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Case Reports
. 2023 Jul:108:108413.
doi: 10.1016/j.ijscr.2023.108413. Epub 2023 Jun 21.

A rare case of floated talar head accompanying medial subtalar dislocation

Seyed Ali Hashemi  1 , Amir Reza Vosoughi  1 , Mohammad Ali Erfani  1 , Kamran Mozaffarian  1 , Armin Akbarzadeh  1 , Roham Borazjani  2
Affiliations
Case Reports

A rare case of floated talar head accompanying medial subtalar dislocation

Seyed Ali Hashemi et al. Int J Surg Case Rep. 2023 Jul.

Abstract

Introduction and importance: Concomitant medial subtalar dislocation and a rotated displaced talar neck fracture may result in poor outcomes. This study aimed to explain this extremely rare injury and assess the clinical outcomes following surgical treatment.

Case presentation: A 22-year-old Iranian man referred to the emergency department with a gross deformity and pain in his right foot and ankle after a falling from 2 m. Plain radiographs showed a rotated free talar head accompanying medial subtalar dislocation. Closed reduction was performed in the emergency department under sedation. Prompt open reduction and internal fixation of talar fracture was done, after removal of free osseocartilaginous fragments in the subtalar and talonavicular joints. At 25 months postoperatively, the clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale and visual analogue scale for pain which were 73 and 3, respectively. In exam, the patient had a stiffed subtalar joint without talar osteonecrosis or collapse.

Clinical discussion: Several osseous and soft tissue barriers could prevent a successful closed reduction of a subtalar dislocation. Associated cartilage injuries or fractures may result in poor clinical outcomes such as persistent pain, limping, osteoarthritis, and osteonecrosis. Immediate open reduction and rigid fixation of associated fractures and resection of small free osseocartilaginous fragments may prevent further soft tissue damages and preserve clinical functions.

Conclusions: Satisfactory clinical outcome could be expected following proper on-time approach to a subtalar dislocation associated with a rotated displaced talar neck fracture.

Keywords: Fracture; Peritalar; Subtalar; Subtalar dislocation; Talar neck; Talus.

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Conflict of interest statement

Conflict of interest statement Authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Anteroposterior (a) and lateral (b) radiographs of the ankle and oblique view of the foot (c) revealed medial subtalar dislocation with dislocated talonavicular joint and floated talar head.
Fig. 2
Fig. 2
Reduced subtalar joint with floated talar head after closed reduction under sedation in the emergency department.
Fig. 3
Fig. 3
Post-reduction CT scan showed a displaced talar neck with a dislocated talonavicular joint. Many small osteocartilaginous fragments in the subtalar joint and below the anteriorly-dislocated talar head are seen.
Fig. 4
Fig. 4
Perfect reduction and fixation of the talar neck with reduced talonavicular and subtalar joints, 21 months following the surgery, before removal of screws.
Fig. 5
Fig. 5
Ankle radiographs showed no osteonecrosis or collapse but mild degenerative arthritis in talonavicular and subtalar joints after the screw removal, 25 months after the injury.
See this image and copyright information in PMC

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