it's clinical implications for both physical rehabilitation and functional anatomy.
Objectives:
Understand basic anatomy of the shoulder complex and its implications for shoulder replacement
Understand indications for shoulder replacement
Understand differences between standard and reverse total shoulder replacements
Understand precautions following rTSA
Understand important concepts in rehabilitation following rTSA
this presentation focus on a specific problem for patients with multiple hereditary exostosis who suffered from forearm deformity . It introduce a new technique to correct the deformity while preserving the epipyseal plate to maintain the growth of the bone.It avoids the complex surgery of distraction osteogenesis.
Diapositivas presentadas por Martina Massa, Marketing & Communications Manager Pragma Consultores, en el eCommerce IT Camp dentro del marco del eCommerce Day Buenos Aires 2016.
Diapositivas presentadas por Brian Gilbert, Jefe de Desarrollo Web & Mobile Grupo Logistico Andreani, en el eCommerce IT Camp dentro del marco del eCommerce Day Buenos Aires 2016.m
http://MobiusKey.com. Derik, Aliyah's old flame from her paragliding days, drops in on her unexpectedly, in the hope of rekindling the spark after 10 years. How would you interpret this - "She hugged herself as she twirled dreamily around the room". Will Derik complicate Aliyah's blossoming sales career? Discover this ongoing 4DStory at http://MobiusKey.com
Proceso Laboral contra Southern Peru Copper Corporation Walter Segura
Nuestra cliente cobró toda la indemnización a la empresa Souther Peru Copper Corporation, a pesar que jamás estuvo en sus planillas.
Descripción: Nuestra cliente fue despedida al haber vencido el plazo para que las empresas que realizan intermediación laboral, se adecuen a una nueva ley. La empresa se adecuo luego de 1 día, y por escasas 24 horas, nuestra cliente, gano el derecho a ser reconocida como empleada de la empresa minera, a pesar que estuvo en planillas de otra.
La minera no tuvo otra salida más, que pagarle todo a nuestra cliente.
Lo cierto es que la legislación laboral reconoce muchos derechos a los trabajadores, que si no los sabe usar, pueden ser aprovechados por la empresa.
Derik arrives at Aliyah's apartment and surprises her by taking her by personal jet to Bruce's fascinating restaurant for a late dinner. Derik and Aliyah catch up on the years they have been away, but it seems he wants their relationship to be much more. Aliyah herself prepares to tell him her secret that is causing her emotional chaos. Discover this ongoing 4DStory at http://MobiusKey.com
Mobius Key_Scene 8_Security On The Mobi | Fiction | HollywoodMobiusKey
MobiusKey.com. Bryce calls with two fresh opportunities for Aliyah at an inopportune time but becomes interested in the skills of Bruce, the restaurant owner. He calls him with a deal that is too good for Bruce to turn down once he realizes he can consult remotely. However, Bruce begins to form his own agenda, little aware that Bryce is ahead of him. Discover this ongoing 4DStory at http://MobiusKey.com
Scaling a service-based business (like a web design or consulting firm) can be tough cookies. Here are a few ways to position yourself for stronger financial growth, and to make proper financial forecasting a whole lot easier and more effective.
The launch of Jio is likely to transform the Indian telecom sector but at the same time put pressure on multiple fronts on the current telecom operator such as Bharti Airtel, Idea & Vodafone. The entrance of the jio has brought a stormy revolution in the Telecom market and Jio has emerged into a brand new world of innovations and up gradation. This article discusses the features of the jio and the edge it would have over its rivals once operational. The objective of this research paper is to find whether the company will become a Star or will remain a question mark.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
comminuted fracture of left patellar with displacement case presentationJOEL RAJAN U
A patella fracture is a break of the kneecap. Symptoms include pain, swelling, and bruising to the front of the knee. A person may also be unable to walk. Complications may include injury to the tibia, femur, or knee ligaments. It typically results from a hard blow to the front of the knee or falling on the knee.
