A 35-year-old male, clerk by occupation, presented with a history of injury to the left foot after a fall while riding a motor cycle six weeks ago. He had pain, swelling, and inability to bear weight on the left foot. Clinical examination revealed diffuse swelling and tenderness in midfoot region. There was no neurovascular compromise in the left foot.
Anteroposterior and oblique radiographs of left foot revealed dislocation of talonavicular joint with medial displacement of navicular and compression defect of anteromedial aspect of head of talus [, ]. CT scan showed talonavicular dislocation with compression defect of head of talus anteroinferiorly with small fracture fragments and congruent subtalar joint [, ].
Preoperative radiographs anteroposterior (a); and oblique (b) and CT scan images (c and d) of left foot showing talonanicular dislocation, compression fracture of head of talus, intact calcaneocuboid joint, and a normal subtalar alignment.
Under spinal anesthesia, closed reduction was attempted, but it failed. Hence, open reduction was done. Under tourniquet control, a 6 cm anteromedial longitudinal incision was made centering the talonavicular joint. Extensor hallucis longus tendon and dorsalis pedis artery were retracted medially, and extensor digitorum longus tendons were retracted laterally, exposing the dislocated talonavicular joint. The impacted fracture in talus was visualized, which was less than 1 cm size, in all dimensions. The loose fracture fragment was excised.
The talonavicular joint dislocation was reduced by traction and lateral rotation of the forefoot. The talonavicular joint was stabilized with 2-mm k-wires introduced from the dorsum of the foot transfixing the talonavicular joint . The wound was closed in layers. The foot was immobilized using below knee cast for 6 weeks. After 6 weeks, k-wires were removed, and weight-bearing was allowed progressively.
Immediate postoperative anteroposterior (a) and lateral (b) radiographs of left foot showing congruent talanavicular, subtalar, and calcaneocuboid joints with k-wires in situ.
After 3 months, the patient returned to his occupation as clerk. The foot was painfree and stable with normal range of ankle and subtalar joint motion. At the recent follow-up of 32 months, the foot was painfree and stable with normal range of ankle and subtalar joint motion . CT scannogram of left ankle and foot at 32 months showed. The sagittal reconstructed CT films demonstrated the well reduced talonavicular joint and congruent subtalar joint .
Thirty-two-month follow-up result showing excellent functional (a-e) and radiological outcome. CT scannogram (f), and sagittal CT reconstruction (g) showing congruent subtalar, talanavicular, and calcaneocuboid joints.