Pseudo Os Trigonum Sign: Missed Posteromedial Talar Facet Fracture

2003 ◽  
Vol 24 (8) ◽  
pp. 642-649 ◽  
Author(s):  
A. Ylenia Giuffrida ◽  
Sheldon S. Lin ◽  
Nicholas Abidi ◽  
Wayne Berberian ◽  
Avril Berkman ◽  
...  
Keyword(s):  
Ct Scan ◽  
Subtalar Joint ◽  
Articular Surface ◽  
Cast Immobilization ◽  
Rare Injury ◽  
Joint Dislocation ◽  
Os Trigonum ◽  
Subtalar Dislocation ◽  
Subtalar Arthritis ◽  
Facet Fracture

Background: Posteromedial talar facet fracture (PMTFF) is a rare injury, sparsely reported in the literature. This article proposes that PMTFF is often left undiagnosed by orthopaedic surgeons and suggests the routine application of advanced radiographic studies (i.e., CT scan) in the recognition of PMTFF. It also evaluates nonoperative management of PMTFF. Methods: After obtaining Institutional Review Board approval, the medical records over a 5-year period (1997–2001) were retrospectively reviewed from the foot and ankle service of a level 1 trauma center, identifying all cases of PMTFF. Charts were reviewed for relevant data. Results of treatment were assessed during follow-up physical examination. Results: Six cases of PMTFF were identified over a 5-year period. All injuries were associated with medial subtalar joint dislocation. Four of six (66%) patients were not initially diagnosed with PMTFF, but instead misdiagnosed as an os trigonum. The remaining two patients had an established diagnosis of PMTFF at the time of initial treatment. All had short leg cast immobilization for medial subtalar dislocation. CT evaluation yielded additional diagnoses in all six patients. All six patients showed a PMTFF. Five patients (83%) revealed persistent subtalar joint subluxation. Five of six (83%) patients required at least one additional procedure as a result of an undiagnosed or nonoperatively treated PMTFF. Four patients underwent subtalar joint fusion, and one patient underwent tibiotalar calcaneal fusion secondary to concomitant ankle/subtalar arthritis. The patient who did not undergo recommended fusion continued to be symptomatic. Conclusions: Diagnosis of PMTFF necessitates a heightened clinical suspicion, especially when a medial subtalar joint dislocation is present. Proper imaging studies, such as coronal CT scan, should be performed after any subtalar dislocation. Timely treatment, in the form of open reduction and internal fixation for large fragments involving the articular surface or surgical excision for smaller fragments, is recommended in order to restore proper anatomy and function of the subtalar joint. This study verifies the significant morbidity associated with an undiagnosed or nonoperatively treated PMTFF.

Fracture-dislocation of the talus in the pediatric patient. An unusual injury

1991 ◽  
Vol 81 (9) ◽  
pp. 495-498 ◽  
Author(s):  
JM Stutz ◽  
JM Karlin ◽  
N Daly
Keyword(s):  
Pediatric Patient ◽  
Closed Reduction ◽  
Subtalar Joint ◽  
Fracture Dislocation ◽  
Joint Dislocation ◽  
Subtalar Dislocation ◽  
Posterior Process ◽  
Fracture Dislocations ◽  
Unusual Injury

Subtalar fracture-dislocations in children are unusual, perhaps because of the greater elasticity of bone in children. The authors have presented a case of medial subtalar dislocation in a 13-year-old boy, accompanied by a rare fracture of the entire posterior process of the talus. This particular fracture has not been previously reported in association with a subtalar joint dislocation, nor has it been reported in a child. The patient was treated successfully by closed reduction of both the dislocation and the fractures.

Occult Fractures Following Subtalar Joint Injuries

1996 ◽  
Vol 17 (3) ◽  
pp. 164-169 ◽  
Author(s):  
Donald R. Bohay ◽  
Arthur Manoli
Keyword(s):  
Subtalar Joint ◽  
Joint Stiffness ◽  
Ct Scanning ◽  
Cast Immobilization ◽  
Joint Dislocation ◽  
Essentially Normal ◽  
Articular Fractures ◽  
Joint Dislocations ◽  
Short Period ◽  
Occult Fractures

Subtalar joint dislocations, although not common, have been increasing in frequency over the last decade. Generally, subtalar joint dislocation can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer minimal disability, with subtalar joint stiffness as the primary complaint. This report includes four cases of suspected joint dislocation or subluxation with occult intra-articular fractures identified only by CT scan following essentially normal radiographs. Evidence seems to indicate that CT scanning in patients with suspected subtalar joint subluxation or dislocation and normal radiographs is justified.

