A useful technique for subtalar fracture dislocation

Background

Subtalar dislocation occurs through disruption of two separate bony articulations: the talonavicular and talocalcaneal joints.¹ It commonly results from motor vehicle accidents, falls from a height, sporting activities, jumping, running, or twisting.² The majority of dislocations can be reduced in a closed manner with appropriate sedation. Failed reduction by closed means occurs in 10–20% of cases of medial and lateral dislocations.³ A number of anatomic explanations exist for failed closed reduction, such as ‘buttonholing’ of the talar head through the extensor digitorum brevis, extensor retinaculum, talonavicular ligaments or joint capsule. We present a novel reduction technique using skeletal traction to assist in closed reduction.

Technique

A 3.5mm diameter, smooth, stainless steel Steinmann pin is drilled through the ipsilateral calcaneus in a medial-to-lateral direction. A traction bow is applied (Fig 1). This has three uses: first, to enable traction to be applied and reduce the fracture; second, to control rotation; and third, to stabilise the talus, which otherwise would be extremely unstable. This technique minimises the soft tissue insult and allows time to plan definitive fixation (Figs 2 and 3).

Figure 1.

Steinmann pin and traction bow construct applied to composite sawbone model, enabling skeletal traction

Figure 2.

Preoperative image showing subtalar fracture dislocation

Figure 3.

Postoperative image demonstrating satisfactory reduction with use of skeletal traction bow

Discussion

This time efficient method uses inexpensive materials and applies basic trauma surgery principles to achieve optimal rotational control to assist in joint relocation and fracture stabilisation. We advocate this technique to facilitate a closed reduction of the subtalar joint but also highlight that it is an invasive technique where the Steinman pin is removed to minimize the risk of potential pin site infection.⁴