A case of complicated lateral 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. Complications i...A case of complicated lateral 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. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis requiring arthrodesis and chronic subtalar instability. Negative prognostic factors include lateral and complicated dislocations, total talar extrusions, and associated fractures. A literature search was performed to identify studies describing outcome after lateral subtalar joint dislocation. Eight studies including fifty patients could be included, thirty out of 50 patients suffered a complicated injury. Mean follow-up was fifty-five months. Ankle function was reported as good in all patients with closed lateral subtalar dislocation.Thirteen out of thirty patients with complicated lateral subtalar joint dislocation developed a complication.Avascular necrosis was present in nine patients with complicated injury. Four patients with complicated lateral subtalar dislocation suffered deep infection requiring treatment with antibiotics. In case of uncomplicated lateral subtalar joint dislocation, excellent functional outcome after closed reduction and immobilization can be expected. In case of complicated lateral subtalar joint dislocation immediate reduction, wound debridement and if necessary(external) stabilisation are critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular talar necrosis and infection.展开更多
Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth m...Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed.展开更多
BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS coul...BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.CASE SUMMARY We present a 64-year-old woman who,at her first visit,complained of discomfort in the right ankle when she walked.Based on the physical signs and X-ray report,the physician failed to make the suspected diagnosis of PVNS.Eighteen months later,the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain.The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint.The laboratory tests were normal,whereas magnetic resonance imaging(MRI)showed a low-intensity area on both T1-and T2-weighted images.A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology.Subsequently,the patient received radiotherapy with 32 Gy in 16 fractions.At 6 mo postoperatively,the patient only complained of discomfort after walking three blocks.The American Orthopedic Foot and Ankle Society Ankle-Hindfoot score was 97.CONCLUSION MRI is necessary for the diagnosis of PVNS.Early soft tissue calcification and painless joint swelling should be of concern.展开更多
Subtalar dislocation is described as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. This injury is rare, and represents 1% of d...Subtalar dislocation is described as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. This injury is rare, and represents 1% of dislocations. We report the case of 28-year-old male patient, without any medical history, who had been involved in a sport accident causing a rare closed external subtalar dislocation without any bone fracture. An open reduction was indicated after failure of closed reduction and the X-ray control showed good joint congruence;the fixation was maintained for 6 weeks and then the rehabilitation was started. The evaluation was favorable, and we noted good functional results after a decline of 12 months.展开更多
Technique of subtalar arthroscopy is rapidly evolving. Increasing number of traditional open procedures for the subtalar joint can now be done arthroscopically. It is hoped that less wound complications, faster rehabi...Technique of subtalar arthroscopy is rapidly evolving. Increasing number of traditional open procedures for the subtalar joint can now be done arthroscopically. It is hoped that less wound complications, faster rehabilitation and better cosmetic outcomes can be achieved with this minimally invasive technique.展开更多
Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as...Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as an essential guide to the design of ankle–foot assistant devices.However,detailed analysis of the continuous 3D motion of the tibiotalar and subtalar joints during normal walking throughout the stance phase is still considered to be lacking.In this study,dynamic radiographs of the hindfoot were acquired from eight subjects during normal walking.Natural motions with six Degrees of Freedom(DOF)and the coupled patterns of the two joints were analyzed.It was found that the movements of the two joints were mostly in opposite directions(including rotation and translation),mainly in the early and late stages.There were significant differences in the Range of Motion(ROM)in Dorsiflexion/Plantarflexion(D/P),Inversion/Eversion(In/Ev),and Anterior–Posterior(AP)and Medial–Lateral(ML)translation of the tibiotalar and subtalar joints(p<0.05).Plantarflexion of the tibiotalar joint was coupled with eversion and posterior translation of the subtalar joint during the impact phase(R^(2)=0.87 and 0.86,respectively),and plantarflexion of the tibiotalar joint was coupled with inversion and anterior translation of the subtalar joint during the push-off phase(R^(2)=0.93 and 0.75,respectively).This coordinated coupled motion of the two joints may be a manifestation of the AJC to move flexibly while bearing weight and still have stability.展开更多
