A Fixed, Unreducible, Unstable Medial Swivel Dislocation of the Talonavicular Joint with Associated Navicular Fracture

A 32-year-old white male was on a second-story balcony when he fell off and landed on the cement below. With initial X-rays being read as negative on the radiology report due to the subtle nature of the injury, the patient was promptly diagnosed with a medial swivel dislocation by the orthopaedic team, which ended up being fixed, unstable, and irreducible. The patient also had acute skin compromise and needed to be taken to the operating room prior to progression of skin breakdown. This dislocation pattern is a rare variant, especially when paired with the fixed nature of the dislocation and the soft tissue compromise. In the end, open treatment was necessary in order to reduce the talonavicular joint. Because of early recognition and prompt treatment, skin breakdown was avoided. Internal screw fixation of the fractured navicular bone was needed along with K-wire insertion to hold the normal anatomy of the talonavicular joint reduced. All hardware was ultimately removed after healing, and anatomy was restored with excellent patient function. This case report highlights the orthopaedic knowledge needed to not only recognize this rare fracture-dislocation pattern but to also treat it promptly when encountered.

Pure isolated medial talonavicular joint dislocation following low-energy trauma: a case report

Midtarsal dislocations are relatively rare injuries secondary to high-energy trauma and are typically accompanied by disruption of ligamentous structures and fractures of the midfoot. We herein present a case of a pure isolated medial swivel dislocation of the talonavicular joint (TNJ) that was sustained following low-energy trauma without an associated fracture. A 78-year-old woman visited our emergency department with severe pain in the midfoot area of the right foot without neurovascular deficits. She had sustained this injury after severe ankle inversion while going downstairs. Plain radiographs of the right foot showed that the navicular was dislocated medially on the talus; no other malalignments were present. Three-dimensional computed tomography revealed dislocation of the TNJ, but no other tarsal or midtarsal bone fractures or dislocations. A medial dorsal incision was made to expose the TNJ. The dorsal talonavicular ligament was ruptured and interposed between the navicular and talus. The ligament was removed and the TNJ was reduced. The clinical outcome at the 1-year follow-up was satisfactory with no limitations in daily activities. In summary, we have reported an extremely rare case of a pure isolated medial TNJ dislocation in which the interposed dorsal talonavicular ligament served as an obstacle to reduction.

Talonavicular Joint-Sparing 3D Printed Navicular Replacement for Osteonecrosis of the Navicular

Pathology of the navicular can be a difficult entity to treat, particularly when the injury has progressed to osteonecrosis. While various nonoperative and operative modalities have been described, the emerging field of additive manufacturing has become a potential solution to this difficult problem in certain scenarios. While these implants have largely been used for fusion in the past, the concept of joint sparing with 3D printed implants is also emerging, and this case highlights a patient treated with a talonavicular joint-sparing, patient-specific 3D printed total navicular replacement.

Quantitative MRI Analysis of the Talocrural and Talonavicular Joints in Ballet Dancers

The ankles of ballet dancers are routinely under heavy loading that may lead to osteoarthritic changes. It would be clinically useful to identify such pathology as early as possible in a dancer's career. Therefore, the purpose of this study was to compare quantitative measurements in magnetic resonance (MR) images of the talocrural and talonavicular joints in ballet dancers and healthy non-dancers for use in formulating prediction of chronic injury and degenerative joint disease in these locations. Quantitative measurements in MR images of the talocrural and talonavicular joints were compared in 10 female ballet dancers, 10 healthy female non-dancers, and nine male ballet dancers. Fat-suppressed density-weighted proton, T1rho, and T2 mapping images were acquired with a 3.0 T MR scanner. Medial and lateral subchondral bone distance between the tibia and talus (MSBD and LSBD), axial navicular-talus axis angle (ANT angle), sagittal talar neck angle against the posterior talocalcaneal joint (TN angle), and curvature of navicular surface at the talonavicular joint were measured on sagittal images. The medial subchondral bone distance was found to be significantly larger in female dancers than female non-dancers (4.05 mm vs. 2.75 mm, p < 0.05), whereas there were no significant differences in LSBD (2.63 mm vs. 2.63 mm, p = 0.87). Axial navicular talus angles in female dancers were significantly larger than those in female non-dancers (38.9° vs. 24.3°, p < 0.05). There was a tendency for the TN angle to be smaller and navicular curvature (NC) to be larger in female dancers compared to female non-dancers, though the differences were not significant (TN angle: 16.6° vs. 22.3°, p = 0.09, and NC: 0.186 vs. 0.165, p = 0.28). There were no significant differences in T1rho or T2 values of talonavicular joint cartilage. These results show that the bony anatomy of dancers' ankles may adapt to the stresses placed on them by ballet.

Medial swivel dislocation of talonavicular joint due to low energy trauma

<p>Medial swivel variant of talonavicular dislocation is rare. Usually, it is caused by high velocity trauma. They are relatively easier to reduce and are associated with fewer complications than pure dorsal dislocations and sub talar dislocations. We report a case of medial swivel dislocation of talonavicular caused by a low energy trauma, its management and one year follow up result.</p>

Medial swivel type dislocation of the talonavicular joint with associated cuboid fracture: a case report

Medial Swivel-type dislocation are dislocation of talonavicular joint (TNJ) medially and the calcaneus swivels under the talus, with the calcaneocuboid joint intact. This is a rare injury due to the strong network of ligament and tendinous structures. An 11-year-old girl presented after 1 week of injury to the left foot. She had pain, swelling on the mid-foot and inability to weight bearing. X-ray and computerized tomography (CT) scan showed medial dislocation of TNJ, with fracture of cuboid body. A closed reduction was attempted but it failed. Patient then underwent open reduction with K-wire fixation and immobilization by below knee cast for 3 weeks. After K-wire removal, the foot was stable with near normal ankle and sub-talar joint range of motion and patient started to partial weight bearing Midtarsal dislocations of the foot are rare injuries. In this case dislocation is resulted from high-energy medial forces to the forefoot. The associated cuboid fracture possibly as a result of tensile forces through the lateral structure of midfoot with adduction. ‘Swivel dislocation’ in which the TNJ dislocates, usually medially, and the calcaneus swivels under the talus, with the calcaneocuboid joint intact. A careful assessment of initial radiograph and CT scan should be done to determine type of dislocation and associated fracture. An open reduction K-wire fixation bring a stable reduction. Talonavicular dislocations are rare injuries, occur as a result of high-energy trauma. A stable reduction and good outcome are anticipated.