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Scientific Articles   |    
Isolated Subtalar Dislocation
Pascal Jungbluth, MD1; Michael Wild, MD1; Mohssen Hakimi, MD1; Sebastian Gehrmann, MD1; Melani Djurisic, MD1; Joachim Windolf, PhD1; Gert Muhr, PhD2; Thomas Kälicke, PhD2
1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany. E-mail address for M. Wild: post@michaelwild.de
2 Department of Surgery, University Clinic Bergmannsheil Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Trauma and Hand Surgery, Heinrich Heine University Hospital Duesseldorf, Duesseldorf, and the Department of Surgery, University Clinic Bergmannsheil Bochum, Bochum, Germany

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Apr 01;92(4):890-894. doi: 10.2106/JBJS.I.00490
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Abstract

Background: 

Little attention has been devoted to subtalar dislocations without an associated bone injury in the literature to date. The aim of this study was to assess the functional and subjective results of a cohort of patients with this injury.

Methods: 

A total of ninety-seven patients with a subtalar dislocation were treated at two major university trauma centers from January 1994 to March 2007. Computed tomographic scans indicated a subtalar dislocation without associated bone injury in twenty-three of these patients. Clinical and radiographic examinations were performed on all twenty-three patients at an average of 58.3 months after the completion of treatment. The postoperative clinical examination was supplemented by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and the degree of arthritis was assessed radiographically.

Results: 

The average score on the AOFAS ankle-hindfoot scale score was 82.3 points. Twenty-one patients achieved a good result, and two patients had a satisfactory result. The range of motion of the subtalar joint was an average of 41.3°. No difference between the results of the medial and lateral subtalar dislocations was observed. Only six patients had minor radiographic changes.

Conclusions: 

The intermediate-term results for a subtalar dislocation without an associated osseous injury are good, and the direction of the dislocation does not appear to make a difference with regard to clinical or radiographic outcome.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    References

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Michael Wild, MD
    Posted on May 07, 2010
    Dr. Wild and colleagues respond to Dr. Jerome
    Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Germany

    Thank you for your interest in our article. As already mentioned, subtalar dislocations are subdivided into medial, lateral, anterior and posterior dislocations. Anterior and posterior dislocations represent rare cases. Even rarer are combined dislocations like the single case of an anteromedial dislocation reported by you, which is not mentioned anywhere else in the literature. You showed that even an anteromedial dislocation can occur without osteochondral fractures and may lead to a good functional outcome. We agree that the expression "anteromedial subtalar dislocation" may be included in the subdivisions of subtatalar dislocations.

    Terrence Jose Jerome
    Posted on April 02, 2010
    Anteromedial Subtalar Dislocation
    Apollo Speciality Hospital, Madurai, India

    To the Editor:

    I have read the article by Jungbluth et al. (1) with huge interest and enthusiasm.

    I would like to make few comments:

    Subtalar dislocations are rarely found in routine orthopedic practice. Inversion or eversion force is dissipated through the weak talonavicular and talocalcaneal ligaments, which eventually results in subtalar dislocation. The dislocations are subdivided on the basis of the direction in which the distal part of the foot has shifted in relation to the talus.

    We emphasize the importance of proper diagnosis and timely management of dislocations around the subtalar joint, because these always produce significant deformity and joint stiffness. Anteromedial subtalar dislocation is one entity reported with the head of the talus felt dorsolaterally and the rest of the foot dislocated medially as a unit. Simple closed reduction was successful in the case. The postreduction radiographs and computed tomography showed normal and stable alignment of subtalar and talonavicular joints with absence of osteochondral fractures. The follow up showed a stable, relatively good functional foot, with minimal pain on walking on uneven ground (2).

    We would like the authors to include this "Anteromedial subtalar dislocation" with no associated bony injury in their subdivisons for all purposes of the interest.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

    References

    1. Jungbluth P, Wild M, Hakimi M, Gehrmann S, Djurisic M, Windolf J, Muhr G, Kälicke T. Isolated subtalar dislocation. J Bone Joint Surg Am. 2010;92:890-4.

    2. Jerome JT, Varghese M, Sankaran B. Anteromedial subtalar dislocation. J Foot Ankle Surg. 2007;46:52-4.

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