Achilles Tendon Tear Following an Unusual Pattern of Open Pure Ankle Dislocation: A Case Report.

We present a rare case of concurrent open Achilles tendon tear and pure subtalar dislocation in a 20-year-old male following a motorcycle accident, highlighting the complexity of managing such unique musculoskeletal injuries. The patient was initially admitted with an open and deformed left ankle, underwent prompt primary debridement, and received immediate medical intervention. Despite unsuccessful attempts to reduce the dislocation through external maneuvers, subsequent radiographic evaluation revealed a subtalar dislocation associated with a 90° rotation of the talus. A direct reduction was achieved in the operating room, uncovering a complete tear of the Achilles tendon and a section of the posterior tibial artery during more intensive debridement. The vascular surgery team repaired the posterior tibial artery, followed by Achilles tendon repair using a Kessler suture technique. Postoperative care involved immobilization and adapted rehabilitation, resulting in the patient regaining full range of motion without complications. To the best of our knowledge, this case represents the first reported open lateral subtalar dislocation associated with an open Achilles tendon tear. The detailed treatment strategies and outcomes offer valuable insights for clinicians facing similar challenges and inspire further research on rare musculoskeletal injuries.

Pure Open Ankle Dislocation Leading to Isolated Lateral Ligament Complex Tear: A Rare Case.

Pure open ankle dislocation is a rare orthopedic emergency characterized by the absence of associated bony lesions, necessitating prompt and immediate management to prevent disastrous complications. This article details a distinctive case of open pure ankle dislocation in an 18-year-old female following a motorcycle accident, resulting in a 6-cm wound and a dislocated left ankle with a concurrent tear of the anterior talofibular ligament and calcaneofibular ligament. Immediate reduction under sedation was performed, followed by intensive debridement and ligament repair in the operating room. Postoperatively, the patient received antibiotic coverage for five days and underwent immobilization for six weeks. At the 18-month follow-up, the patient exhibited a complete range of motion with no reported pain or instability. This study contributes to the existing literature by presenting a successful treatment paradigm, providing valuable insights for practitioners encountering similar cases.

Extremely rare combination of open dislocation of the ankle with superior type anterior hip dislocation without bone fracture: A case report.

Open dislocation of the ankle without associated fracture is extremely rare. Epstein's superior type of hip dislocation is the rarest type of hip dislocation. We reported a case of 50 years Nepalese gentleman who presented with a combination of these two rare orthopedic emergencies with the newly reported mechanism of injury by a garden tractor. Early extensive debridement of the wound with broad spectrum antibiotics coverage, reduction with delta frame external fixator, and postoperative rehabilitation helps in saving limb along with its function.

Open anterior dislocation of the hip in child of 7-years-old: A case report and literature review.

Traumatic hip dislocation is a rare injury in children, and an open dislocation is exceptional. We report the case of a 7 year old patient who presented an open anterior dislocation of the left hip following trauma by accident of the public highway. The patient received treatment under general anesthesia: articular toilet, debridement and reduction. Then, He was put under traction for 6 weeks and antibiotic. The short term evolution is marked by the occurrence of post-traumatic septic arthritis and osteonecrosis of the femoral head after two months.

Open Interphalangeal Dislocation of the Great Toe in an Amateur Football Player: A Rare Case Report.

INTRODUCTION: Open interphalangeal (IP) dislocations are completely uncommon. Up to now, different patterns of dislocation have been described. The combination of axial loading and hyperdorsiflexion forces, leading to plantar dislocation of the distal phalanx, is a rare type of injury, which has yet not been reported. CASE REPORT: A rare case of traumatic open dislocation of the left great toe IP joint in a highly active, overweighted, male, amateur football player is presented. The possible underlying mechanism was impact of the left great toe against the ground and subsequent hyperdorsiflexion. The distal phalanx was dislocated plantarly, whereas the proximal phalanx was protruding out the dorsal skin of the toe. Open exploration and reduction led to excellent clinical results 6 months after surgery. CONCLUSION: Open traumatic IP dislocation of the great toe due to low force activity is a very rare mode of injury, which requires adequate treatment including immediate purification of the exposed joint, control of the sesamoids' position, exclusion of intra-articular fractures, joint's reduction, soft-tissue repair, and proper stabilization.

Luxación expuesta de rodilla: ¿Qué hemos aprendido en los últimos 20 años? / Open knee dislocations: what have we learn about it in the last 20 years?

