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Beitragstitel Subtalar joint dislocation of a climber: case report
Beitragscode P44
Autoren
  1. Majid Bekhtari Hôpital Riviera Chablais Vortragender
  2. Mohand Agaoua HFR Fribourg
Präsentationsform Poster
Themengebiete
  • A06 - Fuss
Abstract Tittle: Subtalar joint dislocation of a climber: case report

Authors: Majid Bekhtari1, Houssemedine Kouki1, Sérgio Soares1, Angela Seidel1, Mohand Agaoua1
1 Department of orthopedic surgery, HFR Fribourg, chemin des Pensionnats 2, 1752 Villars sur Glâne, Switzerland

Introduction:
Acute medial subtalar dislocation is rare. In general, it is the result of a high-energy equine varus trauma, a road accident or a fall from a great height. We report the case of a young 38-year-old climber, victim of a climbing accident and taken care of in our service.

Case description:
A 38-year-old patient, in good health, a nonprofessional climber, is seen in our hospital after hitting his left foot against a climbing wall on a 5C graded track with equine varus foot trauma. In the emergency department, he presented with significant pain in his left foot with deformity and functional impotence when walking.
On clinical examination of the left foot, we find a varus deformity of the hindfoot with a hematoma on the lateral face and facing dermabrasions, diffuse pain on palpation of the Chopart joint and no neurovascular disorder. The radiological assessment carried out in the emergency room shows a medial subtalar dislocation of the left foot. The left subtalar dislocation is reduced in the emergency room by an axial traction maneuver and external translation under sedation. A split cast boot is then put in place. A CT scan of the ankle and left foot is performed to complete the assessment and shows an intra-articular fracture of the head of the talus, extending to the neck, to the medial and posterior process of the type I talus according to Marti, a fracture of the anterior process of the calcaneus and a fracture of the base of the 5th metatarsal on the left foot in zone II.

Discussion:
Subtalar joint dislocation is a rare condition in rock climbing with no case described in the literature. The mechanism of medial subtalar dislocation is by adduction with forced inversion of the forefoot associated with varus of the hindfoot, leading to ligament rupture in a specific order: it is first the dorsal talonavicular ligament which is injured, then the two bundles of the interosseous ligament in hedge (sinus of the tarsus) and finally the calcaneofibular ligament. The diagnosis is clinical and is confirmed by radiological examinations. A CT scan and an MRI of the foot allow us to exclude associated osteo-ligamentous lesions.