Internal fixation of fractures of the capitellum and trochlea - Retrospective...Apollo Hospitals
Fractures of capitellum and trochlea account for 0.5-1% of elbow fractures and 6% of distal humerus fractures. These usually occur due to axial loading of the distal humerus by forces transmitted across the joint producing a coronal shear fracture of the capitellum or the trochlea. Internal fixation is the best modality to restore articular congruity in these fractures.
Bilateral Varus Deformity Correction and Leg Lengthening with an Ilizarov Fixator in a Female with Trichorhinophalangeal Syndrome Type 1 (TRPS I) – Case Report
Crimson Publishers-Abdominal Pain Caused by Bilateral Acetabular Fractures Se...CrimsonPublishersOPROJ
Abdominal Pain Caused by Bilateral Acetabular Fractures Secondary to an Epileptic Seizure Case Report and Review of the Literature by EJP Jansen in Orthopedic Research Online Journal
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Syno...CrimsonPublishersOPROJ
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Synovitis Case Study by Brady Hauser* in Crimson Publishers: Orthopedic Research and Reviews Journal
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
1. Case Report
Ipsilateral hip and knee dislocation: Case report and
review of literature
Gaurav Sharma MBBS, MS (Ortho)a
, Deepak Chahar MBBS, MS (Ortho)b
,
Ravi Sreenivasan MBBS, MS (Ortho), DNB (Ortho)b
,
Nikhil Verma MBBS, MS (Ortho), DNB (Ortho)b
,
Amite Pankaj MBBS, MS (Ortho), DNB (Ortho), MRCS (Edin)c,*
a
Senior Resident, Department of Orthopaedics, AIIMS, Delhi, India
b
Senior Resident, Department of Orthopedics, University College of Medical Sciences, University of Delhi and GTB
Hospital Delhi, India
c
Professor, Department of Orthopedics, University College of Medical Sciences, University of Delhi and GTB Hospital
Delhi, India
1. Introduction
Hip or knee dislocations occurring in isolation are not rare
injuries, but their simultaneous ipsilateral occurrence is
uncommon.1–11
A thorough review of literature identified only
11 such cases. The simultaneous occurrence of these two
orthopedic emergencies affects the normal treatment protocol
for individual injury. The outcome can vary widely from no
significant sequelae4,5,7
to knee amputation.6
We report a
patient with such injury and discuss the literature.
2. Case report
A 23-year-old truck driver was involved in a high velocity road
traffic accident. He presented to tertiary care hospital three
hours after injury. Examination revealed hip in attitude of
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a x x x ( 2 0 1 6 ) x x x – x x x
a r t i c l e i n f o
Article history:
Received 26 September 2015
Accepted 16 February 2016
Available online xxx
Keywords:
Dislocation
Hip
Knee
Ipsilateral
Reconstruction
a b s t r a c t
Hip and knee dislocations are not uncommon but simultaneous ipsilateral dislocation of the
hip and knee joint is rare; consequently, there is an inadequate amount of literature on the
subject. We identified only 11 such cases reported in English literature. In the present report,
we describe the case of a 23-year-old male patient who presented with ipsilateral hip and
knee dislocation on the right side after being involved in a road traffic accident. The hip
dislocation was associated with a posterior wall acetabular fracture. The hip as well as the
knee joints was reduced in the emergency bay. The patient underwent an urgent fixation of
the posterior wall acetabular fracture with delayed ligament reconstruction for the knee
dislocation. At one-year follow-up, he had no pain in the hip or knee. There was grade
1 posterior sag but no symptoms of knee instability. Radiographs revealed no evidence of
avascular necrosis or arthritis of the femoral head. The normal treatment protocol for
individual injury is affected by the simultaneous occurrence of hip and knee dislocation.
# 2016 Delhi Orthopedic Association. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Tel.: +91 9811148080; fax: +91 1122592520.
