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Yo, that subtalar joint looks gnarly! (subtalar  dislocations)

6/7/2015

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Picture
Picture
Picture
HPI: 
Teenage male patient skating at high speed when his board abruptly came to a stop resulting in an inversion injury to his left ankle

PE: 
Skin intact


Left foot locked in supination with plantar flexion, obvious deformity to ankle

2+ DP/PT pulses, capillary refill < sec, SILT, 5/5 motor strength

 

Imaging: 
Medial subtalar dislocation: foot & calcaneus displaced medially, head of talus prominent dorsolaterally, navicular lies medial to talar head and neck


Lateral subtalar dislocation:  calcaneus displaced lateral to talus, talar head lies medially, navicular lies lateral to talar neck

Management:


·      Closed reduction-facilitated with knee flexion, relax gastrocnemius, may require sedation

·      Follow up CT scan ankle to assess for osteochondral lesions or fractures, assess reduction

·      Short leg cast/splint for 3-4 weeks

·      Approximately 10 % of medial dislocations and 20 % lateral require open reduction



Reduction Procedure:


https://www.youtube.com/watch?v=H6Dz566KrcM




 Anatomy: 
See attached

 Discussion:

·      Subtalar dislocation involves dislocation of distal articulations of talus at both talonavicular and talocalcaneal joints

·      Ankle joint undisturbed

·      Associated injuries: osteochondral lesions of talus, ankle fracture, fracture base of 5th metatarsal, navicular and cuboid fractures

·      Lateral dislocations less common, have more complications

Complications: infection (usually open), avascular necrosis (usually following fracture as talus is not disrupted from ankle mortoise and has blood supply).




     Key Points: 



·      Subtalar dislocations-medial more common than lateral, mechanism important part of HPI, clinical diagnosis

·      Obtain x rays to assess for associated injuries (ie fractures)

·      Manage with closed reduction and short leg cast/splint

·      10-20% may require open reduction

·      Obtain post reduction CT scan to assess reduction and osteochondral lesions/fractures

·      Complications rare but include infection (usually open) avascular necrosis ( usually associated fracture)

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction