Dislocation Of Talus Research Articles

Open total talus dislocation without concomitant malleoli fracture: a case report

BackgroundTotal talus dislocation without ankle (malleoli) fracture is a very rare injury with prevalence of only 0.06% of all dislocations and only 2% of talar injuries, and are usually associated with common complications such as infection, avascular necrosis, and posttraumatic arthritis. The treatment usually involves debridement, reduction, stabilization of the ankle joint, and primary or secondary closure of the wound.Case presentationWe present the case of a 40-year-old South Asian woman who was involved in an accident. She was rushed to our hospital, whereby subsequent examination revealed an open total talus dislocation with the talus being exposed in its entirety from a contaminated wound in the medial side. Furthermore, radiograph confirmed total talus dislocation without concomitant malleoli fracture. She was immediately taken to the operating theater whereby debridement and immediate reduction was performed under anesthesia, and the ankle was stabilized with external fixator for about 6 weeks. She is now able to bear weight on the affected ankle with minimal tolerable pain and has normal range of motion of the ankle.ConclusionsOpen total talus dislocation without concomitant malleoli fracture is a rare injury. Reduction of the talus in combination with complete wound debridement potentially successfully avoids infection, provides early revascularization preventing avascular necrosis, and preserves the normal ankle anatomy.

Osteopathische Behandlung neuropathischer Nacken- und Beckenbodenschmerzen

A 32-year-old female patient presented with persistent neck and pelvic floor pain. Despite extensive external evaluations and treatments, including medication and physiotherapy, she experienced no lasting improvement. An osteopathic examination revealed significant dysfunctional and structural findings, including talus dislocation and signs of neural irritation. After targeted osteopathic interventions, the patient reported complete and sustained symptom relief.This report discusses the osteopathic approach in the context of current literature, emphasizing the importance of a deeper understanding of musculoskeletal interactions and neuroanatomical relationships.

Total Closed Talar Dislocation without Ankle Fracture: A Case Report.

We report a case of a 61-year-old female who presented to the emergency room after a fall from stairs. A total closed talar dislocation without talus or ankle fracture was diagnosed. The treating surgeon indicated an open reduction after an unsuccessful attempt at closed reduction. After six months of follow-up, the patient reported mild pain and partial weight-bearing with no discomfort; however, signs of talar avascular necrosis were present on magnetic resonance images and CT scans.

Weight-bearing Ultrasound to Diagnose Talar Dislocation Causing Tarsal Tunnel Syndrome.

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.

Talonavicular Dislocations: A Bad Actor Made Worse Without Sufficient Fixation

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: The talonavicular joint (TNJ) is critical to midfoot architecture, and traumatic disruptions of this joint threaten the midfoot arch. We sought to better elucidate injuries to the TNJ and understand if transient methods of stabilization after TN dislocations (TNDs), such as closed/open reduction with or without percutaneous pinning resulted in different radiographic and clinical outcomes when compared to more permanent methods such as bridge plating or primary arthrodesis of the TNJ. Methods: We retrospectively identified skeletally mature patients from one tertiary level 1 trauma center treated for midfoot injuries between 2002-2022. Patients with isolated or concomitant TNDs were included. Demographics, treatment, radiographic outcomes, and patient reported outcomes (PROs) were recorded. Patients who underwent temporary fixation methods (closed/open reduction and trans-articular pinning with k-wire removal at 6-8 weeks) were compared to those with permanent fixation (bridge plating or primary arthrodesis). Primary outcome was reoperation, including fusions and amputations. Secondary outcomes were radiographic arch measurements (Meary’s angle [MA], calcaneal inclination angle [CIA]) and PROMIS measures of physical function, pain interference, and anxiety. Sixty-two patients and 66 feet were included (Table 1). Average follow up was 2 years. Results: TNDs manifested as both pure dislocations (18) and in conjunction with associated injuries: chopart dislocations (5), talar head/body fractures (23), navicular fractures (35), and subtalar dislocations (25). Twelve were a part of Hawkins IV talar neck fracture dislocations (18%). Forty-two patients were treated with temporary fixation (64%). Injuries treated with transient fixation had higher mean change in MA from immediately postop to final follow-up (-7.9° v -1.1°, p=0.006). They also exhibited significantly different MA and CIA values at final follow-up (7.8° v -1.4°; 17.3° v 21.3°, p< 0.03). Nearly two thirds required reoperation; 32% underwent fusion and 7% required amputation. Fixation method had no significant association with PROMIS scores, but those with temporary fixation methods trended toward lower final PF scores (34.9 v 41.1, p=0.11). Conclusion: TNDs are generally the result of high energy mechanisms, often occurring in combination with other significant mid/hindfoot injuries. Reduction and fixation method of these injuries should be carefully considered to avoid potential ramifications of loss of normal arch and midfoot sag.

