Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 174-175
Rare case of pure medial subtalar dislocation: Conservative treatment and 32 months follow-up


Department of Orthopaedic Surgery and Traumatology, Mohamed V Souissi University, Rabat, Morocco

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Date of Web Publication13-Jul-2015
 

How to cite this article:
Rida-Allah B, Hicham A, Mahfoud M, Elbardouni A, Berrada MS, Elyaacoubi M. Rare case of pure medial subtalar dislocation: Conservative treatment and 32 months follow-up. J Emerg Trauma Shock 2015;8:174-5

How to cite this URL:
Rida-Allah B, Hicham A, Mahfoud M, Elbardouni A, Berrada MS, Elyaacoubi M. Rare case of pure medial subtalar dislocation: Conservative treatment and 32 months follow-up. J Emerg Trauma Shock [serial online] 2015 [cited 2020 Sep 20];8:174-5. Available from: http://www.onlinejets.org/text.asp?2015/8/3/174/145419


Sir,

Pure acute medial subtalar dislocation without any fractures is very rare and hardly reported in the literature. Such injuries are more likely to be open and associated with fractures of the surrounding foot bones. We report a very rare case of a closed subtalar dislocation without any related fractures treated with conservative treatment; a closed reduction with a cast immobilization. The result was satisfactory with a good functional recovery. We discuss in details the mechanism of such an injury and highlight the importance of prompt closed reduction and early mobilization to ensure a satisfactory long term outcome.

A 23-year-old man presented to the Emergency Department after sustaining a motorbike accident, exhibiting a severe pain and deformity in his left ankle. The clinical examination revealed an ankle fixed in plantar flexion with a bony prominence appreciable laterally [Figure 1]a. The dorsalis pedis and the posterior tibialis pulses were palpable. The radiological examination plainly showed a medial dislocation of both the talonavicular and talocalcaneal joints without associated fractures [Figure 1]b. Closed reduction under a general anesthesia was performed by manual foot traction, with application of firm digital pressure over the head of the talus as the ankle was plantar flexed and then dorsiflexed. The reduction was completed with an audible clunk, and the ankle was immobilized in a short leg cast. Post-reduction films showed good realignment and a computed tomography (CT) scan did not reveal any further occult injuries [Figure 2]. The patient was mobilized with crutches on the third day, with no weight-bearing. Passive ankle motion was permitted after cast removal.
Figure 1: Clinical (a) and radiological (b) appearance of a medial subtalar dislocation of the foot

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Figure 2: Computed tomography (CT) scanner evaluation after reduction: No intra-articular or any other fractures observed

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At 4 weeks the patient initiated partial weight-bearing with crutches and full weight-bearing was allowed at 2 months. At 32-months follow-up, the patient was autonomous and active, joint motion and full weight-bearing were painless without instability at the left ankle on joint stress tests.

Subtalar dislocation can be defined as simultaneous dislocation of both the talonavicular and the talocalcaneal joints without a major fracture of the talus. [1] The acute subtalar dislocation represents < 1-2% of all large joint dislocations and approximately 15% of all talar injuries. [2] The incidence of injury has been estimated to be 3-10 times more likely to occur in men than women. [3] Medial subtalar dislocation occurs more frequently than the lateral form because the lateral talocalcaneal and calcaneofibular ligaments are weaker than deltoid and medial talocalcaneal ligaments. As much as 80% of subtalar dislocations display restriction in motion after healing, and 50-80% have radiographic evidence of post-traumatic subtalar arthritis. [4] Subsequently those cases successfully treated with closed reduction are placed in a non weight-bearing below knee cast for a maximum of 4 weeks, [1] followed by progressive mobilization and rehabilitation. The results of the conservative treatment are reported to be good to excellent. However, complications have been reported, including reduced range of motion, stiffness of the joint, residual instability, osteonecrosis of the talus and early osteoarthritis. [5] Post-reduction CT scan is recommended to identify occult fractures.


   Acknowledgements Top


All the authors were fully involved in the study and preparation of the manuscript and that the material within has not been and will not be submitted for publication elsewhere.

 
   References Top

1.
Buckingham WW Jr, LeFlore I. Subtalar dislocation of the foot. J Trauma 1973;13:753-65.  Back to cited text no. 1
    
2.
Syed AA, Agarwal M, Dosani A, Giannoudis PV, Matthews SJ. Medial subtalar dislocation: Importance of clinical diagnosis in distinguishing from other dislocations. Eur J Emerg Med 2003;10:232-5.  Back to cited text no. 2
    
3.
Perugia D, Basile A, Massoni C, Gumina S, Rossi F, Ferretti A. Conservative treatment of subtalar dislocations. Int Orthop 2002;26:56-60.  Back to cited text no. 3
    
4.
Heppenstall RB, Farahvar H, Balderston R, Lotke P. Evaluation and management of subtalar dislocations. J Trauma 1980;20:494-7.  Back to cited text no. 4
    
5.
Jungbluth P, Wild M, Hakimi M, Gehrmann S, Djurisic M, Windolf J, et al. Isolated subtalar dislocation. J Bone Joint Surg Am 2010;92:890-4.  Back to cited text no. 5
    

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Correspondence Address:
Mohamed Saleh Berrada
Department of Orthopaedic Surgery and Traumatology, Mohamed V Souissi University, Rabat
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.145419

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