Irreducible Medial Peritalar Dislocation A Case Report

Abstract

Abstract : Background- Peritalar dislocations are rare injuries involving a simultaneous dislocation of  both subtalar and talonavicular joints with no associated dislocation of the             calcaneocuboid or tibiotalar  joints. We present a rare case report of irreducible closed medial peritalar                                dislocation.Materials and  method- A 29-year-old man was brought to emergency room after an acute inversion injury to his  right foot while playing football. Physical examination revealed that the foot was completely displaced  medially and the head of the talus was palpable and visible with the                overlying skin on the dorsolateral  foot. There was no neurovascular insufficiency. Xrays showed a medial peritalar dislocation with  complete dislocation at the talonavicular joint and talocalcaneal joint with talonavicular impaction.

After an unsuccessful closed manipulation CT scan was taken,which revealed some small  osteochondral fragments from talus which doesnot require fixaton. Hence open                 reduction through an  anterolateral incision was done. We found few loose intraarticular osteochondral fragments                blocking  congruent reduction with the lateral navicular              impacting on the medial talar head.All the fragments  were removed and the impaction was released by                              leverage .Reduction was stabilised with K-wires.                        Postoperative CT showed no intraarticular fragments with congruent reduction. The foot was  immobilized in a                           non-weightbearing short-leg cast for 6 weeks, thereafter the cast and K-wires were  removed, followed by active inversion, eversion, dorsiflexion and plantar flexion exercises with   progressive weightbearing was allowed. Result- After 22 months followup , patient had pain free  ankle movements with mild pain on forced inversion. There was no limitation of ankle movements,  with mild subtalar motion restriction. The AOFAS hind foot score indicated an excellent outcome  (score 89).Conclusion - Irreducible closed medial dislocations are very rare. Early open reduction can  significantly influence the long term functional outcome of the patient. The case has been reported for  its rarity and for its importance in acute management.

Keyword :Peritalar dislocation, talonavicular impaction ,   buttonholing of talar head