scholarly journals Isolated Medial Subtalar Joint Dislocation during Soccer (Football) Game: A Case Report and Review of the Literature

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Fekhaoui MR ◽  
◽  
Bassir R A ◽  
Mekkaoui J ◽  
Boufettal M ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Closed Reduction ◽  
Subtalar Joint ◽  
Full Range ◽  
Joint Stiffness ◽  
Young Male ◽  
High Energy ◽  
Joint Dislocation ◽  
Subtalar Dislocation ◽  
First Choice

Ankles injuries are common in sports such as football and soccer and one of the most serious and most rare is the subtalar dislocation. This injury is rare, touches young male patients and usually associated to fractures of the talus, the malleoli or the fifth metatarsal. Usually, this injury occurs in high-energy trauma, but it is very rare in sports injuries. Here we present the case of a 36-year-old male with an isolated Medial Subtalar Joint Dislocation after a severe tackle in a football (soccer) game. We performed a closed reduction under general anesthesia, and then a short-leg cast was applied for 4 weeks, followed by active and passive range of motion. At one-year follow up from trauma, the patient had a pain-free ankle with active full range of motion. For isolated medial subtalar dislocation occurring during sports activities, the first choice is the conservative treatment: Immediate closed reduction needs to be achieved followed by a short immobilization. Active/passive range of motion need to be started early to avoid joint stiffness.

Subtalar Joint Dislocations

1995 ◽  
Vol 16 (12) ◽  
pp. 803-808 ◽  
Author(s):  
Donald R. Bohay ◽  
Arthur Manoli
Keyword(s):  
Current Literature ◽  
Closed Reduction ◽  
Subtalar Joint ◽  
Joint Stiffness ◽  
Cast Immobilization ◽  
Joint Dislocation ◽  
Posttraumatic Arthrosis ◽  
Articular Fractures ◽  
Joint Dislocations ◽  
Short Period

Dislocations of the subtalar joint are rare injuries. The anatomy, pathophysiology, treatment, and prognosis of subtalar joint dislocations have been well described in the literature. The purpose of this paper is to review the current literature on subtalar joint dislocations, as well as outline those aspects of the anatomy, pathomechanics, and treatment pertinent to care of the patient with subtalar joint dislocation. In addition, complications and obstacles to reduction are described. Subtalar joint dislocations, although not common, have increased in frequency over the last decade. Generally, they can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer some disability with subtalar joint stiffness the primary complaint. Associated intra-articular fractures increase the risk of posttraumatic arthrosis.

scholarly journals Closed medial subtalar dislocation: case report and review of the literature

2019 ◽  
Vol 5 (4) ◽  
pp. 732
Author(s):  
Everisto A. Opondo
Keyword(s):  
Subtalar Joint ◽  
High Energy ◽  
Review Of The Literature ◽  
Osteochondral Fracture ◽  
Joint Dislocation ◽  
Wound Debridement ◽  
Subtalar Dislocation ◽  
Joint Dislocations ◽  
Excellent Functional Outcome

A rare case of medial subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. These talar dislocations represent 1%-2% of all dislocations. A case of uncomplicated medial subtalar joint dislocation managed by closed reduction under anaesthesia with excellent functional outcome is presented. In cases of open subtalar joint dislocation immediate reduction, wound debridement and if necessary (external) stabilization is critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular necrosis of the talus. Other long-term sequelae include osteochondral fracture and subtalar joint instability.

Lateral subtalar dislocation. A literature review and unusual case report

1992 ◽  
Vol 82 (3) ◽  
pp. 162-166 ◽  
Author(s):  
CL Sands ◽  
N Daly ◽  
JM Karlin ◽  
BL Scurran
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Subtalar Joint ◽  
Unusual Case ◽  
Long Term Results ◽  
Review Of The Literature ◽  
Joint Dislocation ◽  
Subtalar Dislocation ◽  
Unusual Case Report

An unusual case of suspected lateral subtalar joint dislocation was reported. A review of the literature found that medial dislocations were reported four times more frequently than lateral dislocations. Half of the cases of subtalar dislocation reviewed here described associated fractures, the incidence of which was higher in lateral dislocations. In both types of dislocations examined, almost half were reduced nonoperatively. In most cases, long-term results of repair of these injuries were considered favorable.

