Closed posterior dislocation of the ankle without fracture

Closed posterior dislocation of the ankle without a fracture is a rare injury. We are reporting a case in a young male on his motorbike, being hit at the right ankle from behind. The mechanisms of injury along with MRI findings are being discussed.     

Pure closed medial ankle dislocation without fracture

Ankle dislocation without associated fracture is rare injury. We reported a case of closed pure medial ankle dislocation without any associated bony injury. In our knowledge there is no previous report on closed pure medial ankle dislocation without fracture published in the English literature. Patient was treated conservatively with immediate reduction under general anaesthesia and immobilised in a below knee cast and resulted in satisfactory outcome at 6 months follow up.     

Pure Closed Posteromedial Dislocation of the Tibiotalar Joint without Fracture

Pure tibiotalar dislocation without an associated fracture is an extremely rare injury. We present three cases of closed posteromedial tibiotalar dislocation without any associated fractures to the foot, ankle, or leg. All patients were treated conservatively with immediate closed reduction under general or local anaesthesia and immobilised in a short leg cast for six weeks without weight‐bearing resulting in a satisfactory outcome at the final follow‐up. A review of the literature is also presented in this paper.     

Neglected Ankle Dislocation

Tibiotalar dislocation without concomitant fracture in the surrounding bones is a rare injury. We report this type of injury presenting unreduced after a 10-month interval. A 23-year-old woman presented to our clinic 10 months after an earthquake in Bam, Iran, during which she had sustained an anterior tibiotalar dislocation without any associated fracture. Open reduction was attempted twice, but was not successful because of poor bone quality. Although ankle dislocation has been reported to be associated with good prognosis, this was not the case with our late-presenting patient. We could not find a similar case in the literature.     

Medial and Lateral Rotatory Dislocations of the Ankle After Trivial Trauma—Pathomechanics and Management of Two Cases

Pure frontal plane rotatory dislocation of the ankle joint without an associated fracture is an extremely rare injury. We report one such case of an eversion rotatory dislocation and one case of an inversion rotatory dislocation. To our knowledge, this is the first report of an eversion injury resulting in dislocation of the ankle without fracture. Both patients had low energy trauma, predisposing ligamentous injuries, and recurrent sprains. In the patient with lateral rotatory dislocation, medial malleolar hypoplasia was also a contributing factor. Both patients healed the presenting index injury with nonoperative treatment, whereas the lateral rotatory dislocation had a lateral ankle stabilization to prevent subsequent injury.     

Fracture dislocation of the talus combined with pilon or bimalleolar fracture: a report of two cases

Talar fractures are uncommon and talar body fracture dislocations are still rare. Simultaneous fractures of the ankle and the talar body are rare and the reported incidence in the literature is fewer than 1% of the ankle fractures. We present two cases of patients, who sustained a simultaneous fracture dislocation of talar body with fracture of medial malleolus and/or tibial pilon. The patients were treated with open reduction and internal fixation of talus through the malleolar fracture. They were evaluated at 1 year (case 1) and 8 years (case 2) of follow-up. The prognosis after this fracture dislocation is poor because of the very high risk of avascular necrosis and arthritis, even after anatomic reduction.     

Consequences of a missed ankle dislocation in an adolescent

Ankle dislocation without associated malleolar fracture(s) remains a rare presentation, especially in adolescence. Identified and treated promptly, these injuries can result in good to excellent outcome. We present an anterior ankle dislocation in a 14 year old, missed for approximately 12 months, necessitating multiple surgical interventions to provide a pain-free and stable joint. A review of the current literature is also provided.     

Interposition of Tibialis Posterior and Flexor Digitorum Longus Tendons Resulted in Irreducible Ankle Fracture-Dislocation

Irreducible ankle fracture-dislocations are very rare entities. The present case report demonstrates an unusual finding of tibialis posterior and flexor digitorum longus tendons interposed in the tibiofibular joint impairing successful closed reduction of ankle fracture-dislocation. A 45-year-old patient presented with a bimalleolar pronation-external rotation ankle fracture-dislocation after a motorcycle accident. Attempts to perform closed reduction before surgery were unsuccessful. Subsequent urgent open reduction and internal fixation surgical management revealed interposition of the tibialis posterior and flexor digitorum longus tendons in the tibiofibular joint. In irreducible fracture-dislocation of the ankle with severe lateral displacement of the talus, one should be aware of the possibility of soft tissue interposition of the tibialis posterior and flexor digitorum longus tendons in the tibiofibular joint.     

