ABSTRACT
INTRODUCTION: Isolated tibiotalar dislocation is an extremely rare injury. They are most often caused by high-energy trauma. CASE PRESENTATION: The authors report the case of an acute pure posteromedial tibiotalar joint dislocation in a 45-year-old patient, which occurred as a result of a road traffic accident. The reduction was performed as an emergency procedure under general anesthesia, followed by a 6-week cast immobilization. Twenty months after the injury, at the last follow-up, a very good functional result was observed, with a stable and painless ankle and satisfactory mobility. DISCUSSION: A pure dislocation of the tibiotalar joint without an associated fracture is a rare injury. The posterior type is the most common dislocation. Treatments include close reduction, short leg cast immobilization, and open dislocation. However, certain factors can lead to unfavorable outcomes, such as delayed therapy, damage to the inferior tibiotalar ligaments, anterior tibial artery rupture, and soft tissue damage. CONCLUSION: It is rare for a tibiotalar joint dislocations to occur as an isolated injury. The necessity of immediate orthopedic intervention in the management of this lesion is demonstrated by our observation.
ABSTRACT
INTRODUCTION: The combination of talar neck fractures with malleolar fractures is a rare. This rare association accounts for 0.3 % of all bone fractures. We describe a one-of-a-kind ankle dislocation with a talar neck fracture and a bimalleolar fracture. CASE PRESENTATION: A 24-year-old male patient presented to the emergency department after a traffic accident. A physical examination revealed swelling and tenderness in the left ankle. The radiograph and the CT scan showed a Hawkins type III comminuted talar neck fracture, with an oblique fracture of the medial malleolus and an infra-syndesmotic fracture of the lateral malleolus. The patient underwent open reduction and internal fixation involving screw fixation for talar neck fracture and the medial malleolus and plating for the lateral malleolus. The treatment and post-operative follow-up showed successful healing and functional recovery, with a score of 85 on the American Orthopedic Foot and Ankle Society ankle-hindfoot at the last follow up. DISCUSSION: The discussion includes insights on the rarity of this fracture combination, treatment challenges, and potential complications such as avascular necrosis. This article emphasizes the importance of achieving anatomical reduction and stable fixation for optimal outcomes in such complex fractures. CONCLUSION: This case report highlights the successful treatment of a rare combination of talar neck and bimalleolar ankle fractures, emphasizing the importance of anatomical reduction and stable fixation for optimal outcomes in complex fractures.
ABSTRACT
INTRODUCTION: Isolated unicondylar fractures of the distal femur are rare injuries, accounting for 3-6 % of adult femur fractures. The association with a femoral shaft fracture is very rare and, to our knowledge, has, never been described in the literature. CASE PRESENTATION: In this article, we report the case of a 19-year-old motorcyclist involved in an accident, that resulted in both a midshaft transverse femoral fracture and an ipsilateral sagittal fracture of the medial femoral condyle (Trélat fracture). CLINICAL DISCUSSION: The surgical intervention involved open reduction and internal fixation for both fractures, utilizing a dynamic compression plate for the femoral shaft fracture and screws for the medial condyle fracture. Postoperative results showed excellent fracture reduction, and the patient progressed well with rehabilitation. The choice of fixation method for the sagittal medial femoral condyle fracture considered the unique anatomical challenges posed by this rare combination, the emergency (fat embolism), and the fact we didn't have a retrograde nail in our structure. A dynamic compression plate was used for femoral shaft fracture and screw fixation for condyle fracture treatment. The traction table in anterograde femoral nailing, led to the recurvatum of the condylar fracture and difficulty accessing it with the medial subvastus approach. CONCLUSION: This case report adds a description of a rare combination and valuable insight into the management of complex femoral fractures, emphasizing the importance of individualized treatment approaches.
