Yung King Shing, Kwok Hoi Ming, Pan Nin Yuan, Lo Bill Archie
Department of Radiology, Princess Margaret Hospital, Kwai Chung, Hong Kong.
Department of Radiology, Tseung Kwan O Hospital, Hang Hau, Hong Kong.
J Clin Imaging Sci. 2024 Aug 16;14:30. doi: 10.25259/JCIS_8_2024. eCollection 2024.
The objectives of this study were to contribute to the limited existing knowledge about subtalar dislocations, analyze the computed tomography (CT) findings and advantages over radiography, and report the rate and potential risk factors of post-traumatic peri-talar osteoarthritis (OA).
A total of 23 cases of traumatic subtalar dislocation during a 15-year period at three regional hospitals were retrospectively reviewed.
All 23 cases were closed dislocations. Successful close reduction was performed in 17 patients (73.9%) and 6 patients (26.1%) required open reduction and internal fixation. Twenty patients (87%) had associated foot and ankle fractures. Fractures of calcaneal medial tubercle were the most common (75%), followed by talar head (30%), sinus tarsi (25%), and medial malleolus (25%). The radiograph's sensitivity for identifying fractures was 48.1%. The mean follow-up period is 30 months. Symptomatic OA affected 8 patients (36.4%). No post-trauatic talar avascular necrosis was noted. Fractures were present in all of those patients with post-traumatic OA (100%). Three out of five patients who sustained high-energy mechanism injury developed radiographic OA (66.7%). Three out of six patients (50%) treated with open reduction and internal fixation also developed radiographic OA.
Subtalar dislocation remains a rare injury. It is strongly associated with foot and ankle fractures. Fractures of the calcaneal medial tubercle were the most common. The risk of post-traumatic symptomatic peritalar OA is high. CT is useful in detecting occult fractures and injured bony subregions. We postulated potential risk factors of post-traumatic OA (fracture, high-energy mechanism of injury, open reduction, and internal fixation); however, this requires further study.
本研究的目的是补充关于距下关节脱位的现有有限知识，分析计算机断层扫描（CT）结果及其相对于X线摄影的优势，并报告创伤后距周骨关节炎（OA）的发生率及潜在危险因素。
回顾性分析三家地区医院15年间共23例创伤性距下关节脱位病例。
23例均为闭合性脱位。17例患者（73.9%）成功闭合复位，6例患者（26.1%）需要切开复位内固定。20例患者（87%）合并足踝部骨折。跟骨内侧结节骨折最常见（75%），其次为距骨头骨折（30%）、跗骨窦骨折（25%）和内踝骨折（25%）。X线摄影识别骨折的敏感度为48.1%。平均随访时间为30个月。8例患者（36.4%）出现有症状的骨关节炎。未发现创伤后距骨缺血性坏死。所有创伤后骨关节炎患者均存在骨折（100%）。5例遭受高能机制损伤的患者中有3例出现X线骨关节炎（66.7%）。6例接受切开复位内固定治疗的患者中有3例（50%）也出现了X线骨关节炎。
距下关节脱位仍然是一种罕见损伤。它与足踝部骨折密切相关。跟骨内侧结节骨折最为常见。创伤后有症状的距周骨关节炎风险较高。CT有助于检测隐匿性骨折和受损的骨亚区域。我们推测了创伤后骨关节炎的潜在危险因素（骨折、高能损伤机制、切开复位和内固定）；然而，这需要进一步研究。
