Posterior dislocation of the shoulder is a rare injury that occurs secondary to trauma and seizures. Diagnosis is often missed and treatment is challenging. Neglected posterior dislocation is associated with Hill-Sachs lesion which leads to locking of dislocation. Correct diagnosis is achieved by history taking, a physical examination and appropriate imaging. In neglected shoulder dislocation with uncontrolled seizure and humeral head defects of up to 45% the McLaughlin procedure shows excellent results at follow-up.
Background: The commonest joint replacement performed around the world as well as in Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia, is total knee joint replacement (TKR). Bilateral TK requires single anesthesia, short hospital stay, single rehabilitation, and is cost-effective. However, some post-TKR risks have been reported. Objective: To determine the incidence of venous thromboembolism (VTE) associated with bilateral TKR. Methods: This was a retrospective study conducted at the Department of Orthopedic Surgery in PSMMC. Data on arthroplasties performed during June 2012 until June 2014 were retrieved. A total of 181 patients who had undergone TKR (unilateral = 94; bilateral = 87) for knee arthritis were included in the study. The patients had undergone primary total knee arthroplasty (TKA) using a mechanical compressive device and had received pharmaceutical prophylaxis. Color Doppler ultrasonography was performed for the bilateral common femoral veins, superficial veins, popliteal veins, and calf veins by a skilled radiologist for all symptomatic (VTE symptoms) patients. Lower-extremity venography dynamic computed tomography was performed for patients suspected of deep vein thrombosis (DVT) or pulmonary embolism (PE). Results: A total of 181 patients had TKR. Of these patients, 84 (46.41%) were male and 97 (53.59%) were female. VTE was diagnosed in 4 patients (2.21%) only. A preoperative anticoagulant was given to 58 patients (32.04%) only. The mean age of the 4 patients diagnosed with VTE was 73.5±7.93 years. Among these patients, 2 (50%) were male and 2 (50%) were female. Only 1 patient (25%) underwent unilateral TKR and the remaining 3 patients (75%) underwent bilateral TKR. Regarding type of VTE, 2 patients (50%) had PE, 1 patient (25%) had massive PE, and 1 patient (25%) had DVT. Conclusion: Our study demonstrates a low frequency of VTE after TKR in patients with and without chemoprophylaxis. Even so, orthopedic surgeons should carefully consider the risk factors of VTE before performing major orthopedic surgeries and should remain aware of the possibility of the development of DVT after surgery in high-risk patients.
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