Closed Pantalar Dislocations

Characteristics, Treatment Approaches, and Outcomes

Amir Reza Vosoughi, MD; Heather A. Vallier, MD

Disclosures

J Am Acad Orthop Surg. 2021;29(7):278-287. 

In This Article

Mechanism of Injury

Pantalar dislocation occurs after a massive force. Pathophysiologic mechanism is still a subject of controversy with different theories. Leitner in 1955 stated that medial/lateral subtalar dislocation is the first stage of injury after excessive foot supination/pronation. If the force continues, it may result in ankle subluxation and finally ankle dislocation.[37] In the other explanation, the pantalar dislocation may be seen after forceful foot plantarflexion and inversion. At first, by extreme plantarflexion, the talus dislocates anteriorly out of the ankle mortise and rotates 90° in vertical axis, then by forceful foot inversion, the talus rotates 90° in longitudinal axis, so the talar head is directed medially and the calcaneal surface is directed posteriorly.[9] The foot then recoils toward the distal tibia, followed by tensioning of surrounding soft tissues and tendons, whereas the talus remains outside of its anatomical position, resulting in anterolateral pantalar dislocation.[8,10] The talus is displaced medially in instances of plantarflexion and eversion of the foot.[9] Another theory is the simultaneous double force, inversion-eversion or vice versa, to dislocate the talus among its three joints. This was expressed based on this fact that surgical dislocation of the talus is very difficult because of its articulation shape with surrounding bones.[16]

After considering the aviation crashes during landing reported by Coltart[8] as motor vehicle collisions because pilot's foot on the rudder seems analogous to a foot on the brake, fall is the most common mechanism (21 cases, 50.0%), followed by motor vehicle collision (19 cases, 45.2%) and sport and twisting injuries (2 cases, 4.8%). In summary, high-energy trauma is the usual cause (95.2%).

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