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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Joint dislocation occurs when there is separation between two articulating bony surfaces following traumatic force; joints commonly affected include the shoulder, finger, patella, hip and elbow. Anterior shoulder dislocations are typically held in an externally rotated and abducted position. Conversely, posterior shoulder dislocations are held in adduction and internal rotation. Dislocations are characterised by pain, immobility, tenderness and swelling. Treatment involves analgesic and a safe method of reduction for which there are many techniques including Kocher's, Milch's, Cunningham's, and so forth.
Orthopaedic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Start the same supportive treatment for a full dislocation, but discuss with the orthopaedic team for consideration of operative intervention. Sling immobilization may be required for 4–6 weeks.
Advances in Adult Dysplasia
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
Patients with true dislocation have different signs and symptoms. In the unilateral form, functional shortening of the limb is a big problem and an obvious limp (due to a combination of limb discrepancy and Trendelenburg limp) is a major complaint. They usually develop genu valgum, which may not be clear at the first look because of the adducted position of the hip, but by keeping the hip in a neutral position the real amount of the genu valgum will appear (Fig. 21.12).
Effect of the medial collateral ligament and the lateral ulnar collateral ligament injury on elbow stability: a finite element analysis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Fang Wang, Shuoqi Jia, Mingxin Li, Kui Pan, Jianguo Zhang, Yubo Fan
The elbow joint is one of the most commonly dislocated joints of human body. A reported incidence of elbow dislocation was average 5.21 per 100,000 people and that was more common in 10-19 years old group, reaching 6.87 per 100,000 people (Stoneback et al. 2012). The main causes of elbow dislocation were falling on outstretched hands, sports and motor vehicle collisions (Hyman et al. 2001). Sports injuries are becoming the first cause of dislocation with the popularization of mass sports in recent years. Elbow injuries occurred frequently in throwing, balls and gymnastic, which due to sports accounted for 44.5% of all the dislocated cases (Stoneback et al. 2012). A combination of bone and ligaments repair was an effective method for the clinical treatment of elbow dislocation. However, the complex biomechanical environment of elbow often leaded to postoperative complications, which included joint stiffness, joint dysfunction and ossifying myositis and caused a 22.4% reoperation rate (Sochol et al. 2019).
Healthcare resource utilization and costs for hip dislocation following primary total hip arthroplasty in the medicare population
Published in Journal of Medical Economics, 2021
Jack Mantel, Abhishek S. Chitnis, Jill Ruppenkamp, Chantal E. Holy, Juan Daccach
While the incidence of revision surgery due to dislocation is well documented in several THA registries, the incidence of dislocations treated conservatively is less commonly reported, as are the associated costs of both surgical and conservative intervention. The existing publicly available data and literature highlight how dislocation following THA increases the burden on healthcare services. Sanchez-Sotelo et al.5 analyzed the hospital costs associated with treatment of post-operative dislocation in US patients. In their analysis of 4,054 consecutive THAs, 99 (2.4%) were dislocated. In 62 of the cases (63%), stability was achieved following one or more closed reductions. The hospital cost of each closed reduction episode represented 19% of the costs of an uncomplicated primary THA. The remaining 37% of cases required surgical intervention, and these revision procedures represented 148% of the cost of an uncomplicated primary THA. A study of patients in Italy by de Palma et al.6 found that an early dislocation increased the cost of a primary THA by 342%, while Vanhegan et al.7 described the mean costs of surgical treatment for dislocation in patients in the UK to be £10,893 per case. Another evaluation of US patients by Abdel et al.8 found that recurrent dislocation and operative treatment increased costs by 300% (£11,456; p < 0.0001) and 40% (£5,217; p < 0.0001), respectively. The authors also observed that operative treatment of recurrent dislocation resulted in significantly better function than non-operative management8.
Increased risk for dislocation after introduction of the Continuum cup system: lessons learnt from a cohort of 1,381 THRs after 1-year follow-up
Published in Acta Orthopaedica, 2020
Oskari A Pakarinen, Perttu S Neuvonen, Aleksi R P Reito, Antti P Eskelinen
We acknowledge a few weaknesses in this study. The retrospective study design may enable information bias in the data that we cannot control. Also, adjusting the right confounding factors is not easy and, even when using the DAG, it is just a subjective view. Moreover, we did not have data on the patients’ alcohol use or neurodegenerative disorders, which are known to affect the risk for dislocation (Espehaug et al. 1997, Gausden et al. 2018). Furthermore, because the study cohorts were not randomized, there is always a risk for selection bias. The follow-up period was also rather short, but the majority of dislocations occur within 1 year after surgery (Blom et al. 2008, Meek et al. 2008). In addition, most revisions for dislocation are also performed within 1 year of the primary operation (Hailer et al. 2012). Still, a longer follow-up period would have provided more specific information about the long-term incidence and consequences of dislocations. The strengths of this study are the comprehensive and consistent data from 1 high-volume center that enabled the specific analysis of perioperative factors, such as liners, as there were no differences between hospitals as confounding factors. Indeed, the investigation of the patients’ case records enabled a more exact identification of all the possible dislocations. A clinical cohort study has an obvious advantage over register studies when there is a need to find and to prove causality. The use of DAG also limits the selection bias resulting from a collider (Shrier and Platt 2008).