Introduction: Subtalar or peritalian dislocation is rare;it represents 15% of peritalian injuries. The aim of this study was to describe the radioclinical and therapeutic characteristics and to assess the functional r...Introduction: Subtalar or peritalian dislocation is rare;it represents 15% of peritalian injuries. The aim of this study was to describe the radioclinical and therapeutic characteristics and to assess the functional result. Patients and Methods: This study is about a continuous descriptive and prospective study over a period of 5 years. It has been conducted from March 2013 to February 2018 at the Ségou Hospital, a second referral hospital in Mali. The functional results were evaluated by the score of the American Orthopedic Foot and Ankle Society (AOFAS). Results: Seven cases of subtalar dislocation fractures were diagnosed in six male patients with an average age of 38 years (36 to 47 years old). In five cases the etiology of the trauma was a motorcycle accident and a fall from height. The lesion was bilateral in one case. The average time to care was 3 hours (1 to 9 hours). There was one case of open dislocation fracture with talus enucleation. The dislocation was medial in 6 cases and lateral in one case. It was pure in three cases. The treatment was orthopedic in 2 cases and surgical in 5 cases. The post-operative complications were complicated by an infection of the operative site in one case. The average length of hospital stay was 4 days. The functional result was excellent in 2 cases;good in 2 cases, fair in 2 cases and poor for 1 case. Conclusion: Subtalar dislocation is a rare and serious lesion of the posterior tarsus. The long-term prognosis depends on the earliness of treatment and the severity of the associated injuries.展开更多
<strong>Background:</strong> Plain radiography usual method to detect degeneration in the subtalar and talonavicluar joints. MRI is a better way to fully characterise non-ossified structures, such as artic...<strong>Background:</strong> Plain radiography usual method to detect degeneration in the subtalar and talonavicluar joints. MRI is a better way to fully characterise non-ossified structures, such as articular cartilage, marrow tissue and synovial fluid and therefore detect changes of arthritis. The motivation behind this study was to develop a quantitative way to score arthritic changes to the subtalar and talonavicular joints using MRI. The developed system will then be used as a research tool and in the close assessment and monitoring of patients with hindfoot degenerative disease. <strong>Methods:</strong> The MRI scans of thirty consecutive subjects with foot and ankle pain were retrospectively evaluated. Images were interpreted independently by three musculoskeletal radiologists in order to determine intra-observer reliability as well as the inter-observer reliability of the score. Five features of osteoarthritis were scored in the Subtalar joint and the Talonavicular joint. These were cartilage morphology, subarticular marrow, subarticular cyst, marginal osteophytes and synovitis. <strong>Results:</strong> For the 30 MRI scans the mean score for the Subtalar joint ranged from 11.7 to 14.4 and for the Talonavicular joint ranged from 3.7 to 5.6. The inter-observer correlation for the Subtalar joint between the three readers ranged between 0.53 and 0.83 for the individual features but overall was excellent at 0.76. For the Talonavicular joint the total correlation was good at 0.67. The inter-observer ICC for the total score was 0.75 which showed excellent agreement between the three readers. The total intra-observer correlation was excellent. <strong>Conclusions:</strong> The current work has shown excellent reliability for the scoring system. It will be a useful tool to diagnose and monitor disease progression of the Subtalar and Talonavicluar joints.展开更多
Subtalar dislocation is a rare injury in elite athletes. We report an unusual case of simultaneous bilateral subtalar dislocation in an international female athlete competing in gymnastics. These injuries require prom...Subtalar dislocation is a rare injury in elite athletes. We report an unusual case of simultaneous bilateral subtalar dislocation in an international female athlete competing in gymnastics. These injuries require prompt reduction and immediate immobilisation in a plaster cast for 8 weeks or wire stabilisation after open reduction if an abrupt end to a promising career is to be prevented.展开更多
Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of...Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints,without major fracture of the talus.They are usually classified as medial(most common),lateral,anterior and posterior dislocations,based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury.They are usually diagnosed by X rays,but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively.Majority being closed injuries,can be managed in ED by closed reduction and cast immobilisation,but if they are open,have poor outcomes.Complications that ensue open dislocations are post-traumatic arthritis,instability and avascular necrosis.展开更多
