Open Ankle Dislocation Without Fractures With Tibialis Posterior Tendon Interposition Through the Interosseous Space.

Open ankle dislocations without fracture are rare injuries. Dislocation or interposition of adjacent tendons are a rare associated feature of ankle fracture-dislocation. We report an extremely unusual case of open ankle dislocation without fracture with concurrent tibialis posterior tendon interposition through the interosseous space that was detected incidentally on computed tomography. We highlight the clinical, radiologic, and intraoperative features to avoid missing similar diagnoses.

Ischiofemoral hip ligament reconstructions for recurrent posterior total hip joint dislocations.

OBJECTIVE: Recurrent dislocations of a total hip joint replacement are a difficult problem to address. We present a technique for reconstructing the ischiofemoral ligament of the hip to prevent recurrent posterior dislocations. METHODS: This is a case series of 5 patients with a reconstruction performed using either a bone-patellar tendon-bone graft autograft or allograft. RESULTS: At an average follow up of 47 months following the reconstruction, there were no redislocations. CONCLUSION: Ischiofemoral hip ligament reconstruction is a viable technique in addressing recurrent dislocations of total hip joint replacements.

Lumbosacral dislocation injuries: management and outcomes.

Lumbosacral dislocations are rare high-energy injuries most often reported as isolated cases. Improved outcomes from major trauma means that these cases will likely become more common. We report six cases treated at our institution in the last decade. Nonoperative care in two cases resulted in severe deformity and pain and required late reconstruction. Surgical decompression, reduction, and stabilization with posterior pedicle screw instrumentation resulted in a stable lumbosacral junction, although in one case, implant failure required revision with anterior column reconstruction to achieve that stability. Nerve root injuries recovered. Two cases had pre-existing spondylolysis/spondylolisthesis. Clinical results were very satisfactory if there was no pre-existing chronic low back pain, although overall function was determined by outcome from other injuries sustained at the initial trauma.

Radiologic stability of titanium mesh cages for anterior spinal reconstruction following thoracolumbar corpectomy.

BACKGROUND: This work evaluated the radiologic stability of titanium mesh cages (TMCs) when used for single-level corpectomy reconstruction of thoracic and thoracolumbar spine. METHODS: Thirty-one patients underwent reconstruction for acute fractures (n = 15), posttraumatic deformity reconstruction (n = 10), neoplastic disorders (n = 4), and infection (n = 2). The cages were placed after corpectomy and excision of the adjacent intervertebral discs. Additional stabilization devices included anterior plates alone (n = 18), anterior double screw and rod constructs alone (n = 9), a single anterior rod system (n = 1), posterior stabilization alone (n = 6), and additional posterior stabilization (n = 2). RESULTS: Mean kyphosis correction was from 16 degrees to 5 degrees with 3 degrees of recurrence at 1-year follow-up (P < 0.0001 for both postoperative and final follow-up). In patients with greater initial kyphosis (>20 degrees ), mean correction was from 33 degrees to 10 degrees without recurrence (P = 0.004). Distance between adjacent vertebral bodies improved by 13 mm after cage placement, with a mean of 2mm of settling at final follow-up. There was one asymptomatic cage fracture without evidence of other problems. Two patients had construct failure after complex three-dimensional deformities were inadequately corrected and the cages had been placed in an angulated position. CONCLUSIONS: This report suggests that TMCs are a sound reconstruction alternative after thoracic and thoracolumbar corpectomy at a single level and may prevent complications associated with the harvest and use of large structural autografts for these reconstructions. Failure to correctly align the spine so the cage can be vertically placed is a contraindication to the use of TMCs.