The treatment of a malunited posterior pilon fracture with talar dislocation: A staged surgical treatment protocol

BackgroundMalunited posterior pilon fractures with talus dislocation (mPPFtd) are rare and there are no appropriate treatment strategies. The purpose of this study was to introduce a stepped strategy featuring preliminary soft tissue management according to the Ilizarov principle and delayed open reduction and internal fixation (ORIF) through a modified posteromedial approach to overcome rigid soft tissue contracture. MethodFrom February 2015 to August 2021, 12 selected patients with mPPFtd who were treated with the staged protocol (Group A) were retrospectively analysed. The clinical and radiographic outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analogue scale (VAS) score, and the Burwell-Charnley score. Moreover, this case series was compared with some cases of fresh fracture (Group B) in patients that had the same baseline data from our previous study. ResultsIn Group A, the average length of time between the date of injury and the date of surgery was 4.8 ± 3.3 months. The average time to external fixator distraction, as the first-stage treatment, was 13.4 ± 1.0 days. In the second stage of ORIF, the posterosuperior dislocation of the talus was corrected with osteotomy and leverage manoeuvres. According to the Burwell-Charnley score system, the reduction quality was excellent in 9 cases and good in 3 cases. After a mean follow-up of 3.8 ± 2.1 years, there were no infections, wound healing problems, or nerve injuries in our cohort, and union was observed in all fractures without a loss of reduction. The baseline data of the two groups were not significantly different (p>0.05). The mean AOFAS score in Group A was 85.0 ± 10.5 and that in Group B was 95.4 ± 6.1 (p<0.05). The mean VAS score in Group A was 1.7 ± 1.4 and that in Group B was 0.7 ± 0.9 (p<0.05). ConclusionA staged surgical treatment strategy characterized by soft tissue management will improve the treatment of mPPFtd and produce satisfactory clinical outcomes. Level of evidenceLevel IV, retrospective case series

Coronal Shearing Fracture of the Talar Body with Talar Head Dislocation Related to a Navicular Compression Fracture: A Rare Case Report.

A talar body fracture is typically associated with talar body dislocation, resulting in ankle and subtalar joint subluxation and/or dislocation. A talar body fracture with talar head dislocation is a very rare injury. In this report, we describe the case of a 23-year-old man who suffered a coronal shearing fracture of the talar body with talar head dislocation related to a navicular compression fracture. The patient sought orthopedic consultation 6 weeks after injury. The injury was managed with open reduction, talar head relocation, internal fixation of the talar body fracture with Kirschner wires and cancellous screws and talonavicular fusion with an iliac bone autograft. Follow-up 4 years after operative treatment showed that the patient had satisfactory treatment results, including good bone healing with minimal changes in the anterior talotibial compartment and excellent function of the hindfoot and ankle.

Talus dislocation and pereonal malleolar fracture after high-energy trauma: a case report.

Talus dislocation is a rare injury and it is usually the consequence of high energy traumas, despite the anatomical features of the talus which predispose to its dissociation (absence of muscle insertions with over 60% of the surface covered by cartilage). It may be associated with malleolar fractures. Standard treatment of closed talar dislocation is a controversial issue. The most common early complications is avascular necrosis. Authors report a case of a complete talar dislocation associated to displaced lateral malleolar fracture in a 18-years-old male following a high energy trauma treated by closed reduction and fixation of the malleolar fracture.

Talar Extrusion Injury: Anatomy, Diagnosis, Treatment, and Outcomes

Talar extrusion is a very rare injury and is defined as talar dislocation from surrounding tibiotalar, subtalar, and talonavicular joints. It often results from high energy trauma. These injuries often have poor outcomes and serious complications including avascular necrosis, infection, and osteoarthritis. There are limited case reports and case series in the literature regarding talar extrusion injuries. In this review, we discuss the complex anatomy, diagnosis, treatment options, complications, and outcomes for patients with talar extrusion injuries.

Isolated talus dislocation: a case report

Peritalar dislocation is a rare injury, usually associated with fractures. It mainly affects males in high-energy traumas such as falls from height, car accidents, or even torsional traumas during the practice of sports activities. This study illustrates a case attended by the authors to discuss peritalar dislocation and its diagnosis, classification, treatment, and prognosis. Such injury may evolve with complications if not properly managed, including ankle movement pain, joint stiffness, deformities, post-traumatic arthrosis, and even osteonecrosis. Level of Evidence V; Therapeutic Studies; Expert Opinion.