Introduction: Although rare, subtalar dislocations are severe injuries with long-term alterations such as clinical dysfunction or painful posttraumatic arthritis. The objective of this study was to investigate long-te...Introduction: Although rare, subtalar dislocations are severe injuries with long-term alterations such as clinical dysfunction or painful posttraumatic arthritis. The objective of this study was to investigate long-term morphological changes of subtalar dislocations and to correlate them to clinical function. Based on the conclusions, suggestions for therapy guidelines were made in order to improve the functional outcome. Methods: Twenty-two patients (12 with a medial, 9 with a lateral and 1 with an anterior dislocation) were re-examined with an average follow-up time of 10 years. Radiological results of a computer tomography examination of the hindfoot were related to the clinical outcome, and both were discussed in the context of further parameters, such as additional injuries, time until reduction, and post-reduction treatment. Results: Additional injuries were found to affect the clinical outcome and/or the radiological changes. Predictive factors for limited range of motion were severe skin trauma and traumatic brain injuries. Factors that predicted both poor clinical function and clear signs of arthritis included complex talus, ankle and calcaneus fractures, long time until reduction, and infection. Conclusions: In many cases, radiological results can be correlated to clinical outcomes. However, the modulating effects of additional injuries should be considered when planning therapy. In cases with additional fractures of the talus and the calcaneus, suffering pain may be reduced by an early arthrodesis of the talo-cal-canear joint. In cases involving a long stay on an intensive care unit, early functional treatment by passive motion should be discussed in special cases to improve the clinical outcome.展开更多
Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations,commonly caused by high-energy mechanisms,which include falls from height,motor vehicle crashes,and twisting leg inj...Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations,commonly caused by high-energy mechanisms,which include falls from height,motor vehicle crashes,and twisting leg injuries.The dislocations are divided into medial,lateral,anterior,and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus.The most common type is medial dislocation resulted from inversion injury.Subtalar dislocation may accompany with other fractures.Physical examination must be performed carefully to assess for neurovascular compromise.Most of the subtalar dislocations can be treated with closed reduction under sedation.If this is not possible,open reduction without further delay should be conducted.After primary treatment,X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures.We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football.The patient was successfully treated by closed reduction,and a good alignment was observed at the last follow-up.The pathogenesis and treatment method of this case were analyzed,and the related literature were reviewed,which provided a reference for future clinical treatment.展开更多
Background Subtalar joint （STJ） neutral position is the position typically used by clinicians to obtain a cast representation of a patient＇s foot before fabrication of biomechanical functional orthosis. But no meth...Background Subtalar joint （STJ） neutral position is the position typically used by clinicians to obtain a cast representation of a patient＇s foot before fabrication of biomechanical functional orthosis. But no method for measuring STJ neutral position has been proven accurate and reproducible by different testers. This study was conducted to investigate the STJ neutral position in normal feet in cadavers. Methods Twelve fresh-frozen specimens of amputated lower legs were used. Pressure-sensitive films were inserted into the anterior and posterior articulation of STJ. The contact areas for various foot positions and under axial loads of 600 N were determined based on the gray level of the digitized film. The STJ neutral positions were determined as the ankle-foot position where the maximum contact area was achieved, because the neutral position of a joint was defined as the position where the concave and convex surfaces were completely congruous. Results In ankle-foot neutral position, the contact area of STJ was （2.79±0.24） cm^2. In the range of motion of adduction-abduction （ADD-ABD）, the maximum contact area was （3.00±0.26） cm^2 when the foot was positioned 10° of ABD （F=-221.361, P 〈0.05）. In the range of motion of dorsiflexion-plantarflexion （DF-PF）, the maximum contact area was （3.61±0.25） cm^2 when the foot was positioned 20° of DF （F=-121.067, P 〈0.05）. In the range of motion of inversion-eversion （INV-EV）, the maximum contact area was （3.14±0.26） cm^2 when the foot was positioned 10° of EV （F=-256.252, P〈0.05）. Conclusions Joints, such as STJ, therefore, are not necessarily in neutral position when the ankle-foot is placed in the traditional concept of neutral position. The results demonstrate that the most approximate STJ neutral position was in the foot Dosition of 10° of abduction, 20° of dorsiflexion and 10° of eversion.展开更多
