Hashemi Seyed Ali, Vosoughi Amir Reza, Erfani Mohammad Ali, Mozaffarian Kamran, Akbarzadeh Armin, Borazjani Roham
Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Int J Surg Case Rep. 2023 Jul;108:108413. doi: 10.1016/j.ijscr.2023.108413. Epub 2023 Jun 21.
Concomitant medial subtalar dislocation and a rotated displaced talar neck fracture may result in poor outcomes. This study aimed to explain this extremely rare injury and assess the clinical outcomes following surgical treatment.
A 22-year-old Iranian man referred to the emergency department with a gross deformity and pain in his right foot and ankle after a falling from 2 m. Plain radiographs showed a rotated free talar head accompanying medial subtalar dislocation. Closed reduction was performed in the emergency department under sedation. Prompt open reduction and internal fixation of talar fracture was done, after removal of free osseocartilaginous fragments in the subtalar and talonavicular joints. At 25 months postoperatively, the clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale and visual analogue scale for pain which were 73 and 3, respectively. In exam, the patient had a stiffed subtalar joint without talar osteonecrosis or collapse.
Several osseous and soft tissue barriers could prevent a successful closed reduction of a subtalar dislocation. Associated cartilage injuries or fractures may result in poor clinical outcomes such as persistent pain, limping, osteoarthritis, and osteonecrosis. Immediate open reduction and rigid fixation of associated fractures and resection of small free osseocartilaginous fragments may prevent further soft tissue damages and preserve clinical functions.
Satisfactory clinical outcome could be expected following proper on-time approach to a subtalar dislocation associated with a rotated displaced talar neck fracture.
距下关节内侧脱位合并距骨颈旋转移位骨折可能导致不良预后。本研究旨在阐释这种极为罕见的损伤，并评估手术治疗后的临床疗效。
一名22岁伊朗男性，从2米高处坠落，右足踝部严重畸形伴疼痛，被送至急诊科。X线平片显示距下关节内侧脱位伴距骨头旋转游离。在急诊科镇静状态下进行了闭合复位。在清除距下关节和距舟关节游离的骨软骨碎片后，迅速对距骨骨折进行了切开复位内固定。术后25个月，采用美国矫形足踝协会踝-后足评分量表和疼痛视觉模拟量表评估临床疗效，分别为73分和3分。检查发现患者距下关节僵硬，无距骨缺血性坏死或塌陷。
多种骨与软组织障碍可能会妨碍距下关节脱位的成功闭合复位。相关的软骨损伤或骨折可能导致不良临床后果，如持续疼痛、跛行、骨关节炎和缺血性坏死。对相关骨折立即进行切开复位和坚强固定，并切除小的游离骨软骨碎片，可防止进一步的软组织损伤并保留临床功能。
对于合并距骨颈旋转移位骨折的距下关节脱位，采取恰当及时的治疗方法有望获得满意的临床疗效。
