Radial head subluxation

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Radial Head Subluxation: Possible Effective Factors on Time to Re-use the Affected Limb

Radial Head Subluxation: Possible Effective Factors on Time to Re-use the Affected Limb

Radial head subluxation (RHS), also called "pulled elbow" or "nursemaid's elbow," is a common disorder in children (1-4). Although it is not accompanied by any important short- or long-term sequel, it could make the parents worried about. Although most of the cases are seen in those under the age of 7 years, RHS has been reported in children younger than six months of age or even until the age of 18 years (5, 6). RHS is a frequent elbow injury in young children, affecting approximately 20,000 children per year in the United States (7, 8). Since there are cases of spontaneous reduction, it is difficult to determine its actual occurrence rate. This injury usually occurs in the left hand and is more common in girls (9, 10).
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Recurrent Nursemaid’s Elbow (Annular Ligament Displacement) Treatment Via Telephone

Recurrent Nursemaid’s Elbow (Annular Ligament Displacement) Treatment Via Telephone

ABSTRACT. Annular ligament displacement (ALD)— also termed radial head subluxation, nursemaid’s elbow, or pulled elbow— can be successfully diagnosed and treated over the telephone by properly trained medical professionals instructing nonmedical caretakers. Two case reports of successful ALD reduction via telephone are described. The pathology of ALD and techniques for its treatment are reviewed, and guidelines are given. The rationale for the introduction of the new term annular ligament displacement as well as areas for additional investigation are discussed. To our knowledge, this is the first published account of ALD reduction via telephone. Pediatrics 2002;110:171–174; annular ligament displace- ment, nursemaid’s elbow, pulled elbow, radial head sub- luxation.
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A Comparison of Supination/Flexion to Hyperpronation in the Reduction of Radial Head Subluxations

A Comparison of Supination/Flexion to Hyperpronation in the Reduction of Radial Head Subluxations

Materials and Methods. This prospective, random- ized study involved a consecutive sampling of children younger than 6 years of age who presented to one of two urban pediatric emergency departments and two subur- ban pediatric ambulatory care centers with a clinical di- agnosis of radial head subluxation. Patients were ran- domized to undergo reduction by one of the two methods and were followed every 5 minutes for return of elbow function. The initial procedure was repeated if baseline functioning did not return 15 minutes after the initial reduction attempt. Failure of that technique 30 minutes after the initial reduction attempt resulted in a cross-over to the alternate method of reduction. The alternate pro- cedure was repeated if baseline functioning did not re- turn 15 minutes after the alternate procedure was at- tempted. If the patient failed both techniques, radio- graphy of the elbow was performed.
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Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

The presenting symptoms were a loss of range of motion of the forearm and cosmetic problems in all four patients. All cases were Class IIB type classified by the Masada and Ono Classification, which means that the radial head is dislocat- ed because of an osteochondroma in the distal portion of the ulna and there are small osteochondromas in the part of the radius. Dislocation of the radial head, which was ob- served preoperatively in all patients, was naturally reduced with a temporary reduction half pin that was located within 6 weeks. In Case 1, we could see radial head subluxation at 20 months follow up, but there was no further progression of the limitation of elbow range of motion. In other cases, stably reduced radial head was observed upon recent fol- low-up radiographic evaluation.
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Radial Head Stability in Anterior Monteggia Injuries: An In Vitro Biomechanical Study

Radial Head Stability in Anterior Monteggia Injuries: An In Vitro Biomechanical Study

