Missed and Associated Injuries after Subtalar Dislocation: The Role of CT

Abstract

Subtalar joint dislocation (STJD) is an uncommon injury, but carries with it a potential for significant functional disability. We hypothesized that a significant number of injuries associated with subtalar joint dislocation may be unrecognized by plain radiographic examination. Therefore, we reviewed the records of all STJDs over a three-year period, identifying nine cases. The majority of injuries occurred in men (78%) with a mean age of 29 years. Overall, the mean age at injury was 32 years. The right lower extremity was most frequently injured (87.5%). Plain films initially diagnosed a STJ dislocation in all patients. A CT scan was performed in all cases. In 100% of patients, CT identified additional injuries missed on initial plain radiographs. In 44% of patient, new information gathered by CT dictated a change in treatment. Based on our findings, we conclude that CT is an invaluable tool to assess for associated injuries in STJ dislocation, and should be performed in all cases of STJ dislocation.

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“…Occasionally, direct soft pressure on the head of the talus can make reduction more easy [25]. In the event that the reduction is not achieved by interposition of bone or soft parts [8,19,20,27,28], multiple attempts with brute force should not be undertaken under any circumstances, and urgent open reduction should be considered [1,18] since, otherwise, we can cause iatrogenic injuries such as fractures of the talus or neurovascular injuries [6].…”

“…Among the notable complications we can find stiffness, being the most frequent complication with rates of up to 70% [32] especially in cases of long periods of time immobilization [19]; arthritis, the main cause of pain [33]; avascular necrosis of the talus, mainly in dislocations caused by high energy trauma resulting in open dislocations and/or associated fractures, regardless of whether it is medial or lateral [8]; skin necrosis or deep tissue infections, only described in open dislocations [34]; and instability [35].The prognosis of these injuries is usually good in cases in which the injury mechanism has been low energy, there are no associated fractures and the lesion has been exclusively ligamentous. Closed lesions, those that have been treated early, and immobilizations that have not been maintained for an excessive period of time have a better prognosis [3,19,25,28,30,36].…”

“…It is a very rare lesion when it occurs without associating fractures in other bones and a very complex injury when involving joint surfaces of load bones [2], with a variable prognosis depending on factors related to the patient and the structures involved [7] and a complication rate close to 20%, among which include osteoarthritis, avascular necrosis or instability of the subtalar joint [8].…”

“…A closed reduction under sedation should be attempted as soon as possible [8] to avoid additional complications such as avascular necrosis of the talus, neurovascular or soft tissue lesions such as skin necrosis [6,25]. To reduce the dislocation, the knee and ankle are flexed towards plantar, in order to relax the triceps surae [6,7], longitudinal traction is performed and force is applied in the opposite direction to the dislocation in order to reduce the head of the talus on the navicular joint facet [19].…”

Medial Subtalar Dislocation in a Basketball Player: Case Report and Literature Review

“…Subtalar dislocations, also known as peritalar dislocations, subastragalar dislocations, or luxatiopedissubtalo, are rare presentations in the emergency department [5]. Judey and Dufaurets in 1811 were the first to describe subtalar joint dislocations [6].…”