背景:完全孤立的跟骨脱位,定义为距骨和跟骨关节脱位,完整的距骨关节无明显骨折,是一种极其罕见的伤害。
方法:一名49岁的男子,机动车碰撞后,表现为跟骨的闭合性孤立性前外侧脱位,并伴有距骨上带骨折,长方体,距骨的侧突,腓上支持带撕脱性骨折。立即在急诊室镇静下进行紧急成功的闭合复位。两天后,通过tarsi窦入路向近端延伸到外侧踝关节的后部,并向远端延伸到跟骨眼关节,腓骨肌腱在后踝沟中减少,上腓骨支持带的撕脱骨折减少并通过缝合锚固定。由于进行了软骨成形术和微骨折,在跟骨的后小面上可见软骨损伤(6×8mm)。此外,从长方体的小骨碎片被切除。减少的跟骨关节由两根克氏针固定。在第二阶段,10天后,通过内侧方法进入距骨关节,多个游离骨碎片被切除。然后使用方头螺钉减少并固定了基头。术后,使用非负重短腿铸型六个星期。患者有权在移除K线后6周开始部分负重。最后,在术后第10周,他完全负重,没有任何辅助工具。受伤后约6个月,他能够恢复常规活动。34个月时,美国骨科足踝协会踝足-后足量表为100分中的92分。足部功能指数百分位数为7%,疼痛的视觉模拟评分为1.9。最后的X光片显示了正常的颅骨构型,跟骨,和距骨关节,距下关节后部有一点关节间隙变窄。
结论:孤立性前外侧跟骨脱位患者,即使有多处相关骨折,可以有可接受的结果,如果紧急诊断和妥善管理。
BACKGROUND: Complete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.
METHODS: A 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.
CONCLUSIONS: Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.