Subtalar joint dislocation

Wikis > Orthopaedics > Trauma > Joint Injuries > Subtalar joint dislocation

Subtalar joint (or peritalar) dislocation involves both talocalcaneal and talonavicular articulations uncommon (<1% of all dislocations). Most due to high energy impact (eg motor vehicle accident; fall from height).
frequently associated with fractures of the rearfoot and ankle, esp talus.
(M:F—6:1)

10% are open.
Medial dislocation is most common (~80%) – looks like a clubfoot
Laterally (~15%), posteriorly (~2.5%) and anteriorly (~1%).

Clinical features:
Pain; obvious deformity (may be masked by swelling); foot appears shorter; foot is in equinus; can palpate head of talus anterior to lateral malleolus, if medial dislocation
X-ray – obvious, but may be missed if only ankle x-rays taken

Management:
Immediate attempt at closed reduction, preferably under general anaesthesia – (to avoid avascular necrosis of talus and skin necrosis)  nonweightbearing cast for 4-6 weeks
If closed unsuccessful  open reduction

failure of closed reduction in 32% of dislocations.

Lateral dislocations more complicated

Duration of immobilisation varies: uncomplicated dislocations – need immobilisation for three-four weeks. If complicated going to need six-eight weeks (will depend on associated fractures).

Complications:
Short term – skin necrosis

Long term:
• avascular necrosis of talus
• arthritis
• stiffness (common finding)

Page last updated: Jul 19, 2022 @ 3:29 am

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