Unusual case of lateral subtalar joint dislocation associated with calcaneal fracture and lateral malleolus fracture

Mohamed Jlidi; Walid Bouaicha; Mohamed Hedi Gharbi; Karim Mallek; Salma Jaziri; Siwar Sbaihi; Selim Daas

doi:10.1016/j.tcr.2023.100897

Unusual case of lateral subtalar joint dislocation associated with calcaneal fracture and lateral malleolus fracture

Trauma Case Rep. 2023 Aug 11:47:100897. doi: 10.1016/j.tcr.2023.100897. eCollection 2023 Oct.

Authors

Mohamed Jlidi^{1

2}, Walid Bouaicha^{1

2}, Mohamed Hedi Gharbi¹, Karim Mallek¹, Salma Jaziri^{3

2}, Siwar Sbaihi^{2

4}, Selim Daas^{1

2}

Affiliations

¹ Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia.
² University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
³ Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, Kef, Tunisia.
⁴ Radiological Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia.

Abstract

Introduction: Subtalar dislocation is defined by a simultaneous total separation of the talocalcaneal and talonavicular joints. Lateral variety is the rarest. It is the result of a high energy trauma. It occurs following forced eversion, with the foot locked in a rut with pressure on the lateral aspect of the leg. Articular fractures of the calcaneus occur as a result of axial impact on the greater tuberosity.We report the case of a lateral subtalar dislocation associated with a calcaneal fracture.

Case presentation: A 62-year-old man who presented to the emergency room following a 9 m fall. Initial examination revealed a swelling of the right foot and ankle with a deformity giving the appearance of a "flat foot" without skin opening. The neuro-vascular examination was normal.A radiological assessment including an antero-posterior and lateral X-ray of the right ankle and a axial view if the calcaneus, showed a calcaneal articular fracture and a lateral dislocation of the subtalar joint. CT scan confirmed the diagnosis. Closed reduction by external maneuvers failed. Through a lateral mini-approach centered on the subtalar joint, open reduction of the dislocation was achieved and controlled fluoroscopically. Osteosynthesis of the calcaneal fracture was performed using a percutaneous pinning. Consolidation was obtained at 3 months post-operatively.At the last follow-up, the patient reported occasional pain. The radiological assessment showed early arthritic changes of the subtalar joint.

Conclusion: In rare cases of subtalar dislocation, the direction of displacement, associated bone injuries, and open reduction would be responsible for a poor functional outcome. At present, there is no certain way to avoid subtalar osteoarthritis.

Keywords: Calcaneal fracture; Case report; Subtalar joint dislocation; Surgery.

Publication types

Case Reports