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Ipsilateral Shoulder and Elbow Dislocation : Case report

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Vol 32| Issue 2 | July – Dec 2019 | page: 59-61| Raphael Thomas, M Raffic, Anoop S

Authors: Raphael Thomas[1], M Raffic[1], Anoop S[1]

[1]Department of Orthopaedics, Sree Gokulam Medical College, Venjaramoodu, Trivandrum, Kerala, India.

Address of Correspondence
Dr. Anoop S,
Sree Gokulam Medical College, Venjaramoodu, Trivandrum, Kerala, India.
E-mail: anoopsuresh88@gmail.com

Abstract

Background: The most commonly dislocated joint in the body is the Shoulder, followed by Elbow. A very rare presentation has both these dislocations on the ipsilateral side and only a few cases of these have been reported. In most cases which have been reported, Shoulder dislocation was initially missed and later diagnosed.
This case report is of a 70 year old Female patient who came to our Casulaty following slip and fall at home and sustained injury to the Right Upper Limb. Initially patient was diagnosed to have Right Elbow Fracture Dislocation. Xray was taken and reduction of elbow dislocation was done in the Casualty. After reduction of the elbow dislocation, one joint above and one joint below the injury was done and patient had complaints of pain over the Right Shoulder and Xray of Right Shoulder was taken and it showed Anterior Dislocation of Right Shoulder. This is a rare presentation of Ipsilateral Shoulder and Elbow Dislocation. The Shoulder Dislocation was reduced and an Above Elbow POP Slab was applied on the Right Upper Limb. Patient was reviewed at 2 weeks, 4 weeks, 1.5 months, 3 months and at 6 months. In the initial 4 weeks patient was on Above Elbow POP slab and it was removed at 4 weeks and shoulder and elbow joints were mobilized. Patient came for review again after 1.5 months, 3 months and 6 months and Range of Movement at the Shoulder and Elbow joints were assessed at each visit.
Conclusion: Ipsilateral dislocation of shoulder and elbow are uncommon and can be treated conservatively with good results. The Shoulder and Elbow range of movement was assessed at 4 weeks, 1.5 months, 3 months and 6 months and ROM of Elbow and Shoulder were found to be satisfactory.
Keywords: Shoulder, Elbow, Dislocation, Ipsilateral, Rare Case Report.

References

1. Inan U, Cevik AA and Omeroğlu H. Open humerus shaft fracture with ipsilateral anterior shoulder fracture-dislocation and posterior elbow dislocation: a case report. J Trauma. 2008; 64(5): 18383-6.
2. Suman RK. Simultaneous dislocations of the shoulder and the elbow. Injury. 1981; 12(5): 438.
3. Ali FM, Krishnan S and Farhan MJ. A case of ipsilateral shoulder and elbow dislocation: an easily missed injury. J Accid Emerg Med. 1998; 15(3):198.
4. Khan MR, Mirdad TM. Ipsilateral dislocation of the shoulder and elbow. Saudi Med J. 2001; 12: 1019-21.
5. Ahmet Imerci, Mert Kumbaraci, Mustafa İncesu, Ahmet Savran, Levent Karapinar. Ipsilateral Simultaneous Shoulder and Elbow Dislocation: A Case Report. Tr J Emerg Med. 2011; 11(2):72-5.

How to Cite this Article: Thomas R, Raffic M, Anoop S | Ipsilateral Shoulder and Elbow Dislocation : Case report| Kerala Journal of Orthopaedics | July – Dec 2019; 32(2): 59-61 .

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Functional and Radiological outcome of volar plates in distal end of radius fractures

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Vol 32| Issue 2 | July – Dec 2019 | page: 20-25 | Ajith John K, Sudheer U, C. Jayaprakash

Authors: Ajith John K [1], Sudheer U [1], C. Jayaprakash [1]

[1] Department Of Orthopaedics, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Address of Correspondence

Dr. Sudheer U,
Amala Institute of Medical Sciences, Thrissur, Kerala, India.
E-mail: sudheeranortho@gmail.com

