Medial subtalar dislocation from a low-energy trauma. A case report and review of the literature. (June 2021)

• Record Type: Journal Article
• Authors: De Luna, V.; Caterini, A.; Petrungaro, L.; Barosso, M.; De Maio, F.; Farsetti, P.
• Is Part Of: International journal of surgery case reports. Volume 83(2021)
• Publication Date: 2021-06
• Subjects: Subtalar joint -- Talonavicular joint -- Subtalar dislocation -- Medial subtalar dislocation -- Low energy trauma; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105954
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction: Subtalar dislocation is a rare injury characterized by a simultaneous dislocation of the talocalcaneal and talonavicular joints. The most common type is caused by high-energy trauma with medial dislocation of the foot. This injury is frequently associated with fractures, but isolated dislocations are also reported. Case presentation: We report a rare case of medial subtalar dislocation secondary to low-energy injury in a 61-year-old woman. Following X-rays and CT scan, prompt closed reduction was performed under sedation and, after reduction, X-rays showed a good realignment of the foot. The CT scan revealed an occult non-displaced fracture of the posterior part of the talus. The patient was managed conservatively by a non-weight bearing cast for four weeks, followed by a rehabilitation program. At follow-up, six months later, we observed a good clinical and radiographic result. Discussion: The reported case confirms that the mechanism of injury is an important factor in predicting the final result, since subtalar dislocations secondary to a high-energy trauma are often associated with significant complications. We believe, in agreement with other authors, that a low-energy trauma generally doesn't produce long-term morbidity. Prompt reduction is very important in order to minimize soft tissue and neurovascular complications, although a CT is recommended to identify occult fractures. Conclusion: Subtalar dislocations, caused by low energy trauma, if adequately reduced in the emergency room, generally heal with conservative treatment, reducing the risk of significant complications. However, since we report a single patient, further case analysis is needed to make solid conclusions. Highlights: Subtalar dislocation is a rare injury characterized by a simultaneous dislocation of the talocalcaneal and talonavicular joints Subtalar dislocation caused by low energy trauma is uncommon. An immediate reduction under sedation is fundamental, in order to prevent damage to the soft tissues and neurovascular complications These lesions, if adequately reduced in the emergency room, heal with conservative treatment without complications