文摘A case of complicated lateral 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. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis requiring arthrodesis and chronic subtalar instability. Negative prognostic factors include lateral and complicated dislocations, total talar extrusions, and associated fractures. A literature search was performed to identify studies describing outcome after lateral subtalar joint dislocation. Eight studies including fifty patients could be included, thirty out of 50 patients suffered a complicated injury. Mean follow-up was fifty-five months. Ankle function was reported as good in all patients with closed lateral subtalar dislocation.Thirteen out of thirty patients with complicated lateral subtalar joint dislocation developed a complication.Avascular necrosis was present in nine patients with complicated injury. Four patients with complicated lateral subtalar dislocation suffered deep infection requiring treatment with antibiotics. In case of uncomplicated lateral subtalar joint dislocation, excellent functional outcome after closed reduction and immobilization can be expected. In case of complicated lateral subtalar joint dislocation immediate reduction, wound debridement and if necessary(external) stabilisation are critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular talar necrosis and infection.
文摘Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed.
文摘BACKGROUND Pigmented villonodular synovitis(PVNS)is an uncommon disease that usually occurs in large joints,and involvement of the subtalar joint is rare.The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.CASE SUMMARY We present a 64-year-old woman who,at her first visit,complained of discomfort in the right ankle when she walked.Based on the physical signs and X-ray report,the physician failed to make the suspected diagnosis of PVNS.Eighteen months later,the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain.The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint.The laboratory tests were normal,whereas magnetic resonance imaging(MRI)showed a low-intensity area on both T1-and T2-weighted images.A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology.Subsequently,the patient received radiotherapy with 32 Gy in 16 fractions.At 6 mo postoperatively,the patient only complained of discomfort after walking three blocks.The American Orthopedic Foot and Ankle Society Ankle-Hindfoot score was 97.CONCLUSION MRI is necessary for the diagnosis of PVNS.Early soft tissue calcification and painless joint swelling should be of concern.
文摘Subtalar dislocation is described as the simultaneous dislocation of the talo-calcaneal and talo-navicular joints without any tibio-talar or talar neck associated fractures. This injury is rare, and represents 1% of dislocations. We report the case of 28-year-old male patient, without any medical history, who had been involved in a sport accident causing a rare closed external subtalar dislocation without any bone fracture. An open reduction was indicated after failure of closed reduction and the X-ray control showed good joint congruence;the fixation was maintained for 6 weeks and then the rehabilitation was started. The evaluation was favorable, and we noted good functional results after a decline of 12 months.
文摘Technique of subtalar arthroscopy is rapidly evolving. Increasing number of traditional open procedures for the subtalar joint can now be done arthroscopically. It is hoped that less wound complications, faster rehabilitation and better cosmetic outcomes can be achieved with this minimally invasive technique.
基金supported by the National Natural Science Foundation of China(52175270,91848204)the Project of Scientific and Technological Development Plan of Jilin Province(20220508130RC).
文摘Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex(AJC)is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders,as well as an essential guide to the design of ankle–foot assistant devices.However,detailed analysis of the continuous 3D motion of the tibiotalar and subtalar joints during normal walking throughout the stance phase is still considered to be lacking.In this study,dynamic radiographs of the hindfoot were acquired from eight subjects during normal walking.Natural motions with six Degrees of Freedom(DOF)and the coupled patterns of the two joints were analyzed.It was found that the movements of the two joints were mostly in opposite directions(including rotation and translation),mainly in the early and late stages.There were significant differences in the Range of Motion(ROM)in Dorsiflexion/Plantarflexion(D/P),Inversion/Eversion(In/Ev),and Anterior–Posterior(AP)and Medial–Lateral(ML)translation of the tibiotalar and subtalar joints(p<0.05).Plantarflexion of the tibiotalar joint was coupled with eversion and posterior translation of the subtalar joint during the impact phase(R^(2)=0.87 and 0.86,respectively),and plantarflexion of the tibiotalar joint was coupled with inversion and anterior translation of the subtalar joint during the push-off phase(R^(2)=0.93 and 0.75,respectively).This coordinated coupled motion of the two joints may be a manifestation of the AJC to move flexibly while bearing weight and still have stability.
