Closed talar body fracture with talonavicular dislocation; a case report

Medial talonavicular dislocation with nondisplaced navicular fracture: A case report

INTRODUCTION

Talonavicular dislocation is a rare injury that usually occurs following high-energy trauma. The mechanism of injury is a force of abduction or adduction applied to the forefoot. In this article, we present a rare case of medial talonavicular dislocation with a fracture of the navicular following low-energy trauma.

PRESENTATION OF CASE

We report a case of talonavicular dislocation with a navicular fracture in a 25-year-old male. He presented at the emergency department with a history of twisting injury to his left foot. Physical examination revealed an obvious deformity of his foot associated with tenderness. No neurological deficit was present. Radiograph and CT scan showed medial talonavicular dislocation and postero-lateral navicular fracture. Closed reduction was done followed by six weeks in a cast. The patient was followed up for six months and no complications were reported.

DISCUSSION

Talonavicular dislocation is commonly associated with ligamentous disruption and midfoot fractures. Most studies reported this type of dislocation in association with a fracture of the navicular, cuboid, talus, calcaneus or metatarsal bones as a result of high-energy trauma. However, in our case, the dislocation resulted from low-energy trauma and was associated with a nondisplaced fracture of the navicular and a minimally impacted fracture of the talus that was treated conservatively.

CONCLUSION

Since this type of dislocation is rare, it is important to recognize it early to avoid complications such as painful equinovarus deformity. Early reduction and immobilization is the ideal treatment for this injury.

Pure isolated medial talonavicular joint dislocation following low-energy trauma: a case report

Midtarsal dislocations are relatively rare injuries secondary to high-energy trauma and are typically accompanied by disruption of ligamentous structures and fractures of the midfoot. We herein present a case of a pure isolated medial swivel dislocation of the talonavicular joint (TNJ) that was sustained following low-energy trauma without an associated fracture. A 78-year-old woman visited our emergency department with severe pain in the midfoot area of the right foot without neurovascular deficits. She had sustained this injury after severe ankle inversion while going downstairs. Plain radiographs of the right foot showed that the navicular was dislocated medially on the talus; no other malalignments were present. Three-dimensional computed tomography revealed dislocation of the TNJ, but no other tarsal or midtarsal bone fractures or dislocations. A medial dorsal incision was made to expose the TNJ. The dorsal talonavicular ligament was ruptured and interposed between the navicular and talus. The ligament was removed and the TNJ was reduced. The clinical outcome at the 1-year follow-up was satisfactory with no limitations in daily activities. In summary, we have reported an extremely rare case of a pure isolated medial TNJ dislocation in which the interposed dorsal talonavicular ligament served as an obstacle to reduction.

Medial Swivel Peritalar Fracture Dislocation: A Case Report

A medial swivel peritalar fracture-dislocation is a rare and disabling foot injury. The terminology describes a peritalar dislocation as the direction of peritalar foot displacement. Medial dislocation is the most frequent type. A rare variant involves talonavicular joint dislocation, subtalar joint fracture-dislocation, and calcaneocuboid fracture-dislocation. The clinical position of the foot resembles an equinovarus deformity. A computed tomography (CT) scan is necessary to obtain a diagnosis and formulate a surgical plan. A medial swivel peritalar fracture-dislocation is a challenging injury, and because there have been few reported cases in the literature, an optimal treatment protocol has not yet been established. We present a case of an unusual fracture-dislocation pattern of the hind and midfoot causing a complex talonavicular fracture-dislocation, subtalar fracture dislocation, and calcaneocuboid fracture-dislocation. The injury was successfully treated with open reduction and internal fixation.

Medial Swivel Dislocation of the Talonavicular Joint with Associated Cuboid Fracture

Medial talonavicular dislocation associated with cuboid fracture is rare. We report an 18-year-old man with this injury who exhibited excellent results after open reduction and stabilization of the joint with temporary Kirshner wires.

