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Irreducible Anterior Subluxation of the Ankle Joint Caused by Os Trigonum and Transverse Ligament: A Case Report
Korean J Sports Med 2021;39:127-130
Published online September 1, 2021;  https://doi.org/10.5763/kjsm.2021.39.3.127
© 2021 The Korean Society of Sports Medicine.

Min Gyu Kyung

Department of Orthopedic Surgery, Armed Forces Yangju Hospital, Yangju, Korea
Correspondence to: Min Gyu Kyung
Department of Orthopedic Surgery, Armed Forces Yangju Hospital, 1133 Hwahap-ro, Eunhyeon-myeon, Yangju 11429, Korea
Tel: +82-31-857-0963, Fax: +82-31-863-6465
E-mail: 20-14709@mnd.go.kr
Received May 28, 2021; Revised August 4, 2021; Accepted August 12, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Ankle joint is a stable mortise structure, therefore pure ankle dislocation without ankle fracture is rare. Several adjacent anatomical structures have been reported as a cause of irreducible ankle dislocation. Author report a case of successful treatment of irreducible anterior subluxation of the ankle joint due to os trigonum and transverse ligament by closed reduction under anesthesia, and a review of the literature as well.
Keywords : Ankle joint, Joint dislocations, Talus, Ligaments
꽌 濡

諛쒕ぉ愿젅 寃⑹옄 臾대뒳쓽 븞젙쟻씤 援ъ“瑜 씠猷④퀬 엳뼱 諛쒕ぉ 怨⑥젅쓣 룞諛섑븯吏 븡 諛쒕ぉ愿젅 깉援щ뒗 留ㅼ슦 뱶臾쇨퀬, 議깆 援닿끝 긽깭뿉꽌 異뺤꽦 븬젰쓣 諛쏆븯쓣 븣 쓷엳 諛쒖깮븳떎1. 媛쒕뒗 룄닔 젙蹂듭쓣 넻빐꽌 移섎즺媛 릺吏留, 씠윭븳 깉援ъ쓽 젙蹂듭쓣 諛⑺빐븯뒗 뿬윭 媛吏 빐遺븰쟻 援ъ“臾쇰뱾씠 蹂닿퀬맂 諛 엳떎2-4. 옄뒗 궪媛 遺怨(os trigonum)怨 슒씤(transverse ligament)뿉 쓽빐 젙蹂듭씠 릺吏 븡뒗 諛쒕ぉ愿젅 쟾諛 븘깉援 솚옄瑜 泥숈텛 留덉랬 썑 룄닔젙蹂듯븯뿬 꽦怨듭쟻쑝濡 移섎즺븯湲곗뿉, 臾명뿄 怨좎같怨 븿猿 蹂닿퀬븯怨좎옄 븳떎. 蹂 뿰援щ뒗 援援곗쓽臾댁궗졊遺 쓽븰뿰援 쑄由ъ떖쓽쐞썝쉶쓽 듅씤쓣 諛쏆븯쑝硫(AFMC-202104-HR-027-01), 빐떦 떖쓽뿉꽌 긽옄 궗쟾 룞쓽 硫댁젣瑜 듅씤븯떎.