文摘Introduction: Subtalar or peritalian dislocation is rare;it represents 15% of peritalian injuries. The aim of this study was to describe the radioclinical and therapeutic characteristics and to assess the functional result. Patients and Methods: This study is about a continuous descriptive and prospective study over a period of 5 years. It has been conducted from March 2013 to February 2018 at the Ségou Hospital, a second referral hospital in Mali. The functional results were evaluated by the score of the American Orthopedic Foot and Ankle Society (AOFAS). Results: Seven cases of subtalar dislocation fractures were diagnosed in six male patients with an average age of 38 years (36 to 47 years old). In five cases the etiology of the trauma was a motorcycle accident and a fall from height. The lesion was bilateral in one case. The average time to care was 3 hours (1 to 9 hours). There was one case of open dislocation fracture with talus enucleation. The dislocation was medial in 6 cases and lateral in one case. It was pure in three cases. The treatment was orthopedic in 2 cases and surgical in 5 cases. The post-operative complications were complicated by an infection of the operative site in one case. The average length of hospital stay was 4 days. The functional result was excellent in 2 cases;good in 2 cases, fair in 2 cases and poor for 1 case. Conclusion: Subtalar dislocation is a rare and serious lesion of the posterior tarsus. The long-term prognosis depends on the earliness of treatment and the severity of the associated injuries.
文摘<strong>Background:</strong> Plain radiography usual method to detect degeneration in the subtalar and talonavicluar joints. MRI is a better way to fully characterise non-ossified structures, such as articular cartilage, marrow tissue and synovial fluid and therefore detect changes of arthritis. The motivation behind this study was to develop a quantitative way to score arthritic changes to the subtalar and talonavicular joints using MRI. The developed system will then be used as a research tool and in the close assessment and monitoring of patients with hindfoot degenerative disease. <strong>Methods:</strong> The MRI scans of thirty consecutive subjects with foot and ankle pain were retrospectively evaluated. Images were interpreted independently by three musculoskeletal radiologists in order to determine intra-observer reliability as well as the inter-observer reliability of the score. Five features of osteoarthritis were scored in the Subtalar joint and the Talonavicular joint. These were cartilage morphology, subarticular marrow, subarticular cyst, marginal osteophytes and synovitis. <strong>Results:</strong> For the 30 MRI scans the mean score for the Subtalar joint ranged from 11.7 to 14.4 and for the Talonavicular joint ranged from 3.7 to 5.6. The inter-observer correlation for the Subtalar joint between the three readers ranged between 0.53 and 0.83 for the individual features but overall was excellent at 0.76. For the Talonavicular joint the total correlation was good at 0.67. The inter-observer ICC for the total score was 0.75 which showed excellent agreement between the three readers. The total intra-observer correlation was excellent. <strong>Conclusions:</strong> The current work has shown excellent reliability for the scoring system. It will be a useful tool to diagnose and monitor disease progression of the Subtalar and Talonavicluar joints.
文摘Subtalar dislocation is a rare injury in elite athletes. We report an unusual case of simultaneous bilateral subtalar dislocation in an international female athlete competing in gymnastics. These injuries require prompt reduction and immediate immobilisation in a plaster cast for 8 weeks or wire stabilisation after open reduction if an abrupt end to a promising career is to be prevented.