This biomechanical investigation demonstrates that biceps loading has a significant effect on anterior radial head translation. Although no previous biomechanical study has directly investigated the impact of biceps loading on radial head translation, this effect was suggested by Tompkins in his observational hypothesis of anterior Monteggia injuries. 3 Moreover, Sandman and colleagues found increasing anterior radial head subluxation with increasing elbow flexion and speculated that this effect might be related to the pull of the biceps during elbow flexion. 4 Interestingly, loads as low as 20N had a significant effect on radial head translation in our study. Previous studies have shown varying loads in the biceps during active elbow flexion. 11,19,41-44 In our simulator, the average load in the biceps was 70N with a maximum load of 130N during active elbow flexion. Thus, our static loading protocol applied clinically relevant loads which would likely be seen clinically with early active motion. In the absence of biceps loading, there was no significant radial head translation even in the higher injury states. This supports the clinical observation that relaxation of biceps by placing the elbow in a flexed and supinated position likely aids in maintaining the reduction of the radial head in anterior Monteggia injuries. 3,45,46
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Acute unstable complex radial head and neck fractures fixed with a mini T-shaped plate in a 20-year-old man: a case report

Acute unstable complex radial head and neck fractures fixed with a mini T-shaped plate in a 20-year-old man: a case report

Abstract: Acute unstable complex radial head and neck fractures in adults are seldom reported in the literature. Early recognition and appropriate management are essential to prevent long- term consequences of the loss of elbow function, forearm rotation, and chronic pain. Here, we describe an unusual case of a 20-year-old man who exhibited acute unstable complex fractures of the head and neck of the right radius without other injuries or comorbidity. An open reduction and mini T-shaped plate fixation were performed within 3 hours after injury, and the results were satisfactory. A long plaster fixation was continued for 3 weeks. A gradual mobilization was started after the removal of the plaster under the supervision of a physiotherapist. At the 12-month follow-up, no complications associated with the use of the mini T-shaped plate were noted, and the Mayo Elbow Performance Score was 97 (excellent). To our knowledge, acute unstable complex radial head and neck fractures in adults can be successfully treated with a mini T-shaped plate reconstruction technique.
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Acute non-ambulatory tetraparesis with absence of the dens in two large breed dogs: case reports with a radiographic study of relatives

Acute non-ambulatory tetraparesis with absence of the dens in two large breed dogs: case reports with a radiographic study of relatives

In this report, we describe one German shepherd (Dog 1) and three poodles that presented with an absent dens and acute non-ambulatory tetraparesis during the first year of life. However, signs of neck pain or gait distur- bances were not detected in four older poodle dogs with an absence or hypoplasia of the dens. This indicates that large breed dogs without a dens run the greatest risk of se- vere atlantoaxial subluxation at an early age. In adult age, hypertrophy of atlantoaxial muscles, tendons, ligaments and the joint capsule may stabilize the joint to the extent that clinical signs of subluxation do not appear. A similar theory is presented by Patton et al. [29], who reported a rottweiler dog with a nine year history of mild neuro- logical deficits, an absent dens, but no associated displace- ment between the atlas and axis. It is speculated that in large breed dogs, the large neck muscle mass together with a thickening of the atlantoaxial joint capsule and the dorsal atlantoaxial ligament, can prevent atlantoaxial in- stability [29].
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Correlation of Qualitative and Quantitative MRI Parameters with Neurological Status: A Prospective Study on Patients with Spinal Trauma

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Among qualitative parameters,when comparing patients with complete and incomplete SCI, haemorrhage/ contusion pre/ paravertebral collection, and facetal subluxation/dislocation, vertebral fracture/subluxation, epidural haemorrhage and ligamentous injury were significantly more common in patients with complete SCI. No significant correlation was observed between the two groups with presence or absence of cord oedema, cord compression and traumatic disc herniation. Overall, presence of cord haemorrhage/ contusion was the most significant qualitative factor for indicating the severity of spinal cord injury using ASIA scoring system. Miyanji et al., [4] also observed significant correlation between severity of SCI and presence or absence of cord haemorrhage, cord oedema, cord swelling and soft tissue injury. They observed no significant correlation with presence or absence of canal stenosis or disc herniation. Overall the presence of cord haemorrhage is most important qualitative marker for indicating the severity of cord injury.
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Evaluation of Functional Outcome of Prosthetic Replacement of Comminuted Radial Head and Neck Fracture

