A Systematic Review of Total Dislocation of the Talus

Abstract

This review summarizes the treatment and resulting outcomes for total talar dislocation. The PubMed database was searched for articles about humans with total talar dislocation published in the English language in the last twenty years. The following data were entered into a Microsoft Excel spreadsheet: type of dislocation, nature of associated fractures (if any), type of reduction/fixation utilized, immobilization, weight-bearing status, outcome, complications and average follow-up time. Thirty-nine articles reporting a total of 86 cases of total talar dislocation are included in this review. Seventy-three of these were open injuries and 13 closed. Forty-three cases had an associated foot or ankle fracture, 32 of those cases specifically having a fracture of the talus. The talus was preserved in the initial management of 74 cases, whereas the remaining 12 cases were managed by primary talectomy. The mean duration of follow-up was 32 months. Twenty-two cases required a secondary arthrodesis or another additional procedure. A good outcome was achieved in 35% of cases, a fair outcome in 37% and a poor outcome in 27%. The complication of avascular necrosis (AVN) occurred in 22 cases and 14 subjects developed clinically significant osteoarthritis. Generally, the outcome of current treatments associated with total talar dislocation is not ideal, only 1/3 of cases achieving good outcomes. So far, preservation of the talus is the best treatment option. AVN is still a relatively common complication even in the absence of fracture or postoperative infection.

A case of the total talus dislocation

“…An open type of dislocation and/or accompanying fracture is considered to be a risk factor with the possibility of an unfavorable outcome. 4 Taken together, we believe that confirming the presence of fractures by CT is critical in determining treatment strategy. In this case, an urgent closed reduction was successfully performed under general anesthesia using image guidance, and open fracture fixation was scheduled for the following day.…”

“…The review showed that a good outcome was achieved in only 35% of cases and avascular necrosis was relatively common (26%) as a complication. An open type of dislocation and/or accompanying fracture is considered to be a risk factor with the possibility of an unfavorable outcome …”

Extruded talus treated with reimplantation and primary tibiotalocalcaneal arthrodesis

“…Weston and colleagues conducted a systematic review of total talar dislocation and identified infection development in 10 of 86 cases. 3 Smith and colleagues also found low infection rates in talus reimplantation after traumatic total dislocations with only 1 late infection from 27 patients. 4 The talus receives blood supply from the anterior and posterior tibial vessels, as well as perforating peroneal vessels and interosseous supply.…”

“…However, discarding the talus adversely affects hindfoot function and treatment should be focused on maximising function. 2 Avascular necrosis can occur anywhere between six months to two years after injury, with estimated rates of 26%, 3 although reports have shown successful reimplantation with no signs of avascular necrosis for at least four months at follow-up. 2,4 Post-traumatic osteoarthritis is another reported complication, with literature suggesting osteoarthritis development in 16% of open talar injuries.…”

Talusfrakturen – ein Update

“…50 % auf den Talushals, die restlichen Frakturen verteilen sich gleichsam auf Korpus sowie die Gelenkfortsätze [2]. Ursächlich sind insbesondere Verkehrsunfälle oder Stürze aus großer Höhe [3,4]. Wegen der großen knorpeligen Oberfläche des Talus (ca.…”