COPLETE DISLOCATION OF THE TALUS

¹ PENSACOLA, FLORIDA
² LOUISVILLE, KENTUCKY

Collins and Collins, Sneed, Ollerenshaw, and Mitchell have all reported reduction of total dislocations of the talus, with satisfactory results. The first two authors reported compound dislocations and the last two, simple dislocations. Mitchell case was very similar to the one presented in this report, but the dislocation in his case was of eighteen hours' duration and the postreduction necrosis over the prominence was much greater.

The majority of earlier authors, such as Stimson and Basil Norris, as cited by Sneed, advised removal of the talus in such cases; but the modern writers, including Watson-Jones, Wilson, and Key and Conwell emphasize the preservation of the talus, if possible. Watson-Jones states that the functional result with the talus preserved is better, even when the complications necessitate arthrodesis, than the functional results following astragalectomy.

See image in the PDF file

Revascularization occurs more readily if the neck has nnot been fractured. The spontaneous reattachment of soft tissue supplies the necessary vascular source. McKeever and Sneed have shown that the major nutrient supply is through the dense superior talonavicular ligament, which extends as a broad band from the dorsal surface of the neck to the dorsal periphery of the navicular. Some small strands of this strolig ligament probably remain attached, and through them revascularization can readily develop.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?