Abstract

Background: Distal end of radius fracture incidence is increasing in younger age group due to road traffic accident and no residual deformity is acceptable nowadays. So Hence, we need to assess whether the good radiological outcome which is achieved by open reduction can cause an excellent functional outcome, along with that we need to address its disadvantages.
Methods: A total of 50 patients (males 36 and females 14) were followed for a period of 1 year. Fracture classified using AO classification. They were selected for the operative procedure based on the Lafontaine’s criteria. During the operative procedure, we used locking plate for 20 patients and T plate for 30.Patient The patient was evaluated for the functional outcome- QuickDASH scoring system and radiological outcome– Lindstorm criteria.
Results: Mean age was 41.76 ± 12.2733. Predominant mode of injury was a road traffic accident (32patients) of which 30 were males and fall at home (16 patients) and majority were females (12). Type of fracture involved (according to AO classification) was C1 (26 patients) followed by B3 (11 patients). Mean QuickDASH was 5.752 ± 6.67 which indicates good functional outcome. Lindstorm criteria score (radiological criteria) at 6 months and 1 year was same indicates that there is no collapse at cortico cancellous junction and no implant failure occurred and no screw pullout. Decreased range of motion observed in 5 cases and range has improved at the end of 1 year. Age and Quick DASH Quickdash Correlation Coefficient(r) 0.260 and P value = 0.068 which suggest age and functional outcome inversely proportional. Excellent radiological outcome has a better functional outcome (5.263±6.5197) when compared to good radiological outcome (11.375± 6.6805).
Conclusion: Volar plates are a good modality of treatment in the distal end of radius. It has a good functional and radiological outcome. When correlating functional outcome and radiological outcome excellent radiological outcome has a better functional outcome when compared to good radiological outcome.
Keywords: AP- Anteroposterior, PA- Posteroanterior, DRUJ- Distal radioulnar joint, CRP- Central reference point, TFCC- Triangular fibrocartilagenous complex, DASH- Disabilities of arm, shoulder, and hand, EPL- Extens or pollicis longus, SRN- Superficial branch of the radial nerve.

References

1. ChungKC, SpilsonSV. The frequeny and epidemiology of hand and forearm fractures in the United States.J Hand Surg Am2001;26:908-15.
2. CollesA. On the fracture of the carpal extremity of the radius. Edinb Med Surg J. 1814;10:181.ClinOrthopRelat Res2006;445:5-7.
3. PogueDJ, ViegasSF, PattersonRM, PetersonPD, JenkinsDK, SweoTD, et al. Effects of distal radius fracture malunion on wrist joint mechanics.J Hand Surg Am1990;15:721-7.
4. AroraR, GablM, ErhartS, SchmidleG, DallapozzaC, LutzM. Aspects of current management of distal radius fractures in the elderly individuals.GeriatrOrthop Surg Rehabil2011;2:187-94.
5. LaroucheJ, PikeJ, SlobogeanGP, GuyP, BroekhuyseH, OʼBrienP, et al. Determinants of functional outcome in distal radius fractures in high-functioning patients older than 55 years.J Orthop Trauma2016;30:445-9.
6. KopylovP, JohnellO, Redlund-JohnellI, BengnerU. Fractures of the distal end of the radius in young adults: A 30-year follow-up.J Hand Surg Br1993;18:45-9.
7. LafontaineM, HardyD, DelinceP. Stability assessment of distal radius fractures.Injury1989;20:208-10.
8. NellansKW, KowalskiE, ChungKC. The epidemiology of distal radius fractures.Hand Clin2012;28:113-25.
9. HozackBA, TostiRJ. Fragment-Specific Fixation in Distal Radius Fractures.Curr Rev Musculoskelet Med2019;12:190-7.
10. DixonD, JohnstonM, McQueenM, Court-BrownC. The disabilities of the arm, shoulder and hand questionnaire (DASH) can measure the impairment, activity limitations and participation restriction constructs from the international classification of functioning, disability and health (ICF).BMC MusculoskeletDisord2008;9:114.
11. GummessonC, WardMM, AtroshiI. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): Validity and reliability based on responses within the full-length DASH.BMC MusculoskeletDisord2006;7:44.
12. GummessonC, AtroshiI, EkdahlC. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery.BMC MusculoskeletDisord2003;4:11.
13. LidstromA. Fractures of the distal end of the radius. A clinical and statistical study of end results.ActaOrthopScandSuppl1959;41:1-18.
14. AmorosaLF, VitaleMA, BrownS, KaufmannRA. A functional outcomes survey of elderly patients who sustained distal radius fractures.Hand (N Y)2011;6:260-7.
15. RaudasojaL, VastamäkiH, RaatikainenT. The importance of radiological results in distal radius fracture operations: Functional outcome after long-term (6.5 years) follow-up.SAGE Open Med2018;6:2050312118776578.
16. HakimiM, JungbluthP, WindolfJ, WildM. Functional results and complications following locking palmar plating on the distal radius: A retrospective study.J Hand Surg EurVol2010;35:283-8.
17. ChouYC, ChenAC, ChenCY, HsuYH, WuCC. Dorsal and volar 2.4-mm titanium locking plate fixation for AO type C3 dorsally comminuted distal radius fractures.J Hand Surg Am2011;36:974-81.
18. ChavhanAN, DudhekarUJ, BadoleCM, WandileKN. Functional and radiological outcome in distal radius fractures treated with locking compression plate.Int J Res Med Sci2017;5:.
19. AroraR, LutzM, HennerbichlerA, KrappingerD, EspenD, GablM. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate.J Orthop Trauma2007;21:316-22.
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How to Cite this Article: Ajith John K, Sudheer U, C. Jayaprakash | Functional and Radiological Outcome of Volar Plates in initial End of Radius Fractures. | Kerala Journal of Orthopaedics | July – Dec 2019; 32(2): 20-25.