利 濡

20꽭쓽 궓옄 솚옄媛 궡썝 떦씪 2떆媛 쟾遺꽣 諛쒖깮븳 슦痢 諛쒕ぉ쓽 떖븳 넻利앷낵 遺醫낆쑝濡 쓳湲됱떎뿉 궡썝븯떎. 異뺢뎄瑜 븯뜕 룄以 슦痢 諛쒕ぉ쓣 理쒕 議깆 援닿끝븳 긽깭뿉꽌 李⑹瑜 뻽떎怨 븯쑝硫, 諛쒕ぉ 넻利앷낵 遺醫낆쑝濡 諛쒕ぉ쓽 吏곸엫씠 젣븳맂떎怨 샇냼븯떎. 떊泥 寃吏꾩뿉꽌 슦痢 諛쒕ぉ 理쒕 議깆 援닿끝 긽깭쑝硫, 湲고 떊寃쏀븰쟻 씠긽 蹂댁씠吏 븡븯怨, 議깅같룞留κ낵 썑寃쎄낏룞留μ 옒 珥됱릺뿀떎. 닔룞 議깅같 援닿끝 떆 떖븳 넻利앹쓣 샇냼븯쑝硫, 議깆 援닿끝 긽깭뿉꽌 以묐┰ 쐞移섎줈 吏곸엫씠 遺덇븯떎. 쓳湲됱떎 궡썝븯뿬 泥섏쓬 떆뻾븳 떒닚 諛⑹궗꽑 寃궗긽 嫄곌낏씠 寃⑹옄 援ъ“ 궡뿉 븞젙쟻쑝濡 쐞移섑븯吏 紐삵뻽怨, 嫄곌낏쓽 썑硫대뿉 궪媛 遺怨⑥쓣 愿李고븷 닔 엳뿀떎(Fig. 1). 臾대쫷 遺쐞뿉 긽쟻 寃ъ씤쓣 쑀吏븳 梨 룄닔젙蹂듭쓣 3쉶 떎떆뻽쑝굹 洹쇱쑁 湲댁옣뿉 쓽빐 떎뙣븯떎. 諛쒕ぉ 옄湲곌났紐낆쁺긽쓣 諛붾줈 珥ъ쁺븯怨, 留롮 뼇쓽 愿젅 궪異쒖븸씠 蹂댁쑝硫, 嫄곌낏쓽 썑諛 遺쐞 궪媛 遺怨 궗씠媛 슒씤뿉 嫄몃젮 엳뒗 寃껋쓣 솗씤븯떎(Fig. 2). 삉븳 쟾嫄곕퉬씤쓽 셿쟾 뙆뿴씠 愿李곕릺뿀쑝굹 젙蹂 씠썑 湲됱꽦 諛쒕ぉ 뿼醫뚯뿉 以븯뿬 떒븯吏 꽍怨 怨좎젙쓣 넻빐 蹂댁〈쟻 移섎즺瑜 怨꾪쉷븯떎.

Fig. 1. Initial right ankle plain radiographs showing anterior subluxation of the ankle joint. Note that the ankle is in full plantar flexion state and os trigonum is present.

Fig. 2. Initial magnetic resonance imaging of right ankle after several trials of manual reduction at emergency room. Note the transverse ligament (arrow-heads) between posterior talar body and os trigonum.

뿬윭 踰덉쓽 룄닔젙蹂듭뿉룄 떎뙣瑜 븯뿬 愿삁쟻 젙蹂듭쓣 뿼몢뿉 몢怨 닔닠諛⑹뿉꽌 泥숈텛 留덉랬瑜 떆뻾뻽떎. 留덉랬 吏곹썑뿉 洹쇱쑁 湲댁옣씠 뾾뒗 긽깭뿉꽌 臾대쫷 遺쐞뿉 긽쟻 寃ъ씤쓣 쑀吏븳 梨 썑議깅瑜 寃쎄낏쓽 옣異뺤쓣 뵲씪 議깆 諛⑺뼢쑝濡 寃ъ씤븯뿬 룄닔 젙蹂듭쓣 옱떆룄븯怨, 異붽쟻씤 愿삁쟻 젙蹂 뾾씠 닔닠諛 궡 諛⑹궗꽑 寃궗뿉꽌 諛쒕ぉ愿젅쓽 븞젙쟻씤 寃⑹옄 援ъ“瑜 솗씤븷 닔 엳뿀떎(Fig. 3). 諛쒕ぉ愿젅쓽 以묐┰ 쐞移섏뿉꽌 떒븯吏 꽍怨 쟻슜쓣 떆뻾븯怨, 닔닠 썑 4二쇨컙 쑀吏븯硫 紐⑸컻쓣 궗슜븯뿬 遺遺 泥댁쨷遺븯瑜 븯룄濡 븯떎. 씠썑 4二쇨컙 諛쒕ぉ 썙而 蹂댁“湲곕줈 蹂寃쏀븯뿬 셿쟾 泥댁쨷遺븯瑜 븯룄濡 븯怨, 諛쒕ぉ愿젅 슫룞쓣 泥쒖쿇엳 떆옉븯떎.

Fig. 3. Intraoperative ankle plain radiograph showing stable mortise structure.

씠썑 솚옄뒗 닔닠 썑 3媛쒖썡吏 쇅옒뿉 궡썝븯쑝硫, 珥ъ쁺븳 떒닚諛⑹궗꽑寃궗뿉꽌 諛쒕ぉ愿젅쓽 븞젙쟻씤 寃⑹옄 援ъ“瑜 솗씤븷 닔 엳뿀떎(Fig. 4). 넻利 젏닔瑜 10젏 留뚯젏뿉 0젏씠씪 몴쁽븯怨, 嫄룰퀬 쎇뒗 뜲 臾몄젣媛 뾾떎怨 븯떎. 諛쒕ぉ愿젅 슫룞 踰붿쐞뒗 議깆 援닿끝 30°, 議깅같 援닿끝 15°濡 뼇샇븳 엫긽 寃곌낵瑜 蹂댁뿬二쇱뿀떎.

