Results of closed subtalar dislocations

Abstract

The results of the present study suggest that detecting and treating any associate peritalar fractures are the keys to a successful long-term outcome.

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“…Peritalar dislocation, also called subtalar or luxatio pedis subtalo [2], was first described by Dufarest and Judey in 1811 [5] and is defined as the dislocation of the talocalcaneal and talonavicular joint without associated fractures or involvement of the tibiotalar or calcaneocuboid joint [6]. It is a very rare lesion when it occurs without associating fractures in other bones and a very complex injury when involving joint surfaces of load bones [2], with a variable prognosis depending on factors related to the patient and the structures involved [7] and a complication rate close to 20%, among which include osteoarthritis, avascular necrosis or instability of the subtalar joint [8].…”

“…A radiographic study should be made for diagnosis with an anteroposterior and lateral projection of the hindfoot to assess the diagnosis and rule out the possible association of bone fractures in the foot or ankle because, if the occur, they will condition the definitive treatment [2,6,19,25].…”

“…A closed reduction under sedation should be attempted as soon as possible [8] to avoid additional complications such as avascular necrosis of the talus, neurovascular or soft tissue lesions such as skin necrosis [6,25]. To reduce the dislocation, the knee and ankle are flexed towards plantar, in order to relax the triceps surae [6,7], longitudinal traction is performed and force is applied in the opposite direction to the dislocation in order to reduce the head of the talus on the navicular joint facet [19].…”

“…To reduce the dislocation, the knee and ankle are flexed towards plantar, in order to relax the triceps surae [6,7], longitudinal traction is performed and force is applied in the opposite direction to the dislocation in order to reduce the head of the talus on the navicular joint facet [19]. Occasionally, direct soft pressure on the head of the talus can make reduction more easy [25].…”

“…Occasionally, direct soft pressure on the head of the talus can make reduction more easy [25]. In the event that the reduction is not achieved by interposition of bone or soft parts [8,19,20,27,28], multiple attempts with brute force should not be undertaken under any circumstances, and urgent open reduction should be considered [1,18] since, otherwise, we can cause iatrogenic injuries such as fractures of the talus or neurovascular injuries [6].…”