Results of closed subtalar dislocations

BACKGROUND

The subtalar dislocation (SD) of the foot is an uncommon injury characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints without involvement of the tibiotalar and calcaneocuboid joints.

PURPOSES

The purpose of this study was to evaluate the clinical and radiological outcome in a consecutive series of close SD.

METHODS

We retrospectively evaluated a case series of patients who presented a close SD. Thirteen patients were selected for this study. There were 9 patients with a medial SD, 3 patients with a lateral dislocation and 1 patient with a posterior subtalar dislocation.

RESULTS

The most frequent symptoms observed in our study included transient mild pain, swelling and decreased ankle ROM, which did not restrict patients' daily activities. However, lower AOFAS scores were observed on patients with associate peritalar osseous injuries.

CONCLUSION

The results of the present study suggest that detecting and treating any associate peritalar fractures are the keys to a successful long-term outcome.

Open ankle dislocation without associated malleolar fracture: Review of the literature

Open ankle dislocation without an associated fracture is an extremely rare injury [1]. We present a case of a 17-years old male who sustained a serious injury of his right ankle during jumping downstairs. He twisted his ankle and sustained an open posteromedial dislocation of his right ankle, without an associated malleolar fracture. The treatment consisted of wound debridement and irrigation open relocation with repair of anterior talo-fibular ligament, and primary closure of the skin post operatively the limb was immobilised in short leg cast for six weeks in a neutral position allowing partial weight bearing. At the 3-month follow-up visit, the patient reported that both ankle and feet had regained full, pain-free range of motion and he returned to full activity.

Consequences of a missed ankle dislocation in an adolescent

Ankle dislocation without associated malleolar fracture(s) remains a rare presentation, especially in adolescence. Identified and treated promptly, these injuries can result in good to excellent outcome. We present an anterior ankle dislocation in a 14 year old, missed for approximately 12 months, necessitating multiple surgical interventions to provide a pain-free and stable joint. A review of the current literature is also provided.

Rearfoot and Ankle Dislocations

Subtalar dislocations, ankle dislocations, and total talar dislocations are high-energy injuries. As such, there may be associated osseous or soft tissue injuries that can be diagnosed with advanced imaging such as computed tomography (CT) or MRI. With closed injuries, closed reduction may require sedation or general anesthesia, flexion of the knee to release the tension of the gastrocnemius-soleus complex, distraction is applied, the deformity is accentuated, then the deformity is corrected. Open injuries are usually associated with a higher level of energy and a higher rate of infection. It is important to thoroughly irrigate and debride open dislocations both before and after reduction.

Partial revision of a dislocated periprosthetic tibial fracture after total ankle replacement with a stemmed implant and plate fixation: A case report

INTRODUCTION

Total ankle arthroplasty (TAR) procedures have become more reliable and incidence is increasing. A growing number of postoperative complications can be expected and should be correctly addressed.

PRESENTATION OF CASE

A 43-year-old woman suffering from severe ankle osteoarthritis underwent TAR (Stryker's Infinity with Prophecy alignment guides, uncemented tibial component and cemented talus component). After a fall, one month after the surgery, she presented with a fracture of the medial malleolus and an anterior periprosthetic fracture of the tibia, with anterior dislocation of the tibial prosthetic component. Fracture fixation and partial revision surgery was planned using the same anterior surgical access. To restore length, rotation and joint articulation, the medial malleolus was first reduced and synthesized with a plate and 6 screws through additional minimally invasive medial ankle incisions. Once the medial malleolus was stabilized, the already mobilized tibial component was removed. Freehand cuts under fluoroscopic guidance on the anterior surface of the tibia were performed. After a final check with a trial component, a Stryker's Inbone II stem, which matched the previously inserted talar component, was implanted and partially cemented to fill the remaining bone gaps.

DISCUSSION

Only few case reports of periprosthetic ankle fractures exist, and none of them were similar to ours. There are no published precedents for this revision approach from a stemless to a stemmed tibial implant without changing the talar implant.

CONCLUSION

Partial revision after a complex periprosthetic fracture results in a satisfactory outcome if surgery is performed in specialized centers.

Pure ligamentous ankle dislocation: A case report

INTRODUCTION AND IMPORTANCE

Pure ankle dislocation is a rare injury, and this injury is an orthopedic emergency requiring immediate reduction. In more common circumstances, this injury is usually associated with malleolar fractures. The standardized treatment protocol is still deficient.

CASE PRESENTATION

We report a case of a 33-year-old woman who presented with an open ankle dislocation without concomitant malleolar fractures. Early extensive wound debridement, immediate reduction, and immobilization of the ankle joint using an external fixator were performed during the first surgery. During the second surgery, which was performed 3 weeks later, the medial and lateral ankle ligaments were repaired, and a suture tape internal brace was added. A good functional outcome with the American Foot and Ankle Society score of 87 was achieved at 1-year follow-up.

DISCUSSION

In an open dislocation with massive ligamentous injury, staged surgery could be performed to prevent deep infection, with extensive debridement and immobilization using an external fixator in the first stage and ligament repair in the second stage. An internal brace using a suture tape is an option for ligament repair if the remnant is not sufficient to be repaired, as in this case. Early range of motion exercises should be initiated after second-stage surgery to prevent stiffness.

CONCLUSION

Staged surgery using an external fixator and ligament repair using a suture tape and internal brace augmentation can be an effective option for a pure ligamentous ankle dislocation with an open wound and a poor remnant of ankle ligaments.

Severe pure open dislocation of the ankle and flexor digitorum longus tendon tear a case report

Proximal avulsion rupture of the flexor digitorum longus (FDL) tendon associated with an ankle dislocation is extremely rare. We report a case of a 29 years old patient presenting a severe open ankle dislocation with flexor digitorum longus tendon tear after a motorcycle accident. We performed wound debridement, ankle reduction, tendon repair and stabilization with external fixation. At our last follow-up 17 months after the operation, the patient had good functional outcome and returned to work. This report is noticeable as it is, to the best of our knowledge, the third study reporting a case with simultaneous open ankle dislocation and proximal avulsion rupture of the FDL tendon.

Pure ankle dislocation after modified Broström repair for chronic lateral instability: Case report and literature review

Ankle dislocation with no concomitant malleolar fracture is an overwhelmingly rare injury, and only a relatively limited number of cases have been reported. Diligent management regarding the treatment of these injuries is requisite to attain an auspicious outcome. Lateral ankle instability is a frequent condition that can derive from recurrent sprains, predominantly at a young age. Broström repair, with its modifications and updates, has been established as the optimal solution when treating chronic lateral unsteadiness. We present a peculiar case of a posteromedial ankle dislocation without accompanying fracture in a patient operated on many years before the injury for chronic lateral instability with a modified Broström procedure. No similar case could be retrieved in the existing literature. After the initial clinical and radiological assessment, urgent closed reduction of the dislocation was achieved, and the foot was immobilized. Further imaging was carried out to evaluate the features of the injury. It was deduced that the repairs from the previous operation were intact. The patient was operated on to repair the distal tibiofibular syndesmosis. The postoperative course was uneventful, and absolute functional capacity was eventually accomplished. Demonstrating this rare case, we accentuate the role of implementing the modified Broström procedure in the surgical treatment of chronic lateral ankle instability.