Severe open subtalar dislocations. Long-term results.
Fifteen adolescents and adults were assessed an average of eighteen years after a type-III open subtalar dislocation. There were ten lateral and five medial dislocations. Associated injuries included ten injuries of the tibial nerve, seven of which were complicated by causalgia; five ruptures of the posterior tibial tendon; five lacerations of the posterior tibial artery; twelve articular fractures involving the subtalar joint; three articular fractures of the talonavicular joint; three fractures of the talar dome; and three malleolar fractures. Osteonecrosis of the body of the talus was found in five of the fifteen patients. It was treated with a triple arthrodesis in all five patients, one of whom had a subsequent conversion to a pantalar arthrodesis. Subtalar arthrodesis was done, because of post-traumatic osteoarthrosis, in two other patients. On functional assessment at the long-term follow-up examination, all patients reported some pain in the ankle, nine had difficulty climbing stairs, fourteen had difficulty walking on uneven surfaces, and eleven wore modified shoes. The patients who had had a tarsal arthrodesis returned to their pre-injury occupation or to a less strenuous job. Four patients who had persistent causalgia did not return to work. We concluded that open subtalar dislocation is a distinctly severe injury and that only fair functional and poor anatomical results can be expected in most patients.
Goldner
J L
JL
Division of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina 27710, USA.
Poletti
S C
SC
Gates
H S
HS
Richardson
W J
WJ
D000293:Adolescent; D000328:Adult; D001174:Arthrodesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000209:etiology; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000293:injuries*; D016896:Treatment Outcome