1. Screw fixation of clavicle to coracoid process, with subsequent calcification and ossification along the conoid and trapezoid ligaments, creates an extra-articular fusion of the acromio-clavicular joint.

2. Though the follow-up is admittedly early, excellent results can be obtained in the young healthy adult. It is possible to return an athlete to competitive sports and a heavy labourer to full work in a surprisingly short time.

3. The operation is of doubtful value in older patients.

4. A precise operative technique is most important in producing a successful result.

5. Screw fixation introduces a new movement into the abduction mechanism of the shoulder: synchronous scapulo-clavicular rotation.

Aims

Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities.

Purpose: Midterm follow up of complete knee dislocation and clinical outcome evaluation. Materials and Methods: Between 1990–2004, we retrospectively reviewed the records of patients with complete knee dislocation. Eighteen patients, 19 knees were followed. Twelve males and 6 females. The average age at follow up was 40.7 years. Treatment consisted of primary knee stabilization with tutor cast in 10 knees and 9 by external fixation for 6 weeks. Following rehabilitation program, further surgical treatment was according to clinical relevancy. Functional and subjective evaluation was registered by the WOMAC questionnaire. Results: Eleven were multiple trauma patients, involved in RTA, 2 had a crush injury, one patient involved in aviation accident had bilateral dislocation and 4 patients had low energy injury. Out of 7 patients, 8 knees had isolated dislocation. One died, 3 were not available for clinical follow up. Twelve patients returned the questionnaire. The average result of the WOMAC score was 46.5, range 7–91. Four knees presented advanced osteoarthritis with painful stiffness. Eight knees presented at the end of the follow up with instability as chief compliant. Five patients underwent later reconstructive procedures. One patient underwent knee arthrodesis. Conclusion: In patients with knee dislocation, associated polytrauma should be regarded as a bed prognostic sign. The results suggest the need to revaluate the initial treatment strategy. The overall outcome shows that nearly all patients were able to perform daily activities, no patients in our study attempted any strenuous activity

Knee dislocation is a rare injury in high energy trauma, but it is even rarer in low energy injuries. We present, to our knowledge, the only case in the world literature of knee dislocation following a cricketing injury. The patient was a 46 year old recreational fast bowler who, whilst bowling, slipped on the pitch on the follow through. He sustained an anteromedial knee dislocation which was reduced under intravenous sedation. He also sustained a neuropraxia of the common peroneal nerve with grade 2 weakness of ankle and toe dorsiflexion. Magnetic Resonance Imaging (MRI) confirmed a complete rupture of anterior cruciate ligament (ACL), lateral collateral ligament (LCL) and postero-lateral corner (PLC). Patient underwent surgical reconstruction and repair of his PLC along with repair of LCL with combination of anchor sutures and metal staple within 72 hours of the injury. He was treated in a cast brace. The ACL insufficiency was treated conservatively. Patient made an uneventful recovery and follow up at 3 months revealed a full range of knee movements with asymptomatic ACL laxity

Introduction. Fibula shortening with an intact anterior tibiofibular ligament (ATFL) and medial ligament instability causes lateral translation of the talus. Our hypothesis was that the interaction of the AITFL tubercle of the fibular with the tibial incisura would propagate lateral translation due to the size differential. Aim. To assess what degree of shortening of the fibular would cause the lateral translation of the talus. Methodology. Twelve cadaveric ankle specimens were dissected removing all soft tissue except for ligaments. They were fixed on a specially-designed platform within an augmented ankle cage allowing tibial fixation and free movement of the talus. The fibula was progressively shortened in 5mm increments until complete ankle dislocation. The medial clear space was measured with each increment of shortening. Results. The larger AITFL tubercle interaction with the smaller tibial incisura caused a significant increase in lateral translation of the talus. This occurred in most ankles between 5–10mm of fibular shortening. The medial clear space widened following 5mm of shortening in 5 specimens (mean=2.0725, SD=±2.5338). All 12 specimens experienced widening by 10mm fibula shortening (Mean=7.2133mm, SD=±2.2061). All specimens reached complete dislocation by 35mm fibula shortening. Results of ANOVA analysis found the data statistically significant (p<0.0001). Conclusion. This study shows that shortening of the fibula causes a significant lateral translation of the talus provided the ATFL remains intact. Furthermore, the interaction of the fibula notch with the ATFL tubercle of the tibia appears to cause a disproportionate widening of the medial clear space due to its differential in size. Knowledge of the extent of fibula shortening can guide further intervention when presented with a patient experiencing medial clear space widening following treatment of an ankle fracture