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Subacromial Bursal Chondromatosis in a Patient with Rheumatoid Arthritis

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Vol 31 | Issue 1 | Jan – Apr 2018 | page: 12-14 | A Shiju Majeed, Shakkir Uvvupara

Authors: A Shiju Majeed [1], Shakkir Uvvupara [1]

[1] Department of Orthopedics, Government Medical College, Thiruvananthapuram, Tamil Nadu, India.

Address of Correspondence
Dr. A Shiju Majeed,
Department of Orthopedics,
Government Medical College,
Thiruvananthapuram, Tamil Nadu, India.
E-mail: shiju78@live.com

Abstract

Introduction: A 51-year-old female, known rheumatoid arthritis patient, presented with soft fluctuant painful swelling of her left shoulder of 4 months duration. Imaging findings are presented which suggested subacromial bursal osteochondromatosis with rice bodies. Histopathology confirmed the diagnosis. Bursal osteochondromatosis though rare should be consider as a differential diagnosis in periarticular swellings.

Keywords: Synovial chondromatosis, bursal chondromatosis,  shoulder, rheumatoid arthritis, rice bodies

References

1. Henderson MS, Joxis HT. Loose bodies in joints and bursae due to synovial osteochondromatosis. J Bone Joint Surg 1923;5:400-4.

2. Jones HT. Loose body formation in synovial osteochondromatosis with special reference to the etiology and pathology. J Bone Joint Surg 1924;6:407-58.

3. Mussey RD Jr, Henderson MS. Osteochondromatosis. J Bone Joint Surg Am 1949;31A:619-27.

4. Jeffreys TE. Synovial chondromatosis. J Bone Joint Surg Br 1967;49:530-4.

5. Sah AP, Geller DS, Mankin HJ, Rosenberg AE, Delaney TF, Wright CD, et al. Malignant transformation of synovial chondromatosis of the shoulder to chondrosarcoma. A case report. J Bone Joint Surg Am 2007;89:1321-8.

6. Milgram JW. Synovial osteochondromatosis: A histopathological study of thirty cases. J Bone Joint Surg Am 1977;59:792-801.

7. Bloom R, Pattinson JN. Osteochondromatosis of the hip joint. J Bone Joint Surg Br 1951;33-B:80-4.

8. McKenzie G, Raby N, Ritchie D. A pictorial review of primary synovial osteochondromatosis. Eur Radiol 2008;18:2662-9.

How to Cite this Article: Majeed A S, Uvvupara S. Subacromial Bursal Chondromatosis in a Patient with Rheumatoid Arthritis. Kerala Journal of Orthopaedics Jan – July 2018; 31(1):12-14.

 

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