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OBJECTIVES: This study aimed to verify the accuracy of clinical protocols for the diagnosis of disc displacement (DD) compared with MRI, considering examiners' calibration. METHODS: PubMed, Cochrane (Central), Scopus, Web of Science, LILACS, Embase, Science Direct, Google Scholar, and DANS EASY Archive databases were searched. Two reviewers independently screened and selected the studies. A meta-analysis was conducted using the R Statistical software. Results are shown using sensitivity and specificity, and 95% confidence intervals. RESULTS: Of the 20 studies included in the systematic review, only three were classified as low risk of bias. Seventeen studies were included in the meta-analysis. Compared to MRI, clinical protocols showed overall sensitivity and specificity of 0.75 (0.63-0.83) and 0.73 (0.59-0.84) for DD diagnosis, respectively. For DD with reduction, sensitivity was 0.64 (0.48-0.77) and specificity was 0.72 (0.48-0.87). For DD without reduction, sensitivity was 0.58 (0.39-0.74) and specificity 0.93 (0.83-0.97). Only 8 studies reported examiner calibration when performing clinical and/or MRI evaluation; nevertheless, calibration showed a tendency to improve the diagnosis of DD. CONCLUSION: The sensitivity and specificity of clinical protocols in the diagnosis of DD are slightly below the recommended values, as well as the studies lack calibration of clinical and MRI examiners. Examiner calibration seems to improve the diagnosis of DD.

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Trans-scaphoid perilunate fractures-dislocations are rare injuries caused by high-energy trauma of the wrist. Diagnosis is based on medical history, physical examination, and tools such as radiographs, computed tomography scan, and magnetic resonance imaging. Early treatment consists of closed reduction and casting to stabilize the limb. Definitive treatment is surgical and includes bone and soft tissue repair. A case of trans-scaphoid perilunate fracture-dislocation is presented, along with diagnosis, management and outcome.

Las fracturas-luxaciones transescafo-perilunares son lesiones infrecuentes causadas por impactos de alta energía hacia la muñeca. El diagnóstico se basa en la historia clínica, exploración física y herramientas como la radiografía, la tomografía computarizada y la resonancia magnética. El manejo inmediato consiste en una reducción cerrada e inmovilización para estabilizar la extremidad. El tratamiento definitivo es de carácter quirúrgico e incluye la reparación ósea y de tejidos blandos. Se presenta un caso de fractura-luxación transescafo-perilunar, su diagnóstico, manejo y evolución.

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This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR). Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 - TMJ arthrocentesis with the classic concentric needle; and group 2 - TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale - VAS, 0-10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes). Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups. Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients' pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months.

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The neuropathic compression of the tibial nerve and/or its branches on the medial side of the ankle is called tarsal tunnel syndrome (TTS). Patients with TTS presents pain, paresthesia, hypoesthesia, hyperesthesia, muscle cramps or numbness which affects the sole of the foot, the heel, or both. The clinical diagnosis is challenging because of the fairly non-specific and several symptomatology. We demonstrate a case of TTS caused by medial dislocation of the talar bone on the calcaneus bone impacting the tibial nerve diagnosed only by ultrasound with the patient in the standing position.

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INTRODUCTION: metacarpophalangeal dislocations of the thumb are not very frequent injuries, it is necessary to know the anatomy of the region to know possible causes of interposition that prevent a closed reduction of this pathology. CASE PRESENTATION: we present the case of a 75-year-old woman with a post-traumatic metacarpophalangeal dislocation of the thumb that required open reduction and surgical repair. In this procedure, we performed reduction of the dislocation, mobilization of the interposed structures, repair of the capsule and reinsertion of the ulnar collateral ligament. The early mobilization protocol helped to obtain very good results. CONCLUSION: it is imperative to consider possible associated injuries during the acute phase to achieve optimal short, medium, and long-term outcomes for our patients. A comprehensive and proactive approach to diagnosis and treatment is vital in effectively addressing this pathology and minimizing its potential sequelae.

INTRODUCCIÓN: las luxaciones metacarpofalángicas del pulgar no son lesiones muy frecuentes, es necesario conocer la anatomía de la región para conocer posibles causas de interposición que impidan una reducción cerrada de esta patología. PRESENTACIÓN DEL CASO: presentamos el caso de una mujer de 75 años con luxación metacarpofalángica postraumática del pulgar que requirió reducción abierta y reparación quirúrgica. En este procedimiento realizamos reducción de la luxación, movilización de las estructuras interpuestas, reparación de la cápsula y reinserción del ligamento colateral cubital. El protocolo de movilización temprana ayudó a obtener muy buenos resultados. CONCLUSIÓN: es imperativo considerar posibles lesiones asociadas durante la fase aguda para lograr resultados óptimos a corto, mediano y largo plazo para nuestros pacientes. Un enfoque integral y proactivo del diagnóstico y tratamiento es vital para abordar eficazmente esta patología y minimizar sus posibles secuelas.