Introduction and Objective. In recent years, along with the extending longevity of patients and the increase in their functional demands, the number of annually performed RSA and the incidence of complications are also increasing. When a complication occurs, the patient often needs multiple surgeries to restore the function of the upper limb. Revision implants are directly responsible for the critical reduction of the bone stock, especially in the shoulder. The purpose of this paper is to report the use of allograft bone to restore the bone stock of the glenoid in the treatment of an aseptic glenoid component loosening after a reverse shoulder arthroplasty (RSA). Materials and Methods. An 86-years-old man came to our attention for aseptic glenoid component loosening after RSA. Plain radiographs showed a complete dislocation of the glenoid component with 2 broken screws in the neck of glenoid. CT scans confirmed the severe reduction of the glenoid bone stock and critical bone resorption and were used for the preoperative planning. To our opinion, given the critical bone defect, the only viable option was revision surgery with restoration of bone stock. We planned to use a bone graft harvested from distal bone bank femur as component augmentation. During the revision procedure the baseplate with a long central peg was implanted “on table” on the allograft and an appropriate osteotomy was made to customize the allograft on the glenoid defect according to the CT-based preoperative planning. The Bio-component was implanted with stable screws fixation on residual scapula. We decided not to replace the humeral component since it was stable and showed no signs of mobilization. Results. The new bio-implant was stable, and the patient gained a complete functional recovery of the shoulder. The scheduled radiological assessments up to 12 months showed no signs of bone resorption or mobilization of the glenoid component. Conclusions. The use of bone allograft in revision surgery after a RSA is a versatile and effective technique to treat severe glenoid bone loss and to improve the global stability of the implant. Furthermore, it represents a viable alternative to autologous graft since it requires shorter operative times and reduces graft site complications. There are very few data available regarding the use of allografts and, although the first studies are encouraging, further investigation is needed to determine the biological capabilities of the transplant and its validity in complex revisions after RSA

We describe our experience in the reduction of dislocation of the hip secondary to developmental dysplasia using ultrasound-guided gradual reduction using flexion and abduction continuous traction (FACT-R). During a period of 13 years we treated 208 Suzuki type B or C complete dislocations of the hip in 202 children with a mean age of four months (0 to 11). The mean follow-up was 9.1 years (five to 16). The rate of reduction was 99.0%. There were no recurrent dislocations, and the rate of avascular necrosis of the femoral head was 1.0%. The rate of secondary surgery for residual acetabular dysplasia was 19.2%, and this was significantly higher in those children in whom the initial treatment was delayed or if other previous treatments had failed (p = 0.00045). The duration of FACT-R was significantly longer in severe dislocations (p = 0.001) or if previous treatments had failed (p = 0.018). . This new method of treatment is effective and safe in these difficult cases and offers outcomes comparable to or better than those of standard methods. Cite this article: Bone Joint J 2015;97-B:405–11

Complete dislocation of the knee is a relatively rare condition. When it occurs as a result of high-velocity injury, such as in a road traffic accident, associated vascular injury is generally suspected. In low-velocity injuries, however, distal pulses are often maintained throughout, and the possibility of vascular injury may erroneously be discounted. We report four cases of low-velocity dislocation of the knee, only one of which had an overt vascular disruption, but three of which had arterial damage. On the basis of our experiences, we recommend arteriography in all cases of complete dislocation of the knee

Aims

Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes.

Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes.

Cite this article: Bone Joint J 2024;106-B(12):1431–1442.

