Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided. We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. It combines aspects of approaches which have been reported previously and consists of an anterior dislocation through a posterior approach with a ‘trochanteric flip’ osteotomy. The external rotator muscles are not divided and the medial femoral circumflex artery is protected by the intact obturator externus. We report our experience using this approach in 213 hips over a period of seven years and include 19 patients who underwent simultaneous intertrochanteric osteotomy. The perfusion of the femoral head was verified intraoperatively and, to date, none has subsequently developed avascular necrosis. There is little morbidity associated with the technique and it allows the treatment of a variety of conditions, which may not respond well to other methods including arthroscopy. Surgical dislocation gives new insight into the pathogenesis of some hip disorders and the possibility of preserving the hip with techniques such as transplantation of cartilage

1. The operative findings in seventeen cases of recurrent dislocation of the shoulder are presented and discussed. Detachment of the glenoid labrum (thirteen cases) and the formation of a posterior humeral groove (eleven cases) were the most consistent findings. 2. In one case recurrent dislocation of the shoulder was due to avulsion of the subscapularis muscle. 3. The surgical treatment of these cases is described, usually consisting of a modification of Bankart's operation. 4. The results of follow-up are given as an intermediate report. No post-operative dislocation has so far been reported

1. Two cases of recurrent post-traumatic dislocation of the hip are reported. 2. The literature is reviewed and the rarity of the condition is emphasised. Only twenty-two cases have been previously reported, eleven in adults and eleven in children. 3. The sequence of events leading to recurrent dislocation is not understood but the following important facts emerge. The initial incident could not be distinguished from that causing uncomplicated dislocations. There was a significant delay in reduction in a number of cases. Subsequent dislocations followed minor injury. A large defect in the posterior capsule with a large synovial-lined pouch or false joint was found at operation in both our cases. The ligamentum teres was not seen at operation. The surgeon was unable to redislocate the hips during the operation. 4. In both cases reported here treatment was by excision of the posterior pouch and repair of the capsular defect. 5. Based on the above facts some tentative deductions are made

The brachial artery is rarely injured after closed dislocation of the elbow. We describe an unusual variation of this injury, namely, a delayed thrombosis of the brachial artery after a closed dislocation sustained during a low-energy fall. This has not previously been described in the English literature, but may be more common than this suggests. We stress the importance of a thorough neurovascular examination and vigilance in regard to this potentially disastrous complication

1. Twenty-two dislocations of the hip occurring in patients paralysed from an early age have been studied. All showed abnormal coxa valga. The coxa valga, which may gradually reach 180 degrees, precedes dislocation and makes it inevitable. The presence of unbalanced adductor power may hasten dislocation, but the latter can occur in complete flaccid paralysis. 2. The combination of structural instability of the hip joint and muscular weakness may make independent walking impossible, but restoration of stability gives considerable improvement in any remaining muscular power and may alter the patient's whole future. 3. A method of correcting the basic deformity of coxa valga by osteotomy is described and the results of nine operations are reviewed

1. At an operation for recurrent posterior dislocation of the shoulder observations were made on the mechanism, head defect, method of reduction, and the position of greatest stability. 2. Experimentally, avulsion of the glenoid labrum in a monkey was shown to be capable of sound repair without operation. 3. In the treatment of primary posterior dislocation it is suggested that the position of abduction, lateral rotation and extension is favourable for the approximation of the stripped labrum and capsule to the glenoid rim, and for an effective buttress after cicatrisation. 4. If the risk of recurrence is to be reduced to a minimum the shoulder should be retained in the position of greatest stability for at least four weeks, to allow firm union of the avulsed soft tissues. 5. This position for an optimum buttress would also apply after surgical repair for recurrent posterior dislocation

