A rare case of Grade III A compound medial subtalar dislocation with fracture lateral mallelous

Abstract

A 25 year old patient presented with a history of fall from height and injury to his right ankle and foot. He had a compound wound over the lateral malleolar area of size 10 into 6 cm. The lateral compartment tendons were found to be exposed and cut. The talus and calcaneum were visible. X ray showed a medial subtalar dislocation along with a chip                   fracture of lateral malleolus. Manual reduction was attempted. The dislocation reduced with some difficulty in the OP but it was found to be unstable. Plastic surgery opinion was                 obtained. They suggested nil active plastic surgery                      intervention was needed at present and advised to review later. The patient was taken up for surgery immediately Under spinal anesthesia, through wound debridement was done. The dislocation was reduced under C-arm guidance. The subtalar, talo navicular and calcaneo cuboid joints were found to be congruent. The reduction was maintained with the use of 2 talo navicular, 1 calcaneo cuboid and 1 calaneo talar K wire. Fibular chip fracture was fixed with a K wire. The           peroneus longus and brevis were found to be cut. They were repaired by modified Kessler repair. Stay sutures applied over the skin. A below knee slab applied.Post operatively, regular dressing done and antibiotics given. The wound healed            uneventfully. Patient was discharged on the 10th day                following suture removal. At 6 weeks, all the K- wires except the fibular K-wire were removed and active aggresive                mobilization of the ankle and subtalar joints started. At 6 weeks post operative period, ankle Xray showed Hawkins sign (Subchondral radiolucency) in the talus which is an             indicator of vascularity of the talus. Patient was put on weight bearing as tolerated.At 2 months follow up, the range of movements in the ankle and subtalar joints were full. The American Orthopedic Foot and Ankle score at 2 months was found to be 85 out of 100 which signifies excellent outcome. CONCLUSION This case has been presented for its rarity of presentation and its excellent outcome following proper        skeletal stabilization and soft tissue repair.