Closed medial total subtalar joint dislocation without ankle fracture: a case report

Abstract

IntroductionTotal subtalar dislocation without fracture of the ankle is a rare clinical entity; it is usually due to a traumatic high-energy mechanism. Standard treatment is successful closed reduction under general anesthesia followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 weeks.Case presentationWe present the case of a 30-year-old Moroccan woman who was involved in a road traffic accident. She subsequently received a radiological assessment that objectified a total subtalar dislocation without fracture of her ankle. She was immediately admitted to the operating theater where an immediate reduction was performed under sedation, and immobilization in a plaster boot was adopted for 8 weeks. The management of this traumatic lesion is discussed in the light of the literature.ConclusionsMedial subtalar dislocation is a rare dislocation and is not commonly seen as a sports injury because it requires transfer of a large amount of kinetic energy. The weaker talocalcaneal and talonavicular ligaments often bear the brunt of the energy and are more commonly disrupted, compared to the relatively stronger calcaneonavicular ligament. Urgent reduction is important, and closed reduction under general anesthesia is usually successful, often facilitated by keeping the knee in flexion to relax the gastrocnemius muscle. Long-term sequelae include talar avascular necrosis and osteochondral fracture, as well as chronic instability and pain.

Neglected Posterior Subtalar Dislocation: A Case Report and Operative Technique

“…There was also EDB muscle interpositioning between talus and naviculare. 8 The chance of repositioning the joint by closed manipulation diminished considerably over time, while complications associated with closed reduction substantially increase due to fibrotic soft tissues. 9 Following an unsuccessful attempt of closed reduction, open reduction is the next step.…”

Subtalar Dislocation Associated with a Ruptured Tibialis Posterior Tendon: A Rare Case Report

“…In our personal experience we have described a case of medial subtalar dislocation without skin opening reduced by external maneuver with splint immobilization which had excellent final results [3]. Some complications are possible: infection, trophic trouble.…”

“…It constitutes 15% of the trauma injury of the talus [2]. This dislocation mainly affects young men, following a violent trauma with foot blocked on the ground [3].…”

Isolated Medial Subtalar Joint Dislocation during Sports Activities: A Systematic Review of the Literature with Individual Participant Data Analysis

“…The medial dislocation is the most common one, representing about 80% of the isolated dislocation (without fracture) due to its intrinsic instability in inversion. When high energy is applied, forcing supination in a blocked foot, the ligaments that ensure the stability of the STJ break in a specific order: first the dorsal talonavicular ligament, then the interosseous talocalcaneal ligament and finally the calcaneofibular ligament [5,6]. This injury can be caused by repetitive low energy traumas (repetitive jumps and landings [1], hence its vulgar name "basketball foot" due to how prevalent those actions are in that sport) or a single high energy trauma (like a motorcycle crash or falling from heights).…”

“…Further, it is not unusual to have an open wound associated with the dislocation. In some cases, however, the dislocation reduces spontaneously, leaving a swollen ankle with ecchymosis [1,[5][6][7][8][9][10][11][12][13][14]. The third and last step is to obtain appropriate imaging: radiological images are important for the diagnosis of STJD: standard antero-posterior and lateral radiographic views can show rotational defects or any relics of lateral displacement.…”