文摘Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints,without major fracture of the talus.They are usually classified as medial(most common),lateral,anterior and posterior dislocations,based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury.They are usually diagnosed by X rays,but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively.Majority being closed injuries,can be managed in ED by closed reduction and cast immobilisation,but if they are open,have poor outcomes.Complications that ensue open dislocations are post-traumatic arthritis,instability and avascular necrosis.
文摘Introduction: Although rare, subtalar dislocations are severe injuries with long-term alterations such as clinical dysfunction or painful posttraumatic arthritis. The objective of this study was to investigate long-term morphological changes of subtalar dislocations and to correlate them to clinical function. Based on the conclusions, suggestions for therapy guidelines were made in order to improve the functional outcome. Methods: Twenty-two patients (12 with a medial, 9 with a lateral and 1 with an anterior dislocation) were re-examined with an average follow-up time of 10 years. Radiological results of a computer tomography examination of the hindfoot were related to the clinical outcome, and both were discussed in the context of further parameters, such as additional injuries, time until reduction, and post-reduction treatment. Results: Additional injuries were found to affect the clinical outcome and/or the radiological changes. Predictive factors for limited range of motion were severe skin trauma and traumatic brain injuries. Factors that predicted both poor clinical function and clear signs of arthritis included complex talus, ankle and calcaneus fractures, long time until reduction, and infection. Conclusions: In many cases, radiological results can be correlated to clinical outcomes. However, the modulating effects of additional injuries should be considered when planning therapy. In cases with additional fractures of the talus and the calcaneus, suffering pain may be reduced by an early arthrodesis of the talo-cal-canear joint. In cases involving a long stay on an intensive care unit, early functional treatment by passive motion should be discussed in special cases to improve the clinical outcome.
文摘Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations,commonly caused by high-energy mechanisms,which include falls from height,motor vehicle crashes,and twisting leg injuries.The dislocations are divided into medial,lateral,anterior,and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus.The most common type is medial dislocation resulted from inversion injury.Subtalar dislocation may accompany with other fractures.Physical examination must be performed carefully to assess for neurovascular compromise.Most of the subtalar dislocations can be treated with closed reduction under sedation.If this is not possible,open reduction without further delay should be conducted.After primary treatment,X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures.We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football.The patient was successfully treated by closed reduction,and a good alignment was observed at the last follow-up.The pathogenesis and treatment method of this case were analyzed,and the related literature were reviewed,which provided a reference for future clinical treatment.
文摘Background Subtalar joint （STJ） neutral position is the position typically used by clinicians to obtain a cast representation of a patient＇s foot before fabrication of biomechanical functional orthosis. But no method for measuring STJ neutral position has been proven accurate and reproducible by different testers. This study was conducted to investigate the STJ neutral position in normal feet in cadavers. Methods Twelve fresh-frozen specimens of amputated lower legs were used. Pressure-sensitive films were inserted into the anterior and posterior articulation of STJ. The contact areas for various foot positions and under axial loads of 600 N were determined based on the gray level of the digitized film. The STJ neutral positions were determined as the ankle-foot position where the maximum contact area was achieved, because the neutral position of a joint was defined as the position where the concave and convex surfaces were completely congruous. Results In ankle-foot neutral position, the contact area of STJ was （2.79±0.24） cm^2. In the range of motion of adduction-abduction （ADD-ABD）, the maximum contact area was （3.00±0.26） cm^2 when the foot was positioned 10° of ABD （F=-221.361, P 〈0.05）. In the range of motion of dorsiflexion-plantarflexion （DF-PF）, the maximum contact area was （3.61±0.25） cm^2 when the foot was positioned 20° of DF （F=-121.067, P 〈0.05）. In the range of motion of inversion-eversion （INV-EV）, the maximum contact area was （3.14±0.26） cm^2 when the foot was positioned 10° of EV （F=-256.252, P〈0.05）. Conclusions Joints, such as STJ, therefore, are not necessarily in neutral position when the ankle-foot is placed in the traditional concept of neutral position. The results demonstrate that the most approximate STJ neutral position was in the foot Dosition of 10° of abduction, 20° of dorsiflexion and 10° of eversion.