INTRODUCCIÓN: La luxación expuesta de rodilla es compleja, de incidencia baja con grandes secuelas funcionales. Existen escasos reportes de series en la literatura relativos a su manejo y resultados. OBJETIVO: El objetivo de este trabajo fue describir los resultados obtenidos de todos los pacientes con luxación expuesta de rodilla tratados durante las últimas dos décadas en nuestro hospital bajo un mismo estándar de tratamiento. MÉTODO: Estudio descriptivo retrospectivo en una serie quirúrgica de 11 pacientes con luxación expuesta de rodilla, tratados entre 1994 y 2015. Todos fueron estudiados y manejados según esquema estandarizado: Angiografía/ angioTC, aseo quirúrgico, fijador externo y reparación neurovascular en casos necesarios. Revisión de registros clínicos e imagenológicos consignando datos demográficos, lesiones concomitantes, número y tipo de cirugías, y complicaciones asociadas. Seguimiento promedio fue de 10,7 años con evaluación mediante encuesta funcionales SF-12/IKDC durante el mes de marzo de 2015. RESULTADOS: Diez pacientes eran hombres, 1 mujeres. Edad promedio al accidente 38,6 años. Mecanismo lesional de alta energía; como referencia la clasificación de Schenck, 1 lesión III-M, 4 tipo IV y los 6 restantes una tipo V. 4 lesiones vasculares (36.4%) y 7 lesiones neurológicas (63.6%). Tratamiento definitivo consistió en 4 reconstrucciones ligamentarias, 2 prótesis, 3 artrodesis y 2 amputaciones supracondíleas. Evaluaciones funcionales dieron como resultados un puntaje promedio de 37 y 48,5 para SF-12 físico y mental respectivamente, y de 44,1 para IKDC. CONCLUSIÓN: La luxación expuesta de rodilla es una lesión infrecuente, muy compleja, asociada a accidentes de alta energía, con complicaciones severas, lo que determina resultados funcionales relativamente malos. La estandarización permite sistematizar las distintas etapas de atención, racionalizar los recursos disponibles evitando la improvisación en momentos críticos, lo que podría incidir en la obtención de resultados.

INTRODUCTION: Open knee dislocation is a complex lesion of low incidence and large functional sequelae. There are few series reports in the literature regarding its management and outcomes. OBJECTIVE: Describe the results obtained from all patients with open knee dislocation treated during the last two decades in our hospital under the same treatment standard. METHOD: Retrospective descriptive study in a surgical series of 11 patients with open knee dislocation, treated between 1994 and 2015. All were studied and managed according to a standardized protocol: Angiography/angioCT, surgical debridement, external fixation and neurovascular repair in necessary cases. Review of clinical and imaging records, recording demographic data, concomitant injuries, number and type of surgeries and associated complications. Average follow-up was 10.7 years, with an evaluation through functional surveys SF-12/IKDC during March 2015. RESULTS: 10 patients were men, 1 woman. Average age at accident 38.6 years. High-energy trauma mechanism of injury; Schenk classification as reference, 1 lesion type III-M, 4 type IV and the remaining 6 type V. 4 vascular lesions (41.7%) and 7 neurological lesions (63.6%). Definitive treatment consisted in 4 ligamentous reconstructions, 2 prostheses, 3 arthrodesis and 3 supracondylar amputations. Functional evaluations showed an average score of 37 and 48.5 for SF-12 physical and mental respectively, and 44.1 for IKDC. CONCLUSION: Open knee dislocation is a rare, very complex, associated to high-energy trauma, with severe complications, which determines relatively poor functional outcomes. Standardization allows to systematize the different stages of attention and rationalize available resources avoiding improvisation at critical moments, which could affect the results.

Traumatic Open Anterior Hip Dislocation in an Adult Male: A Case Report.

This case report describes the surgical treatment and one-year follow-up of an adult male patient, who was treated for a severe anterior open hip dislocation fracture with no sign of femoral head necrosis and maintaining a Harris Hip Score (HHS) of 93.

Open Dislocation of Ankle without Fracture Treated with an External Fixator.

Ankle dislocations are orthopedic emergencies that require immediate treatment to avoid neurovascular impairment. They are usually accompanied by one or more comminuted fractures of the ankle mortis. In rare circumstances, such as high-energy trauma, the ankle dislocations may not be accompanied by concomitant malleolar fractures and, thus, are named "pure ankle dislocations". We presented a very rare and interesting case of an open medial dislocation of the ankle without associated fracture in an 18-year-old man with no known predisposing risk factors. The patient was admitted to the emergency department after sustaining a catastrophic trampoline accident resulting in severe inversion of the right ankle. The patient was treated with an external fixator and was mobilized early in the post-surgical course. Despite initial presentation that revealed lack of posterior tibial pulse, the post-surgical course was uneventful, with full functional recovery and joint mobility. The primary goals of treatment are immediate reduction of the joint and relief of neurovascular stress. External fixation is a prompt, fairly easy treatment that one should keep in mind in pure ankle dislocations. Nonetheless, ligamentous restoration and early mobilization were the key elements as seen in our case for full functional recovery.

