Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan, Korea.
Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Nowon-gu, Seoul, Korea.
J Int Med Res. 2021 Apr;49(4):3000605211004697. doi: 10.1177/03000605211004697.
Midtarsal dislocations are relatively rare injuries secondary to high-energy trauma and are typically accompanied by disruption of ligamentous structures and fractures of the midfoot. We herein present a case of a pure isolated medial swivel dislocation of the talonavicular joint (TNJ) that was sustained following low-energy trauma without an associated fracture. A 78-year-old woman visited our emergency department with severe pain in the midfoot area of the right foot without neurovascular deficits. She had sustained this injury after severe ankle inversion while going downstairs. Plain radiographs of the right foot showed that the navicular was dislocated medially on the talus; no other malalignments were present. Three-dimensional computed tomography revealed dislocation of the TNJ, but no other tarsal or midtarsal bone fractures or dislocations. A medial dorsal incision was made to expose the TNJ. The dorsal talonavicular ligament was ruptured and interposed between the navicular and talus. The ligament was removed and the TNJ was reduced. The clinical outcome at the 1-year follow-up was satisfactory with no limitations in daily activities. In summary, we have reported an extremely rare case of a pure isolated medial TNJ dislocation in which the interposed dorsal talonavicular ligament served as an obstacle to reduction.
中跗关节脱位较为少见，通常继发于高能创伤，常伴有韧带结构断裂和中跗骨骨折。本文报告了一例由低能量创伤引起的单纯性内侧旋转性距舟关节（TNJ）脱位，无相关骨折。一名 78 岁女性因右脚中足部剧烈疼痛就诊于我院急诊科，无神经血管缺损。她在严重的踝关节内翻后下楼时受伤。右足的普通 X 线片显示舟骨在距骨内侧脱位；没有其他错位。三维 CT 显示 TNJ 脱位，但无其他跗骨或中跗骨骨折或脱位。行背侧内上切口暴露 TNJ。距舟背侧韧带断裂，夹在舟骨和距骨之间。切除韧带并复位 TNJ。1 年随访时临床结果满意，日常活动无受限。总之，我们报告了一例非常罕见的单纯性内侧 TNJ 脱位病例，其中嵌入的背侧距舟韧带是复位的障碍。
