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Background Congenital dislocation of the knee is characterised by excessive knee extension or dislocation and anterior subluxation of the proximal tibia, and this disease can occur independently or coexist with different systemic syndromes. Nevertheless, significant controversy surrounds treating this disease when combined with hip dislocation. This paper presents a case of a 4-month-old patient diagnosed with bilateral hip dislocation combined with this disease. The study discusses the pathophysiology, diagnosis, and treatment methods and reviews relevant literature. Case presentation We reported a case of a 4-month-old female infant with congenital dislocation of the right knee joint, which presented as flexion deformity since birth. Due to limitations in local medical conditions, she did not receive proper and effective diagnosis and treatment. Although the flexion deformity of her right knee joint partially improved without treatment, it did not fully recover to normal. When she was 4 months old, she came to our hospital for consultation, and we found that she also had congenital dislocation of both hip joints and atrial septal defect. We performed staged treatment for her, with the first stage involving surgical intervention and plaster orthosis for her congenital dislocation of the right knee joint, and the second stage involving closed reduction and plaster fixation orthosis for her congenital hip joint dislocation. Currently, the overall treatment outcome is satisfactory, and she is still under follow-up observation. Conclusions Early initiation of treatment is generally advised, as nonsurgical methods prove satisfactory for mild cases. However, surgical intervention should be considered in cases with severe stiffness, unresponsive outcomes to conservative treatment, persistent deformities, or diagnoses and treatments occurring beyond the first month after birth.

In materials science, dislocations are irregularities within the crystal structure or atomic scale of engineering materials, such as metals, semi-conductors, polymers, and composites.Discussing this specific aspect of materials science and engineering, Introduction to Dislocations is a key resource for students.

Purpose Congenital dislocation of the knee and hip is a rare congenital disorder. The specific aim of the study was to evaluate the clinical and radiological outcomes of the children with congenital dislocation of the knee and hip who presented after six months of age. Methods All the consecutive children with congenital dislocation of the knee and hip joints were retrospectively reviewed. We included cases that were treated after six months of age and followed up for a minimum of two years. Twenty-four children with congenital dislocation of the knee and hip (thirteen with ligamentous laxity, eleven children with stiff joints) were included. The knee was dislocated in 45 limbs; the hip was dislocated in 40 instances. The knee joint dislocation was treated with quadricepsplasty in all twenty-four children (45 knees). The hip dislocation ( n = 32) was addressed with either closed reduction ( n = 8) or open reduction of the hip ( n = 24). Eight hip dislocations were not addressed. The outcome of the hip and knee was evaluated. Results The clinical and radiological outcomes were better in children with ligamentous laxity than without laxity. Twenty-two children were community walkers. An orthosis was needed in eight children. The frequency of spontaneous reduction of unreduced dislocation of the hip was noted in three children (5/8 hips). Conclusion Outcome in combined dislocation of knee and hip is good in most cases with surgical interventions. The outcome is better in children with ligamentous laxity. Spontaneous reduction of the dislocated hips might be achieved after gaining knee flexion following knee surgery for congenital the knee in a few cases.