Evaluation of Functional Outcome of Prosthetic Replacement of Comminuted Radial Head and Neck Fracture

insertion. Stiffness is prevented by encouraging early active motion. Indomethacin can be used in an effort to prevent heterotopic ossification in patients without contraindications; however, its effectiveness remains unproven. Posterior interosseous nerve injuries can be avoided by maintaining the forearm in pronation during the surgical approach and avoidance of Homan retractors placed anterior to the radial neck. Capitellar wear or erosions can occur, particularly with over lengthening of a radial head prosthesis or maltracking of implant. Management can include revision or removal of the implant if the elbow is stable. Mechanical failure of the prosthesis can arise from failure to link the modular implant correctly, or a failure of the coupling mechanism such as a screw or polyethylene in the setting of a bipolar device. Revision should be corrective. Polyethylene wear with secondary osteolysis and implant at the head–neck junction.
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Design and Fabrication of Radial Flow High Head Impeller in Submersible Pump

Design and Fabrication of Radial Flow High Head Impeller in Submersible Pump

Abstract—The objective of this project is to increase the delivery head of the existing pump by incorporating modifications in the impeller design without altering the existing power consumption. Typical submersible pump used in the industry has 20 stages and it operates with an input power of 7.5HP. For drought hit zone water cannot obtained with at a depth of 210 metres. The present available model of the impeller is thoroughly studied and analysed. Tests are conducted on the present models and reports are generated. With the help of velocity triangles diagram it is found by changing the design of the impeller by reducing the impeller width, the flow decreases which in turn increases the head. Also when number of blades is increased from 4 to 5 pressures is increased. By implementing the above concept and proceeding with the calculations and experiments it is found that the delivery head of the pump is increased.
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Dens agenesis and cervical vertebral malformation in a Labrador Retriever puppy

Dens agenesis and cervical vertebral malformation in a Labrador Retriever puppy

Physical examination revealed a bright, alert, and responsive patient with pain on palpation of the dorsal cervical and thoracic region of the spinal column. Maxillary brachygnathism and mandibular malposition of incisors 301 and 401 were noted. Complete blood count was unremarkable. Radiographs of the spinal column were performed under sedation. Radiographs revealed osseous malformations confined to the cervical spinal column. These findings included subluxation of the atlantoaxial articulation and shortening of the dorsal spinous process of the axis (Figure 1A and B), subluxation of C4–C5 articulation, and lack of rectangular shape of C6 and C7 vertebral bodies (Figure 1A). Conservative analgesic therapy was elected and the patient was discharged with oral carprofen at 2 mg/kg and tramadol hydrochloride at 2.5 mg/kg every 12 hours. Twenty-eight days later, due to increasing unmitigated pain, the own- ers elected euthanasia and postmortem evaluation.
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Traumatic Isolated Radial Head Dislocation in Children: A Case Report

Traumatic Isolated Radial Head Dislocation in Children: A Case Report

The occurrence of an isolated traumatic dislocation of the radial head is controversial, because it is generally described in a Monteggia’s lesion. Hume [2] reported that the flexibility of children’s bone allows the ulna to bend. Vesely D. [3] meanwhile suggested the presence of an occult fracture of the ulna that a careful examination of the forarm X-ray should detected. In our case, both bending and fracture of ulna were not seen on X-ray.

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The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