Introduction. Alumina-on-alumina bearings exhibit low wear rates in vitro and one commonly used ceramic implant is the Trident system (Stryker, Mahwah, NJ). There are some reports of incomplete seating of the ceramic liner in the Trident acetabular shell. However, it is often difficult to detect incomplete seating intraoperatively. We sought to prevent incomplete seating using intraoperative radiography. Materials and Methods. We retrospectively reviewed 19 hips in 17 patients who had undergone primary total hip arthroplasty using a Trident shell with a metal-backed alumina liner between 2007 and 2010. There were 16 women and 1 man, with an average age of 45.7 years. Preoperative diagnosis revealed 14 cases of osteoarthritis and 5 cases of osteonecrosis. All procedures were performed using a posterolateral approach with PSL cups. The minimum follow-up time was 12 months (average 28 months). All procedures included an intraoperative anteroposterior view radiograph to evaluate cup seating. If incomplete seating was recognized we reinserted the liner. Postoperatively, radiographs (supine anteroposterior and cross table lateral views) and computed tomography were performed in all cases in order to assess any residual incomplete seating. We investigated whether it was possible to avoid incomplete seating using intraoperative radiography. Results. Six (32%)of 19 hips had evidence of incomplete seating. Of these, 3 revealed incomplete seating on intraoperative radiography, 2 were reinserted adequately, and the liner was replaced with a polyethylene liner in one case. Postoperative radiography revealed incomplete seating in 3 cases. One hip had become correctly seated as shown by follow-up radiography at 3 months and the other hips remained incompletely seated for the follow up period. The location of the gap between the socket and liner caused by incomplete seating was inferomedial in all cases, as seen on the intraoperative anteroposterior view radiographs. We were able to avoid incomplete seating in all of these cases except for one, which was missing the gap. Cases in which the location of the gap was anterior could not be diagnosed by intraoperative radiographs, and were diagnosed postoperatively. Incomplete seating was seen in 3 of 9 cases that used a 2.8 mm shell thickness, and in 3 of 10 cases that used a 3.8 mm thickness. No case had complete dislocation or failure of the ceramic liner. There were no revision surgeries. Discussions. Although there have been no published case reports regarding complete dislocation or failure of the ceramic liner caused by incomplete seating, adverse influences that are caused by incomplete seating remain uncertain. Some reports describe that incomplete seating was potentially attributed to poor exposure, bony and soft tissue impingement, and cup deformity. The attempt to avoid incomplete seating using intraoperative radiography was effective in cases where medial or lateral gaps were seen. However, it was ineffective in cases where gaps were anterior or posterior. Trident system ceramic liners need to be used with care to avoid incomplete seating

There are few reports describing dislocation of the metacarpophalangeal joint of the thumb in children. This study describes the clinical features and outcome of 37 such dislocations and correlates the radiological pattern with the type of dislocation. The mean age at injury was 7.3 years (3 to 13). A total of 33 children underwent closed reduction (11 under general anaesthesia). Four needed open reduction in two of which there was soft-tissue interposition. All cases obtained a good result. There was no infection, recurrent dislocation or significant stiffness. So-called ‘simple complete’ dislocations that present with the classic radiological finding of the joint at 90° dorsal angulation may be ‘complex complete’ injuries and require open reduction

We reviewed the medical records of 115 patients with 130 hips with developmental dysplasia with complete dislocation in the absence of a neuromuscular disorder, spontaneous reduction with a Pavlik harness, and a minimum of 14 years’ follow-up. The mean age at the time of harness application was 4.8 months (1 to 12) and the mean time spent in the harness was 6.1 months (3 to 12). A total of 108 hips (83.1%) were treated with the harness alone and supplementary surgery for residual acetabular dysplasia, as defined by an acetabular index > 30°, was performed in 22 hips (16.9%). An overall satisfactory outcome (Severin grade I or II) was achieved in 119 hips (91.5%) at a mean follow-up of 16 years (14 to 32) with a follow-up rate of 75%. Avascular necrosis of the femoral head was noted in 16 hips (12.3%), seven of which (44%) underwent supplementary surgery and nine (56%) of which were classified as satisfactory. The acetabular index was the most reliable predictor of residual acetabular dysplasia

Aims

The Uppföljningsprogram för cerebral pares (CPUP) Hip Score distinguishes between children with cerebral palsy (CP) at different levels of risk for displacement of the hip. The score was constructed using data from Swedish children with CP, but has not been confirmed in any other population. The aim of this study was to determine the calibration and discriminatory accuracy of this score in children with CP in Scotland.

