Lateral Subtalar Dislocation Associated with Cuboid Fracture. Prompt Diagnosis and Initial Management of This Rare Orthopaedic Manifestation at the Emergency Department

INTRODUCTION: Subtalar dislocations are rare injuries, representing around 1% of all dislocations. Defined as talonavicular and talocalcaneal separation, occurs in medial, lateral, anterior, or posterior direction. They are more common in young men, usually as a result of high energy trauma and are associated with posttraumatic arthritis, especially when accompanied with peritalar fracture (a cuboid fracture in this case), so prompt recognition is necessary in order all these complications to be avoided. CASE PRESENTATION: This study presents a rare case of subtalar dislocation associated with cuboid fracture in a young male adult as a result of a Motor Vehicle Accident (MVA) as treated in the Accident & Emergency (A&E) Department, and discuss the diagnostic protocols, the reduction technique and the initial management as performed. A 21-year-old man was transferred to the Emergency Department of our hospital after a MVA (driver of a motorbike). After the initial management of the patient according to the ATLS, deformity on the foot was observed and a lateral subtalar dislocation was suspected. Prompt closed reduction achieved, avoiding skin complications. The limb was immobilized in a bellow knee splint and plain radiographs confirmed the reduction. A CT scan was performed to evaluate entrapped intraarticular fragments or associated fractures and the patient was referred to the Orthopaedic department for final treatment. CONCLUSION: Emergency and Trauma teams should be aware of these rare injuries during the initial management of a patient particularly a poly-trauma one. Delayed diagnosis or misdiagnosis are common especially when more serious and life-threatening injuries are present in the same patient. Proper initial assessment of the patient and high incidence of suspicious is the key for an early diagnosis. When the suspected dislocation is confirmed, closed reduction, post reduction evaluation and immobilization is important to reduce complications as skin necrosis, neurovascular injuries, or post traumatic arthritis.