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

Abstract and Introduction

Abstract

Closed pantalar dislocation mainly occurs among male adults aged 20 to 45 years and is usually associated with high-energy trauma, mostly falls (50.0%). The talus dislocates anterolaterally in about 85% of cases. Pure pantalar dislocation is more common (54.7%) than cases with concomitant fractures (45.3%). Ankle fractures are the most common associated fractures, followed by fractures of the talar posterior process. Among 40 reported cases, 24 had successful closed reduction (60%), 11 had unsuccessful closed reduction (27.5%), and 5 underwent open reduction without attempting closed reduction (12.5%). The success rate for closed reduction of closed pantalar dislocation is 68.5% (24/35 cases). Post-traumatic arthrosis occurs in 32.3%. Osteonecrosis occurs less often than previously reported. Infection after closed reduction of pantalar dislocation is very rare except after open reduction and fixation for concomitant talar fractures. Conclusively, closed pantalar dislocations are very rare injuries and may portend a poor prognosis. Urgent talar relocation restores ankle and hindfoot anatomy and reduces pressure on surrounding soft tissues to optimize outcome. A closed reduction maneuver should be attempted initially, followed by urgent open reduction when the talus is not accurately reduced through closed means.

Introduction

Pantalar dislocation is defined as simultaneous dislocation of tibiotalar, subtalar, and talonavicular joints (Figure 1). Because it is a high-energy injury, native ligaments and capsules around the talus are disrupted. It is one of the most disabling and potentially catastrophic injuries to the ankle and foot. Several associated complications may occur, such as arthrosis of surrounding joints, osteonecrosis, and talar collapse, with ensuing leg length discrepancy, alteration in foot and ankle biomechanics, and limitations in daily activities. Secondary reconstructive surgeries may be proposed to alleviate pain and to improve function.[1,2] Because these injuries are rare, no epidemiologic study exists regarding incidence and late function of pantalar dislocation.

Figure 1.

Radiographs demonstrating a 52-year-old diabetic woman with closed pantalar dislocation accompanying medial malleolus fracture. Anterior-posterior (A) and lateral (B) plain radiographs on arrival are shown. Postoperative anterior-posterior (C) and lateral (D) radiographs of the ankle joint demonstrate reduction and fixation.

Most pantalar dislocation cases are open injuries.[3] Although some authors conducted a literature review after presenting a closed pantalar dislocation case report,[4,5] to our knowledge, no previous extensive literature review exists on closed pantalar dislocation to assess the treatments and outcomes after this devastating injury. The aim of this review article was to evaluate and analyze patients and injury features, associated injuries, different treatments, outcomes, and complications in previous reports and case series. A secondary goal was to optimize treatment recommendations, including closed reduction versus open reduction for closed pantalar dislocation, in effort to mitigate complications and to enhance functional outcome.

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