How to reduce a displaced Lateral Subtalar Dislocation with Talar Neck fracture.... скачать в хорошем качестве

How to reduce a displaced Lateral Subtalar Dislocation with Talar Neck fracture....

This is a rare injury; it accounts for approximately 1 – 2% of all dislocations. This can look similar to an ankle dislocation on examination, but the tibiotalar joint and mortise are intact. These injuries typically from a high energy mechanism such as a fall from height or high energy RTA. TYPES OF SUBTALAR DISLOCATIONS The vast majority of subtalar dislocations are either medial (85%) or lateral (15%). Lateral Subtalar Dislocation Lateral subtalar dislocations account for around 15% of subtalar dislocations. On physical examination, you will find that the foot is everted, the calcaneus is lateral to talus, and the foot is locked in pronation. Lateral dislocations tend to result from higher mechanism injuries; therefore, these injuries are more likely to be open and have more associated injuries. REDUCTION TECHNIQUE Reduction should be attempted rapidly due to the threat of skin necrosis if dislocation is prolonged. Reduction should occur prior to obtaining radiographs (either immediately upon presentation to the ED or in the field) if the foot has obvious neurovascular compromise such as absent or thready dorsalis pedis or posterior tibial pulse, decreased capillary refill, or lack of sensation to the bottom of the foot. Obtaining a thorough vascular and sensory exam of the foot before and after any reduction attempts is key. Often procedural sedation is necessary to perform this procedure. The approach to reduction is as follows: Knee bent at 90 degrees to relax gastrocnemius and soleus muscles Apply traction at heel and counter-traction to thigh Accentuate deformity followed by reversal. Medial dislocations: Further invert, pull traction, and then evert Lateral dislocations: Further evert, pull traction, and then invert Apply a splint – short posterior slab splint with side gussets If reduction is successful, then obtain post-reduction x-rays and CT scan of foot and ankle. It is recommended that the patient is non-weight bearing in short leg cast for 4 to 6 weeks.