Subtalar dislocations:Mechanisms,clinical presentation and methods of reduction

Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints,without major fracture of the talus.They are usually classified as medial(most common),lateral,anterior and posterior dislocations,based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury.They are usually diagnosed by X rays,but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively.Majority being closed injuries,can be managed in ED by closed reduction and cast immobilisation,but if they are open,have poor outcomes.Complications that ensue open dislocations are post-traumatic arthritis,instability and avascular necrosis.

Survival analysis in nonagenarian patients with non-hip lower limb fractures

BACKGROUND The United Kingdom has an aging population with nearly 1 in 5 being over the age of 65,and over 0.5 million over the age of 90.The treatment of acute fractures of the lower limb in the nonagenarian cohort of patients poses a technical challenge to orthopaedic surgeons.AIM To report the fracture incidence,survival outcomes of treating acute non-hip lower limb fractures in nonagenarians in Major Trauma Centre.METHODS Thirty Lower limb long bone fractures in patients of age from 90 to 99 years were identified during 12-mo at a Level 1 trauma centre from a computerized database.A retrospective evaluation performed for fracture incidence,treatment,length of hospital duration and mortality at 30-d,1-year and 2-year.RESULTS Thirty fractures(28 patients)were identified,twenty-four fractures were treated with surgery(mean age 93 years SD±2.59)and 6 managed conservatively(mean age 94 years SD±2.07).The mean length of the hospital stay was 18.2 d for both groups.The 30-d,1-year and 2-year mortality risks were 1/23,6/23 and 9/23(4%,26%and 39%)in the surgery group and 0/5,1/5 and 2/5(0%,20%and 40%)in the conservative group,with no evidence for a difference between the two groups at any time point.CONCLUSION Nonagenarians in the surgical group had similar length of hospital stay and mortality risks as those treated conservatively.Patients with fewer comorbidities and admitted from their own home were offered surgery.