Fracture of the Posterior Process of the Talus With Concomitant Subtalar Dislocation

Posteromedial Talar Body Fracture: Case Discussion and Surgical Technique

Posteromedial talar body fractures are a rare form of talus fracture that involves the tibiotalar and subtalar joints. In cases of displaced injuries, open reduction and internal fixation is typically recommended to minimize the risk of instability and post-traumatic osteoarthritis. This video presents a case of a posteromedial talar body fracture and highlights the technique for operative fixation through a posteromedial approach. Multiple methods to obtain reduction are discussed, and considerations with implant placement are described. The indications for surgical intervention are reviewed, and published outcomes following operative and nonoperative management of these injuries are presented.

Calcaneal fracture with a concomitant unstable subtalar dislocation: A case report

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Subtalar dislocation is a rare injury with post reduction instability being even rarer.

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Rarity is attributed to the presence of a strong ligament connecting the talus and the calcaneus.

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They occur more frequently in men than in women and predominately affect people in their mid-30 s.

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Our case highlighted the importance of the calcaneo-fibular ligament as a subtalar stabilizer.

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Our case is unique in using a synthetic graft to reconstruct the calcaneofibular ligament.

Background

Traumatic dislocation of the subtalar joint is an infrequently occurring injury, first described by DuFaurest in 1811. They were later on classified by Broca as medial, lateral, posterior and anterior dislocations based on the direction of the dislocation.

Case report

We present a case of a 30 year old male who presented after a 5 m height fall and direct right foot trauma. Investigations done in the emergency department revealed a right subtalar lateral dislocation with associated calcaneal intraarticular displaced fracture. Open reduction internal fixation of the calcaneal fracture was decided alongside with reduction of the subtalar joint. Intraoperatively the subtalar reduction was totally unstable due to the deficiency of the lateral collateral ligament. A decision of reconstruction of the calcaneofibular ligament using a synthetic ligament was taken. This reconstruction resulted in an adequate intraoperative stability of the subtalar joint. On a 2 year follow up the patient was asymptomatic with no residual subtalar instability.

Discussion

These injuries must be suspected after high energy trauma or twisting forces in the foot. They occur more frequently in men than in women and predominately affect people in their mid-30 s. Our case is unique in that the reconstruction of the calcaneofibular ligament was done using a synthetic graft to stabilize an acute unstable subtalar joint dislocation.

Conclusion

Subtalar dislocation is a rare injury with post reduction instability being even rarer. Care has to be taken not to overlook the frequently associated bony injuries, due to their impact on treatment decision and prognosis.

Rare injury of the foot: Os trigonum fracture: A case report

Os trigonum fractures are seen rarely. Our patient was a 16-year-old male patient who applied to our emergency service with right ankle pain due to acute hyperplantar flexion while playing football. There was a swelling on the right ankle and he had difficulty in walking. Os trigonum fracture was detected at lateral X-ray of the right ankle. No additional injury was detected with computed tomography and magnetic resonance imaging (MRI). Patient was treated conservatively. A short leg cast was applied. Cast was removed after six weeks and range of motion exercises were started. Union of fracture was seen on X-ray at six weeks from injury. Conservative treatment is thought to be a good option in these fractures. Computed tomography and MRI are important in the differential diagnosis and evaluation of additional injuries in this type of fracture.

Nonoperative Treatment of Fracture of the Entire Posterior Process of the Talus With Subtalar Dislocation: Case Report

Level V, expert opinion.

Surgical Treatment of Posteromedial Talus Fractures: Technique Description and Results of 10 Cases

BACKGROUND

The aim of this study is to describe a surgical technique for successful treatment of posteromedial talar body fractures and establish treatment recommendations for fractures of the posterior aspect of the talus.

MATERIALS AND METHODS

Ten patients treated operatively for a posteromedial talar body fractures entering both the subtalar and ankle articulations with a minimum of 1-year followup were identified from a trauma database. Age, mechanism of injury, associated injuries, time to surgery, complications, the range of motion, secondary procedures, and need for arthrodesis were evaluated.

RESULTS

Followup averaged 4.8 years (1-10). Eight of ten patients had high-energy mechanisms of injury. Six patients had associated medial subtalar dislocations with two open. Associated injuries were common. No surgical complications occurred. The range of motion was present but decreased. No arthrodesis procedures were performed.

CONCLUSIONS

Operative fixation of posteromedial talus fractures with the described surgical technique resulted in acceptable outcomes in this series of patients with improved outcomes when compared to prior reports in the literature.

Lateral Subtalar Dislocation with Tarsometatarsal Dislocation: A Case Report of a Rare Injury

Dislocation of the fourth and fifth tarsometatarsal joints in conjunction with lateral subtalar dislocation is a rare occurrence. Little is known about the mechanism of injury, the appropriate treatment for this condition, and its ultimate prognosis. In this report, we describe this atypical presentation in a middle aged, otherwise healthy male who sustained a trivial twisting injury to the ankle when he slipped and fell on ice. Open reduction and K-wire fixation were necessary to affix the lateral tarsometatarsal and talonavicular joints. At one year postoperatively, he was able to return to his preinjury occupation with mild to moderate pain with prolonged walking. His Foot and Ankle Disability Index and American Orthopaedic Foot and Ankle Society scores were 64 and 65 points, respectively. Surgical intervention resulted in a stable plantigrade foot; however, the patient had early radiographic evidence of posttraumatic arthritis in the midfoot joints at one-year follow-up.

Posteromedial Approach for Open Reduction and Internal Fixation of Talar Process Fractures

Fractures of the posteromedial process of the talus are frequently the result of high-energy trauma to the lower extremity. The treatment of these uncommon injuries may be unfamiliar and challenging to many surgeons. Significant pain and disability can result if these injuries are not recognized or treated appropriately. Open reduction and internal fixation via a posteromedial approach with screws is a mainstay of operative treatment for simple fractures. In cases of fracture impaction and/or comminution, a medial uniplanar external fixator may be used to improve intraoperative fracture visualization and mini-fragment plates and screws can be used to secure areas of comminution.

LEVEL OF EVIDENCE

Level V, expert opinion.