Zaraa Mourad, Jerbi Ismail, Mahjoub Sabri, Sehli Heithem, Mbarek Mondher
Department of Orthopedics, Trauma Center of Ben Arous, Ben Arous, Tunisia.
J Orthop Case Rep. 2017 Jan-Feb;7(1):58-60. doi: 10.13107/jocr.2250-0685.688.
Subtalar dislocation is an uncommon lesion in traumatology chiefly when it concerns the lateral form. Surgical treatment is required when a fracture is related or the dislocation is irreducible. Even well treated, these dislocations progress unavoidably to subtalar arthrosis, which stays well tolerated.
A 46-year-old male with irreducible lateral subtalar dislocation caused sustentaculum tali incarceration confirmed on computed tomography (CT). The patient underwent emergent open reduction and internal fixation; the sustentaculum tali was reduced and fixed with a compression screw. At 3 years, "American Orthopaedic Foot and Ankle Society Ankle-hindfoot" score was 86, and the functional result was considered excellent despite a Grade I subtalar osteoarthritis on the ankle X-ray.
An irreducible subtalar dislocation is exceptionally due to the incarceration of sustentaculum tali. CT is of great interest for good fracture analysis and management planning. Anatomical reduction of the articular surfaces, stable osteosynthesis, sufficient immobilization, and a well-conducted rehabilitation are the only guarantors of a good functional outcome.
距下关节脱位在创伤学中是一种罕见的损伤,尤其是外侧型脱位。当伴有骨折或脱位无法复位时,需要进行手术治疗。即使治疗得当,这些脱位仍不可避免地会发展为距下关节骨关节炎,但患者对此耐受性良好。
一名46岁男性,经计算机断层扫描(CT)证实为不可复位的外侧距下关节脱位,伴有载距突嵌顿。患者接受了急诊切开复位内固定术;载距突复位并用加压螺钉固定。3年后,“美国矫形足踝协会踝 - 后足”评分为86分,尽管踝关节X线显示为I级距下骨关节炎,但功能结果仍被认为 excellent。
不可复位的距下关节脱位极少见是由于载距突嵌顿所致。CT对于准确的骨折分析和治疗计划制定非常重要。关节面的解剖复位、稳定的骨固定、充分的固定以及良好的康复训练是获得良好功能结果的唯一保证。