advantages might result from an inappropriate slice thick- ness of standard CT and MRI scans or low sensitivity in detecting chondral flake fractures. In our study we found loose bodies in 85%. Respecting the fact that osteochon- dral lesion of the capitellum were found in 80% of the cases, the loose joint bodies not only originated from the radial head fracture, but also from capitellar lesions. Fur- thermore, injuries to the lateral collateral ligaments be- came evident during examination under anesthesia and arthroscopy in 35%. Loose joint bodies, osteochondral le- sions of the humeral capitellum and lesions to the collat- eral ligaments are known to be common injuries associated with radial head fractures [10, 12, 33, 34]. Our findings go well in line with Itamura et al. who revealed loose bodies in 22 of 24 (92%) MRIs of radial head frac- tures [35]. Ward et al. found an incidence of 24% capitel- lar lesions during open surgery on radial head fractures [36]. Michels et al. found 14% capitellar cartilage lesions during arthroscopic treatment of type II fractures [20]. In our study, (oseto-)chondral lesions to the capitellum were identified in a higher number, which might be due to the high incidence of type IV fractures. Combinations of frac- tures to the radial head and corresponding capitellar le- sions might particularly affect the outcome since 60% of the axial load at the elbow is transmitted through the radiocapitellar joint [37]. Caputo et al. published a case series of capitellar chondral lesions that have been trapped between the fracture fragments of radial head fractures [36]. They also stressed the importance of complete re- moval of loose joint bodies. Van Riet et al. reported on less good results in the patients with lesions of the capitellum [34] and recommended fixation of larger displaced frac- tures and excision of small fragments. According to these recommendations we conducted removal of loose bodies in 85% and a chondroplasty in 40%. In our series none of the (osteo-)chondral fragments was suitable for refixation, nevertheless we performed microfracturing in one case of a larger chondral shear lesion (Fig. 1). Unfortunately, there is a lack of literature on the management of traumatic car- tilage lesions to the capitellum and evidence-based recom- mendations are missing.
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Effect of different orientations of screw fixation for radial head fractures: a biomechanical comparison

Effect of different orientations of screw fixation for radial head fractures: a biomechanical comparison

Twenty-four Synbone radial bones (Malans Synbone Company, Switzerland) of the same size and density were used. The radius was cut mid-shaft, leaving an ap- proximately 10-cm-long proximal segment. A Mason type II fracture was produced (Fig. 1). The fracture was created with an oscillating saw parallel to the longitu- dinal axis of the specimen. With this fragment size, the fracture ended at the radial neck without any bony sup- port. The fragment included the safe zone that is the part of the radial head that does not articulate with the proximal radioulnar joint. Reduction was performed and maintained with a reposition clamp, and the screws were implanted. We used two screws (Wright, Beijing, China) to fix the fracture model. The three different orienta- tions were as follows: (1) convergent group: two screws were inserted 30 ° convergent to each other in the trans- verse plane; (2) parallel group: two screws were inserted parallel to each other and perpendicular to the fracture line; (3) divergent group: two screws were inserted 30 ° divergent to each other in the transverse plane. Figure 2 shows X-rays of the reconstructed radial heads with the three screw fixations described above. The screws were inserted 5 mm proximal to the top of the radial head. The screws were all spaced 5 mm apart at the medial cortex regardless of orientation.
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Structure of cationic surfactant micelles from molecular simulations of self-assembly

Structure of cationic surfactant micelles from molecular simulations of self-assembly

assumptions regarding the size, shape and structure of the aggregates were necessary. Furthermore, a novel method to determine the orientation of interfacial water molecules, previously applied only to planar systems, was applied here to the highly curved micelle/water interface, together with the calculation of radial distribution functions and density profiles. This analysis showed that the micelle core is dry and is composed of only tail atoms, forming an environment that is rather similar to a liquid alkane. The environment becomes hydrophilic as one moves past the well-defined layer of head-group atoms, with water molecules penetrating the micelle as far as the innermost head site. The first solvation layer of the micelle surface is
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MR imaging of the cervical spine in rheumatoid arthritis

MR imaging of the cervical spine in rheumatoid arthritis

Occiput-C2: Horizontal subluxation, C1C2 Vertical subluxation, C1-C2 Erosion of odontoid process Soft-tissue mass at odontoid process Cord compression Isolated sac compression Increased [r]

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Fractures of both bones forearm: A Comparative study on fixation techniques and functional outcome between intramedullary nailing and plate osteosynthesis

Fractures of both bones forearm: A Comparative study on fixation techniques and functional outcome between intramedullary nailing and plate osteosynthesis

