Subtalar Dislocation Research Articles

Anesthesia Management in a Rare Case of Closed Subtalar Dislocation with Posterior Process Talus Fracture: A Case Report and Review of Literature

Anesthesia Management in a Rare Case of Closed Subtalar Dislocation with Posterior Process Talus Fracture: A Case Report and Review of Literature

Medial Subtalar Dislocation: Case Report and Review of the Literature

Medial Subtalar Dislocation: Case Report and Review of the Literature

Fracture of the Posteromedial Tubercle of the Talus: Case Series of Fifteen Patients Along with Cadaveric Dissection and Anatomic Considerations for Surgical Approach

Category:Ankle; Hindfoot; TraumaIntroduction/Purpose:Fractures of the talus are among the most commonly fractured bone of the foot, with 10 to 21% involving the posterior process. These fractures have not been well characterized or reported in the literature and is limited to case reports and case series. The primary objective of this study is to characterize posterior process fractures, describe a surgical approach for open reduction internal fixation (ORIF) with the use of cadaveric dissection pictures of surgical technique and describe 15 cases.Methods:A search query of the institutional database was performed for all adult patients that sustained talar fractures at the University of Cincinnati Medical Center from 1/1/2010 to 12/31/2018. Patients sustaining posterior process talus fractures who underwent operative fixation and nonoperative treatment were identified. All radiographs and CT images were then reviewed by three orthopedic surgeons and the electronic medical record was reviewed for injury characteristics, method of operative fixation, and postoperative complications.Results:15 cases of posterior process fractures were identified. Overall, 4 patients had fixation placed in the posterior process fracture while 11 did not. None of the patients who underwent ORIF of the posterior process developed subtalar arthritis at their latest follow-up, while 3 of the 11 (27.3%) that did not receive fixation suffered from subtalar arthritis and 1 (9.1%) required surgery for removal of retained loose bodies. 13 patients (86.67%) initially had plain radiographs that missed the diagnosis. Cadaveric specimens were used to illustrate surgical approach for ORIF of these talus fractures. Anatomic pictures of the surgical dissection were taken to show the extent of exposure to the posterior process fracture using traditional techniques, as well as methods of distraction to enhance visualization are demonstrated.Conclusion:Providers must have high suspicion for posterior process talus fractures as many are missed on the initial radiographs. CT scans are recommended for all patients with subtalar dislocations. Those with subtalar dislocation tend to have comminuted fragments. Significant morbidity is associated with this injury regardless of whether it is treated operatively or nonoperatively. We describe a surgical technique using distractors to adequately visualize the posteromedial process fracture of the talus.

Repair of a Comminuted Talar Neck Fracture using a Cellular Bone Allograft combined with a Textured Allograft Wedge

Category:Trauma; AnkleIntroduction/Purpose:Talar neck fractures are uncommon and are characterized by displacement, comminution, and soft tissue injury. Treatment of talar neck fractures while avoiding complications, such as osteonecrosis and long-term morbidity, presents a unique challenge to surgeons. One option for treating talar neck fractures is cellular bone allograft containing viable lineage- committed bone cells (V-CBA), which provides the osteoconductive, osteoinductive, and osteogenic properties needed for bone formation. Additionally, a structural textured allograft (STA) wedge designed to resist migration and sustain compressive force can also be used in repairing talar neck fractures. This case study describes the successful repair of a comminuted talar neck fracture using V-CBA combined with an STA wedge.Methods:A 46-year-old male patient sustained a talar neck fracture following a fall from a 12-foot ladder. Radiographic and computed tomography (CT) imaging revealed significant comminution, consequent varus angulation, and a large bony void, as well as dislocation of the posterior subtalar joint. The patient was otherwise healthy with no comorbidities. Open reduction internal fixation was performed laterally to reduce the posterior subtalar dislocation. Medially, a 6.5mm STA wedge was used to correct the varus deformity and 1cc of V-CBA was used to fill the void.Results:At 6 months, the talar neck fracture had healed with solid osseous consolidation evident on radiographic images.Conclusion:These results demonstrate that an STA wedge, with a textured design that resists migration, used in combination with a V-CBA successfully repaired a comminuted talar neck fracture.

Tibial Nerve Dysfunction Associated With Operatively Treated Talar Neck Fractures.

