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

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.

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

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-81-9-495 ◽

1991 ◽

Vol 81 (9) ◽

pp. 495-498 ◽

Cited By ~ 3

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.

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Subtalar Joint Dislocations

Foot & Ankle International ◽

10.1177/107110079501601212 ◽

1995 ◽

Vol 16 (12) ◽

pp. 803-808 ◽

Cited By ~ 33

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.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192694 ◽

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.

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Pseudo Os Trigonum Sign: Missed Posteromedial Talar Facet Fracture

Foot & Ankle International ◽

10.1177/107110070302400813 ◽

2003 ◽

Vol 24 (8) ◽

pp. 642-649 ◽

Cited By ~ 33

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.

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Occult Fractures Following Subtalar Joint Injuries

Foot & Ankle International ◽

10.1177/107110079601700309 ◽

1996 ◽

Vol 17 (3) ◽

pp. 164-169 ◽

Cited By ~ 35

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.

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Lateral subtalar dislocation. A literature review and unusual case report

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-82-3-162 ◽

1992 ◽

Vol 82 (3) ◽

pp. 162-166 ◽

Cited By ~ 5

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.

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Fracture of the Entire Posterior Process of Talus Associated with Subtalar Dislocation: A Case Report

Foot & Ankle International ◽

10.1177/107110079601700408 ◽

1996 ◽

Vol 17 (4) ◽

pp. 226-229 ◽

Cited By ~ 19

Author(s):

Yeung-Jen Chen ◽

Robert Wen-Wei Hsu ◽

Hsin-Nung Shih ◽

Tsung-Jen Huang

Keyword(s):

Case Report ◽

Closed Reduction ◽

Subtalar Joint ◽

Traffic Accident ◽

Talus Fracture ◽

Posterior Portion ◽

Subtalar Dislocation ◽

Posterior Process ◽

And Inversion

This is a case report of a 52-year-old woman who sustained a medial subtalar dislocation with fracture of the posterior process of the talus in a traffic accident. After closed reduction of the subtalar dislocation, tomography demonstrated that the talus fracture involved the entire posterior process and the posterior portion of the talar body. The fracture of the talus was treated with an open reduction and miniscrew fixation. At follow-up examination 32 months later, the functional and radiographic results were graded as good. The proposed mechanism of this case was a forced plantarflexion and inversion acting simultaneously on the subtalar joint. This was different from an isolated medial subtalar dislocation, which was caused by an inversion.

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Injury Characteristics and the Clinical Outcome of Subtalar Dislocations: A Clinical and Radiographic Analysis of 25 Cases

Foot & Ankle International ◽

10.1177/107110070302400210 ◽

2003 ◽

Vol 24 (2) ◽

pp. 158-163 ◽

Cited By ~ 75

Author(s):

Christopher Bibbo ◽

Robert B. Anderson ◽

W. Hodges Davis

Keyword(s):

Subtalar Joint ◽

Motor Vehicle ◽

High Energy ◽

Aofas Score ◽

Exact Test ◽

Subtalar Dislocation ◽

Vehicle Accidents ◽

The Mean ◽

Radiographic Changes

The objective of this study was to determine the mechanisms of injury and pattern of associated foot and ankle injuries and systemic injuries associated with subtalar dislocations, and, correlate these data with the radiographic and clinical/functional outcome of patients after subtalar dislocation. Results: Twenty-five patients with a subtalar dislocation were identified over a seven year period. The mean patient age was 38 years. Males (n=19) comprised 76% of patients, with a mean age of 36 years. High energy mechanisms (motor vehicle accidents, falls) accounted for 68% of subtalar dislocations. Although high energy mechanisms showed a strong trend toward open subtalar dislocations, the association was not statistically significant (p=0.0573, Fisher's exact test). Closed dislocations predominated (75%). Left and right-sided dislocations were nearly equally distributed, even among motor vehicle accidents. Medial dislocations predominated (65%): these were not influenced by mechanism of injury and did not result in statistically lower AOFAS ankle/hindfoot scores. Subtalar dislocation was irreducible (requiring open reduction) in 32%, with higher energy mechanisms of injury being statistically associated with an irreducible subtalar dislocation (p=0.0261, Fisher's exact test). Block to reduction was evenly distributed among soft tissue elements (posterior tibial tendon, flexor hallucis longus tendon, capsule, extensor retinaculum) and osseous elements. Eighty-eight percent of patients incurred concomitant injuries to the foot and ankle (95% of which were closed injuries), namely, the ankle and talus. Systemic injuries occurred in 88% of patients. At a mean follow-up of five years, the mean AOFAS score of the subtalar dislocation side was significantly lower (mean=71 vs. 93, p=0.0007, unpaired Student's t-test). No statistical relation was found between the number of associated extremity injuries and AOFAS score (Spearman correlation coefficient, r=(–)0.236, p=0.331). Radiographic follow-up demonstrated 89% of ankles with radiographic changes (31% symptomatic); however, the majority of these patients (61%) had an associated ankle injury. The subtalar joint demonstrated radiographic changes in 89% of patients, with 63% being symptomatic; 75% of patients with subtalar joint changes incurred a fracture about the subtalar joint at the time of dislocation. Four patients went on to subtalar fusion at an average of 8.8 months post-dislocation. The midfoot showed radiographic changes in 72% of patients, with only 15% of these patients being symptomatic. All patients with midfoot symptoms were well controlled by nonsurgical measures.

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