Surgical management of closed tibiotalar dislocation: a case report and 2-year follow-up

Abstract

We report a case of a closed tibiotalar dislocation without an associated malleolar fracture, in the presence of medial malleolar hypoplasia, treated with closed reduction and surgical repair of the deltoid ligament, followed by cast immobilization. Post-reduction radiographs, before open repair of the deltoid ligament, revealed an Elisé test ratio of 0.43. The ruptured superficial and deep portions of the deltoid ligament and the anterior ankle capsule were primarily repaired with suture, after which cast immobilization and non-weight bearing were used before physiotherapy and rehabilitation. Two years after the injury, the patient was pain free with a full range of ankle motion, and there were no signs of residual instability or early osteoarthritis. Subjective clinical testing using a valid health measurement instrument revealed an excellent clinical outcome. Based on our experience in this case, closed ankle dislocation in the presence of a hypoplastic medial malleolus and stress manipulation evidence of medial instability indicates the need for primary repair of the deltoid ligament.

Level of clinical evidence: 4.