Complete dislocation of the talus unaccompanied by fracture

Total dislocation of the talus without a concomitant fracture is an extremely rare injury. Such a case was treated by immediate closed reduction and 6 weeks of cast immobilization. At the 9-year follow-up, the patient had a full range of ankle motion without any signs of avascular necrosis or arthritis.     

Open Dislocation of Ankle without Fracture Treated with an External Fixator

Ankle dislocations are orthopedic emergencies that require immediate treatment to avoid neurovascular impairment. They are usually accompanied by one or more comminuted fractures of the ankle mortis. In rare circumstances, such as high‐energy trauma, the ankle dislocations may not be accompanied by concomitant malleolar fractures and, thus, are named “pure ankle dislocations”. We presented a very rare and interesting case of an open medial dislocation of the ankle without associated fracture in an 18‐year‐old man with no known predisposing risk factors. The patient was admitted to the emergency department after sustaining a catastrophic trampoline accident resulting in severe inversion of the right ankle. The patient was treated with an external fixator and was mobilized early in the post‐surgical course. Despite initial presentation that revealed lack of posterior tibial pulse, the post‐surgical course was uneventful, with full functional recovery and joint mobility. The primary goals of treatment are immediate reduction of the joint and relief of neurovascular stress. External fixation is a prompt, fairly easy treatment that one should keep in mind in pure ankle dislocations. Nonetheless, ligamentous restoration and early mobilization were the key elements as seen in our case for full functional recovery.     

Irreducible Salter Harris Type II Distal Tibial Physeal Fracture Secondary to Interposition of the Posterior Tibial Tendon: A Case Report

Pediatric distal tibial fractures generally occur without significant long-term sequelae, and patients are commonly able to return to their preinjury activities after proper management. The literature reports excellent outcomes after anatomical reduction of distal tibial and ankle physeal fractures with closed or open treatment. Treatment options include simple immobilization of nondisplaced fractures, and closed or open reduction for restoration of anatomic alignment of displaced fractures. Soft tissue interposition within the fracture can threaten successful closed reduction, and may warrant open management if closed reduction fails to produce a satisfactory result. Despite the documented possibility of soft tissue interposition preventing closed reduction of pediatric ankle fractures, there is a paucity of literature reporting this complication. We report a unique case of an irreducible Salter-Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon.     

Bartonicek Ⅱ型Bosworth骨折脱位一例报道并文献复习

踝关节骨折是四肢骨折中常见损伤，但Bosworth骨折脱位在踝关节骨折中较为罕见，其由Bosworth在1947年首先描述报道并以此命名，特点是腓骨骨折近端嵌入胫骨腓切迹后方，导致脱位难以闭合复位，常需要切开复位。因其损伤机制及特点，容易出现漏诊，如未及时诊治，或按照一般踝关节骨折处理，可能导致围手术期相关严重并发症，如骨筋膜室综合征、距骨缺血性坏死及创伤性关节炎等。Bartonicek将此类损伤分为三型，其中报道较多的为Ⅲ型，合并腓骨远端骨折。我院近期收治了一例踝关节Bosworth骨折脱位患者，腓骨全长无骨折，为较罕见的Ⅱ型。该患者经过及时闭合复位、二期内固定手术，未出现不良事件，预后良好，本文通过该病例结合文献复习Bosworth骨折脱位的临床表现、损伤机制、诊断及治疗，分析BartonicekⅡ型Bosworth骨折脱位的特点。     

Übersehene Talushalsfraktur und hintere subtalare Luxation

A 26-year-old female patient fell during bouldering and impacted her left foot against a handle on the wall. A technically not standardized ankle X-ray was taken in the emergency room. Here a bony injury was excluded. The diagnosis was ancle sprain and the patient was treated as such. Because of persistent complaints a second opinion was obtained. Clinically she complained of foot pain, tingling paresthesia at the forefoot and presented claw toes. X-ray examination showed a talar neck fracture and a posterior subtalar dislocation. We performed open reduction and screw fixation of the talus with iliac crest interposition and a transfixation of the lower and upper ankle joint. The patient still has a limited range of motion but is able to walk and uses her left foot again with full weight bearing.ConclusionX-ray images should be evaluated by an experienced physician. The correct setting and projections of the X-ray images is a fundamental principle for the correct evaluation of the images. A talar fracture with subtalar joint dislocation should be reduced and fixed as soon as possible to avoid complications.     

