RESUMO
Introduction: Traumatic open total extrusion of talus without soft-tissue attachment and not associated with surrounding fracture is a very rare injury which requires very high energy impact. In literature, optimal treatment protocols are yet to be established. A few options described in literature are talectomy and tibiocalcaneal arthrodesis or reimplantation of talus which may be immediate or after some interval. Case Report: A 28-year-old female suffered road traffic accident and had total open extrusion of talus without soft-tissue attachment, and we managed it with thorough debridement of the wound, saline irrigation, and immediate reimplantation of the talus with stabilization by delta frame external fixator. Proper pre- and post-operative antibiotic coverage was given as per protocol. We did not face post-operative infection, wound complication, and until 12 months followed up, there are some signs of avascular necrosis of the talus but the good functional outcome. Conclusion: With this case experience, we suggest that this is the valid treatment protocol for total extrusion of the talus, and it will provide a better hindfoot mechanism, heel height, and the patient can resume his/her daily routine activity as early as possible.
RESUMO
Introduction: Elbow dislocations are commonly encountered by orthopedic surgeons all over. Management is straightforward and the result is generally satisfactory. However, in a small subset, associated injuries like convergent or divergent dislocations at superior radioulnar joints are present. These associated injuries are often missed initially leading to their delayed treatment and suboptimal elbow function. We report one such rare case of Convergent dislocation at the elbow. Although reported from other parts of the world till date, there has been none reported from India. It is extremely rare in adults. Twenty-three cases in children and only two in adults stand reported so far in world literature. Thus, our reporting it could be the first report of convergent dislocation at the elbow from India. To the best of our knowledge, it is only the third reported adult case in world literature. Case Report: We describe a 68-year-old male visiting a local hospital with a history of fall from a two-wheeler. An initial radiograph revealed an obvious posterior dislocation of the elbow. Closed reduction was performed, and posterior above elbow slab was given. Patient presented to us 10 days later with persistent pain. Evaluation with radiographs confirmed reduction of ulno-humeral joint but translocation of the radius and ulna which is combined posterior and convergent elbow dislocation. Conclusion: Combined posterior and convergent elbow dislocation is a rare scenario. The rarity of these associated injuries is the reason for lack of awareness. We suggest careful scrutiny of pre-reduction anteroposterior radiographic view or 3D CT in suspected cases as well as X-ray/Carm anteroposterior view in extended position of elbow on the operation table immediately after reduction before slab application in every case of elbow dislocation. Significant difficulty was encountered in open reduction in our case. This could be attributed to buttonholing of the radial head through insertion of brachialis fibers. The reporting of this surgical difficulty is important because it will help the surgeon know it beforehand and the awareness would make the surgeon take appropriate measures well in time.