E-mail address: amitepankaj@gmail.com (A. Pankaj).
JCOT-232; No. of Pages 7
Please cite this article in press as: Sharma G, et al. Ipsilateral hip and knee dislocation: Case report and review of literature, J Clin Orthop
Trauma. (2016), http://dx.doi.org/10.1016/j.jcot.2016.02.012
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/jcot
http://dx.doi.org/10.1016/j.jcot.2016.02.012
0976-5662/# 2016 Delhi Orthopedic Association. Published by Elsevier B.V. All rights reserved.
2. flexion, adduction, and internal rotation with a posterior
dislocation of the right knee. The posterior tibial and the
dorsalis pedis artery were palpable. Dorsiflexion of the right
ankle was absent along with reduced sensations along the
lateral aspect of the leg and the dorsum of the foot, suggesting
common peroneal nerve involvement. Radiographic evalua-
tion revealed a posterior dislocation of the right hip with a
posterior wall acetabular fracture (Fig. 1) and a posterior knee
dislocation (Fig. 2).
The patient underwent immediate closed reduction of the
knee in the emergency bay under sedation followed by
application of a posterior splint with the knee in 908 flexion.
The hip joint was then reduced by giving traction over the
distal part of thigh with the hip and knee in 90/90 flexed
position and pelvis stabilized by second assistant. A third
person stabilized the leg while traction was applied through
the distal part of the thigh, with the hip reducing easily.
Postreduction CT scan of the hip showed a concentrically
reduced femoral head with a large posterior wall acetabular
fracture (Fig. 3), while the postreduction MRI knee revealed
disruption of the cruciates, medial collateral ligament (MCL),
and the posterolateral corner (PLC) (type IV) (Fig. 4).
Next morning the patient underwent osteosynthesis of the
posterior wall acetabular fracture. He was operated in
the lateral position using the Kocher Langenbeck approach.
The posterior wall fragment was fixed with two lag screws and
a buttress plate (Fig. 5). At the time of surgery, the knee was
protected using a posterior splint.
In order to reduce the surgical insult to the patient and to
reduce the risk of arthrofibrosis, a delayed reconstruction was
planned for the knee. It was placed in a hinged PCL brace
initially locked in extension. Controlled range of motion
exercises were started at three weeks. The patient was
mobilized with crutches, nonweight bearing on the right
lower extremity for the first eight weeks. At this time, the knee
range of motion was 10–1208. Examination under anesthesia
revealed a mildly positive Lachman test with a firm end point,
a positive posterior drawer test with more than 15 mm
translation, and a positive dial sign. Under fluoroscopy, valgus
stress testing did not reveal instability, but varus stress testing
at 08 and 308 showed more than 10 mm opening of lateral
compartment of the knee. Ten weeks post injury, he
underwent combined PCL and PLC reconstruction (Fig. 6).
Fig. 1 – X-ray pelvis anteroposterior view showing fracture
dislocation of hip. Note the large posterior wall fragment.
Fig. 2 – X-ray knee anteroposterior and lateral views showing dislocation of knee. Note the fractures of the avulsion fracture of
head of fibula and fracture of shaft of fibula.
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a x x x ( 2 0 1 6 ) x x x – x x x2
JCOT-232; No. of Pages 7
Please cite this article in press as: Sharma G, et al. Ipsilateral hip and knee dislocation: Case report and review of literature, J Clin Orthop
Trauma. (2016), http://dx.doi.org/10.1016/j.jcot.2016.02.012
3. Fig. 3 – Postreduction CT scan of the hip showed a concentrically reduced femoral head with a large posterior wall acetabular
fracture.
Fig. 4 – Postreduction MRI knee revealed disruption of the cruciates, medial collateral ligament (MCL), and the posterolateral
corner (PLC) (type IV).
Fig. 5 – Photograph and X-ray pelvis anteroposterior view illustrating the osteosynthesis of posterior acetabular wall fracture.