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Nontraumatic pathologic conditions of the craniovertebral junction encompass a range of conditions affecting the complex anatomy of this region without direct physical injury. These conditions include congenital syndromes that predispose individuals to ligamentous laxity, potentially leading to instability. Additionally, rare but noteworthy cases such as Grisel syndrome, a cause of pediatric torticollis, may arise without a traumatic trigger. Inflammatory diseases, including rheumatoid arthritis, ankylosing spondylitis, and crystal deposition, can lead to cervical instability and spinal cord compression. Infections at the upper cervical spine are dominated by tuberculosis, typically transmitted through hematologic or lymphatic routes with characteristic imaging findings. On the other hand, purulent bacterial infections in this area are rare. Furthermore, although tumors involving the structures of the craniovertebral junction are infrequent, they can lead to significant complications, albeit less frequently through cord compression and more commonly via pathologic fractures or subluxation. The craniocervical junction is a complex anatomic region comprising ligaments, bones, joints, and muscles that support the head's weight and enable its wide range of motion. Accurate recognition and understanding of the complex anatomy and the various nontraumatic pathologic conditions at the craniovertebral junction are pivotal for initiating timely and appropriate treatment strategies. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

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OBJECTIVES: Lateral humeral condyle fractures account for 12% to 17% of all distal humerus fractures in children, and usually occur as an isolated injury or are associated with radial neck and/or proximal ulna fractures. The presentation with a concomitant dislocation of the elbow is rare. Therefore, literature on young patients with this uncommon combination is sparse and mostly limited to case reports and small case series. The aim of the present study is to identify the best treatment strategy for this injury, recognize potential risk factors for the development of complications, and identify predictors of outcome. METHODS: This is a multicenter retrospective review of electronic and written medical records for skeletally immature patients who were diagnosed with a lateral condyle fracture of the humerus associated with elbow dislocation (ED). Data recorded included patient demographics, fracture classification, direction of the dislocation, treatment strategy, time to union, elbow range of motion, complications, and additional procedures. The modified Flynn criteria were used to determine the outcomes. RESULTS: We identified 23 patients who presented to 3 institutions with a concomitant lateral humeral condyle fractures and an ED. The mean age at the time of injury was 8.7 years (range: 6 to 13 y). The median time from injury to surgery was 1 day (interquartile range: 0.5, minimum to maximum: 0 to 29 d). The median follow-up was 24 weeks (interquartile range: 16, minimum to maximum: 4 to 120 wk). The injury occurred more commonly in males (79%) with Weiss type 3 fractures. The direction of the dislocation was posterior or posteromedial in most cases. Open reduction through a modified Kocher lateral approach and fixation with either Kirschner wires (N = 12) or cannulated screws (N = 9) was the preferred method of treatment. Eight patients (34.8%) developed complications, including persistent elbow stiffness (N = 5), elbow instability (N = 1), and avascular necrosis (N = 2). There were no cases of delayed union, nonunion, malunion, heterotopic ossification, neurological injury, or hardware failure. Patients treated with casting or Kirschner wire fixation had a significantly increased rate of elbow stiffness compared with screw fixation (50%, 25%, and 11%, respectively, P = 0.015). According to Flynn's criteria, 65% of the patients had good or excellent outcomes, and 35% had poor. CONCLUSION: The findings of this study demonstrate a higher than previously described rate of complications in children with lateral condyle humerus fracture associated with ED, including persistent elbow stiffness, avascular necrosis, and chronic elbow instability, leading to unsatisfactory clinical outcomes in over one-third of the cases. Our findings suggest that the internal fixation with screws, combined with a shorter postoperative immobilization period (2 wk) may lead to improved clinical outcomes. LEVEL OF EVIDENCE: Level III-therapeutic, case series.

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PURPOSE: High success rates and minimal complications have consolidated arthroscopy as the therapeutic alternative of choice for minimally invasive treatment of internal disorders (ID) of the temporomandibular joint (TMJ). However, there is no certainty regarding the demographic and clinical factors associated with the technique's success or failure. This study was performed to analyze the effectiveness of arthroscopy regarding pain and the mandibular dynamics and also to determine whether variables such as age, sex, and preoperative Wilkes stage influence the results. METHODS: A retrospective study was conducted involving 92 patients with ID of the TMJ between September 2017 and February 2020. In all cases, a first stage of intra-articular lysis and lavage was executed. As needed, a phase of operative arthroscopy or arthroscopic discopexy was implemented. RESULTS: A total of 152 arthroscopies were performed. Both the variation in pain and mouth opening in patients with ID of the TMJ treated were statistically significant for the follow-up periods studied. Better results were observed for patients with lower Wilkes stages. No association with age was found. CONCLUSION: Based on the results, we recommend early intervention as soon as an ID in the TMJ is detected.

