Introduction Typically from a high-energy mechanism 25% may be open lateral dislocations more likely to be open 65% to 80% are medial dislocations remaining are lateral dislocations case reports of anterior or posterior dislocations Associated injuries associated dislocations talonavicular associated fractures (up to 44%) with medial dislocation dorsomedial talar head posterior process of talus navicular with lateral dislocation cuboid anterior calcaneus lateral process of talus fibula Presentation Physical exam foot will be locked in supination with medial dislocation foot will be locked in pronation with lateral dislocation Imaging Radiographs medial subtalar dislocation talar head will be superior to navicular on lateral image lateral subtalar dislocation talar head will be colinear or inferior to navicular on lateral image CT scan perform following reduction look for associated injuries or subtalar debris Treatment Nonoperative closed reduction and short leg non-weight bearing cast for 4-6 weeks indications first line of treatment 60-70% can be reduced by closed methods technique requires adequate sedation typical maneuvers include knee flexion and ankle plantar flexion followed by distraction and hindfoot inversion or eversion depending on direction of dislocation perform a post-reduction CT to look for associated injuries Operative open reduction indications failure of closed reduction up to 32% require open reduction medial dislocation reduction blocked by lateral structures including peroneal tendons extensor digitorum brevis talonavicular joint capsule lateral dislocation reduction blocked by medial structures including posterior tibialis tendon flexor hallucis longus flexor digitorum longus place temporary transarticular pins as needed if joint remains unstable Complications Post-traumatic Arthritis long-term follow up of these injuries show degenerative changes Subtalar joint most commonly affected with up to 89% of patients demonstrating radiographic arthrosis (63% symptomatic)
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next (OBQ12.150) Which of the following is true when comparing Figure A to Figure B? Review Topic QID: 4510 FIGURES: A B 1 Figure B is more likely to have an associated fracture 8% (429/5323) 2 Figure A is more likely to be blocked from closed reduction by the extensor digitorum brevis 12% (645/5323) 3 FIgure A is more likely to be open 54% (2885/5323) 4 FIgure B is more likely to be blocked from closed reduction by the posterior tibial tendon 19% (1003/5323) 5 Figure A more likely to be stable following closed reduction 6% (310/5323) Select Answer to see Preferred Response PREFERRED RESPONSE 3 (OBQ09.76) A 34-year-old male falls 10 feet from a balcony and is brought to the emergency room with the deformity seen in Figure A. Radiographs shown are shown in Figure B and C. Which of the following structures can block closed reduction of this injury pattern? Review Topic QID: 2889 FIGURES: A B C 1 Flexor hallucis longus tendon 12% (395/3360) 2 Extensor digitorum brevis muscle 62% (2089/3360) 3 Posterior tibial tendon 20% (679/3360) 4 Tibialis anterior tendon 5% (171/3360) 5 Plantar fascia 0% (12/3360) Select Answer to see Preferred Response PREFERRED RESPONSE 2 (OBQ09.123) A 37-year-old female sustains the injury seen in Figures A and B. At long-term follow up, degeneration of which of the following joints has been shown to have the highest rate of patient symptoms? Review Topic QID: 2936 FIGURES: A B 1 Tibiotalar joint 5% (21/438) 2 Talonavicular joint 13% (58/438) 3 Calcaneocuboid joint 1% (5/438) 4 Lisfranc joint 9% (41/438) 5 Subtalar joint 71% (311/438) Select Answer to see Preferred Response PREFERRED RESPONSE 5 Sorry, this question is for Virtual Curriculum Members Only Click here to purchase (OBQ08.216) A 30-year-old male falls off the roof and sustains the injury seen in Figure A. Multiple attempts at a closed reduction are made, but are unsuccessful. Entrapment of which of the following structures is the most likely etiology? Review Topic QID: 602 FIGURES: A 1 Peroneal tendons 18% (284/1544) 2 Posterior tibial tendon 62% (964/1544) 3 Extensor retinaculum 3% (41/1544) 4 Anterior tibial tendon 3% (42/1544) 5 Flexor hallucis longus 13% (208/1544) Select Answer to see Preferred Response PREFERRED RESPONSE 2 (OBQ04.153) A 40-year-old male suffers the isolated injury shown in figure A with no associated fractures. What joint is dislocated in this radiograph? Review Topic QID: 1258 FIGURES: A 1 Tibiotalar 1% (9/749) 2 Talonavicular 95% (709/749) 3 Calcaneocuboid 4% (29/749) 4 First metatarsophalangeal 0% (0/749) 5 First tarsometatarsal 0% (1/749) Select Answer to see Preferred Response PREFERRED RESPONSE 2
Dislocations of the Talus - Educational Animation General - Subtalar Dislocations - Dislocations Of The Talus Dr. Nabil Ebraheim 7/11/2012 1060 views
Medial subtalar dislocation with fracture (C1818) Trauma - Subtalar Dislocations HPI - 21 yo male, volleyball injury. Closed reduced in OR. CT scan post reveals posterior medial talus fracture. How would you treat this patient? 3/9/2014 172 0 7 iatrogenic tibio-talar dislocation (C1912) Trauma - Subtalar Dislocations HPI - fall from height ( 3 feet). at presentation in ER we attempted to reduce peritalar dislocation in iv. sedation, and due to a relative anatomic position of the foot we assumed that it was fine (marked swelling). finally, at the Rx control we realized that instead of reducing the subtalar joint, we dislocated the tibio-talat joint how would you describe this lesion? 5/18/2014 158 0 6