De Luna V, Caterini A, Petrungaro L, Barosso M, De Maio F, Farsetti P
Department of Clinical Science and Translational Medicine, Section of Orthopedics and Traumatology, University of Rome "Tor Vergata", Italy.
Department of Clinical Science and Translational Medicine, Section of Orthopedics and Traumatology, University of Rome "Tor Vergata", Italy.
Int J Surg Case Rep. 2021 Jun;83:105954. doi: 10.1016/j.ijscr.2021.105954. Epub 2021 May 6.
Subtalar dislocation is a rare injury characterized by a simultaneous dislocation of the talocalcaneal and talonavicular joints. The most common type is caused by high-energy trauma with medial dislocation of the foot. This injury is frequently associated with fractures, but isolated dislocations are also reported.
We report a rare case of medial subtalar dislocation secondary to low-energy injury in a 61-year-old woman. Following X-rays and CT scan, prompt closed reduction was performed under sedation and, after reduction, X-rays showed a good realignment of the foot. The CT scan revealed an occult non-displaced fracture of the posterior part of the talus. The patient was managed conservatively by a non-weight bearing cast for four weeks, followed by a rehabilitation program. At follow-up, six months later, we observed a good clinical and radiographic result.
The reported case confirms that the mechanism of injury is an important factor in predicting the final result, since subtalar dislocations secondary to a high-energy trauma are often associated with significant complications. We believe, in agreement with other authors, that a low-energy trauma generally doesn't produce long-term morbidity. Prompt reduction is very important in order to minimize soft tissue and neurovascular complications, although a CT is recommended to identify occult fractures.
Subtalar dislocations, caused by low energy trauma, if adequately reduced in the emergency room, generally heal with conservative treatment, reducing the risk of significant complications. However, since we report a single patient, further case analysis is needed to make solid conclusions.
距下关节脱位是一种罕见的损伤，其特征为距跟关节和距舟关节同时脱位。最常见的类型由高能创伤导致足部向内侧脱位引起。这种损伤常伴有骨折，但也有孤立性脱位的报道。
我们报告一例61岁女性因低能量损伤继发内侧距下关节脱位的罕见病例。经X线和CT扫描后，在镇静状态下迅速进行了闭合复位，复位后X线显示足部对位良好。CT扫描显示距骨后部有一处隐匿性无移位骨折。患者通过非负重石膏固定四周进行保守治疗，随后进行康复计划。六个月后的随访中，我们观察到临床和影像学结果良好。
该病例报告证实损伤机制是预测最终结果的重要因素，因为高能创伤继发的距下关节脱位常伴有严重并发症。我们与其他作者观点一致，认为低能量创伤一般不会导致长期发病。为尽量减少软组织和神经血管并发症，迅速复位非常重要，不过建议进行CT扫描以识别隐匿性骨折。
由低能量创伤引起的距下关节脱位，若在急诊室得到充分复位，通常通过保守治疗即可愈合，降低严重并发症的风险。然而，由于我们仅报告了一例患者，需要进一步的病例分析才能得出确凿结论。