Effect of Calcaneus Fracture Gap Without Step-Off on Stress Distribution Across the Subtalar Joint

2016 ◽  
Vol 38 (3) ◽  
pp. 298-303 ◽  
Author(s):  
Brett Barrick ◽  
Donald A. Joyce ◽  
Frederick W. Werner ◽  
Maria Iannolo
Keyword(s):  
Subtalar Joint ◽  
Peak Pressure ◽  
Articular Surface ◽  
Axial Loading ◽  
Calcaneal Fracture ◽  
Subtalar Arthritis ◽  
Pressure Area ◽  
Fracture Models ◽  
Lateral Fragment ◽  
Surface Changes

Background: Subtalar arthritis is a common consequence following calcaneal fracture, and its development is related to the severity of the fracture. Previous calcaneal fracture models have demonstrated altered contact characteristics when a step-off is created in the posterior facet articular surface. Changes in posterior facet contact characteristics have not been previously characterized for calcaneal fracture gap without step-off. Methods: The contact characteristics (peak pressure, area of contact, and centroid of pressure) of the posterior facet of the subtalar joint were determined in 6 cadaveric specimens. After creating a calcaneal fracture to simulate a Sanders type II fracture, the contact characteristics were determined with the posterior facet anatomically reduced followed by an incremental increase in fracture gap displacement of 2, 3, and 5 mm without a step-off of the articular surface. Results: Peak pressure on the medial fragment was significantly less with a 5-mm gap compared to a 2- or 3-mm gap, or reduced. On the lateral fragment, the peak pressure was significantly increased with a 5-mm gap compared to a 2- or 3-mm gap. Contact area significantly changed with increased gap. Conclusion: In this study, there were no significant differences in contact characteristics between a <3-mm gap and an anatomically reduced fracture, conceding the study limitations including limiting axial loading to 50% of donor body weight. Clinical Relevance: A small amount of articular incongruity without a step-off can be tolerated by the subtalar joint, in contrast to articular incongruity with a step-off present.

Lateral Subtalar Joint Dislocation

2004 ◽  
Vol 94 (1) ◽  
pp. 65-69 ◽  
Author(s):  
David B. Randall ◽  
Anthony Jon Ferretti
Keyword(s):  
Computed Tomography ◽  
Subtalar Joint ◽  
Treatment Plan ◽  
Plain Film ◽  
Calcaneal Fracture ◽  
Interesting Case ◽  
Rare Injury ◽  
Joint Dislocation ◽  
Lateral Dislocation ◽  
Treatment Prognosis

Subtalar joint dislocation is a relatively rare injury, with lateral dislocation occurring less frequently than medial dislocation. Associated fractures alter the treatment plan and the prognosis, but they are often missed on plain film radiographs. A brief review of the anatomy, pathomechanics, treatment, prognosis, and complications of subtalar joint dislocation is presented. An interesting case of lateral subtalar joint dislocation with an associated calcaneal fracture not evident on plain film radiographs but delineated with computed tomography is presented. (J Am Podiatr Med Assoc 94(1): 65-69, 2004)

scholarly journals Arthroscopic treatment for posteromedial talar process fracture (Cedell fracture): a case report

2021 ◽  
Vol 15 (3) ◽  
pp. 273-277
Author(s):  
Carla Fernandes Martins ◽  
Patrícia Alexandra Nunes Gomes ◽  
Paulo Jorge Reino dos Santos Felicíssimo
Keyword(s):  
Case Report ◽  
Ct Scan ◽  
Ankle Sprain ◽  
Subtalar Joint ◽  
Surgical Techniques ◽  
Ankle Pain ◽  
Level Of Evidence ◽  
Rare Injury ◽  
Fracture Reduction And Fixation ◽  
Good Access

Fracture of the posteromedial talar process (Cedell fracture) is a rare injury and is easily misdiagnosed as a simple ankle sprain. Suspicion should be heightened if specific mechanisms of injury are present, and, in these cases, a CT scan should be performed. Significant ankle pain and disability can result if these injuries are not identified and treated properly. Few cases have been described in the literature, and the efficacy of surgical techniques and approaches for fractures of the posterior talar process remains controversial. We report a 56-year-old man with an acute posteromedial talar fracture treated arthroscopically. This approach provides good access to the posterior ankle compartment, subtalar joint, and extraarticular structures, which may allow fracture reduction and fixation under arthroscopic visualization. Level of Evidence V; Therapeutic Studies; Expert Opinion.

scholarly journals Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Megan Reilly ◽  
Kurosh Darvish ◽  
Soroush Assari ◽  
John Cole ◽  
Tyler Wilps ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Articular Surface ◽  
Joint Surface ◽  
Central Dome ◽  
Below The Knee ◽  
Joint Surfaces ◽  
Circular Surface ◽  
The Mean ◽  
Pass Through

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact.

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