Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy; Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy.
Azienda USL Toscana Sud-Est, Ospedale di Campostaggia, Poggibonsi (SI), Italy.
Injury. 2024 Sep;55 Suppl 4:111474. doi: 10.1016/j.injury.2024.111474.
Subtalar dislocation is an uncommon orthopaedic pathology, representing 1 % of all traumatic injuries of the foot and 1-2 % of all dislocations, mostly affecting young male adults. While its urgent treatment consisting in reduction and immobilization of the dislocation has been well described, disagreement exists about post-operative management with specific regards to immobilization length and rehabilitation protocols.
A case series of traumatic subtalar dislocations treated with urgent reduction, a mean of 4 weeks immobilization and subsequent rehabilitation is presented, with 1-year minimum clinical and subjective follow up. Also, a systematic review of the literature concerning the post-operative management following a subtalar dislocation, and subsequent results, has been performed.
At 1-year minimum follow up, none of the patients presented with complications such as recurrence of dislocation or talus osteonecrosis. Tibio-talar and subtalar range of motion (ROM) were superimposable to the contralateral joints, with a maximum difference of 5°. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score highlighted a good functionality and a full recovery in all patients but one. Pure subtalar dislocations led to better results than complicated ones. Review of current literature available on the topic demonstrated that an earlier mobilization resulted in better ROM, but the global outcome did not differ among 4 to 6 weeks of immobilization.
Conflicting reports are present in the literature regarding the most appropriate post-reduction management of subtalar dislocations. In our case series, successful results have been obtained with a mean of 4 weeks of limb immobilization and an early rehabilitation protocol.
Although some limitations are present, 4 weeks immobilization appears to be the best balance between a good overall outcome and a better recovery of ROM. Further studies are needed to deepen the subject.
距下关节脱位是一种罕见的骨科病理，占足部所有创伤性损伤的 1%，占所有脱位的 1-2%，主要影响年轻男性成年人。虽然其紧急治疗包括复位和脱位固定已得到很好的描述，但对于术后管理存在分歧，特别是在固定长度和康复方案方面。
我们报告了一组采用紧急复位治疗的创伤性距下关节脱位患者，平均固定 4 周，随后进行康复治疗，临床和主观随访时间至少为 1 年。此外，我们还对距下关节脱位后术后管理的文献进行了系统回顾，并对后续结果进行了评估。
在至少 1 年的随访中，没有患者出现脱位复发或距骨坏死等并发症。胫距关节和距下关节的活动度（ROM）与对侧关节相似，最大差异为 5°。美国矫形足踝协会踝关节-后足评分（AOFAS）显示，除 1 例患者外，所有患者的功能均良好且完全恢复。单纯距下关节脱位的结果优于复杂脱位。对现有文献的回顾表明，早期活动可获得更好的 ROM，但在 4 至 6 周的固定时间内，整体结果并无差异。
文献中对于距下关节脱位后最适当的复位管理存在相互矛盾的报道。在我们的病例系列中，采用平均 4 周的肢体固定和早期康复方案，取得了成功的结果。
尽管存在一些局限性，但 4 周的固定时间似乎是获得良好整体结果和更好 ROM 恢复之间的最佳平衡。需要进一步的研究来深入探讨这个问题。
