Open-fracture dislocation of the talus

Abstract

Purpose The aim was to evaluate the incidence of infection and functional outcome of these injuries. Patients and methods A total of 14 patients with open-talar fracture dislocations or total dislocations of the talus were managed and the functional results evaluated between November 2012 and December 2016. Eleven of these patients were males and three were females. The injuries were sustained between the 20- and 50-year age group . The right side was affected in 10 and the left side was injured in four patients. Road traffic accident was the cause in nine patients and fall from the height was the cause in five patients. The principles of management were debridement and minimal fixation of fractures. Results The mean follow-up period was 33 months (range: 16–50 months). Two of 14 cases (14.2%) developed infection. One patient had resolved clinically with antibiotics alone. One patient had persistent drainage 4 months after injury and required late ankle and subtalar arthrodesis. The functional outcome according to Boston Children’s Hospital ankle grading system was excellent in six (42.85%), good in five (35.71%), fair in two (14.28%), and failure in one (7.14%). There was no evidence of osteonecrosis or collapse of the talar dome. Conclusion In conclusion, patients with major open-fracture dislocation of the talus have a significant incidence of the best results with modern orthopedic techniques that dramatically decreased the rates of infection, avascular necrosis (AVN), and poor functional results although continued work is required to improve patient care and outcomes. Open-talar fractures should be managed as emergently including administration of broad-spectrum antibiotics, irrigation of the wound, operative debridement, reduction, and minimal fixation.