Fig. 4. Standing ankle plain radiographs of postoperative 3 months.
怨 李

諛쒕ぉ愿젅 궡怨, 쇅怨, 洹몃━怨 寃쎄낏쓽 븯떒遺濡 씠猷⑥뼱吏 寃⑹옄 臾대뒳쓽 븞젙쟻씤 援ъ“瑜 씠猷④퀬 엳떎. 뵲씪꽌 諛쒕ぉ愿젅쓽 깉援щ뒗 媛 겙 뿉꼫吏쓽 쇅긽뿉 쓽빐 깮湲곕ʼn, 諛쒕ぉ 怨⑥젅쓣 룞諛섑븯吏 븡 諛쒕ぉ愿젅 깉援щ뒗 留ㅼ슦 뱶臾쇰떎1. 二쇰맂 닔긽 湲곗쟾 議깆 援닿끝 긽깭뿉꽌 異뺤꽦 븬젰쓣 諛쏆븯쓣 븣 諛쒖깮븳떎1. 뿬윭 諛⑺뼢쑝濡 깉援ш 맆 닔 엳吏留, 二쇰줈 썑궡痢(46%) 諛⑺뼢쑝濡 諛쒖깮븳떎1. 蹂 利앸쓽 솚옄뒗 議깆 援닿끝 긽깭뿉꽌 寃⑹옄 궡뿉 긽쟻쑝濡 醫곸 嫄곌낏 泥대쓽 썑諛 遺쐞媛 쐞移섑븯怨 씤媛 뒛뼱굹뒗 遺덉븞젙븳 옄꽭뿉꽌 異뺤꽦 븬젰쓣 諛쏆븯怨, 썑諛⑹뿉꽌 쟾諛⑹쑝濡 뼢븯뒗 옒씠 옉슜븯뿬 嫄곌낏씠 寃쎄낏뿉 鍮꾪빐 긽쟻쑝濡 쟾諛⑹쑝濡 븘깉援щ릺뿀쓣 寃껋씠떎. 씠뒗 씠쟾뿉 蹂닿퀬맂 諛쒕ぉ 怨⑥젅쓣 룞諛섑븯吏 븡 쟾諛 깉援 利앸 蹂닿퀬뿉꽌쓽 닔긽 湲곗쟾怨 媛숈 留λ씫씠떎5. 씠쇅뿉 닚닔 諛쒕ぉ 깉援ъ쓽 냼씤 씤옄濡 蹂닿퀬맂 쟾떊 씤 씠셿씠굹 궡痢 蹂듭궗堉덉쓽 삎꽦 벑 愿李곕릺吏 븡븯떎5.

Wight 벑1뿉 뵲瑜대㈃, 遺遺(88%)쓽 怨⑥젅쓣 룞諛섑븯吏 븡뒗 諛쒕ぉ愿젅 깉援ъ뿉꽌 룄닔젙蹂듭쓣 넻빐 移섎즺媛 媛뒫븯떎怨 븯떎. 룓뇙삎 깉援ъ뿉꽌 냼닔(5%)留뚯씠 씤 遊됲빀 벑 닔닠씠 븘슂븯떎怨 븯怨, 媛쒕갑삎 깉援ъ쓽 寃쎌슦뿉뒗 愿삁쟻 젙蹂 諛 꽭泥(42%) 삉뒗 씤 遊됲빀(48%) 벑 異붽쟻씤 닔닠씠 븘슂븳 寃쎌슦媛 留롮븯떎1. 닔닠 씠썑뿉뒗 4–6二쇨컙쓽 떒湲곌컙 꽍怨 怨좎젙 씠썑 옱솢 썕젴쓣 넻빐 씪긽 깮솢濡 옒 蹂듦븷 닔 엳떎. 蹂 利앸뒗 룓뇙삎 븘깉援ъ吏留 궪媛 遺怨⑥씠 룞諛섎릺뿀쑝硫, 슒씤뿉 쓽빐 젙蹂듭씠 諛⑺빐諛쏆븯怨 쓳湲됱떎뿉꽌뒗 洹쇱쑁 湲댁옣뿉 쓽빐꽌 룄닔젙蹂듬릺吏 븡븯떎. 븯吏留 泥숈텛 留덉랬瑜 넻빐 洹쇱쑁 湲댁옣씠 뾾뒗 긽깭뿉꽌 異붽쟻씤 愿삁쟻 젙蹂 뾾씠 諛쒕ぉ愿젅쓽 븘깉援ш 꽦怨듭쟻쑝濡 移섎즺릺뿀怨, 쇅옒 異붿떆뿉꽌 엫긽쟻 寃쎄낵媛 留ㅼ슦 뼇샇븯떎.