To investigate the presence of tibial nerve dysfunction (TND) in operatively treated talar neck fractures. Retrospective chart review. Urban Level-1 trauma center. Sixty-four patients for a total of 65 talar neck fractures treated with open reduction and internal fixation between January 1, 2014, and May 1, 2018. Incidence of TND. Evidence of TND was documented in 20 of 65 cases (30.8%) of talar neck fractures. There were no cases of TND associated with Hawkins I fractures, but TND was found in 7 of 32 Hawkins II fractures (21.9%), 10 of 24 Hawkins III fractures (41.7%), and 3 of 5 Hawkins IV fractures (60%). TND was reported in 11 of 19 open talar neck fractures (57.9%) (P = 0.002). TND was associated with tibiotalar dislocation (P = 0.017) but not subtalar dislocation (P = 0.17). TND did not occur in the absence of subtalar subluxation/dislocation. Of 18, a total of 6 (33.3%) reported partial recovery, and 6 (33.3%) reported full recovery within 6 months of the initial injury. By 12 months, of the 18, 8 (44.4%) reported partial recovery and 7 (38.9%) reported full recovery. The tibial nerve and its distal branches are at risk of injury in the setting of displaced talar neck fracture, tibiotalar subluxation/dislocation, and open talar neck fracture with increasing risk among those with a higher Hawkins grade. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Endoscopically Assisted Reduction and Screw Fixation of Acute Fracture of the Posteromedial Talar Process (Cedell Fracture)

Fracture of the posteromedial talar process (Cedell fracture) is a rare injury and is usually associated with other injuries such as medial subtalar dislocation. Diagnosis of the fracture necessitates a heightened clinical suspicion, and computed tomography should be performed in any suspicious cases. Timely treatment is important for restoration of proper anatomy and function of the subtalar joint. Significant morbidity is associated with an undiagnosed or nonoperatively treated fracture of the posteromedial talar process, especially in a larger fracture that is intra-articular at both the ankle and subtalar joints. In this Technical Note, the technical details of endoscopically assisted reduction and screw fixation of acute posteromedial talar fracture is described. This can allow fracture reduction and fracture fixation under endoscopic visualization.

Functional outcome of modified Blair’s arthrodesis for injuries of Talus

Introduction: Fracture neck of the talus associated with or without subtalar, tibiotalar joint and talonavicular joint dislocation can be considered a devastating injuries to the ankle joint. Most of these cases will complicate as osteonecrosis of body of talus, which takes very long time (years) for revascularization even after prolonged non weight bearing. The present study reports the functional outcome of talus injuries, which are treated with modified blair’s arthrodesis through anterior approach. Materials and Methods: This is a prospective study conducted in katuri medical college & hospital, Guntur, from July 2018 to January 2020. Total nine number of patients who were treated with modified blair’s arthrodesis for talar neck fracture in nonunion and osteonecrosis were selected in this study. The median interval between injury and index surgery was 6 weeks to 20 weeks. All the patients were followed with serial radiographs and assessment of tibio pedal movement was done. Ankle joint functional outcome after the surgery was assessed by rating systems such as visual analog scale and American orthopaedic foot and ankle society score preoperatively and at follow up of 1 year. Results: Tibio talar bony union was achieved in all cases at an average of 20Weeks. Five cases (55.5%) had excellent results with 15-20 deg tibio pedal movements and four cases (44.4%) had good results with 10-15 deg of tibio pedal movements. In this study, postoperative American orthopaedic foot and ankle society score was 85.44 + 5.20, P 51.3+16.19, P +1.05 to 0.44+0.88 at follow up of 1 year (P value= 0.0001). Conclusion: Good longterm results were achieved with modified blair’s arthrodesis. This technique has high reliability in pain relief and with remaining tibio pedal motion patient can walk more physiologically without any difficulty. Keywords: Talus, Fracture dislocation, Non-union, Osteonecrosis, Modified blair’s arthrodesis.

