The Journal of Bone and Joint Surgery, Vol 77, Issue 7 1075-1079, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Severe open subtalar dislocations. Long-term results
JL Goldner, SC Poletti, HS Gates and WJ Richardson
Division of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina 27710, USA.
Fifteen adolescents and adults were assessed an average of eighteen years
after a type-III open subtalar dislocation. There were ten lateral and five
medial dislocations. Associated injuries included ten injuries of the
tibial nerve, seven of which were complicated by causalgia; five ruptures
of the posterior tibial tendon; five lacerations of the posterior tibial
artery; twelve articular fractures involving the subtalar joint; three
articular fractures of the talonavicular joint; three fractures of the
talar dome; and three malleolar fractures. Osteonecrosis of the body of the
talus was found in five of the fifteen patients. It was treated with a
triple arthrodesis in all five patients, one of whom had a subsequent
conversion to a pantalar arthrodesis. Subtalar arthrodesis was done,
because of post-traumatic osteoarthrosis, in two other patients. On
functional assessment at the long-term follow-up examination, all patients
reported some pain in the ankle, nine had difficulty climbing stairs,
fourteen had difficulty walking on uneven surfaces, and eleven wore
modified shoes. The patients who had had a tarsal arthrodesis returned to
their pre-injury occupation or to a less strenuous job. Four patients who
had persistent causalgia did not return to work. We concluded that open
subtalar dislocation is a distinctly severe injury and that only fair
functional and poor anatomical results can be expected in most patients.
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