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Subtalar Dislocation Types and Treatment

Join this channel to support the channel.    / @nabilebraheim   When a subtalar dislocation occurs, the talonavicular joint is also dislocated. There are two main types of subtalar dislocation: medial and lateral. Medial subtalar dislocations are about four times more common than lateral ones. Some of these injuries are open dislocations. Urgent reduction is critical to reduce the risk of skin necrosis and interruption of blood supply to the foot. After closed or open reduction, the joint is usually stable. Lateral Subtalar Dislocation In lateral subtalar dislocation, the foot is displaced laterally. The medial structures become trapped, most often the posterior tibial tendon, which blocks successful closed reduction. Lateral subtalar dislocations are less common but carry a worse prognosis than medial ones. They are frequently associated with fractures of adjacent tarsal bones and instability after reduction. Lateral dislocations are more likely to be open injuries, which carry a high risk of infection. If the talus is completely extruded, management requires urgent antibiotics, wound debridement, irrigation of the talus with antiseptic or antibiotic solution, and reimplantation into its anatomical bed, sometimes with external fixation for stabilization. Medial Subtalar Dislocation Medial dislocations usually reduce easily with closed reduction. Rare irreducibility can occur due to: Impaction fracture of the talar head Interposition of the extensor digitorum brevis tendon (a common exam question) Interposition of the peroneal tendons Clinically, medial dislocation produces a supinated foot, while lateral dislocation produces a pronated foot. Management Most subtalar dislocations can be managed with urgent closed reduction and immobilization. Closed reduction may be difficult in 5–10% of medial dislocations and 15–20% of lateral dislocations. Post-reduction X-rays are essential to confirm alignment and detect associated fractures. If no fractures are present, immobilization with a splint or cast usually produces excellent outcomes. Medial dislocations generally have a better prognosis, with rare late instability. Immobilization for medial dislocations is short, about 3–4 weeks. In lateral dislocations, post-reduction CT is recommended to evaluate for bony fragments or osteochondral fractures. Large fragments should be fixed, while small intra-articular fragments should be excised. If instability persists after reduction, investigate for large intra-articular fractures requiring fixation. Early range of motion is encouraged once stable reduction is achieved to prevent stiffness, but care must be taken to avoid recurrence or instability. Complications Irreducible dislocation requiring open reduction Stiffness of the subtalar joint Degenerative arthritis Entrapment of specific tendons: Extensor digitorum brevis in medial dislocation Posterior tibial tendon in lateral dislocation Quizzes 1. In subtalar dislocation, which joint is always dislocated along with the subtalar joint? A. Calcaneocuboid joint B. Talonavicular joint C. Tibiotalar joint D. Naviculocuneiform joint Answer: B. Talonavicular joint Explanation: Subtalar dislocation invariably involves the talonavicular joint. Recognition is important for understanding the instability pattern. 2. Which type of subtalar dislocation is more common? A. Medial B. Lateral C. Posterior D. Anterior Answer: A. Medial Explanation: Medial subtalar dislocations are about four times more common than lateral ones. 3. What is the most important first step in managing a subtalar dislocation? A. External fixation B. Urgent closed reduction C. CT scan evaluation D. Immediate arthroscopy Answer: B. Urgent closed reduction Explanation: Prompt reduction prevents skin necrosis and vascular compromise. 4. Which tendon blocks closed reduction in lateral subtalar dislocation? A. Peroneus longus B. Tibialis posterior C. Flexor hallucis longus D. Extensor digitorum brevis Answer: B. Tibialis posterior Explanation: The tibialis posterior tendon often becomes interposed, preventing successful closed reduction. 5. Which tendon is most often interposed in irreducible medial subtalar dislocation? A. Tibialis posterior B. Extensor digitorum brevis C. Flexor digitorum longus D. Achilles tendon Answer: B. Extensor digitorum brevis Explanation: Entrapment of the extensor digitorum brevis is a classic cause of irreducibility in medial dislocation. 6. Clinically, medial subtalar dislocation results in which foot position? A. Neutral B. Pronation C. Supination D. Equinus Answer: C. Supination Explanation: Medial dislocations typically produce a supinated foot, while lateral dislocations produce pronation. 7. Lateral subtalar dislocations are associated with a high risk of: Osteochondral fractures Explanation: High-energy lateral dislocations frequently produce osteochondral injuries.

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