諛쒕ぉ愿젅 깉援ъ쓽 젙蹂듭쓣 諛⑺빐븯뒗 빐遺븰쟻 援ъ“臾쇱 뿬윭 媛吏媛 엳쓣 닔 엳뒗뜲, 씠쟾 臾명뿄뿉꽌뒗 쟾寃쎄낏嫄, 썑寃쎄낏嫄, 궪媛곸씤, 옣議깆떊쟾嫄 벑쓽 씤젒븳 援ъ“臾쇱뿉 쓽빐 諛쒖깮븷 닔 엳떎怨 븯떎2-4. 삉븳 Segal 벑6 궪媛 遺怨⑥쓣 룞諛섑븳 諛쒕ぉ 쟾諛 셿쟾 깉援щ 蹂닿퀬븳 諛 엳쑝硫, Irving 벑7 궪媛 遺怨⑥쓽 쟾쐞瑜 룞諛섑븳 썑궡痢 諛쒕ぉ 깉援 利앸瑜 蹂닿퀬븯硫, 궪媛 遺怨⑥씠 닚닔븳 諛쒕ぉ 깉援ъ쓽 쐞뿕씤옄媛 맆 닔 엳떎怨 二쇱옣븯떎. 븯吏留 援궡뿉꽌뒗 씠윭븳 궪媛 遺怨⑥쓣 룞諛섑븯硫 슒씤뿉 쓽빐 룄닔젙蹂듭쓣 諛⑺빐諛쏆 臾명뿄 蹂닿퀬媛 뾾뿀湲곗뿉 蹂 利앸瑜 蹂닿퀬븳떎.

궪媛 遺怨⑥ 嫄곌낏쓽 썑쇅痢 遺쐞뿉 議댁옱븯硫, 젙긽 諛쒕떖 怨쇱젙뿉꽌 嫄곌낏쓽 씠李 怨⑦솕 以묒떖 7–14꽭뿉 굹굹, 嫄곌낏쓽 泥대뿉 1뀈 븞뿉 쑀빀씠 맂떎8. 븯吏留 쑀빀씠 젙긽쟻쑝濡 씠猷⑥뼱吏吏 븡쓣 寃쎌슦 궪媛 遺怨⑥ 嫄곌낏뿉 꽟쑀꽦 寃고빀쑝濡 遺숈뼱엳寃 맂떎. 궪媛 遺怨⑥쓽 議댁옱뒗 떒닚븳 빐遺븰쟻 蹂씠 씠긽쑝濡 諛쒕ぉ쓽 깮뿭븰쓣 諛붽 닔 엳쑝硫, 諛쒕ぉ 遺덉븞젙꽦쓽 쐞뿕슂냼媛 맆 닔 엳떎9. 삉븳, 蹂 利앸泥섎읆 슒씤뿉 쓽빐 궪媛 遺怨⑥씠 겮뼱꽌 젙蹂듭씠 諛⑺빐諛쏆쓣 닔룄 엳떎.

蹂 뿰援ъ뿉꽌 뼵湲됲븳 슒씤뒗 썑諛 寃쎈퉬씤쓽 떖遺瑜 씪而ル뒗떎(Fig. 5). 蹂듭궗삤紐⑹쓽 洹쇱쐞遺뿉꽌 떆옉븯뿬 寃쎄낏 썑諛⑹쓽 紐⑥꽌由ъ뿉 遺숇뒗떎10. 씠 슒씤뒗 愿젅 닚쓣 삎꽦븯뿬 諛쒕ぉ愿젅쓽 븞젙꽦뿉 湲곗뿬븯硫, 嫄곌낏씠 썑諛⑹쑝濡 鍮좎吏 븡룄濡 룄二쇰뒗 뿭븷쓣 븳떎11.

Fig. 5. Illustration of posterior ankle ligament structures.

蹂 利앸뒗 諛쒕ぉ愿젅 二쇰 빐遺븰쟻 援ъ“쓽 씠빐쓽 以묒슂꽦쓣 媛뺤“븳떎. 듅엳 諛쒕ぉ愿젅 깉援ш 옒 젙蹂듬릺吏 븡뒗떎硫, 궪媛 遺怨④낵 슒씤쓽 媛뒫꽦뿉 빐꽌룄 怨좊젮빐빞 븷 寃껋씠떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Additional Contributions

Author would like to thank Min Kyung Lee for the medical illustration.

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