Dhaulagiri Hospital, Baglung, Nepal.
Department of Orthopaedics, BPKIHS, Dharan, Nepal.
J Med Case Rep. 2024 Aug 14;18(1):379. doi: 10.1186/s13256-024-04632-x.
Total talus dislocation without ankle (malleoli) fracture is a very rare injury with prevalence of only 0.06% of all dislocations and only 2% of talar injuries, and are usually associated with common complications such as infection, avascular necrosis, and posttraumatic arthritis. The treatment usually involves debridement, reduction, stabilization of the ankle joint, and primary or secondary closure of the wound.
We present the case of a 40-year-old South Asian woman who was involved in an accident. She was rushed to our hospital, whereby subsequent examination revealed an open total talus dislocation with the talus being exposed in its entirety from a contaminated wound in the medial side. Furthermore, radiograph confirmed total talus dislocation without concomitant malleoli fracture. She was immediately taken to the operating theater whereby debridement and immediate reduction was performed under anesthesia, and the ankle was stabilized with external fixator for about 6 weeks. She is now able to bear weight on the affected ankle with minimal tolerable pain and has normal range of motion of the ankle.
Open total talus dislocation without concomitant malleoli fracture is a rare injury. Reduction of the talus in combination with complete wound debridement potentially successfully avoids infection, provides early revascularization preventing avascular necrosis, and preserves the normal ankle anatomy.
距骨全脱位而无踝（腓骨）骨折是一种非常罕见的损伤，其发病率仅为所有脱位的 0.06%，距骨损伤的 2%，通常伴有常见并发症，如感染、缺血性坏死和创伤后关节炎。治疗通常包括清创、复位、踝关节稳定以及伤口的一期或二期闭合。
我们介绍了一位 40 岁的南亚女性患者，她遭遇了一场事故。她被紧急送往我们医院，随后的检查显示为开放性距骨全脱位，距骨完全从内侧污染的伤口中暴露出来。此外，影像学检查证实为距骨全脱位而无伴发的腓骨骨折。她立即被送往手术室，在麻醉下进行清创和即刻复位，并使用外固定器固定踝关节约 6 周。现在她可以用受影响的脚踝承受体重，只有轻微可耐受的疼痛，并且脚踝的活动范围正常。
开放性距骨全脱位而无伴发的腓骨骨折是一种罕见的损伤。距骨复位结合彻底清创，可有效避免感染，早期实现血运重建，防止缺血性坏死，并保留正常的踝关节解剖结构。