Subtalar and Chopart Dislocations in Children and Adolescents

Subtalar and Chopart dislocations are extremely rare in childhood but become slightly more common in older children and adolescents. Subtalar dislocation involves dislocation of the subtalar and talonavicular joints, with intact tibiotalar and calcaneocuboid joints, in the absence of a talar neck fracture. It should be differentiated from the Chopart dislocation and from traumatic entities presenting radiographically as isolated talonavicular dislocations. Chopart joint injury involves the talonavicular and calcaneocuboid joints of the foot. The injury may appear as sprain, fracture, subluxation or dislocation. Diagnosis is made on plain radiographs; although initial views may not reveal the severity of the lesion, since spontaneous reduction may occur. The radiographic detection of an isolated talonavicular dislocation is probably indicative of a Chopart joint injury, in which a momentary subluxation or dislocation of the calcaneocuboid joint has occurred. The differential diagnosis of a radiographically detected isolated talonavicular dislocation should also include traumatic entities associated with intact calcaneocuboid joint, such as the swivel talonavicular dislocation and the isolated displacement of only the medial part of the Chopart joint. The swivel talonavicular dislocation is a subtype of the Chopart joint injury, in which the foot with the calcaneus is rotated beneath the talus, producing subtalar subluxation but not dislocation. In the isolated displacement of only the medial part of the Chopart joint the subtalar joint is not injured. The injury is usually associated with a fracture of the body of the tarsal navicular and it is believed to be the result of severe abduction or adduction of the forefoot. Subtalar dislocations and Chopart joint injuries in children and adolescents seem to be comparable with their adult counterparts in the mechanism of injury, classification, treatment, complications and outcome. The challenges in treating these injuries are to achieve adequate diagnosis and prompt treatment. It appears mandatory that obtaining and maintaining an early anatomic reduction remains the key factor in achieving good outcomes. However, a high incidence of complications, such as compartment syndrome, soft tissue compromise, avascular necrosis of bone, bone growth deformities and debilitating early post-traumatic arthritis, have been reported. The purpose of this report is to review the relevant publications on subtalar and Chopart dislocations in children and adolescents and to present illustrative cases treated at our institution.

90° Rotation of talus in a closed medial subtalar dislocation: A unique case

Subtalar dislocations are rare and account for about 1% of all dislocations. Standard management is by prompt reduction by closed means, which if unsuccessful, should be followed by open reduction. We present a case report of a closed medial subtalar dislocation in which the talus is internally rotated by 90° and the talar dome formed a pseudoarticulation with the medial malleolus following unsuccessful attempts at closed manipulation and reduction. The patient underwent successful open reduction and fixation and subsequently recovered completely with an American Orthopaedic Foot and Ankle Society hindfoot score of 100 at 5 years after injury. To the best of our knowledge, this is the first case report of a closed talus rotation.

Diagnosis and Treatment of Peritalar Injuries in the Acute Trauma Setting: A Review of the Literature.

The bony and ligamentous structure of the foot is a complex kinematic interaction, designed to transmit force and motion in an energy-efficient and stable manner. Visible deformity of the foot or atypical patterns of swelling should raise significant concern for foot trauma. In some instances, disruption of either bony structure or supporting ligaments is identified years after injury due to chronic pain in the hindfoot or midfoot. This article will focus on injuries relating to the peritalar complex, the bony articulation between the tibia, talus, calcaneus, and navicular bones, supplemented with multiple ligamentous structures. Attention will be given to the five most common peritalar injuries to illustrate the nature of each and briefly describe methods for achieving the correct diagnosis in the context of acute trauma. This includes subtalar dislocations, chopart joint injuries, talar fractures, navicular fractures, and occult calcaneal fractures.

Management of Subtalar Fractures-Dislocations at Ségou Hospital in Mali: A 7 Cases Series

Introduction: Subtalar or peritalian dislocation is rare; it represents 15% of peritalian injuries. The aim of this study was to describe the radioclinical and therapeutic characteristics and to assess the functional result. Patients and Methods: This study is about a continuous descriptive and prospective study over a period of 5 years. It has been conducted from March 2013 to February 2018 at the Segou Hospital, a second referral hospital in Mali. The functional results were evaluated by the score of the American Orthopedic Foot and Ankle Society (AOFAS). Results: Seven cases of subtalar dislocation fractures were diagnosed in six male patients with an average age of 38 years (36 to 47 years old). In five cases the etiology of the trauma was a motorcycle accident and a fall from height. The lesion was bilateral in one case. The average time to care was 3 hours (1 to 9 hours). There was one case of open dislocation fracture with talus enucleation. The dislocation was medial in 6 cases and lateral in one case. It was pure in three cases. The treatment was orthopedic in 2 cases and surgical in 5 cases. The post-operative complications were complicated by an infection of the operative site in one case. The average length of hospital stay was 4 days. The functional result was excellent in 2 cases; good in 2 cases, fair in 2 cases and poor for 1 case. Conclusion: Subtalar dislocation is a rare and serious lesion of the posterior tarsus. The long-term prognosis depends on the earliness of treatment and the severity of the associated injuries.

Closed External Subtalar Dislocation: A Case Report

Subtalar dislocation is described as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. This injury is rare, and represents 1% of dislocations. We report the case of 28-year-old male patient, without any medical history, who had been involved in a sport accident causing a rare closed external subtalar dislocation without any bone fracture. An open reduction was indicated after failure of closed reduction and the X-ray control showed good joint congruence; the fixation was maintained for 6 weeks and then the rehabilitation was started. The evaluation was favorable, and we noted good functional results after a decline of 12 months.