Aims

The aim of this study was to report the incidence of implant-related complications, further operations, and their influence on the outcome in a series of patients who underwent primary reverse total shoulder arthroplasty (RTSA).

Injuries to the acromioclavicular joint are common but underdiagnosed. Sprains and minor subluxations are best managed conservatively, but there is debate concerning the treatment of complete dislocations and the more complex combined injuries in which other elements of the shoulder girdle are damaged. Confusion has been caused by existing systems for classification of these injuries, the plethora of available operative techniques and the lack of well-designed clinical trials comparing alternative methods of management. Recent advances in arthroscopic surgery have produced an even greater variety of surgical options for which, as yet, there are no objective data on outcome of high quality. We review the current concepts of the treatment of these injuries

A case is described of bilateral traumatic chylothorax after complete dislocation of the thoracic spine. An explanation is advanced for the delayed, sudden onset of symptoms due to the chylothorax in this and other cases

Anterior subluxation of the cervical spine from flexion-rotational violence is often overlooked. Either radiography is omitted or the slight displacement visible on the films is not recognised. A method for recognising these injuries is suggested. Five cases are described showing that in these subluxations the soft-tissue damage is severe, that late increasing displacement can occur, with varying neurological sequelae, and that instability can persist indefinitely. Four of the patients required stabilisation by operation, in contrast with complete dislocations in which 80 to 90 per cent fuse spontaneously

Twelve patients were operated upon after unsuccessful conservative treatment for complete dislocation of the sternoclavicular joint. Three methods were used; stabilisation using fascial loops, reconstruction with a tendon graft, and resection of the sternal end of the clavicle. The results were good in only four patients, three treated with a tendon graft and one by fascial loops. Another four patients had fair results, but all four treated by resection of the medial end of the clavicle had poor results, with pain and weakness of the upper extremity. In our opinion resection of the sternal end of the clavicle should not be used in old traumatic dislocation

Aims. To describe the distribution and clinical presentation of SLAP tears in rugby players, and time taken for return to sport. Method. A retrospective review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period was carried out. All patients diagnosed with a SLAP lesion at arthroscopy were identified. Each patient's records were reviewed to record age, injury side, mechanism of injury, clinical diagnosis, investigations and results, management, and return to play. Results. The incidence of SLAP tears was 35%. All 18 patients were male with an average age of 27 yrs. There were 11 isolated SLAP tears (61%), 3 SLAP tears associated with a Bankart lesion (17%), 2 SLAP tears associated with a posterior labral lesion (11%) and 2 SLAP tears associated with an anterior and posterior labral injury (11%). Of the 18 SLAP tears, 14 (78%) were Type 2, 3 (17%) were Type 3 and 1 (5%) was Type 4. All patients recalled a specific heavy tackle with fall onto the lateral aspect of shoulder. No patient sustained a complete dislocation. None of the patients presented with symptoms of instability. MR Arthrograms were performed in 17 of the 18 patients. SLAP tears were detected in 13 patients (76%). All patients underwent arthroscopic reconstruction within 6 months post-injury. At Arthroscopy 7 patients (39%) were found to have associated injuries. Pre-operatively 11% of patients were satisfied with their shoulder. By 6 months post-surgery 89% of patients were satisfied and 95% were back to their previous activity level. Patients with isolated SLAP tears returned to sports at an average of 2.6 months post-surgery. Conclusion. SLAP tears are a common injury in rugby players with shoulder pain following injury. These can often be diagnosed with MR arthrography. Arthroscopic repair is associated with excellent results and early return to sports