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a x x x ( 2 0 1 6 ) x x x – x x x 3
JCOT-232; No. of Pages 7
Please cite this article in press as: Sharma G, et al. Ipsilateral hip and knee dislocation: Case report and review of literature, J Clin Orthop
Trauma. (2016), http://dx.doi.org/10.1016/j.jcot.2016.02.012
4. Patient underwent PCL (arthroscopic single bundle with
ipsilateral quadrupled hamstrings) and PLC reconstruction
with Larson's procedure (contralateral semitendinosus graft).
3. Result
At 18 months follow-up, the patient had no symptoms of knee
instability, although he had mild discomfort in the knee. He
had no pain in the hip and used no ambulatory aid. The CPN
palsy had resolved completely. On examination, the right hip
had a full painless range of motion. Knee examination
revealed negative posterior drawer test as well as a negative
dial test. Valgus and varus stress testing were negative. The
ROM at the right knee was 10–1208 compared to 0–1408 on the
left. Radiographs revealed a congruous hip without evidence of
AVN or arthritis (Figs. 7 and 8).
4. Discussion
Although injury to the ipsilateral knee is common in the
setting of traumatic hip dislocation,12,13
the simultaneous
occurrence of ipsilateral knee and hip dislocation seems to be a
rare event.1–11
Table 1 lists the reported cases of ipsilateral hip
and knee dislocation (twelve, including the present one).
4.1. Pattern of injury
The right side was involved more often1,4–8,11
(eight times) as
compared to the left3,4,9,10
(four times). All twelve cases of
Fig. 6 – Photograph and line diagram illustrating the reconstruction of the posterolateral ligament complex.
Fig. 7 – X-ray pelvis anteroposterior view revealed a
congruous hip without evidence of AVN or arthritis.
Fig. 8 – X-ray knee anteroposterior and lateral views
revealed a congruous knee without evidence of arthritis.
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a x x x ( 2 0 1 6 ) x x x – x x x4
JCOT-232; No. of Pages 7
Please cite this article in press as: Sharma G, et al. Ipsilateral hip and knee dislocation: Case report and review of literature, J Clin Orthop
Trauma. (2016), http://dx.doi.org/10.1016/j.jcot.2016.02.012
5. Table 1 – Reported cases of ipsilateral hip and knee dislocation.
Author
name;
year
Side Hip
dislocation
Knee
dislocation
Associated
injuries
Treatment Result at final follow-up
Hip Knee Hip Knee
Malimson;
1984
Right P + PW Posterior closed;
KD V
Tarsometatarsal
fracture dislocation,
fracture body of
sternum
CR; Acetabular wall #
treated
conservatively
Fractured LFC treated
conservatively
Painless 0–1008 ROM, knee
stable
Kreibich;
1989
Left P + FN Posterior closed;
KD III L
None OR with fixation of
femoral neck #
Primary repair of
ligaments
Intermittent pain,
AVN
Flexion up to 1058;
no instability;
Arthrosis+
Millea;
1991
Left P + FH Rotary closed Ipsilateral femoral
shaft fracture, open
bimalleolar fracture
OR with fixation of
femoral head #
Primary repair/
fixation of ligaments
Occasional
discomfort of
the hip
Occasional
discomfort of the
knee
Freedman;
1994
Right P Posterior closed;
KD III L
None CR Early ligament
reconstruction
Painless, no AVN 10–1058 ROM, mild
Lachman+
Schierz;
2002
Right P + PW Posterior closed;
KD III L
None CR acetabular wall #
treated
conservatively
PCL repaired, ACL
planned for delayed
reconstruction but
patient refused
Painless, no AVN 0–1258 ROM, Mild
Lachman+ pivot
shiftÀ
Motsis;
2006
Right P + PW Posterior open; KD
IV (C)
None CR Acetabular wall #
treated
conservatively
Through knee
amputation
Not mentioned Walking with
crutches
Dubois;
2006
Right P + PW Posterior closed;
