Gursu Sarper, Sahin Vedat, Demir Bilal, Yildirim Timur
Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey.
J Am Podiatr Med Assoc. 2013 Jan-Feb;103(1):73-5. doi: 10.7547/1030073.
Total talar dislocation, ie, disruption of the talus from the calcaneus, navicula, and tibia, is a rare and severe injury. We present a case of closed peritalar dislocation without any accompanying fractures and, thus, discuss the conflicts encountered in this rare injury. A 25-year-old male patient presented with severe pain, swelling, and deformity in his right ankle within 30 minutes of a fall from a height. There were no wounds around the ankle. Radiographs revealed that the talus was disrupted from the calcaneus, navicula, and tibia moving in the anterolateral direction. No accompanying fractures were seen in the talus or in surrounding bones. After an unsuccessful closed reduction attempt, a further decision was open reduction. It was seen that the interposed joint capsula was preventing reduction. After reduction, stability of the ankle was checked and found to be satisfactory, so no fixation material was used. It has been 2 years since the first injury, and the patient is functioning well, with no pain. The ankle has the same range of motion as the unaffected side. No sign of an avascular necrosis or sclerosis is seen on the final radiographs. Closed total dislocation of the talus without any accompanying fractures is a rare entity. The injury is open to various important complications, such as avascular necrosis, infection in patients with open wounds, and arthritic changes. To achieve a good outcome, early reduction of the dislocation has key importance.
距骨完全脱位，即距骨与跟骨、舟骨和胫骨分离，是一种罕见且严重的损伤。我们报告一例无任何合并骨折的闭合性距周脱位病例，并讨论这种罕见损伤中遇到的问题。一名25岁男性患者在从高处坠落30分钟内，出现右踝严重疼痛、肿胀和畸形。踝关节周围无伤口。X线片显示距骨与跟骨、舟骨和胫骨分离并向前外侧移位。距骨及周围骨骼未见合并骨折。闭合复位尝试失败后，决定行切开复位。发现嵌入的关节囊阻碍了复位。复位后，检查踝关节稳定性，结果满意，因此未使用固定材料。自首次受伤已过去2年，患者功能良好，无疼痛。患侧踝关节活动范围与未受伤侧相同。最终X线片未见缺血性坏死或硬化迹象。无任何合并骨折的距骨闭合性完全脱位是一种罕见情况。该损伤易引发多种重要并发症，如缺血性坏死、开放性伤口患者的感染以及关节病变。为获得良好预后，早期复位脱位至关重要。