BACKGROUND: This study aimed to compare the medium- to long-term results of elbow collateral ligament repairs performed with suture anchors. METHODS: Patients undergoing surgery for elbow collateral ligament repairs between 2011 and 2023 were retrospectively analyzed. We included patients who had undergone surgery for complex elbow dislocations. Patients were excluded from the study if they had a previous infection, a fracture, an operation on the same elbow, a stiff elbow, or a follow-up period of less than 1 year. For the functional evaluation, the range of motion (ROM) and the Mayo Elbow Performance Score (MEPS) were used for the postoperative functional assessments. The radiological evaluation used varus and valgus stress radiographs of healthy and operated extremities taken while applying an 80 N force with a digital dynamometer. RESULTS: Thirty-five patients (24 male and 11 female) were included in the study. Eighteen patients had isolated lateral collateral ligament (LCL) injuries, nine patients had isolated medial collateral ligament (MCL) injuries, and eight patients had LCL and MCL injuries. The mean age was 32 (18-68) years, and the follow-up period was 104.8 (32-147) months. The mean value of the MEPS was 92.1 [+ or -] 10.3; 22 patients had excellent, 11 patients had good, and only two patients had fair results. Patients with isolated LCL and MCL repairs achieved better flexion motion than patients with combined ligament repairs (142.5[degrees] and 141.7[degrees] vs. 138.6[degrees]). When comparing operated and healthy extremities, radiocapitellar joint distance (RCJD) was found to increase by 0.8 [+ or -] 0.5 mm, and ulnotrochlear joint distance (UTJD) was found to increase by 1.18 [+ or -] 0.5 mm, but these changes were not statistically significant. CONCLUSION: The results of this study suggest that the use of suture anchors in elbow collateral ligament injuries is a valid solution for treatment and prevention of instability in patients with isolated or combined repairs. Keywords: Collateral ligament; elbow dislocation, repair; stability. AMAC: Bu calismanin amaci, sutur capa kullanilarak yapilan dirsek kollateral bag tamirlerinin orta ve uzun vadeli sonuclarini karsilastirmaktir. GEREC VE YONTEM: 2011-2023 yillari arasinda dirsek kollateral bag onarimi yapilan hastalar retrospektif olarak analiz edildi. Kompleks dirsek cikiklari nedeniyle ameliyat edilen hastalar calismaya dahil edildi. Daha once ayni dirsekten enfeksiyon geciren, ayni dirsekten kirik ve ameliyat gecirme oykusu olan veya sert dirsek tanisi olan ve 1 yildan daha kisa takip suresi olan hastalar calismaya dahil edilmedi. Fonksiyonel degerlendirme icin eklem hareket acikligi (EHA) ve Mayo Elbow Performance Score (MEPS) kullanildi. Radyolojik degerlendirmede saglam ve ameliyat edilen ekstremitelere dijital dinamometre ile 80 N kuvvet uygulanirken cekilen varus ve valgus stres radyografileri kullanildi. BULGULAR: Calismaya 35 hasta (24 erkek ve 11 kadin) dahil edildi. On sekiz hastada izole lateral kollateral ligament (LKL) yaralanmalari, dokuz hastada izole medial kollateral ligament (MKL) yaralanmalari ve sekiz hastada LKL ve MKL yaralanmalari vardi. Ortalama yas 32 (18-68) yildi ve takip suresi 104.8 (32-147) aydi. Hastalarimizin ortalama MEPS degeri 92.1 [+ or -] 10.3 idi; 22 hastada mukemmel, 11 hastada iyi ve sadece iki hastada orta sonuc vardi. Izole LKL ve MKL onarimli hastalar, kombine bag onarimli hastalara gore daha iyi fleksiyon hareketi elde ettiler (142.5[degrees] ve 141.7[degrees]'ye karsi 138.6[degrees]). Ameliyat edilen ve saglam ekstremiteler karsilastirildiginda ameliyat edilen tarafta radyokapitellar eklem mesafesinin (RKEM) 0.8 [+ or -] 0.5 mm, ulnotroklear eklem mesafesinin (UTEM) ise 1.18 [+ or -] 0.5 mm arttigi bulundu, ancak bu degisiklikler istatistiksel olarak anlamli degildi. SONUC: Bu calismanin sonuclari, dirsek kollateral bag yaralanmalarinda dikisli capa kullanilarak yapilan izole veya kombine bag tamirlerinin instabilitenin tedavisi ve onlenmesi icin gecerli bir cozum oldugunu gostermektedir. Anahtar sozcukler: Dirsek cikigi; kollateral bag; stabilite; onarim.