KD III L
None CR using shanks'
screw, Posterior wall
treated
conservatively
Early ligament
reconstruction
Painless, no AVN 0–125 ROM, no
instability
Ali;2009 Right A Anterior KD I None CR Early ligament
reconstruction
Painless, no AVN Up to 120 ROM,
mild instability
Vaseenon;
2010
Left A Posterior closed;
KD I
Ipsilateral olecranon
fracture
CR Ligament
reconstruction not
discussed
Not mentioned Not mentioned
Sen; 2011 Left P + PW
+ FH
Posterior closed;
KD V
Contralateral open
leg fracture
OR with fixation of
femoral head and
acetabular fragments
Open reduction of
tibial plateau fracture
Painless, no AVN 0–105 ROM, no
instability or
arthrosis
Waterman;
2011
Right P Posterior closed;
KD III M (C)
Ipsilateral tibiotalar
dislocation,
contralateral tibia
fracture
CR Patient refused
ligament
reconstruction
Painless, no AVN 0–125, no
instability
Present
case
Right P + PW Posterior closed,
KD IV
None CR fixation of
posterior wall
fragment
Delayed ligament
reconstruction
Painless, no AVN 0–120 ROM, mild
Lachman+
P – posterior; PW – posterior wall; FH – femoral head; FN – femoral neck; (C) – vascular injury; CR – closed reduction; OR – open reduction; # – fracture; LFC – lateral femoral condyle.
journalofclinicalorthopaedicsandtraumaxxx(2016)xxx–xxx5
JCOT-232;No.ofPages7
Pleasecitethisarticleinpressas:SharmaG,etal.Ipsilateralhipandkneedislocation:Casereportandreviewofliterature,JClinOrthop
Trauma.(2016),http://dx.doi.org/10.1016/j.jcot.2016.02.012
6. ipsilateral hip and knee dislocation resulted from road traffic
accidents. The hip dislocated posteriorly in ten cases, while
two had anterior dislocations.8,9
The most common pattern
was a posterior hip dislocation hip with a posterior wall
acetabular fracture.
The knee dislocated posteriorly in eleven of the twelve
cases. Two of them were fracture dislocations, involving the
tibial plateau,10
and lateral femoral condyle.1
Rest of them
involved ligamentous disruptions (substance tears/avulsions).
The most common pattern of knee dislocation involved a
closed posterior ligamentous dislocation.
4.2. Associated injuries other than hip and knee
Seven2,4–8
of the twelve patients, including the present one,
had no other injury apart from the ipsilateral hip and knee
dislocation. Three patients1,3,11
had ipsilateral foot and ankle
injuries. This probably reflects the specific mechanism of
injury involved, as well as transfer of most of the force to the
knee, and through it, to the ipsilateral hip.
4.3. Nerve and vascular injuries
Two of the patients had popliteal artery injury6,11
; one had a
successful arterial repair11
with grafting, whereas the other
required an amputation.6
Three2,7
patients, including the
present one, had common peroneal nerve injury, and all of
them ultimately recovered. Cornwall and Radomisli14
reported
a 10% incidence of nerve injury after traumatic hip dislocation.
The peroneal component was most commonly involved. In
cases of nerve injury associated with hip dislocation, explora-
tion of the nerve is generally not recommended. The incidence
of concomitant neurologic injury with knee dislocation is
reported to be from 10% to 40%.15,16
The indications for
peroneal neurolysis and cable grafting in the setting of knee
dislocations are controversial. Patients who are undergoing
PLC repair or reconstruction and have a peroneal nerve injury
should be treated with at least a peroneal neurolysis.17
4.4. Technique of hip reduction
Previous reports of ipsilateral hip and knee dislocation have
described different techniques of reducing the hip. Freedman
et al.4
reduced the hip with manual traction over the thigh.
