Youssef Yasmin, Schöffl Volker, Weber Gordian, Röttel Steffen, Willy Christian, Patzsch Falko
Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
Klinik für Orthopädie und Unfallchirurgie, Zentrum für Interdisziplinäre Sportmedizin, Klinikum Bamberg, Buger Straße. 80, 96049, Bamberg, Deutschland.
Unfallchirurgie (Heidelb). 2025 Jul;128(7):545-551. doi: 10.1007/s00113-025-01583-w. Epub 2025 Jun 2.
Subtalar dislocations (simultaneous dislocations of the talocalcaneal and talonavicular joints) without concomitant fracture are rare and account for 1-2% of all dislocations. The treatment has been described in several case reports and consists primarily of closed reduction with the patient under anesthesia followed by immobilization.
A 30-year-old male patient sustained a multidimensional nonfractured dislocation of the ankle joint with a predominantly subtalar component (luxatio subtalolateralis) while climbing. As it turned out later, a closed reduction was not possible due to interposition of the tendons of the posterior tibialis muscle and the flexor digitorum pedis longus muscle, so that an open reduction had to be performed. The full extent of the injury could only be assessed during the surgical exploration. The patient was treated in an external fixator for 12 weeks. Subsequently, physiotherapy was initiated. After only 6 months postoperatively the patient showed good mobility, functionality and resilience in the affected ankle joint. After 30 months the patient was free of symptoms. The prolonged immobilization after subtalar dislocation using an external fixator over a total period of 12 weeks, as performed in this case report, demonstrated good long-term functional outcomes.
距下关节脱位（即距跟关节和距舟关节同时脱位）且无合并骨折的情况较为罕见，占所有脱位的1% - 2%。已有多篇病例报告描述了其治疗方法，主要包括在麻醉下对患者进行闭合复位，随后进行固定。
一名30岁男性患者在攀爬时发生了以距下关节为主的多维度无骨折踝关节脱位（距下外侧脱位）。后来发现，由于胫后肌和趾长屈肌肌腱嵌入，无法进行闭合复位，因此不得不进行切开复位。只有在手术探查时才能评估损伤的全貌。患者使用外固定架治疗12周。随后开始进行物理治疗。术后仅6个月，患者患侧踝关节就表现出良好的活动度、功能和恢复能力。30个月后患者无症状。如本病例报告中所述，使用外固定架对距下关节脱位进行长达12周的延长固定，显示出良好的长期功能结果。
