Medial Subtalar Dislocation in a Basketball Player: Case Report and Literature Review

Case Report

Austin J Orthopade & Rheumatol. 2017; 4(3): 1060.

Medial Subtalar Dislocation in a Basketball Player: Case Report and Literature Review

Jalal Y¹*, Zaimi S², Ouzaa MR¹, Zine A¹ and Jaafar A¹

¹Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco

²Department of Radiology, Military Hospital Mohamed V, Morocco

*Corresponding author: Youssef Jalal, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohamed V, Faculty of Medicine and Pharmacy, Rabat, Morocco

Received: October 18, 2017; Accepted: November 21, 2017; Published: November 28, 2017

Abstract

We report a case of purely ligamentous medial subtalar dislocations with closed reduction and conservative treatment, with a cast immobilization. Medial subtalar dislocations following sports injuries are uncommon and rarely reported in the literature, and have an excellent prognosis with early reduction. In the examined case, the dislocation was resulted following landing from a rebound, with the right foot being forced mainly into hyperplantar flexion and eversion. Closed reduction was followed by cast immobilization for 4 weeks. Two years later, the patient had a full range of motion without any pain, while there were no signs of residual instability or early post-traumatic osteoarthritis.

We discuss in details the mechanism of such an injury and we highlight the importance of prompt closed reduction and early mobilization to ensure a satisfactory long-term outcome.

Keywords: Medial dislocation; Purely ligamentous; Reduction

Introduction

Subtalar Dislocation (SD) accounts for only an estimated 1–2% of all joint dislocations, making it one of the rarest forms of orthopedics injuries [1]. This entity is defined as a simultaneous dislocation of the distal articulations of the talus at both the talocalcaneal and talonavicular joints. It occurs in active young men and its result of a high-energy trauma such as falls from a height, or motorcycle accidents [2]. However, it is not commonly seen as a sports injury because it requires transfer of a high energy. Depending on the position of the foot at the time of injury, Broca (1852) distinguished three types of subtalar dislocation: the medial dislocation, the lateral, and the posterior dislocation. In 1856, Malgaigne and Burger described the fourth type: anterior dislocation [3]. Of all types of subtalar dislocation, medial form is the most frequent, accounting for 79.5% of all cases, and rest are mostly lateral SD, with only occasional reports of anterior and posterior SD [4]. Those injuries are frequently associated with talar fracture, malleolus fracture, or fracture of the fifth metatarsal bone. However, less than one third of such dislocations are isolated.

We present a case of isolated medial subtalar dislocation in basketball player to discuss the mechanism of such an injury and to highlight the importance of prompt closed reduction and early mobilization to improve the functional outcome after an isolated SD.

Case Presentation

A 22-year-old basketball player was brought to our accident and emergency department with pain and spectacular deformity of the right foot following landing from a rebound, with the right foot being forced mainly into hyperplantar flexion and eversion (Figure 1). Local examination noticed slightly swollen right ankle, with minimal ecchymosis, and the ankle was found fixed in medial plantar flexion. Pulse of the posterior tibial and dorsalispedis artery were present but weak. General somatic exploration was normal. He subsequently received a radiological assessment that objectified isolated medial subtalar dislocation (Figures 2 & 3). A closed reduction under sedation was attempted in the emergency room. Thus, firm manual foot traction with counter-traction on the leg followed by eversion of the foot, with direct digital pressure over the head of talus was accomplished. An audible clunk confirmed successful reduction. Once reduced (Figures 4 & 5), no residual subluxation was noticed and the patient was discharged and immobilized in a short-leg posterior plaster splint for 4 weeks. At his fourth week post-reduction, partial weight bearing was initiated, and active exercise program was started.