Subtalar Dislocations: Case Series Inclusive of the Rare Anterior Subtalar Dislocation and Review of the Literature / Dislocaciones subtalares: serie de casos con inclusión de la rara dislocación subtalar anterior y revisión de la literatura

ABSTRACT Subtalar dislocations were first described by Judey and Dufaurest in 1811. These dislocations represent only 1-2% of all joint dislocations, making them a rare injury. In this rare injury, there are four variations with differing clinical presentations. The clinical picture may vary from a dramatic deformity (as in medial and lateral dislocations) to a more subtle presentation (as in anterior and posterior dislocations). This case series highlights the variations in clinical presentations and the management difficulties associated with each subtype.

RESUMEN Las dislocaciones subtalares fueron por primera vez descritas por Judey y Dufaurest en 1811. Estas dislocaciones representan solamente el 1-2% de todas las dislocaciones de las articulaciones, por lo que constituye una lesión poco frecuente. Esta rara lesión se caracteriza por cuatro variaciones con presentaciones clínicas que difieren. El cuadro clínico puede variar desde una deformidad dramática (tal cual ocurre en las dislocaciones intermedias y laterales) hasta una presentación más sutil (como en el caso de las dislocaciones anteriores y posteriores). Esta serie de casos destaca las variaciones en las presentaciones clínicas y las dificultades en el tratamiento asociado con cada subtipo.

Revisit of Broden's View for Intraarticular Calcaneal Fracture

BACKGROUND: This study was performed to investigate the relationship between coronal computed tomography (CT) and Broden's view in terms of location of the fracture line and fracture pattern. METHODS: Forty-five feet of 45 patients with intraarticular calcaneal fractures were evaluated. The mean age of the patients was 46.3 years (standard deviation, 18.1; range, 15 to 80 years), and there were 34 men and 11 women. The Broden's views were acquired using the ray sum projection, reviewed, and correlated with the coronal CT image to determine the location of the fracture on the posterior facet and fracture pattern described by the Sanders classification. The quantified location of the fracture line was defined as the distance between the medial margin of posterior facet and the fracture line divided by the whole length of the posterior facet, which was expressed as a percentage. RESULTS: The fracture line on the Broden's view was positioned at 22.3% (standard deviation, 29.6) laterally compared to that on coronal CT (p < 0.01). Although all cases showed posterior facet involvement on the CT scan, the fracture line was positioned lateral to the posterior facet in 6 cases (13.3%) in the Broden's view. The coronal CT and Broden's view showed a low level of agreement in the fracture pattern according to the Sanders classification, with kappa values of 0.23. CONCLUSIONS: Surgeons should consider that the fracture line on the Broden's view shows positioning laterally compared to coronal CT and they should consider that the fracture line at the lateral to posterior facet on the Broden's view might be an intraarticular fracture line. There are some limitations when applying the Sanders classification with the Broden's view.

Evaluation of the Sigmoid Notch Involvement in the Intra-Articular Distal Radius Fractures: The Efficacy of Computed Tomography Compared with Plain X-ray

BACKGROUND: The purpose of this study is to evaluate the efficacy of computed tomography (CT) scans compared with plain radiographs on detecting the involvement of the sigmoid notch. METHODS: This study involved 121 cases diagnosed as the intra-articular distal radius fracture and performed post-reduction CT scans. We determined the presence of the sigmoid notch involvement with both plain radiographs and CT scans and compared findings of plain radiographs with CT scans about the incidence and the pattern of injuries. And the differences of results between arbeitsgemeinschaft fur osteosyntheses (AO) type C2 and C3 were compared. RESULTS: The incidences of sigmoid notch involvement detected in plain radiographs were 81 cases (66.9%), whereas CT scans were 99 cases (81.9%). The sensitivity of plain radiographs compared with CT scans was 74.7%, the specificity was 68.2%, the positive predictive value was 91.4%, the negative predictive value was 37.5%, the false negative value was 25.3%, and the false positive value was 31.8%. In comparison between AO type C2 and C3, the incidence of sigmoid notch involvement was not a significant difference, but the displacement of fracture fragment showed a significant difference. CONCLUSIONS: The intra-articular distal radius fracture usually accompanies the sigmoid notch involvement. Considering that the evaluation of sigmoid notch involvement by plain radiography often results in misinterpretation or underestimation, performing CT scan in intra-articular distal radius fracture is thought to be beneficial.

Evaluation of the Sigmoid Notch Involvement in the Intra-Articular Distal Radius Fractures: The Efficacy of Computed Tomography Compared with Plain X-ray

BACKGROUND: The purpose of this study is to evaluate the efficacy of computed tomography (CT) scans compared with plain radiographs on detecting the involvement of the sigmoid notch. METHODS: This study involved 121 cases diagnosed as the intra-articular distal radius fracture and performed post-reduction CT scans. We determined the presence of the sigmoid notch involvement with both plain radiographs and CT scans and compared findings of plain radiographs with CT scans about the incidence and the pattern of injuries. And the differences of results between arbeitsgemeinschaft fur osteosyntheses (AO) type C2 and C3 were compared. RESULTS: The incidences of sigmoid notch involvement detected in plain radiographs were 81 cases (66.9%), whereas CT scans were 99 cases (81.9%). The sensitivity of plain radiographs compared with CT scans was 74.7%, the specificity was 68.2%, the positive predictive value was 91.4%, the negative predictive value was 37.5%, the false negative value was 25.3%, and the false positive value was 31.8%. In comparison between AO type C2 and C3, the incidence of sigmoid notch involvement was not a significant difference, but the displacement of fracture fragment showed a significant difference. CONCLUSIONS: The intra-articular distal radius fracture usually accompanies the sigmoid notch involvement. Considering that the evaluation of sigmoid notch involvement by plain radiography often results in misinterpretation or underestimation, performing CT scan in intra-articular distal radius fracture is thought to be beneficial.