Nonoperative Treatment of Fracture of the Entire Posterior Process of the Talus With Subtalar Dislocation: Case Report.
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SUBMITTER: McCoy JS
PROVIDER: S-EPMC8697178 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
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Nonoperative Treatment of Fracture of the Entire Posterior Process of the Talus With Subtalar Dislocation: Case Report.
McCoy Jordan S JS Meyers Amy L AL Marquart Matthew M
Foot & ankle orthopaedics 20200429 2
Level V, expert opinion. ...[more]
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Project description:IntroductionTalar neck fractures are injuries which frequently result in adverse outcomes or impairment of functional activity. Four groups were identified according to Hawkins classification and Canale modification. We present a female patient with a fractured neck of the talus associated with talonavicular dislocation, but intact tibiotalar and subtalar joints; an injury pattern not fulfilling the criteria described in the Hawkins classification.Patient concernsA 46-year-old woman missed a step and fell down stairs with an immediate painful right ankle and inability to bear weight.DiagnosisTalar neck fracture with an unusual isolated talonavicular dislocation.InterventionsTemporary closed reduction followed by open reduction and internal fixation were performed.OutcomesThe patient had excellent functional and radiological outcomes following surgical management.ConclusionWe discuss the management of this rare case in addition to a review of the current literature to provide the best evidence-based recommendations for this injury pattern.
| S-EPMC9646572 | biostudies-literature
Project description:INTRODUCTION:Subtalar dislocations are rare injuries and treatment recommendations missing. Gross contamination and devascularisation are aspects supporting talectomy as potential treatment choice. Reconstruction in these cases can be challenging. The Masquelet technique presents one viable option. PRESENTATION OF CASE:A carpenter sustained a high energy chrush injury with traumatic open lateral talar dislocation qualifying as Gustillo Anderson type IIIc injury, a mangeled extremity index of 7 and gross contamination. The severity of soft tissue damage and contamination prompted the decision for talectomy before plastic coverage with a gracilis flap. Additionally a Masquelet procedure with cement spacer was initiated. After consolidation of the soft tissues a hindfoot arthrodesis with approximate preservation of leg length could be performed. In the course of treatment, the patient suffered no infection and could resume full weight bearing after nine months. The patient resumed his previous occupation with adapted workload and is satisfied with the treatment result. DISCUSSION:In the present case the principle options were talus preservation or talectomy with reconstruction. Talus preservation in the presence of gross contamination can be associated with the risk of infection, in addition there is a risk to develop secondary arthritis. For this individual patient the a fast and definite solution was important at this point in life. Surgeons therefore opted for talectomy. To optimally reconstruct leg length and optimize for arthrodesis the Masquelet technique was employed. CONCLUSION:The Masquelet technique is a viable option also in the emergency situation to preserve extremity length and optimize tissue viability.
| S-EPMC6833435 | biostudies-literature
Project description: Not available
| S-EPMC4171447 | biostudies-literature
Project description:Posterior sternoclavicular dislocations are very rare and pose immediate threat to mediastinal structures should a patient sustain this type of injury. This case report discusses the presentation and diagnosis of a young male who presented with isolated right arm swelling after blunt trauma one day prior while participating in a bull riding rodeo event. He was diagnosed with posterior right sternoclavicular joint dislocation with compression of the left brachiocephalic vein that was seen on computed tomography (CT) angiogram study. Patient was transferred to a tertiary care center for a higher level of care and definitive reduction management. Any history of blunt shoulder trauma or direct sternoclavicular trauma with symptoms to suggest compression of mediastinal structures should make one suspicious for posterior sternoclavicular dislocation. Evaluation is best made by computed tomography (CT) scan. Reduction should be performed by an orthopedic surgeon in the operating room with cardiothoracic surgery available for any vascular compromise that may occur.TopicsSternoclavicular joint dislocations, trauma, orthopedics.
| S-EPMC10332753 | biostudies-literature
Project description:BackgroundFractures of the posterior process of the talus are frequently overlooked, possibly leading to nonunion, arthritis, and chronic pain. Given the rare occurrence, previous case series have been small and without functional outcome scores. Therefore, we aimed to provide evidence on outcomes after nonoperative and operative management of posterior process fractures of the talus.MethodsAll patients treated at a level 1 trauma center between 2012 and 2018 were retrospectively evaluated. Patient, fracture, and treatment characteristics were collected, and functional outcome as well as quality of life were assessed. Twenty-nine patients with posterior process fractures of the talus were identified in our database.ResultsThe most frequently seen mechanism of trauma was fall from height in 13 patients (44.8%). Twenty-two patients underwent primary arthrodesis or operative reduction and fixation of the fracture (75.9%). Eighty-two percent of the patients returned the questionnaires with a mean follow-up of 6 years. The 2 patients with primary arthrodesis were excluded from outcome analysis. The mean Foot Function Index score was 1.8 (range 0.0-10). The mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 78.7 points (range 0-100). The mean quality of life EuroQol-5D (EQ-5D) index score was 0.78 (range -0.26 to 1). The mean visual analog scale (VAS) on overall patient satisfaction was 8.2 (range 1-10).ConclusionOperative management of extended posterior talar fractures was found to provide good functional outcome, quality of life, and patient satisfaction. Although the patients treated nonoperatively were found to have less severe injuries, they demonstrated worse overall outcome, which is supportive of surgical management. Nonoperative treatment is therefore only justified in selected patients.Level of evidenceLevel IV, retrospective case series.
