UMEM Educational Pearls

Question

19 year-old male presents with L ankle pain and obvious deformity after jumping out of a window and landing on his inverted foot. What's the diagnosis?

Answer

Sub-talar dislocation

  • Dislocation of distal talar articulation at talocalcaneal and talonavicular joints (ankle joint is undisturbed)
  • Also known as "basketball foot"; a common mechanism of injury
  • Medial dislocation is more common than lateral (85% vs 15%) and it is usually caused by injury while foot is in inversion
  • Closed reduction is facilitated with knee in flexion to relax the gastrocnemius
  • Approximately 20% of lateral dislocations require open reduction
  • CT scan is recommended following closed reduction to rule out osteochondral lesions and better assess the reduction

References

Wheeless' Textbook of Orthopedics

Follow me on Twitter (@criticalcarenow) or Google+ (+haney mallemat)