Subtalar dislocation associated with fracture of the posterior process of the talus: a case report and review of the literature
Zhang Cheng, Wang Qingxian, Zhou Yabin, Zhao Shimeng
Emergency Center of Trauma, the Thrid Affiliated Hospital of Hebei Medical University, Orthopaedic Research Institution of Hebei Province, Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang 050051, China
Abstract：Objective Subtalar dislocation associated with fracture of the posterior process of talus is very rare. The diagnose and treatment about this rare case was reported and the related literatures were reviewed to summarize the anatomy of the posterior process, mechanism and treatment of this pattern injury. Methods The literatures about the Subtalar dislocation associated with fracture of posterior process of talus before October 2017 were searched in PubMed, CNKI, Weipu and Wanfang database by using “subtalar dislocation” and “posterior process fracture of talus” as key words. Six cases reported in English and 1 case reported in Chinese were detected. The clinical and imaging findings, mechanism of this pattern injury, treatment and clinical prognosis of 7 cases reported in literature and 1 case in this paper were observed and analysed. Results A 25-year-old male suffered an traffic accident was presented with pain, swelling, malformation and activity limitation at the right ankle.The X-ray revealed subtalar dislocation and an unconfirmed fracture. The closed reduction and plaster fixation were performed immediately to correct the subtalar dislocation but the result was not satisfying. X-ray and CT scan revealed subtalar medial dislocation associated with navicular fracture and posterior process fracture of talar. The patient underwent open reduction and internal fixation 27 days later after the accident and got a good result in 6 months after operation. Eight cases of subtalar dislocation associated with fracture of the posterior process of talus are involved, including 1 case in this paper and 7 cases reported, 7 males and 1 female, age ranges from 17 to 52 years old, all the patients were presented with pain, swelling, malformation and activity limitation at the ankle. Seven cases underwent open reduction and internal fixation and 1 case was treated by minimally invasive technique. The X-ray and CT scan revealed a good reduction after open reduction and internal fixation. There was no pain at the hindfoot and the patient regained a good activity 3 months after the surgery. Conclusions When at the time of the impact the foot is in inversion and plantarflexion medial subtalar dislocations occur. The avulsion force from talocalcaneal ligament lead to fracture of posterior process of talus. Subtalar dislocation associated with nondisplaced fracture can be treated conservatively, open reduction and internal fixation is recommended to the case that with fracture displaced more than 2 mm. The symptomatic delayed fractures of posterior process of talus should be excised by arthroscopy.
张程, 王庆贤, 周亚斌, 赵士猛. 距下关节脱位伴距骨后突骨折一例及文献复习[J]. 中华解剖与临床杂志, 2018, 23(3): 251-257.
Zhang Cheng, Wang Qingxian, Zhou Yabin, Zhao Shimeng. Subtalar dislocation associated with fracture of the posterior process of the talus: a case report and review of the literature. Chinese Journal of Anatomy and Clinics, 2018, 23(3): 251-257.
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2018, Vol. 23 