| S-EPMC6900211 | biostudies-literature
Project description:IntroductionAcromioclavicular (AC) joint injury associated with coracoid process (CP) fracture is a rare injury and only case reports had been published in the literature. Although AC joint injury is not uncommon, there is controversy as regard the best stabilization method whether to use wires, hook plate, arthroscopic reconstruction or the recently described techniques of anatomic restoration of both the coracoclavicular (CC) and acromioclavicular (AC) ligaments to add stability in both the vertical as well as the horizontal plane for the AC joint. Isolated CP fracture rarely necessitates surgical intervention; but in association with AC joint injury; a controversy as regard best management, surgical approach, technique of stabilization and implant used is present due to paucity of literature.Patient and methodA 36 years old manual worker who sustained a combined injury of AC joint (grade III) and CP comminuted base fracture had been treated surgically in our hospital using a biplanar fixation technique; blind 4 mm cannulated screw for the CP fracture and anatomic reconstruction of the AC ligament using FibreTape (Arthrex, Naples, FL); to add stability in both the vertical and horizontal plane. Follow up was done for one year.ResultsAfter completion of rehabilitation program, patient could return to work with no shoulder pain in ten weeks postoperatively. Till the last follow up there was no evidence of loss of reduction or shoulder pain with a Constant score of 86.ConclusionOur technique in combined AC joint and CP fracture, address both injuries to add biplanar AC joint stability allowing accelerated rehabilitation and avoids metal hardware complications.
| S-EPMC5987262 | biostudies-literature
Project description:Subtalar dislocations of the talonavicular and talocalcaneal joints are rare, accounting for approximately one percent of all dislocations.1 These dislocations are typically the result of a high energy mechanism and present a challenge during reduction attempts. We present the case of a male in his early 20's who presented to the emergency department after a motorcycle accident with right foot and ankle pain and obvious deformity. Emergent X-ray and immediate attempt at reduction are of utmost importance with these dislocations. After multiple failed attempts at reduction in the ED, this patient was taken to the operating room for an open reduction with podiatry. This case report reviews the pathophysiology and management of this rare injury including nerve blocks and reduction techniques.TopicsSubtalar dislocation, trauma, podiatry, joint reduction, nerve blocks, local anesthesia.
| S-EPMC11312880 | biostudies-literature
Project description:Study Design Case report. Objective The diagnosis and surgical management of a patient with traumatic bilateral posterior dislocation of L4-L5 is presented with a thorough review of the existing literature. Summary of Background Data Traumatic dislocation of L4-L5 has been reported in the English literature in only five cases; of these, only two were retrolisthesis. Methods A 20-year-old patient was involved in a high-energy vehicular accident and presented with back pain and inability to ambulate. Neurological assessment showed motor strength grade 2/5 in the proximal lower-extremity muscle groups (L1-L3 myotomes) and 0/5 strength distally (L4-S1 myotomes); in addition, incontinence of sphincters was found. X-rays and computed tomography (CT) scan revealed a three-column ligamentous injury with posterior fracture-dislocation of the L4 vertebral body with complete posterior displacement of L4 to L5 vertebral body. The patient underwent posterior approach with reduction, transpedicular fixation, and posterolateral fusion with autologous bone graft. Results At 1-year follow-up, the patient had recovered muscular strength in proximal lower-extremities muscle groups, sphincter function had fully recovered, and he was able to ambulate with crutches. There was no recovery of distal extremity sensorimotor function. Plain radiograph and CT scan showed good alignment and progressive maturation of his fusion procedure. Conclusion Traumatic retrolisthesis of L4-L5 is a high-energy unstable fracture; reduction of the dislocation is challenging because of the heavy forces acting in the lower lumbar spine. Instrumented fusion restores alignment and maintains segmental stability.
| S-EPMC3864497 | biostudies-other
Project description:The distal radioulnar joint plays a critical role in pronation and supination of the forearm and can be injured with traumatic axial loading of the wrist. This is a case report of a 36-year-old male who presented to the emergency department with left upper extremity pain after falling onto an outstretched arm. The physical exam showed swelling and decreased range of motion of the elbow and wrist due to pain. Radiographs demonstrated left posterolateral elbow dislocation and left dorsal distal radioulnar joint dislocation. The patient underwent a successful closed reduction and splinting of both the left elbow and left distal radioulnar joint with good outcomes on follow up a week later. Since elbow dislocations are usually easily recognized and commonly treated in the emergency department, this case report focuses on the rarer finding of associated distal radioulnar joint dislocation because these injuries are often underdiagnosed or missed on initial assessment.TopicsDistal radioulnar joint dislocation, DRUJ, DRUJ dislocation, elbow dislocation, orthopedics, ortho, upper extremity, wrist injury, elbow injury, closed reduction.
| S-EPMC10332524 | biostudies-literature
Project description:IntroductionDislocation of the knee after primary total knee arthroplasty is rare in a posterior stabilized knee and extremely rare in a constrained total knee arthroplasty. Constrained total knee prostheses are used for severe knee deformities and to provide stable and mobile knees.Presentation of caseIn this case, we describe a dislocation of a primary constrained total knee arthroplasty using the Genesis II (Smith & Nephew, Memphis Tennessee, USA) prosthesis. Without any significant trauma, the constrained insert dislocated fifteen months after surgery and revision surgery with a bigger insert was needed. Surgical error may have been the cause of dislocation, but we were unable to establish a clear reason behind this dislocation.DiscussionKnee dislocation after TKA is rare but easily overlooked and can lead to serious complications and permanent disability. This system should provide stable and mobile knees to correct collateral ligament laxity.ConclusionHere, we report the first case, to our knowledge, of dislocation with a constrained prosthesis without any history of trauma.
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