Open Anterior Dislocation of the Hip in Togo.

Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours.

Open Anterior Dislocation of the Hip in Togo

Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours.

Open Anterior Dislocation of the Hip in Togo

Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours.

Subtalar dislocations.

Subtalar dislocations make up 1-2% of all dislocations, about 75% of them being medial dislocations. Treatment consists of early reduction under adequate sedation. In cases of soft tissue interposition or locked dislocations, open reduction is warranted. More than 60% of subtalar dislocations are associated with additional fractures, therefore a postreduction CT is recommended. Complications include avascular necrosis of the talus, infection, posttraumatic arthritis, chronic subtalar instability, and complex regional pain syndrome with delayed reduction. The prognosis of purely ligamentous injuries is excellent after early reduction. Negative prognostic factors include lateral and open dislocations, total talar dislocations, and associated fractures.

Osteonecrosis of distal tibia in open dislocation fractures of the ankle.

INTRODUCTION: Open ankle dislocation fractures are one of the most severe injuries of the ankle. Development of posttraumatic arthrosis is well known. However, there are just a few case reports describing evidence of posttraumatic osteonecrosis (PON) of distal tibia. The pathophysiological mechanism remains unclear and the question of morphologic or personal risk factors cannot be answered. The goal of this study was to evaluate the morphologic characteristics of open dislocated ankle fractures in correlation with the development of PON to facilitate early identification of patients with higher risk of posttraumatic osteonecrosis. MATERIAL AND METHODS: In this study data from 28 patients with open dislocation fractures of the ankle between 1975 and 2006 found at our databases were evaluated retrospectively. For each patient we documented personal data, mechanism of injury, type of lateral malleolar fracture, severity of open fracture, degree of tibiotalar dislocation, presence of medial malleolar fracture, presence of deltoid ligament rupture, time until joint reduction and kind of surgical treatment. We also documented clinical complications and number of surgeries. Presence of PON was examined by radiographs, magnetic resonance imaging (MRI) or histological analysis. RESULTS: Within 12 out of 28 patients with open ankle dislocation fractures a PON of the distal tibia could be found. Nine out of 15 patients with high-energy trauma and 12 out of 19 patients with type C fibular fracture developed PON. 73% of male patients and 88% of the patients with type III soft tissue damage according to Gustillo developed PON. However, if patients suffered from type C fibular fracture, total talus dislocation and grade III soft tissue damage ("necrotic triad") PON was developed in 100% of cases. Other patient's characteristics like late joint reduction, postoperative infection or bimalleolar fracture showed no higher proportion of patients with PON. CONCLUSION: In this study we were able to identify clinical manifestations and risk factors for the development of PON of the distal tibia. All indentified risk factors were associated with heavy fracture mechanisms leading most likely to a serious devascularisation of at least parts of the distal tibial epiphysis. With regard to presented results early identification of patients with higher risk of PON might be possible and maybe additional treatment options can be initialised to protect patients from this process.

Treatment of an open medial tibiotalar dislocation with no associated fracture.

Tibiotalar dislocations without associated fractures are very uncommon in adults, and only a few studies have been published regarding this injury. More than 50% of these dislocations will be posteromedial, with a high incidence of open injuries, and 25% are pure posterior dislocations. In the present report, we discuss our experience and management of a medial tibiotalar dislocation with no associated fracture. In the present case, the patient was brought to the operating room on presentation to our facility and underwent irrigation and debridement with primary closure of his wound. He was immobilized postoperatively. The patient tolerated the operation well and did not sustain any postoperative complications. He was able to regain function of the injured extremity until he was lost to follow-up. Regarding treatment, the surgery should be speedy, gentle to the soft tissue, and with as little implanted material as possible. Although we do not advocate that our management and treatment of this injury become the standard, the present case provides a good example of some of the challenges often encountered when treating these injuries.

Delayed debridement of an open total talar dislocation reimplanted in the emergency room.

Open total talar dislocation is a rare but well known injury. Its management is controversial and fraught with complications such as infection, avascular necrosis, and post-traumatic osteoarthritis. We report the case of a woman sustaining a pure open talar dislocation reduced in the emergency room. Debridement was done three days after the injury in the operating room. There was no infection. One year after surgery she complained of occasional pain. Ambulation was normal. She wore regular shoes. The overall alignment of the ankle, hindfoot, and midfoot was normal. Movements of the tibiotalar and subtalar joints were not impaired. She has resumed her regular activities. Radiographs showed no signs of avascular necrosis. All components of the treatment strategy of open total dislocation should be carried out in emergency. This results in environment close to the original biological state. Good results can be achieved if infection is avoided.