Of 545 consecutive patients with anterior shoulder dislocations, 108 (20%) were aged 60 years or more at the time of injury. We reviewed and radiographed 95 of these elderly patients after a mean follow-up of 7.1 years. Axillary nerve injuries were seen in 9.3% of the 108 patients, but all recovered completely in 3 to 12 months. There were single or multiple recurrences of dislocation in 21 patients (22.1%), but within this group age had no influence on the tendency to redislocate. Tears of the rotator-cuff were diagnosed by imaging studies or clinically in 58 patients (61%), including all who had redislocations. Sixteen patients required surgery. Eight with a single dislocation and a cuff tear had only repair of the torn cuff. Of the eight patients with multiple dislocations requiring operation, five also had a torn cuff and needed either a stabilising procedure and a cuff repair or repair of the cuff only. All patients who were operated on had a satisfactory result, with the exception of those with multiple redislocations and a cuff tear who had repair of the cuff only. Anterior shoulder dislocation in elderly subjects is more common than is generally believed; 20% suffer redislocation and 60% have a cuff tear. Operation may be needed to repair a torn cuff or to stabilise the shoulder. Patients with multiple redislocations will probably require both procedures

1. Fifty dislocations and fracture-dislocations of the pelvis have been reviewed. 2. Complications were unusual. Two patients with rupture of the bladder died; two with rupture of the urethra survived. Of eight patients with retroperitoneal haemorrhage four died; the treatment advised is controlled blood transfusion maintaining a blood-pressure of not more than 100 mm. 3. Two types of pelvic disruption should be distinguished: 1) pubic injury with sacro-iliac dislocation; 2) pubic injury with fracture near the sacro-iliac joint. The first is twice as common as the second. 4. In each type, displacement is maintained by extension of the hip and outward roll of the limb. This may be controlled by the Watson-Jones plaster method but the pelvic sling technique is preferred and was used in all cases in this series. 5. The prognosis in fracture-dislocations is very good; nearly all patients went back to heavy work. 6. The prognosis in sacro-iliac dislocations is not so good; only half the patients went back to heavy work and there was often persistent sacro-iliac pain. Sacro-iliac arthrodesis is advised in those cases

Seven children with chronic post-traumatic dislocation of the radial head were treated by open reduction and ligament reconstruction by a triceps tendon slip. In the four patients with anterior dislocation, good results were achieved; in the two with anterolateral dislocations bowing of the ulna persisted and subluxation recurred. One patient with an anterior dislocation developed a radio-ulnar synostosis. For anterolateral dislocations, we advise the combining of open reduction and ligament reconstruction with osteotomy of the ulna

1. Coracoid transplantation for recurring dislocation of the shoulder is described. 2. In my experience of over thirty cases only once has true dislocation recurred after this operation. Recurrence was due to avulsion of the bone block. 3. Failure to repair the original detachment of the glenoid labrum is a frequent cause of recurrence of dislocation of the shoulder. An explanation is offered for this failure; namely that the injured labrum adheres to the deep surface of the subscapularis muscle instead of reattaching itself to bone. This reinforces Watson-Jones's advice that the original dislocation should be treated by complete immobilisation in full medial rotation for three weeks

During open reduction of an irreducible anterior dislocation of a total hip replacement with an Oxinium femoral head, it was observed that the head had been significantly damaged. Gross and scanning electron microscopic examination revealed cracking, gouging, and delamination of the surface. Because of the risk which this poses for damaging the polyethylene acetabular liner, it is strongly recommended that patients with this type of prosthetic head be carefully monitored after a dislocation

1 . Dislocation of the upper end of the fibula is probably less unusual than the paucity of the published reports suggests. 2. Dislocation may be anterior or posterior, anterior dislocation occurring about twice as often as posterior. Rarely the fibula moves proximally. 3. In most cases a closed manipulation suffices for reduction, and a full and rapid return of normal function follows. 4. Five cases are described. In one case operative reduction was required

1. The literature of dislocation of the hip in childhood from 1922 to 1954 is reviewed. A total of eighty-eight cases have been recorded. 2. A further case, in a child of one year and eleven months, is described. 3. Nine of the children whose cases have been recorded developed Perthes' disease of the hip after the dislocation, an incidence of 10 per cent. A similar incidence of avascular necrosis of the femoral head has been reported after dislocation of the hip in adults

Twenty-three patients, aged from 10 to 60 years, underwent open reduction for untreated posterior dislocations of the elbow. The dislocations had been unreduced for periods varying from one month to two years. All patients underwent a standard procedure based on the Speed technique. Complications after operation included one case of gross sepsis and five cases of ulnar neuritis. Most patients gained a useful range of flexion-extension of the elbow. Neither the age of the patient nor the duration of the unreduced dislocation influenced the result

