Naranje Sameer, Mittal Ravi
Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India.
Orthopedics. 2010 Feb;33(2):123-5. doi: 10.3928/01477447-20100104-29.
A chronic presentation of closed dorsolateral dislocation of the talus is a rare injury. A 35-year-old woman presented with pain and deformity of the right foot of 6 months' duration. Her medical history was significant for rheumatoid arthritis, for which she was being treated with steroids. Radiographs and computed tomography of the right foot showed dorsolateral talar dislocation with fracture of the medial malleolus. Dislocation of the talus from the tibiotalar, talocalcaneal, and talonavicular joints was indicative of talus dislocation with a fracture of the medial malleolus rather than a fracture-dislocation of the ankle joint. Because of chronic presentation of the injury and an inability to reduce this talus dislocation by closed methods, open total talectomy was performed. At 2-year follow-up, the patient had an AOFAS score of 78. The patient had an obvious limp on the affected limb but managed her activities of daily living well without a shoe raise or brace. Because of the severe varus inversion deformity of the foot preoperatively, the patient was not able to walk. Postoperatively, the deformity was corrected and the patient was able to stand and walk; she was satisfied with the outcome of the surgery.To our knowledge, this is the first report of chronic closed dorsolateral talus dislocation. We recommend that chronic closed isolated dorsolateral talus dislocation can be effectively managed by total talectomy.
距骨闭合性背外侧脱位的慢性表现是一种罕见的损伤。一名35岁女性因右足疼痛和畸形就诊，症状持续6个月。她有类风湿关节炎病史，正在接受类固醇治疗。右脚的X线片和计算机断层扫描显示距骨背外侧脱位并伴有内踝骨折。距骨从胫距关节、距跟关节和距舟关节脱位，提示距骨脱位合并内踝骨折，而非踝关节骨折脱位。由于损伤呈慢性表现且无法通过闭合方法复位距骨脱位，遂行开放性全距骨切除术。在2年的随访中，患者的美国足踝外科协会（AOFAS）评分为78分。患者患侧肢体有明显跛行，但在不使用增高鞋或支具的情况下能很好地自理日常生活。由于术前足部存在严重的内翻畸形，患者无法行走。术后，畸形得到纠正，患者能够站立和行走；她对手术结果感到满意。据我们所知，这是慢性闭合性距骨背外侧脱位的首例报告。我们建议，慢性闭合性孤立性距骨背外侧脱位可通过全距骨切除术得到有效治疗。