Posterior subtalar joint dislocation with associated fracture of talus and soft tissue injury: A case report

Posterior subtalar joint dislocation with associated fracture of talus and soft tissue injury: A case report

Closed medial subtalar dislocation: case report and review of the literature

A rare case of medial subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. These talar dislocations represent 1%-2% of all dislocations. A case of uncomplicated medial subtalar joint dislocation managed by closed reduction under anaesthesia with excellent functional outcome is presented. In cases of open subtalar joint dislocation immediate reduction, wound debridement and if necessary (external) stabilization is critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular necrosis of the talus. Other long-term sequelae include osteochondral fracture and subtalar joint instability.

Conservative management of isolated medial subtalar joint dislocations in volleyball players: a report of three cases and literature review

Isolated subtalar dislocations (SDs) are rare injuries, representing only 1% of all foot traumas. In the current literature, only a few reports have described this acute injury as a consequence of low-middle-energy trauma during sports activities and none in professional or recreational volleyball players. Further, to the best of our knowledge, no validated standard rehabilitation programs have been described for SDs as most of them are usually treated like an ankle sprain. This report describes 3 cases of isolated, closed medial SD, which occurred during non-professional volleyball activities. All cases were successfully treated by the same conservative method: standard radiographs for diagnosis, closed reduction, subsequent CT scan to exclude associated lesions, 4-week immobilization in a below-knee cast and an early physiokinesis therapy program. Further, a review of the recent literature concerning SD was performed. The standard method applied allowed our patients to return to full sports activity at 3 months from trauma, reaching a medium AOFAS score of 96.6 at minimum follow-up of 48 months. The treated cases and the review of the literature suggest that a conservative method and early mobilization should be the first-choice treatment for closed SD, even in volleyball players. Despite the absence of a sport-specific rehabilitation program for these injuries, early physiokinesis therapy, after no more than 4-week immobilization period, allowed the improvement of our patients' hindfoot stability and their fast return to full sports activities, without any recurrence at minimum follow-up of 2 years.

Diagnosis and treatment of subtalar dislocation of the foot

Diagnosis and treatment of subtalar dislocation of the foot

Isolated medial subtalar dislocation: the importance of early mobilization

Background and objective: Isolated subtalar dislocations are rare injuries. Current studies have reported that it requires 5 or 6 weeks immobilization after the injury. The purpose of this study was to understand the effect of 4-week immobilization on the recovery of foot function after isolated medial subtalar dislocation. Subject and methods: We reported a rare case of an isolated medial subtalar dislocation in a male who was immobilized for only 4 weeks after closed reduction under anesthesia. The patient underwent early mobilization of the feet and ankles. This report has been submitted after due approval from the Institutional Review Board of Jagadguru Sri Shivarathreeshwara Hospital, India. Results: The patient was successfully managed by closed reduction under anesthesia. The foot function of the patient recovered well at 6 months of follow-up. The results of 1-year follow-up showed that the foot function was basically normal. Conclusion: Early closed reduction and early mobilization of the foot and ankle ensured the good functional outcome.

Talar neck fracture accompanied with subtalar dislocation

Talar neck fracture accompanied with subtalar dislocation

Operative treatment of closed subtalar dislocation with associated fracture: A case report

Operative treatment of closed subtalar dislocation with associated fracture: A case report

Surgical Treatment of Posteromedial Talus Fractures: Technique Description and Results of 10 Cases.

Background:The aim of this study is to describe a surgical technique for successful treatment of posteromedial talar body fractures and establish treatment recommendations for fractures of the posterior aspect of the talus.Materials and Methods:Ten patients treated operatively for a posteromedial talar body fractures entering both the subtalar and ankle articulations with a minimum of 1-year followup were identified from a trauma database. Age, mechanism of injury, associated injuries, time to surgery, complications, the range of motion, secondary procedures, and need for arthrodesis were evaluated.Results:Followup averaged 4.8 years (1–10). Eight of ten patients had high-energy mechanisms of injury. Six patients had associated medial subtalar dislocations with two open. Associated injuries were common. No surgical complications occurred. The range of motion was present but decreased. No arthrodesis procedures were performed.Conclusions:Operative fixation of posteromedial talus fractures with the described surgical technique resulted in acceptable outcomes in this series of patients with improved outcomes when compared to prior reports in the literature.