The mechanisms of injury that causes fractures of the radius and ulna are myriad. By far the most common is some form of vehicular accident, especially automobile and motor cycle accidents. Most of these vehicular accidents result in some type of direct blow to the forearm. Other causes of direct blow injuries include fights in which one of the adversaries is struck in the forearm with a stick or rod. The person throws the forearm upto protect his or her head, and the forearm is the recipient of the violence. Following violent twisting of forearm, rotational deforming forces act leading to fracture of forearm bones.
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The effect of trauma and patient related factors on radial head fractures and associated injuries in 440 patients

The effect of trauma and patient related factors on radial head fractures and associated injuries in 440 patients

The current study was with 440 included patients one of the largest studies on the epidemiology of radial head fractures [2, 1, 18, 19]. The influences of mechanism of injury on radial head and neck fractures and associated injuries have only been once reported before [2]. The current study focused both on modes of injury and pa- tient related factors on associated injuries for radial head fractures, leading to other findings. This study had sev- eral limitations in addition to its retrospective nature. First, associated injuries were documented based on available imaging studies instead of standardized radio- graphic studies for all patients. For instance, a standard MRI was not performed, and the LCL lesions in this study were identified as avulsion fractures from the epi- condyle or during surgical reconstruction of Mason type 3 fractures. However, since most associated injuries are not clinically relevant, it is not advised to perform MRI scans on a regular basis for radial head fractures [10]. Second, the interobserver reliability of the Mason classi- fication is known to be only moderate [20]. In addition, it might be difficult to take standardized radiographs of the elbow in the acute setting because of pain. Third, there is no clear definition of amounts of energy that are transferred during different mechanisms of injury. More- over, the direction of impact (axial, direct, rotation of forearm, etc.) during trauma, may be more important to sustain associated injuries than the kind of trauma [21].
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Multiple Hereditary Exostosis of Distal Ulna with Dislocation of Radial Head: A Case Report

Multiple Hereditary Exostosis of Distal Ulna with Dislocation of Radial Head: A Case Report

First, the cross-sectional area of the distal ulnar physis was only one-quarter that of the distal radius. The distal ulnar physis being significantly smaller means that its growth could be more severely affected by the disease in the wrist. Second, the distal ulna was more commonly involved in the condi- tion than the distal radius. Third, there was more longitudinal growth at the distal ulnar physis than at the distal radial physis. Final- ly, the distal ulnar physis contributed more to total Ulnar Length than the distal radial physis did to Radial length. The contribution of the distal ulnar physis compared to the distal radius physis toward the overall growth of the ulna and the radius were 85 and 75% respectively (O’Hagan et al., 2012; Chimenti and Hammert, 2013; Cheng et al., 2014).
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Is the distal radioulnar variance useful for identification of radial head prosthesis overlengthening? A cadaver study

Is the distal radioulnar variance useful for identification of radial head prosthesis overlengthening? A cadaver study

However, there are also fibres preventing distalization of the radius against the ulna, which are mostly localised at the proximal and distal part of the forearm [25, 26]. It can be assumed that these ligamentous interactions play a significant role in the impact of overlengthening on the alignment of the proximal and distal radioulnar joints. Lanting and colleagues found that the tension within the interosseous membrane of the forearm decreased by increasing the radial head implant length [27]. Lanting et al. also found increased radiocapitellar contact pres- sures with increased length of the radial head implant. The pressure onto the capitulum exerted by overlength- ening, leading to thrust towards distalization of the radius, might be neutralised by compensatory move- ments of the highly flexible multipolar design. A possible mechanism might increase angulation by anterior tilt of the mobile head component. This leads to dorsal sublux- ation of the shaft. Yian and colleagues found multipolar prostheses to allow compensatory movements within the radiocapitellar joint [28]. Monopolar systems in con- trast do not allow compensatory movements as the shaft is amotile to the head component. This could be the rea- son why in the study of Moon and colleagues more dis- tinct differences were found by overstuffing of the radial column on the radioulnar variance [17].
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