Posteromedial dislocation of the ankle without fracture

Dislocation of the tibiotalar joint without fracture or diastasis is a rare injury. We report a case of an open postermedial ankle dislocation without fracture in a 42-year-old woman. A good result was obtained after 2 years follow up.     

Isolated anterior syndesmosis diastasis without fracture

Pure syndesmosis disruption at ankle without fracture of the fibula was rare. We reported a young man who had persistent left ankle pain and swelling 4 weeks after road traffic accident. X-rays did not reveal any fracture along whole fibula. Computed tomography showed anteriorly displaced fibula at syndesmosis level. Arthroscopic reduction and syndesmosis screw fixation followed by ligament reconstruction was done. Finally, he enjoyed pain-free range of motion of his ankle.     

Arthrodese – Pseudarthrosen am Sprunggelenk Die fehlgeschlagene Arthrodese

Non-unions after fracture dislocation of the ankle joint are extremely rare with predominantly operative treatment. In contrast, after fractures of the tibial plafond (pilon fractures) infections are seen in the literature in 37 % and non-unions are seen in 27 % after open reduction and internal fixation, requiring secondary ankle arthrodesis in about one quarter of all cases. In contrast to aseptic non-union or arthrosis, which can be salvaged with screw arthrodesis, with prevailing infection and severe osteoporosis external fixation (either one- or two-sided) is the treatment of choice. In isolated non-unions of the malleoli, either plate osteosynthesis with 3.5 low-contact dynamic compression plate or tension banding with autologous bone graft interposition, or alternatively sliding graft technique, is performed with good results.     

Tibiofibular diastasis without ankle fracture: a review and report of two cases.

Diastasis of the distal tibiofibular syndesmosis is commonly seen with ankle fractures, but is a rare finding in the absence of fracture. The anatomy, biomechanics, mechanism of injury, evaluation, and radiographic assessment of the tibiofibular syndesmosis are reviewed. The authors present a review and two cases of traumatic ankle diastasis without ankle fracture.     

Avoiding pitfalls in ankle fracture-dislocations: A case report of a dislocated tibialis posterior tendon causing persistent ankle subluxation

Tibialis posterior tendon dislocation, a rare complication in ankle fracture-dislocations, can impede anatomical reduction of the ankle mortise. We report on a 59-year-old healthy male with an open fracture-dislocation of the right ankle. Despite multiple attempts under direct vision of the anterior syndesmosis, anatomical reduction of the ankle mortise was not possible. Soft tissue windows in a computed tomography (CT) scan revealed the dislocated tibialis posterior tendon to be the impeding structure. At the level of the fibula fracture the tendon passed through the interosseous membrane anterior to the distal tibia and was then incarcerated in the medial talocrural joint before returning to the flexor retinaculum and its insertion on the navicular bone. Understanding the trauma mechanism and the course of the dislocated tendon as well as correct interpretation of CT and magnetic resonance images of the ankle enable surgeons to early diagnose and correctly treat this condition.     

Open medial ankle dislocation without associated fracture: A case report

Tibiotalar dislocation without associated fracture is a rare injury. We report a case of an unusual open medial ankle dislocation without any associated bony injury. After reduction and debridement under general anaesthesia, capsule suture and ligaments repair were performed. An external fixator was applied for ankle immobilization. After 3 years follow-up, functional results were excellent without signs of instability or degenerative arthritis.     

Traumatic Hip Dislocation in Childhood: A Report of 26 Cases and a Review of the Literature

Twenty-six cases of traumatic hip dislocation in children are presented. Although closed reduction was achieved in most instances, open procedures had to be employed in two cases of soft tissue interposition and in a patient with ipsilateral fracture of the femoral shaft. In 16 patients, with a follow-up averaging 14 years, the incidence of complications (avascular necrosis, coxa magna and arthrosis) was significant. Factors predisposing to abnormal results were delayed reduction and severe trauma. Neither the method of immobilization nor the interval without weight-bearing over 4 weeks were of influence. Principles of treatment are suggested.