SLR - June 2021 - Marissa Mogavero
Reference: Vosoughi AR, Vallier HA. Closed Pantalar Dislocations: Characteristics, Treatment Approaches, and Outcomes. J Am Acad Orthop Surg. 2021 Apr 1;29(7):278-287.Level of Evidence: V
Scientific Literature Review
Reviewed By: Marissa Mogavero, DPM
Residency Program: Beaumont Wayne, MI
Podiatric Relevance: Pantalar dislocations are rare, significant surgical challenges for foot and ankle surgeons. Due to the rarity of the injury, no previous literature review exists on closed pantalar dislocation to assess treatments and outcomes. This article evaluated patients, features, associated injuries, treatments, and outcomes in previous reports and case series of closed total talar dislocations. A secondary goal of the article was to optimize treatment recommendations to help reduce complications and improve functional outcome.
Methods: A comprehensive literature review was completed through Medline and Google Scholar on all case reports, series and review articles through March 2020 on closed pantalar dislocation. Thirty-three articles and forty-six reported cases were included in the study.
Results: Among the cases reviewed, 54.7 percent had pure closed pantalar dislocation without associated fracture. Of those with associated fractures, ankle fracture was the most common concomitant injury. A fall was the most frequently reported mechanism of injury with anterolateral dislocation of the talus reported in 84.1 percent of cases. The main goal of treatment for these closed pantalar dislocations was to achieve a stable, anatomical reduction of the talocrural, subtalar and talonavicular joints with reduction and fixation of associated fracture patterns. Reduction was accomplished as soon as possible to prevent skin necrosis and alleviate any arterial or neurologic impingement. Among the cases reviewed, the success rate for closed reduction of closed pantalar dislocations was found to be 68.5 percent. In terms of clinical outcomes, many cases with good and excellent results were reported however, most had very limited follow-up of less than two years. Clinical and radiological results followed by closed reduction were associated with superior functional outcome in comparison to open reduction. This may be due to surgeon trauma to local soft tissue, risk of infection, wound complications, osteonecrosis and scar tissue formation. In regards to complications, in thirty-four cases that reported on it, 32.3 percent of patients developed post-traumatic arthritis of either the subtalar joint, talonavicular joint or talocrural joint. Other complications found include infection reported in 11 percent of patients that underwent open reduction followed by osteonecrosis of the talus found in 7.7 percent of patients.
Conclusions: Pantalar dislocations are rare injuries with the potential for poor prognosis. Immediate anatomical reduction of the talus restores proper alignment and reduces pressure on neurovascular and soft tissue structures. Closed reduction of pantalar dislocations should be attempted first, followed by urgent open reduction when the talus cannot be reduced. Complications such as post-traumatic arthritis and osteonecrosis of the talus are seen more commonly with open injuries. In this study, a review of the literature revealed the most common features, associated fractures, complications and outcomes of closed pantalar dislocations to improve management of these rare injuries.