A case series of three patients with rare pantalar dislocation

Abstract

Total talar dislocations are rare, significant surgical challenges for foot and ankle surgeons. These dislocations can be very difficult to manually close-reduce, requiring immediate surgical intervention secondary to arterial impingement, pain and risk of skin necrosis attributable to skin tenting. In this case series, we report on three patients who presented to the emergency room following a traumatic ankle injury. Ankle radiographs and computed tomography (CT) scans were obtained, revealing pantalar dislocations. Closed reduction utilizing Charnley’s principles was attempted in the emergency room through manual accentuation of the deformity, traction and reduction. Closed reduction was unsuccessful in all three patients which led to immediate surgical intervention consisting of open reduction of the dislocated talus with internal fixation of concomitant fracture patterns. Postoperatively, all patients were carefully monitored for avascular necrosis of the talus with serial radiographs. One year following surgical intervention, no evidence of talar avascular necrosis (AVN) was observed and two of the three cases developed subtalar joint arthritis. This case report serves to display the treatment and outcomes of a rare dislocation with follow up to complete return to normal activity.