An unusual variety of simultaneous fracture dislocation pattern: medial swivel dislocation of talonavicular joint with displaced fractures of the fourth and fifth metatarsals

In published studies, a very rare, special type of Chopart dislocation termed a swivel dislocation has been reported. This injury is characterized by dislocation of the talonavicular joint, but the calcaneocuboid joint remains intact. The foot creates a typical rotational movement without inversion or eversion. The axis of rotation is the interosseous talocalcaneal ligament, which remains intact. We report the case of an 18-year-old male who had experienced a medial swivel dislocation of the talonavicular joint associated with displaced fractures of the fourth and fifth metatarsals. The occurrence, features, and method of treatment of this rare injury are presented.

The Edinburgh variant of a talar body fracture: a case report

We describe a novel closed pantalar dislocation with an associated sagittal medial talar body and medial malleolus fractures. Closed reduction was attempted unsuccessfully. Open reduction was performed, revealing a disrupted talonavicular joint with instability of the calcaneocuboid joint. This configuration required stabilisation with an external fixator. There were no signs of avascular necrosis, or arthrosis at 15 months follow but is currently using a stick to mobilise.

Talonavicular dislocation and nondisplaced fracture of the navicular

Dislocation of the talonavicular joint is rare. We report a case of talonavicular dislocation in a 24-year-old man associated with a nondisplaced fracture of the navicular. Closed reduction was achieved, followed by 4 weeks in a cast. After 2 years of follow-up, no complications have been reported. This patient is still successfully employed as a manual worker 2 years after injury.

Surgical treatment of talar body fractures

BACKGROUND

Fractures of the body of the talus are uncommon and poorly described. The purposes of the present study were to characterize these fractures, to describe one treatment approach, and to evaluate the clinical, radiographic, and functional outcomes of operative treatment.

METHODS

Fifty-six patients with fifty-seven talar body fractures who had been treated operatively during a sixty-seven-month period at a level-1 trauma center were identified with use of a database. Twenty-three patients had a concomitant talar neck fracture. Eleven of the fifty-seven fractures were open. All patients underwent open reduction and internal fixation. Complications, secondary procedures, and the ability to return to work were evaluated at a minimum of one year. The radiographic presence of osteonecrosis and posttraumatic arthritis was ascertained. Foot Function Index and Musculoskeletal Function Assessment questionnaires were completed.

RESULTS

Thirty-eight patients were evaluated after an average duration of follow-up of thirty-three months. Early complications occurred in eight patients. Ten of the twenty-six patients who had a complete set of radiographs had development of osteonecrosis of the talar body. Five of these ten patients experienced collapse of the talar dome at a mean of 10.2 months after surgery. All patients with a history of both an open fracture and osteonecrosis experienced collapse. Seventeen of twenty-six patients had posttraumatic arthritis of the tibiotalar joint, and nine of twenty-six had posttraumatic arthritis of the subtalar joint. Fractures of both the talar body and neck led to development of advanced arthritis more frequently than did fractures of the talar body only (p = 0.04). All patients with open fractures had end-stage posttraumatic arthritis (p = 0.053). Twenty-three (88%) of twenty-six patients had radiographic evidence of osteonecrosis and/or posttraumatic arthritis. Worse outcomes were noted in association with comminuted and open fractures. Osteonecrosis and posttraumatic arthritis adversely affected outcome scores.

CONCLUSIONS

Open reduction and internal fixation of talar body fractures may restore congruity of the adjacent joints. However, early complications are not infrequent, and most patients have development of radiographic evidence of osteonecrosis and/or posttraumatic arthritis. Associated talar neck fractures and open fractures more commonly result in osteonecrosis or advanced arthritis. Worse functional outcomes are seen in association with advanced posttraumatic arthritis and osteonecrosis that progresses to collapse. It is important to counsel patients regarding these devastating injuries and their poor prognosis and potential complications.