DuBois et al.7
described the use of Schanz pins placed in the
femoral condyle as well as lateral aspect of the proximal femur
to affect the reduction. Brian et al.11
described a technique
where the patient's knee was flexed over the surgeon's
shoulder and traction applied through the distal femur;
gradual internal and external rotation completed the reduc-
tion. Of note in most of the described techniques for reducing
isolated hip dislocations, traction is applied through the
proximal leg, either directly18
or using the surgeon's arms19
/
knee as fulcrum.20
It makes sense that in case of an ipsilateral
knee dislocation, traction be applied through the distal thigh
instead of the proximal leg with the knee stabilized either by a
third person or by the person attempting the reduction. We
agree with Waterman et al.11
that an initial attempt of
reducing the hip should be made in the trauma bay under
sedation so as to reduce the time the hip remains dislocated.
4.5. Management of the knee dislocation
Withrespecttothe timingofligamentreconstructioninisolated
knee dislocations, recommendations have ranged from immo-
bilization followed by delayed surgery21,22
to surgical treatment
within three weeks after injury.23,24
The few published studies
offering direct comparison of surgical timing have typically
shown greater improvements in functional and clinical out-
comes with early treatment.25,26
However, a recent systematic
reviewofliteratureregardingtimingofsurgeryinmultiligament
injured knees found residual anterior knee instability as well as
more flexion deficits in acutely managed knees compared to
delayed reconstructions.27
Additional treatment for joint
stiffness was also more likely in association with acute
treatment. One of the reasons for advocating early surgery in
multiligament knee injuries is that the collaterals can be
repaired; the repair becomes increasingly difficult two to three
weeks after surgery. However, recent literature suggests that
reconstructionofthePLCisbetterthanrepair,28,29
andtherefore,
ifoneiscontemplating areconstruction,anearlysurgeryisnota
necessity.
Giannoudis et al.30
reported five cases of knee dislocation
with ipsilateral femoral shaft fractures. They advocate a
delayed knee ligament reconstruction in this setting.
We opted for a delayed reconstruction to reduce the
surgical insult to the patient as well as to reduce the chances
of postoperative arthrofibrosis. All three4,7,8
of the twelve
patients with ipsilateral hip and knee dislocation who
underwent an acute reconstruction required an additional
procedure for arthrofibrosis. Based on these findings, we
recommend a delayed reconstruction of the multiligament
injured knee in the setting of an ipsilateral hip and knee
dislocation.
4.6. Rehabilitation
The simultaneous occurrence of hip and knee dislocation
precludes early weight bearing, which may be allowed after an
isolated knee dislocation. The rehabilitation protocol however,
also depends on the other associated injuries.
4.7. Outcome
The outcome for ipsilateral hip and knee dislocation can vary
widely from no significant sequelae4,5,7
to through the knee
amputation.6
Surgeon-related factors that could improve
outcome include emergent reduction of the knee joint,
assessment of neurovascular injury, reduction of the hip joint
as soon as possible, preferably in the emergency room with the
knee stabilized, and management of the multiligament knee
injury on an elective basis.
5. Conclusion
The ipsilateral occurrence of knee and hip dislocation is a
serious injury with important differences related to the
technique of hip reduction, the timing of knee ligament
reconstruction, and rehabilitation. The outcome is highly
variable and remains guarded.
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JCOT-232; No. of Pages 7
Please cite this article in press as: Sharma G, et al. Ipsilateral hip and knee dislocation: Case report and review of literature, J Clin Orthop
Trauma. (2016), http://dx.doi.org/10.1016/j.jcot.2016.02.012
7. Conflicts of interest
The authors have none to declare.
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JCOT-232; No. of Pages 7
Please cite this article in press as: Sharma G, et al. Ipsilateral hip and knee dislocation: Case report and review of literature, J Clin Orthop
Trauma. (2016), http://dx.doi.org/10.1016/j.jcot.2016.02.012