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OBJECTIVE: Evaluate injury trends in Brazilian Jiu Jitsu (BJJ) participation by presenting to U.S. emergency departments over a 10-year period and formulate an injury profile. METHODS: The U.S. Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS) database was queried for martial arts related injuries from 1 January 2012 to 31 December 2021. Codes and narratives were examined to compile data for patients sustaining BJJ-related injuries. RESULTS: From 1 January 2012 to 31 December 2021 there were 7,722 (NE = 282,315) ED-diagnosed martial arts related injuries with 911 (NE = 36,023) BJJ-related injuries identified. Regression analysis demonstrated an increasing trend in the annual incidence of Brazilian Jiu Jitsu injuries presenting to the ED (R2 = 0.934; SE = 2.069: p < .0001). Average age was 25.68 years of age (range 4-83). The most common injury diagnoses were sprains/strains and other/not listed at 27.68% and 26.39%. The most commonly injured body parts were the upper trunk, and the shoulder comprising 13.66% and 12.14% of injured body parts, respectively. The most commonly fractured region was toes, at 14.15% of all fractures. The most common dislocations occurred at the shoulder and knee, at 32.49% and 28.45% of dislocations, respectively. The most common mechanisms of injury specifically identified were indeterminate contact between players, fall onto ground, or fall onto another player comprising 18.62% and 17.17%, of injuries, respectively. CONCLUSION: There was an increasing trend of BJJ-related injuries presenting to U.S. Emergency Departments. The most common diagnoses and body parts injured were sprains/strains and upper trunk and shoulder, respectively. The most commonly fractured and dislocated regions were toes and shoulder, respectively. The most common mechanisms of injury were indeterminate contact or falling. This study provides novel information concerning trends in injury and injury profiles for Brazilian Jiu Jitsu related injuries.

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Introducción: Las luxofracturas vertebrales toracolumbares se producen por traumatismos de alta energía, representan el 10% de las lesiones traumáticas de la columna vertebral y se asocian frecuentemente con otras lesiones. El objetivo de este estudio fue comparar las complicaciones tempranas en pacientes con una luxofractura toracolumbar según la oportunidad quirúrgica, antes o después de las 24 h del trauma. Materiales y métodos: Estudio multicéntrico, analítico, observacional y retrospectivo de una cohorte de pacientes operados por una luxofractura toracolumbar, desde el 1 de enero de 2014 hasta el 1 de enero de 2023. Se inclu-yó a pacientes de ambos sexos, >18 años, operados por una luxofractura vertebral de alta energía. Se los agrupó según si habían sido operados de columna antes o después de las 24 h del trauma. Se registraron las complicaciones totales y agrupadas. Resultados: Se evaluó a 72 pacientes, 64 hombres (88,9%) y 8 mujeres (11,1%), con una edad promedio de 35.94 años. Predominaron las instituciones laborales (n = 60; 83,3%). El mecanismo de lesión más frecuente fueron los accidentes de tránsito (n = 42; 58,3%), seguidos de las caídas de altura (n = 26; 36,1%). El 86% sufrió una o más lesiones asociadas. Se registraron 283 complicaciones en 67 (93,1%) pacientes y 45 complicaciones quirúrgicas en 26 pacientes (36,1%). La mediana de complicaciones fue mayor en pacientes operados tardíamente (p = 0,004). Conclusiones:Los pacientes con luxofractura toracolumbar operados después de las primeras 24 h presentaron una mediana de complicaciones totales significativamente mayor que los operados precozmente. Nnivel de Evidencia: IV

Introduction: Thoracolumbar fracture-dislocations account for 10% of traumatic spinal injuries and typically occur in the context of high-energy trauma. Our objective is to compare early complications in patients with thoracolumbar fracture-dislocation based on surgical timing, either before or after 24 hours from the trauma.materials and methods: This is a multicenter, retrospective cohort study of patients surgically treated for thoracolumbar dislocations, from January 1, 2014 to January 1, 2023. We included adult patients (>18 years old) of any gender, surgically treated for high-energy thoracolumbar fracture-dislocations. Patients were grouped based on when they underwent spinal surgery: before or after 24 hours following trauma. Total and grouped complications were recorded. Results: Our sample comprised 72 patients, with 64 men (88.9%) and 8 women (11.1%) at an average age of 35.94 years. Occupational health care centers were predominant (n=60; 83.3%). Road traffic accidents (n=42; 58.3%) were the most frequent cause of injury, followed by falls from height (n=26; 36.1%). Furthermore, 86% of patients had one or more associated injuries. In total, 283 complications were recorded, with 67 patients (93.1%) suffering at least one complication, and 26 patients (36.1%) experiencing surgical complications. The median number of complications was significantly higher in late-operated patients (p=0.004). Conclusions: Patients with thoracolumbar dislocations who underwent surgery after the first 24 hours following trauma had a significantly higher median rate of complications than those who underwent early surgery. Level of Evidence: IV

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