Irreducible Medial Peritalar Dislocation A Case Report

Background- Peritalar dislocations are rare injuries involving a simultaneous dislocation of both subtalar and talonavicular joints with no associated dislocation of the calcaneocuboid or tibiotalar joints. We present a rare case report of irreducible closed medial peritalar dislocation.Materials and method- A 29-year-old man was brought to emergency room after an acute inversion injury to his right foot while playing football. Physical examination revealed that the foot was completely displaced medially and the head of the talus was palpable and visible with the overlying skin on the dorsolateral foot. There was no neurovascular insufficiency. Xrays showed a medial peritalar dislocation with complete dislocation at the talonavicular joint and talocalcaneal joint with talonavicular impaction. After an unsuccessful closed manipulation CT scan was taken,which revealed some small osteochondral fragments from talus which doesnot require fixaton. Hence open reduction through an anterolateral incision was done. We found few loose intraarticular osteochondral fragments blocking congruent reduction with the lateral navicular impacting on the medial talar head.All the fragments were removed and the impaction was released by leverage .Reduction was stabilised with K-wires. Postoperative CT showed no intraarticular fragments with congruent reduction. The foot was immobilized in a non-weightbearing short-leg cast for 6 weeks, thereafter the cast and K-wires were removed, followed by active inversion, eversion, dorsiflexion and plantar flexion exercises with progressive weightbearing was allowed. Result- After 22 months followup , patient had pain free ankle movements with mild pain on forced inversion. There was no limitation of ankle movements, with mild subtalar motion restriction. The AOFAS hind foot score indicated an excellent outcome (score 89).Conclusion - Irreducible closed medial dislocations are very rare. Early open reduction can significantly influence the long term functional outcome of the patient. The case has been reported for its rarity and for its importance in acute management.