Closed posterior dislocation of ankle joint without fracture: A case report and literature review

Pure Ankle dislocation is an ankle dislocation without any associated fractures of the ankle and an intact tibiofibular syndesmosis. Only a few isolated case reports and small series of cases are reported in literature. We report a posterior dislocation of ankle joint without any bony fractures with description of its mechanism, management, and literature review Keywords: Pure Ankle dislocation; ankle dislocation without fracture; posterior dislocation of ankle.

Estudo descritivo sobre o financiamento da assistência à saúde frente ao tratamento cirúrgico de fratura do tornozelo e retirada de placas/parafuso em Belo Horizonte, Minas Gerais, Brasil, 2014–2019

Objetivo: descrever as internações e os custos hospitalares por tratamento cirúrgico de fratura do tornozelo unimaleolar; por tratamento cirúrgico de fratura do tornozelo bimaleolar, trimaleolar, da fratura luxação do tornozelo; e por retirada de placa e/ou parafusos, no período de 2014 a 2019, no município de Belo Horizonte, Minas Gerais. Métodos: estudo retrospectivo descritivo realizado entre 2014 a 2019 com dados epidemiológicos obtidos no banco de dados do Departamento de Informática do Sistema Único de Saúde, oriundos do cadastro da Autorização de Internação Hospitalar e dos valores, total e por serviços hospitalares, despendidos com o tratamento cirúrgico de fratura do tornozelo unimaleolar; o tratamento cirúrgico de fratura do tornozelo bimaleolar, trimaleolar, da fratura de luxação do tornozelo; e o procedimento de retirada de placa e/ou parafusos. Resultados: entre 2014 e 2019 foram registrados 13.721 procedimentos cirúrgicos em região de tornozelo, sendo gastos R$ 7.889.737,75 com as intervenções invasivas. Conclusão: sugere-se a partir dos resultados desta pesquisa a necessidade de reforçar políticas públicas voltadas para a implementação de ações concretas, para à busca de melhor eficácia no processo de seleção de materiais, revisão de protocolos clínicos e cirúrgicos.Palavra-chave: fraturas do tornozelo; fixação interna de fraturas; traumatismos do tornozelo; financiamento da assistência à saúde; ortopedia. Descriptive study on health care financing for surgical treatment of ankle fractures and removal of plates / screws in Belo Horizonte, Minas Gerais, Brazil, 2014-2019 ABSTRACTObjective: to describe hospitalizations and hospital costs for surgical treatment of unimaleolar ankle fractures; by surgical treatment of bimaleolar, trimaleolar ankle fracture, ankle dislocation fracture; and by removing the plate and / or screws, from 2014 to 2019, in the city of Belo Horizonte, Minas Gerais. Methods: retrospective descriptive study carried out between 2014 and 2019 with epidemiological data obtained in the database of the Department of Informatics of the Unified Health System, from the Hospitalization Authorization record and the values, total and for hospital services, spent on treatment surgical fracture of the unimaleolar ankle; surgical treatment of bimaleolar, trimaleolar ankle fracture, ankle dislocation fracture; and the procedure for removing the plate and / or screws. Results: between 2014 and 2019, 13,721 surgical procedures were recorded in the ankle region, with R$ 7,889,737.75 being spent on invasive interventions. Conclusion: it is suggested from the results of this research the need to reinforce public policies aimed at implementing concrete actions, in order to seek better efficiency in the process of selecting materials, reviewing clinical and surgical protocols.Keywords: ankle fractures; internal fracture fixation; ankle injuries; health care financing; orthopedics.

A Series of Pure Ankle Dislocations without Associated Fracture: Our Clinical Experience

Background: Pure ankle dislocation without associated fracture is extremely rare, thus the literature almost limited to case reports and small case series. The standardized treatment protocol is in controversy and the studies of mechanism and outcome of the injury are still deficient. We report a series of eight cases of pure tibiotalar dislocations managed with emergency reduction and other heterogenic procedures, hoping to add some material to the published data on this topic and present our clinical experience.Methods: We retrospectively reviewed the eight cases of isolated ankle dislocations without associated fracture that were treated in our department from 2015 to 2019. Results: The eight cases were all posteromedial dislocations with six open and two closed. Emergency reduction was performed for all patients followed by average 6 weeks’ immobilization with external fixators in five and short leg cast in three. The mean follow-up period was 33 (range, 12 to 61) months. None of the eight patients showed obvious instability though only one patient underwent ligaments repair. The average range of motion (ROM) loss of the ankles was 10 degrees for plantarflexion and 3 degrees for dorsiflexion. Two patients complained of moderate stiffness and three complained of persistent mild pain in whom degenerative change was found. Neurovascular sequela was presented in one patient with numbness. Only one patient developed superficial infection. The average AOFAS score was 90 (range, 78 to 100) points at the final follow-up with five ankles rated as excellent and three rated as good. All of the eight patients returned to their prior daily life and the two closed patients with sports injuries resumed sports activity.Conclusion: Pure ankle dislocation is a rare ligamentous ankle injury with complicated mechanism. Most of the injuries treated with emergency reduction and thorough debridement followed by a short period of immobilization and functional rehabilitation have good clinical outcomes. Ligaments repair should only be considered in cases of chronic ankle instability after failed conservative treatment.

Isolated Posterior Medial Ankle Dislocation with Associated Os Trigonum Dislocation after Low-Energy Mechanism

We describe a case of an isolated posteromedial ankle dislocation, without malleolar fracture, with associated dislocation of an os trigonal process after a low-energy tennis injury. We demonstrate that nonoperative treatment results in excellent functional outcome scores with minimal arthritic progression at 2 years of follow-up. We discuss pathoanatomic risk factors of pure dislocations and propose that an os trigonum is a risk factor for isolated dislocations of the ankle.