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

Clinical Outcomes

Regarding the criteria of Kenwright and Taylor,[10] clinical assessment was categorized as excellent, good, fair, and poor based on the patient symptoms and disabilities, pain, and peritalar joint range of movement in comparison to the normal side (Table 2). Kenwright and Taylor[10] reported good results for two cases after 5 years and 8 months after the treatment. Ritsema[2] reported two cases with good result and one case with fair outcome. Many cases with good and excellent results are reported in the previous literature;[11,13,16–18,20,21,25] however, most are limited to follow-up of two years or less. Bas et al[14] reported one case as fair and another as poor outcome after Blair arthrodesis.

Among 11 closed pantalar dislocation associated with talus, ankle, navicular, and calcaneus fractures, all had excellent or good outcome except one patient with osteomyelitis who had talectomy and tibiocalcaneal arthrodesis[1] and another case of anterolateral dislocation associated with fracture of the medial malleolus and posterior process of the talus reduced by open reduction, with post-traumatic arthrosis 4 years after the surgery.[9] However, the other reported case accompanying posterior process talus fracture and medial malleolus fracture had an excellent result with 10° of dorsiflexion to 40° of plantarflexion and without osteonecrosis.[22]

Clinical and radiographic results after closed reduction of pantalar dislocation are associated with better functional outcome when compared with those patients who underwent open reduction. Various explanations could account for this. Patients with unsuccessful closed reduction have additional injury severity. The open reduction also imparts surgeon trauma to the local soft tissues, potentially even the blood supply. This may increase risks of infection, wound complications, and osteonecrosis. Open approaches may also generate scar tissue associated with late stiffness.

As shown in Table 3, anterolateral dislocation of the talus has superior outcome in comparison to the other direction of dislocations. Fair or poor clinical outcomes were reported in about 10% of cases with anterolateral pantalar dislocation, although it is about 33% for other dislocations. The reason is unclear and requires additional study.

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