MyMedR

Fulltext Simultaneous dislocation of the metacarpophalangeal and subluxation of the carpometacarpal joints of the thumb in a child

Rashdeen FMN, Manohar A, Pathmanathan V

Med J Malaysia, 2005 Jul;60 Suppl C:117-8.

PMID: 16381297

Double dislocations of joints of the thumb are uncommon injuries. We report an unusual case of simultaneous dislocation of the metacarpophalangeal (MCP) and subluxation of the carpometacarpal (CMC) joints of the thumb in a child to illustrate problems related to their treatment.

Matched MeSH terms: Dislocations/therapy*

Fulltext Bipolar clavicular injury

Pang KP, Yung SW, Lee TS, Pang CE

Med J Malaysia, 2003 Oct;58(4):621-4.

PMID: 15190643

While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end and a dislocation at the other. We present two cases; a patient with a bipolar clavicular dislocation, and another with a fracture in both medial and lateral ends of the clavicle with anterior dislocation of the sternoclavicular joint. Both were treated conservatively, with fairly good range of motion and return to normal activity.

Matched MeSH terms: Dislocations/therapy*

Paediatric mandibular fractures: report of a case

Qadri GW, Mokhtar SM

Dent Traumatol, 2008 Dec;24(6):e67-70.

PMID: 19021642 DOI: 10.1111/j.1600-9657.2008.00700.x

The conservative approach in the treatment of maxillofacial trauma in children has been widely adopted. The type of fracture and its presence within the growing facial skeleton along with the presence of tooth buds may result in different management strategies to that employed in adults. An understanding of conservative treatment options is essential to make informed choices which will best manage these injuries, and an example is presented in this paper. This case report describes a 14-year-old boy who sustained trauma to the chin as a result of a fall, causing a mandibular symphyseal fracture. He was successfully treated by the means of applying direct interdental wiring combined with an acrylic splint.

Matched MeSH terms: Dislocations/therapy

Fulltext The results of treatment of dislocation and fracture--dislocation of the elbow--a review of 41 patients

Azmi I, Razak M, Hyzan Y

Med J Malaysia, 1998 Sep;53 Suppl A:59-70.

PMID: 10968184

Forty-one patients with 42 elbow dislocations, of which 13 had acute simple dislocations, 21 had fracture-dislocations and 8 had neglected elbow dislocations, were evaluated with regard to limitation of motion, pain, instability and residual neurovascular deficit. All patients with acute simple dislocation were treated with closed reduction, but the duration of immobilization before commencement of active motion varied. Open-reduction was indicated for failed closed reduction and neglected-dislocations. Internal fixation as a primary procedure was only performed for displaced fracture-dislocation. Excision of radial head or tricepsplasty were performed if the reduction was impossible in neglected elbow dislocation. Despite a good results in acute simple dislocation, 33.07% had flexion contracture of between 5 to 30 degrees. In fracture dislocation, satisfactory results were seen in whom the elbow was immobilized for three weeks or less. Neglected-dislocation is associated with poor functional outcome, 37.5% were good and 62.5% were poor. Prolonged immobilization after injury was strongly associated with an unsatisfactory result. The results indicate that early properly supervised active motion is a key factor in the rehabilitation of elbow dislocation.

Matched MeSH terms: Dislocations/therapy*

Fulltext Congenital atlanto-axial dislocation

Tan CT, Loh TG, Balasubramaniam P

Med J Malaysia, 1981 Dec;36(4):230-3.

PMID: 7334959

Matched MeSH terms: Dislocations/therapy

Grisel's syndrome: a rare complication of tonsillectomy

Sia KJ, Tang IP, Kong CK, Nasriah A

J Laryngol Otol, 2012 May;126(5):529-31.

PMID: 22361094 DOI: 10.1017/S0022215112000175

To discuss the pathophysiology of atlanto-axial subluxation as a rare complication of tonsillectomy, and to discuss the important radiological findings for diagnosis and treatment planning.

