Anazor Fitzgerald C, Dhinsa Baljinder S
Department of Trauma and Orthopaedics, William Harvey Hospital, Ashford, UK.
Postgraduate Medical Education Directorate, Nottingham University NHS Foundation Trust, UK.
Br J Hosp Med (Lond). 2023 Feb 2;84(2):1-9. doi: 10.12968/hmed.2022.0211. Epub 2023 Feb 20.
Although uncommon, subtalar joint dislocations remain a frequently missed orthopaedic emergency. Detailed soft tissue and neurovascular assessment is important and these should be documented as appropriate. Failure of urgent reduction might lead to increased risk of conversion to an open injury as a result of pressure necrosis of the overlying skin, risk of talar avascular necrosis and risk of neurovascular compromise. A computed tomography scan is needed in all cases following successful closed or open reduction to identify associated occult foot and ankle fractures. The goal of treatment is to reduce the risk of soft tissue and neurovascular compromise and achieve a supple, painless foot. This article highlights the importance of early identification of this injury and institution of appropriate management according to the latest evidence, to reduce the risk of complications and lead to the best outcomes.
虽然距下关节脱位并不常见，但仍是一种常被漏诊的骨科急症。详细的软组织和神经血管评估很重要，应进行适当记录。紧急复位失败可能会因覆盖皮肤的压迫性坏死而增加转为开放性损伤的风险、距骨缺血性坏死的风险以及神经血管受损的风险。在成功进行闭合或切开复位后，所有病例都需要进行计算机断层扫描，以识别相关的隐匿性足踝骨折。治疗的目标是降低软组织和神经血管受损的风险，并使足部柔软无痛。本文强调了早期识别这种损伤并根据最新证据进行适当处理的重要性，以降低并发症风险并实现最佳治疗效果。
