Manojlović Radovan, Starcević Branislav, Tabaković Dejan, Tulić Goran, Lesić Aleksandar, Bumbasirević Marko
Srp Arh Celok Lek. 2010 Mar-Apr;138(3-4):252-5. doi: 10.2298/sarh1004252m.
Subtalar dislocation (SI) is a term that refers to an injury in which there is dislocation of the talonavicular and talocalcanear joint, although the tibiotalar joint is intact.
A case of medial subtalar dislocation as a result of basketball injury, so-called "basketball foot", is presented. Closed reposition in i.v. anaesthesia was performed with the patient in supine position and a knee flexed at 90 degrees. Longitudinal manual traction in line of deformity was carried out in plantar flexion. The reposition continued with abduction and eversion simultaneously increasing dorsiflexion. It was made in the first attempt and completed instantly. Rehabilitation was initiated after 5 weeks of immobilization. One year after the injury, the functional outcome was excellent with full range of motion and the patient was symptom-free. For better interpretation of roentgenogram, bone model of subtalar dislocation was made using the cadaver bone.
Although the treatment of such injury is usually successful, diagnosis can be difficult because it is a rare injury, and moreover, X-ray of the injury can be confusing due to superposition of bones. Radiograms revealed superposition of the calcaneus, tarsal and metatarsal bones which was radiographically visualized in the anterior-posterior projection as one osseous block inward from the talus, and on the lateral view as in an osteal block below the tibial bone. Prompt recognition of these injuries followed by proper, delicately closed reduction under anaesthesia is crucial for achieving a good functional result in case of medial subtalar dislocation.
距下关节脱位(SI)是指距舟关节和距跟关节脱位,而胫距关节完整的一种损伤。
本文介绍了一例因篮球运动损伤导致的内侧距下关节脱位,即所谓的“篮球足”病例。在静脉麻醉下,患者仰卧位,膝关节屈曲90度进行闭合复位。在跖屈位沿畸形方向进行纵向手法牵引。复位过程中同时进行外展和外翻并逐渐增加背屈。首次尝试即成功完成复位。固定5周后开始康复治疗。伤后一年,功能恢复良好,活动范围正常,患者无症状。为更好地解读X线片,利用尸体骨骼制作了距下关节脱位的骨模型。
尽管此类损伤的治疗通常是成功的,但诊断可能困难,因为这是一种罕见损伤,而且由于骨骼重叠,损伤的X线表现可能令人困惑。X线片显示跟骨、跗骨和跖骨重叠,在前后位片上表现为从距骨向内的一个骨块,在侧位片上表现为胫骨下方的一个骨块。对于内侧距下关节脱位,及时识别损伤并在麻醉下进行适当、精细的闭合复位对于获得良好的功能结果至关重要。