Aims. The aim of this systematic review was to report the rate of dislocation following the use of dual mobility (DM) acetabular components in primary and revision total hip arthroplasty (THA). Materials and Methods. A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed. A comprehensive search of Pubmed/Medline, Cochrane Library and Embase (Scopus) was conducted for English articles between January 1974 and March 2016 using various combinations of the keywords “dual mobility”, “dual-mobility”, “tripolar”, “double-mobility”, “double mobility”, “hip”, “cup”, “socket”. The following data were extracted by two investigators independently: demographics, whether the operation was a primary or revision THA, length of follow-up, the design of the components, diameter of the femoral head, and type of fixation of the acetabular component. Results. In all, 59 articles met our inclusion criteria. These included a total of 17 908 THAs which were divided into two groups: studies dealing with DM components in primary THA and those dealing with these components in revision THA. The mean rate of dislocation was 0.9% in the primary THA group, and 3.0% in the revision THA group. The mean rate of intraprosthetic dislocation was 0.7% in primary and 1.3% in revision THAs. Conclusion. Based on the current data, the use of DM acetabular components are effective in minimising the risk of instability after both primary and revision THA. This benefit must be balanced against continuing concerns about the additional modularity, and the new mode of failure of intraprosthetic dislocation. Longer term studies are needed to assess the function of these newer materials compared with previous generations. . Cite this article: Bone Joint J 2017;99-B(1 Supple A):18–24

Entire human cadaveric cervical spines with the basiocciput were subjected to load in a compression apparatus to simulate the clinical situation of forward dislocation. The movements were recorded by lateral cineradiography. Vertical load was measured by a potentiometric transmitter synchronised with each frame of the cineradiograph. The lower part of the spine was flexed and fixed, and the upper extended and free to move forward. Vertical compression then produced bilateral dislocation of the facets without fracture. If lateral tilt or axial rotation occurred as well, a unilateral dislocation was produced. The maximum vertical load was only 145 kilograms, and coincided with the rupture of the posterior ligament and capsule and the stripping of the anterior longitudinal ligament, but this occurred before dislocation. The low vertical load indicates a peculiar vulnerabiity of the cervical spine in this position and correlates well with the minor trauma often seen in association with forward dislocation

1. Isolated dislocation of the radius at the elbow occurs most commonly as a pronation injury, associated with slight elbow flexion and a varus strain. Disruption of the radio-ulnar articulation occurs primarily because of tearing of the annular ligament, which is the most important reinforcing structure of this joint. The tensing of the interosseous membrane through neutral into supination, and consequently the approximation of the radius to ulna, supports the recognised supination manoeuvre to reduce such an injury. 2. It is suggested that this injury may be more common than previously appreciated. It may be not diagnosed, it may be over-diagnosed as total dislocation of the elbow, or it may be belatedly diagnosed as a congenital dislocation of the radial head

1. A collected series of forty-seven traumatic dislocations of the hip in children is reported and reviewed in detail. 2. All were simple hip dislocations, and no child was included in whom there was any other injury to the affected joint. 3. All were posterior dislocations. 4. No anatomical predisposition was observed. 5. Significant complications occurred in fourteen children: avascular necrosis of the head of the femur in four, degenerative joint changes in three, premature epiphysial fusion in one and overgrowth of the femoral head in six. Study of the children with these complications revealed no common cause except the dislocation itself. 6. The injury responsible was often trivial. 7. The results suggest that it is harmless to bear weight four weeks after reduction

The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation. Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN. Cite this article: Bone Joint J 2013;95-B:1453–7

To determine the natural history of dislocation of the hip in cerebral palsy, and to evolve methods to predict dislocation, the notes and radiographs of 462 patients with cerebral palsy were reviewed. Dislocation occurred in 10% of patients by progressive migration and subluxation of the proximal femur in the presence of acetabular dysplasia. Statistical analysis identified the radiographic features that helped to predict dislocation. Measurement of acetabular index, by a method that allows for rotation of the acetabulum, was the most powerful single predictor. Measurement of this index at two and four years of age could identify patients who would dislocate unless effective treatment was undertaken, those at risk of dislocation only if scoliosis developed, and those who would not dislocate. On the basis of this method of screening for dislocation, a logical system of surgical prophylaxis is proposed