Dislocations are the intrinsic origin of crystal plasticity. However, initial high-density dislocations in work-hardened materials are commonly asserted to be detrimental to ductility according to textbook strengthening theory. Inspired by the self-organized critical states of non-equilibrium complex systems in nature, we explored the mechanical response of an additively manufactured medium entropy alloy with segregation-dislocation self-organized structures (SD-SOS). We show here that when initial dislocations are in the form of SD-SOS, the textbook theory that dislocation hardening inevitably sacrifices ductility can be overturned. Our results reveal that the SD-SOS, in addition to providing dislocation sources by emitting dislocations and stacking faults, also dynamically interacts with gliding dislocations to generate sustainable Lomer-Cottrell locks and jogs for dislocation storage. The effective dislocation multiplication and storage capabilities lead to the continuous refinement of planar slip bands, resulting in high ductility in the work-hardened alloy produced by additive manufacturing. These findings set a precedent for optimizing the mechanical behavior of alloys via tuning dislocation configurations. Textbook theory asserts that dislocation hardening inherently sacrifices ductility. Here, the authors report that high-density dislocations with segregation-modified configurations produced by additive manufacturing increase strength without compromising ductility.

Pure isolated dislocation of the hamatometacarpal joint is extremely rare. Herein we reported a rare case of pure isolated dislocation of the fifth carpometacarpal joint which was successfully treated surgically. Although, the hamatometacarpal dislocations are uncommon and frequently missed, a high index of suspicion combined to adequate radiological assessment usually ascertain the diagnosis.

AbstractObjectiveTo assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy.DesignPragmatic, multicentre, randomised controlled trial (ARTISAN).Setting and participantsTrauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management.InterventionsOne session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses.Main outcome measuresThe primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications.Results482 participants were recruited from 40 sites in the UK. 354 (73%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95% confidence interval −0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05).ConclusionsAn additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy.Trial registrationCurrent Controlled Trials ISRCTN63184243.

Purpose Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. Methods Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. Results Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI ( p  = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38–11.03], LTI (6.6 [0.6–68.1]), TT-TG (2.9 [0.9–9.2]), and patellar height according to ISI (2.3 [0.7–7.5]) and CDI (2.3 [0.7–7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42–100) points and an IKDC score of 90.6 ± 11.7 (55.2–100) points. Conclusion Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. Level of evidence Level IV

A wide variety of industrial applications require materials with high strength and ductility. Unfortunately, the strategies for increasing material strength, such as processing to create line defects (dislocations), tend to decrease ductility. We developed a strategy to circumvent this in inexpensive, medium manganese steel. Cold rolling followed by low-temperature tempering developed steel with metastable austenite grains embedded in a highly dislocated martensite matrix. This deformed and partitioned (D and P) process produced dislocation hardening but retained high ductility, both through the glide of intensive mobile dislocations and by allowing us to control martensitic transformation. The D and P strategy should apply to any other alloy with deformation-induced martensitic transformation and provides a pathway for the development of high-strength, high-ductility materials.

Purpose The purpose of this study was to investigate the Danish population as a whole from 1994 to 2013 to find the incidence of acute and recurrent patellar dislocation. Methods The study was performed as a descriptive epidemiological study. The Danish National Patient Registry was retrospectively searched from 1994 to 2013 to find the number of acute and recurrent patellar dislocation. National population data were collected from Statistics Denmark. Results The period 1994–2013 saw a total registration of 24,154 primary patellar dislocations. A mean incidence of 42 (95% CI 37–47) per 100,000 person-years at risk was found, and young females aged 10–17 had the highest incidence of 108 (95% CI 101–116). In a 10-year follow-up, patients were at an overall risk of 22.7% (95% CI 22.2–23.2) of suffering a recurrent dislocation, with young girls aged 10–17 experiencing the highest risk, namely 36.8% (95% CI 35.5–38.0). The overall risk of suffering a patellar dislocation in the contralateral knee was 5.8% (95% CI 5.5–6.1) and 11.1% (95% CI 10.4–11.7) for patients aged 10–17. Conclusion A high incidence rate of primary patellar dislocation was found both as a mean in the population (42/100,000), and particularly in patients aged 10–17 (108/100,000). The risk of recurrent dislocation in the affected knee (22.7%) and the contralateral knee (5.8%) was high, which could indicate the influence of an underlying pathomorphology. This is relevant knowledge to the clinician, as he/she should be aware of the high risk of recurrent dislocation when deciding on treatment, especially in young patients. Level of evidence IV.