A case series of three patients with rare pantalar dislocation

Total talar dislocations are rare, significant surgical challenges for foot and ankle surgeons. These dislocations can be very difficult to manually close-reduce, requiring immediate surgical intervention secondary to arterial impingement, pain and risk of skin necrosis attributable to skin tenting. In this case series, we report on three patients who presented to the emergency room following a traumatic ankle injury. Ankle radiographs and computed tomography (CT) scans were obtained, revealing pantalar dislocations. Closed reduction utilizing Charnley’s principles was attempted in the emergency room through manual accentuation of the deformity, traction and reduction. Closed reduction was unsuccessful in all three patients which led to immediate surgical intervention consisting of open reduction of the dislocated talus with internal fixation of concomitant fracture patterns. Postoperatively, all patients were carefully monitored for avascular necrosis of the talus with serial radiographs. One year following surgical intervention, no evidence of talar avascular necrosis (AVN) was observed and two of the three cases developed subtalar joint arthritis. This case report serves to display the treatment and outcomes of a rare dislocation with follow up to complete return to normal activity.

Closed pure total talar dislocation, open reduction assisted by bone distractor: a case report

Closed pure total talar dislocation, open reduction assisted by bone distractor: a case report

Closed total (pan-talar) dislocation: A case report

Pan-talar dislocations without talar fracture are rare with serious complication in future like osteonecrosis, and posttraumatic osteoarthritis. There are few reported cases of closed pan-talar dislocations in literature and still, there is no consensus regarding the appropriate treatment. Our reported case of closed pan- talar dislocation for 26-year old healthy male treated successfully by open reduction and internal fixation without radiological and clinical sighs of avascular necrosis and excellent Range of motion (ROM) of the ankle on 2-year follow-up.

Assessment of Midterm Functional Outcomes Following Talar Extrusion Injuries

Category:Ankle; Hindfoot; TraumaIntroduction/Purpose:Open talar dislocations with complete or partial extrusion of the talus are rare, high energy injuries associated with major complications including infection, avascular necrosis and post-traumatic arthritis. These are debilitating injuries with significant long-term effects including avascular necrosis and post traumatic arthritis. Functional outcome data in the literature is limited and predominantly consists of case reports and few single centre case series. Historically these injuries have been treated with talectomy and tibiocalcaneal arthrodesis, however there has been a subsequent trend towards debridement and reimplantation with preservation of the extruded talus. Our aim was to evaluate mid-term functional outcomes, assess complication profile and need for secondary surgery in a single-centre series of cases treated with reimplantation.Methods:All talar extrusion injuries presenting between January 2015 and January 2018 were identified from the trauma database search at our major trauma centre. Inclusion criteria was defined as open talar dislocations associated with either complete or partial extrusion of the talus. Case-note review was performed collecting baseline demographic data including age, gender, injury mechanism, associated injuries, Gustilo-Anderson grade, smoking and diabetes status, and method and timing of surgical management. Twelve patients were identified with a mean follow-up of 3 years (minimum 26 months). Primary outcome measure was functional outcome assessed using the Manchester-Oxford Foot Questionnaire (MOxFQ). Results for each of the three domains were converted to a 0-100 scale for comparison. Secondary outcomes included complication rate and all cause re- operation ratesResults:Mean age was 37.8 years (17-74 years). Five patients (42%) had total talar extrusion without fracture and 7/12 (58%) sustained fracture-dislocation with partial talar extrusion. All were Gustilo-Anderson grade III. All underwent successful reimplantation with 8/12 (67%) treated with single stage surgery, and 4/12 (33%) in two stages. The mean MOxFQ scores for total talar extrusions versus partial talar extrusions with fracture were 79 (range 9-18) vs 41 (range 0-86) for walking domain, 65 (range 45-80) vs 42 (range 0-90) for pain domain, and 63 (range 38-75) vs 48 (range 19-51) for social domain. One patient (8%) developed avascular necrosis, 3/12 (25%) developed infection and 1/12 (8%) patient eventually required below knee amputation. One (8%) patient underwent secondary surgery fusion for post-traumatic arthritis.Conclusion:Our series demonstrates the serious ramifications of sustaining talar extrusions. Patients who sustain these injuries should expect persistent functional deficit and pain at mid-term follow-up. Functional outcomes are relatively poor. The data demonstrates a trend towards better functional outcomes in patients who have partial extrusion of the talar dome with associated fractures, compared to ligamentous total talar extrusion injuries. The incidence of avascular necrosis, deep infection and secondary surgery in our cohort supports reimplantation as an effective treatment strategy.

