medial subtalar dislocations - early mobilisation protocol

8/9/2019 Medial Subtalar Dislocations - Early mobilisation protocol

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SUBTALARDISLOCATION:SUBTALARDISLOCATION:

REVIEW

OF

5

CASES

AT

3

YEARS

MEAN

FOLLOWREVIEW

OF

5

CASES

AT

3

YEARS

MEAN

FOLLOW

UP.

UP.

THEOUTCOMESOFEARLYMOBILIZATIONTHEOUTCOMESOFEARLYMOBILIZATION

N.Lasanianos,G.Mouzopoulos,E.Morakis,G.Nikolaras,M.Kaminaris,I.Spanos,C.Garnavos1stTrauma&OrthopaedicSurgerydept.,AthensGeneralInfirmary Evaggelismos

Subtalar Dislocation (SD) Disruptionofthetalocalcanealandtalonavicularjoints,without

involvementofthecalcaneocuboid ortibiotalar jointsortalarneck#

Rarelesion(1%ofalldislocations)

Twobasictypes: i) Medialdislocation(mostusual)

ii)Lateral

dislocation

(rarer

/has

worse

prognosis)

Usuallycomplicatedbyimpairedmobility,painandperitalar arthritis

Usuallytreatedby: i)Closedoropenreductionii)Immobilizationfor45weeks(castorExfix)

iii)NonWeightBearing(WB)forthesameperiodiv)Physiotherapyprogramafter5weeks

10th EFORT Congress, Vienna-Austria


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Five patients with medial SD treated in a 3 years period

4 male 1 female with mean age 32 years (23-46)

4 closed SD dislocations 1 open SD Mean follow-up : 3 years

All dislocations were reduced in the A & E dept. under

regional anesthesia The open dislocation case was thoroughly washed out and

reduced in the A & E. Antibiotic treatment followed and the

wound was closed 2 days later. Immobilization period for 3 weeks in a below knee cast

Early passive & active ROM started at week 3 post injuryand PWB mobilization at week 4

Patients & Methods


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Male32yearsold,MedialSD RoadTrafficaccident

Pre&postreduction

AP&

Lateral

X

rays

Male46yearsold,MedialSD Fallfromheight

Pre&postreductionAP&LateralXrays.Prereductionclinicalview

Cases


4/6

Female35yearsold,OpenMedialSD RoadTrafficaccident

PrereductionAP/LateralXrays&Clinicalview

Cases

Postreduction AP/LateralXrays

&Clinical

view

FullROM

4weeks

post

injury CT

Scan

3years

post

injury

not

indicating

peritalardegenerativelesions


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AllpatientsacquiredfullROM4weekspostinjuryandreduction AllpatientseasilyanticipatedearlyROMexercisesandearlyweight

bearingmobilization NocomplicationsofperitalarpainorROMrestrictionwerenoted

duringthe3yearsfollowup

Results

Conclusions

TheresultsarefavorableofearlyROMandearlyWBmobilization

Threeweeks

cast

immobilization

appears

sufficient

for

simple

MedialSD Jointstiffnessandpainproblemswereavoidedinallcases Thenumberofpatientsandthetimeoffollowupdonotallow

definiteconclusionstobeextractedbutareindicativeofthesafetyandefficacyofearlymobilizationinSD


6/6

SUBTALARDISLOCATION:SUBTALARDISLOCATION:REVIEWOF5CASESAT3YEARSMEANFOLLOWREVIEWOF5CASESAT3YEARSMEANFOLLOWUP.UP.

THEOUTCOMES

OF

EARLY

MOBILIZATIONTHE

OUTCOMES

OF

EARLY

MOBILIZATION

N.Lasanianos,G.Mouzopoulos,E.Morakis,G.Nikolaras,M.Kaminaris,I.Spanos,C.Garnavos1stTrauma&OrthopaedicSurgerydept.,AthensGeneralInfirmary Evaggelismos

10thEFORTCongress,ViennaAustria

Literature

1. RockwoodCA,GreenDP(1984)Fractures,2ndedn,vol 2.Lippincott,.Philadelphia2. Bibbo C,AndersonRB,DavisWH(2003)Injurycharacteristicsandtheclinicaloutcome

ofsubtalar

dislocations:

aclinical

and

radiographic

analysis

of

25

cases.

Foot

Ankle

Int24(2):158163

3. BrunetP,Dubrana F,Burgaud A,Nen DeLe,Lefebre C(2004)Subtalardislocation:reviewoftencasesatmeantenyearfollowup.JBoneJointSurg Br86B:57

4. Merianos P.,PapagiannakosK,Hatzis A,Tsafantakis E(1988)Peritalardslocation:afollowupreportof21cases.Injury19:439442

medial subtalar dislocations - early mobilisation protocol

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