Luthfi Andi Praja Wira Yudha, Maruanaya Samuel, Dalitan Ivan Mucharry, Wedhanto Sigit
Department of Orthopaedics and Traumatology, Bhayangkara Tk.I R. Said Sukanto Police Hospital, Jakarta, Indonesia.
Faculty of Medicine, Universitas Pattimura, Ambon, Indonesia.
Int J Surg Case Rep. 2023 Apr;105:108081. doi: 10.1016/j.ijscr.2023.108081. Epub 2023 Apr 5.
Pure ankle dislocation is a rare injury, and this injury is an orthopedic emergency requiring immediate reduction. In more common circumstances, this injury is usually associated with malleolar fractures. The standardized treatment protocol is still deficient.
We report a case of a 33-year-old woman who presented with an open ankle dislocation without concomitant malleolar fractures. Early extensive wound debridement, immediate reduction, and immobilization of the ankle joint using an external fixator were performed during the first surgery. During the second surgery, which was performed 3 weeks later, the medial and lateral ankle ligaments were repaired, and a suture tape internal brace was added. A good functional outcome with the American Foot and Ankle Society score of 87 was achieved at 1-year follow-up.
In an open dislocation with massive ligamentous injury, staged surgery could be performed to prevent deep infection, with extensive debridement and immobilization using an external fixator in the first stage and ligament repair in the second stage. An internal brace using a suture tape is an option for ligament repair if the remnant is not sufficient to be repaired, as in this case. Early range of motion exercises should be initiated after second-stage surgery to prevent stiffness.
Staged surgery using an external fixator and ligament repair using a suture tape and internal brace augmentation can be an effective option for a pure ligamentous ankle dislocation with an open wound and a poor remnant of ankle ligaments.
单纯踝关节脱位是一种罕见的损伤，这种损伤是一种骨科急症，需要立即复位。在更常见的情况下，这种损伤通常伴有踝关节骨折。目前仍缺乏标准化的治疗方案。
我们报告一例33岁女性患者，其表现为开放性踝关节脱位，无合并踝关节骨折。在首次手术中进行了早期广泛的伤口清创、立即复位，并使用外固定器固定踝关节。在3周后进行的第二次手术中，修复了踝关节的内侧和外侧韧带，并增加了缝合带内支撑。在1年随访时，美国足踝协会评分为87分，获得了良好的功能结果。
在伴有严重韧带损伤的开放性脱位中，可采用分期手术以预防深部感染，第一期进行广泛清创并使用外固定器固定，第二期进行韧带修复。如果韧带残端不足以修复，如本病例，使用缝合带的内支撑是韧带修复的一种选择。在二期手术后应尽早开始进行活动度锻炼以防止关节僵硬。
对于伴有开放性伤口且踝关节韧带残端情况不佳的单纯韧带性踝关节脱位，采用外固定器分期手术以及使用缝合带和内支撑增强进行韧带修复可能是一种有效的选择。