Open Total Talar Dislocation with Extrusion: Tips and Tricks in Management

Open Total Talar Dislocation with Extrusion: Tips and Tricks in Management

Retrospective analysis of treatment strategies and clinical outcome of isolated talar dislocations

Talar dislocations are rare injuries of the foot and ankle and require quick and decisive diagnostic and therapeutic decisions. Evidence concerning the treatment and outcome of these injuries is sparse. The aim of this study was to analyze all talar dislocations of the last ten years treated in a large German level I trauma center in an effort to add to the experience on these injuries. Methods: All patients with a talar dislocation injury were retrospectively included. Medical reports, x-ray and computertomography scans were analyzed for the sex, age, trauma mechanism, and injury classifications as well as for the clinical outcome as measured by the Foot Function Index (FFI). Results: A total of 18 patients were included in this study: Luxatio pedis cum talo (n = 1), Luxatio tali totalis (n = 3), Luxatio pedis sub talo (n = 14). Analysis of the therapeutic algorithms revealed that only one patient was treated conservatively, the other 17 patients underwent operation. In most cases, stabilization was achieved using an external fixator and if necessary, the subtalar and talonavicular joints were temporarily stabilized using K-wires. The mean follow-up time was 4.25 years (2.05 SD) and the mean FFI-sum score 45.00 (42.26 SD). Two patients required subtalar fusion two years after the injury. Conclusion: Isolated talar dislocations can have a good outcome and be effectively treated in the emergency setting by basic techniqes if neurovasular structures are not injured. Often, these injuries are associated with fractures of adjacent bones which then need complex reconstruction.

A mouse model of ankle-subtalar joint complex instability induced post-traumatic osteoarthritis

BackgroundAnkle-subtalar joint complex instability is not uncommonly presented in the clinic, but symptoms and signs similar to other conditions can easily lead to its misdiagnosis. Due to the lack of appropriate animal models, research on ankle-subtalar joint complex instability is limited. The aims of the present study were to establish an animal model of ankle-subtalar joint complex instability in mice and to explore its relationship with post-traumatic osteoarthritis (PTOA).MethodsTwenty-one male C57BL/6J mice were randomly divided into three groups: SHAM group (sham surgery group), transected cervical ligament + anterior talofibular ligament (CL+ATFL) group, and transected cervical ligament + deltoid ligament (CL+DL) group. Two weeks after surgery, all mice underwent cage running training. Balance beam and gait tests were used to evaluate the changes in self-movement in the mice after ankle-subtalar ligament injury. Micro-CT and histological staining were used to evaluate the progress of PTOA.ResultsCompared with the SHAM group, balance and gait were affected in the ligament transection group. Twelve weeks after surgery, the time required to cross the balance beam in the CL+ATFL group was 35.1% longer and the mice slipped 3.6-fold more often than before surgery, and the mean step length on the right side was 7.2% smaller than that in the SHAM group. The time required to cross the balance beam in the CL+DL group was 32.1% longer and the mice slipped 3-fold more often than prior to surgery, and the average step length on the right side was 5.6% smaller than that in the SHAM group. CT images indicated that 28.6% of the mice in the CL+DL group displayed dislocation of the talus. Tissue staining suggested that articular cartilage degeneration occurred in mice with ligament transection 12 weeks after surgery.ConclusionsTransected mice in the CL+ATFL and CL+DL groups displayed mechanical instability of the ankle-subtalar joint complex, and some mice in the CL+DL group also suffered from talus dislocation due to ligament injury leading to loss of stability of the bone structure. In addition, as time progressed, the articular cartilage displayed degenerative changes, which affected the ability of animals to move normally.

Luxação completa do astrágalo associada a fratura do maléolo peronial no jovem desportista

Complete closed talus dislocation is a rare and serious injury, with a bad prognosis due to the risk of avascular necrosis. This article describes the clinical case of a young soccer player, who during sports competition suffered an injury in his right ankle, after bad positioning of his foot on the ground. On examination, an irreducible deformity in supination of the foot was evident, and the X-ray and the CT-scan showed a complete anterolateral talus dislocation associated with a peroneal malleolus fracture. An emergent open reduction was performed with osteosynthesis of the peroneal malleolus fracture. The teenager had a satisfactory functional recovery, with no evidence of progression to avascular necrosis, having resumed his sports practice after 6 months of follow-up.

Complete Traumatic Talus Dislocation: A Rare Case Report

A complete traumatic talus dislocation is an exceedingly rare injury pattern. A case of reimplantation of an open traumatic complete intact talus dislocation and distal fibula fracture following a motor vehicle accident is reported. A review of the literature and emergency medicine management recommendations follows.

Medial swivel dislocation of talonavicular joint due to low energy trauma

&lt;p&gt;Medial swivel variant of talonavicular dislocation is rare. Usually, it is caused by high velocity trauma. They are relatively easier to reduce and are associated with fewer complications than pure dorsal dislocations and sub talar dislocations. We report a case of medial swivel dislocation of talonavicular caused by a low energy trauma, its management and one year follow up result.&lt;/p&gt;