Matched MeSH terms: Dislocations/therapy

An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy

Haflah NH, Ibrahim S, Sapuan J, Abdullah S

J Pediatr Orthop B, 2010 Sep;19(5):459-61.

PMID: 20555271 DOI: 10.1097/BPB.0b013e32833b6032

Elbow dislocations associated with a medial epicondyle fracture and ulnar nerve palsy are uncommon injuries. We present the case of an 11-year-old girl with an elbow dislocation treated by closed manual reduction. The medial epicondyle fracture was missed initially until she developed an ulnar nerve palsy 2 months later. Intraoperatively we discovered the bony epicondyle piercing the joint capsule and compressing the ulnar nerve. Removal of the bony fragment relieved her symptoms and she returned to normal activities at 1 year follow-up. We would like to highlight this rare occurrence and present the detailed history and management of this case.

Matched MeSH terms: Dislocations/therapy

Fulltext Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia in the emergency department

Jamal SM, Fathil SM, Nidzwani MM, Ismail AK, Yatim FM

Med J Malaysia, 2011 Aug;66(3):231-3.

PMID: 22111446

The study compared the effectiveness of ketamine and midazolam/fentanyl as procedural sedation and analgesia agents for reduction of fractures and dislocated joints. Forty-one adult patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Depth of sedation, pain score, procedural outcome and memory of the procedure were documented. The ketamine group had deeper sedation, but there was no statistical difference in other variables between the two groups. Three patients in the midazolam/fentanyl group had oxygen desaturation. More adverse effects were associated with ketamine. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation.

Matched MeSH terms: Dislocations/therapy

Fulltext Blunt trauma to the antecubital fossa causing brachial artery injury and minor fractures around the elbow joint, an easily missed diagnosis with potential devastating consequences: a case report

Phang ZH, Miskon MFB, Ibrahim SB

J Med Case Rep, 2018 Jul 18;12(1):211.

PMID: 30016981 DOI: 10.1186/s13256-018-1751-7

BACKGROUND: Blunt trauma causing brachial artery injury in a young patient is very rare. Cases of brachial artery injury may be associated with closed elbow dislocation or instability. Elbow dislocation may not be evident clinically and radiologically on initial presentation.

CASE PRESENTATION: This is a case of a 37-year-old, right-hand dominant, Malay man who fell approximately 6 meters from a rambutan tree and his left arm hit the tree trunk on his way down. He was an active tobacco smoker with a 20 pack year smoking history. On clinical examination, Doppler signals over his radial and ulnar arteries were poor. He proceeded with emergency computed tomography angiogram of his left upper limb which showed non-opacification of contrast at the distal left brachial artery just before the bifurcation of the left brachial artery at his left elbow joint. Radiographs and computed tomography scan also showed undisplaced fracture of left lateral epicondyle and radial head with no evidence of elbow dislocation. He subsequently underwent left brachial to brachial artery bypass which was done using reversed saphenous vein graft and recovered well. His fractures were treated using 90 degree long posterior splint for 2 weeks and he was then allowed early range of motion of the left elbow. This patient developed left elbow dislocation 6 weeks postoperatively. Closed manipulative reduction of his left elbow resulted in incomplete reduction. The functional outcome of his left elbow was limited with a range of motion of left elbow of 0-45 degrees. However, he was not keen for surgery to stabilize his elbow joint during his last follow-up 6 months post injury.

CONCLUSIONS: This is an uncommon case of brachial artery injury in a civilian caused by blunt trauma associated with occult elbow instability/dislocation and minor fractures around the elbow joint. The treatment of brachial artery injury with clinical evidence of distal ischemia is surgical revascularization. The possibility of elbow instability and dislocation need to be considered in all cases of brachial artery injury because early radiographs and computed tomography scans may be normal. Short-term posterior splint immobilization is not sufficient to prevent recurrent dislocations.

Matched MeSH terms: Dislocations/therapy

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