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 OJO  Vol.5 No.3 , March 2015
Subtalar Dislocation: Long-Term Follow-Up and CT-Morphology
Abstract: Introduction: Although rare, subtalar dislocations are severe injuries with long-term alterations such as clinical dysfunction or painful posttraumatic arthritis. The objective of this study was to investigate long-term morphological changes of subtalar dislocations and to correlate them to clinical function. Based on the conclusions, suggestions for therapy guidelines were made in order to improve the functional outcome. Methods: Twenty-two patients (12 with a medial, 9 with a lateral and 1 with an anterior dislocation) were re-examined with an average follow-up time of 10 years. Radiological results of a computer tomography examination of the hindfoot were related to the clinical outcome, and both were discussed in the context of further parameters, such as additional injuries, time until reduction, and post-reduction treatment. Results: Additional injuries were found to affect the clinical outcome and/or the radiological changes. Predictive factors for limited range of motion were severe skin trauma and traumatic brain injuries. Factors that predicted both poor clinical function and clear signs of arthritis included complex talus, ankle and calcaneus fractures, long time until reduction, and infection. Conclusions: In many cases, radiological results can be correlated to clinical outcomes. However, the modulating effects of additional injuries should be considered when planning therapy. In cases with additional fractures of the talus and the calcaneus, suffering pain may be reduced by an early arthrodesis of the talo-cal-canear joint. In cases involving a long stay on an intensive care unit, early functional treatment by passive motion should be discussed in special cases to improve the clinical outcome.
Cite this paper: Hoelscher-Doht, S. , Frey, S. , Kiesel, S. , Meffert, R. and Jansen, H. (2015) Subtalar Dislocation: Long-Term Follow-Up and CT-Morphology. Open Journal of Orthopedics, 5, 53-59. doi: 10.4236/ojo.2015.53008.
References

[1]   Schontag, H., et al. (1984) Late Results in the Treatment of Subtalar Dislocations. Zentralbl Chir, 109, 1436-1440.

[2]   DeLee, J.C. and Curtis, R. (1982) Subtalar Dislocation of the Foot. Journal of Bone and Joint Surgery, 64, 433-437.

[3]   Kinik, H., Oktay, O., Arikan, M. and Mergen, E. (1999) Medial Subtalar Dislocation. International Orthopaedics, 23, 366-367.
http://dx.doi.org/10.1007/s002640050396

[4]   Freund, K.G. (1989) Subtalar Dislocations: A Review of the Literature. The Journal of Foot Surgery, 28, 429-432.

[5]   Perugia, D., et al. (2002) Conservative Treatment of Subtalar Dislocations. International Orthopaedics, 26, 56-60.
http://dx.doi.org/10.1007/s002640100296

[6]   Marcinko, D.E. and Zenker, C.C. (1991) Peritalar Dislocation without Fracture. The Journal of Foot Surgery, 30, 489-493.

[7]   Zimmer, T.J. and Johnson, K.A. (1989) Subtalar Dislocations. Clinical Orthopaedics and Related Research, 238, 190-194.
http://dx.doi.org/10.1097/00003086-198901000-00027

[8]   Heppenstall, R.B., Farahvar, H., Balderston, R. and Lotke, P. (1980) Evaluation and Management of Subtalar Dislocations. Journal of Trauma, 20, 494-497.
http://dx.doi.org/10.1097/00005373-198006000-00011

[9]   Marsh, J.L.; Saltzman, C.L., Iverson, M. and Shapiro, D.S. (1995) Major Open Injuries of the Talus. Journal of Orthopaedic Trauma, 9, 371-376.
http://dx.doi.org/10.1097/00005131-199505000-00002

[10]   Merchan, E.C. (1992) Subtalar Dislocations: Long-Term Follow-Up of 39 Cases. Injury, 23, 97-100.
http://dx.doi.org/10.1016/0020-1383(92)90041-P

[11]   Bohay, D.R. and Manoli II, A. (1995) Subtalar Joint Dislocations. Foot & Ankle International, 16, 803-808.
http://dx.doi.org/10.1177/107110079501601212

[12]   Lasanianos, N.G., Lyras, D.N., Mouzopoulos, G., Tsutseos, N. and Garnavos, C. (2011) Early Mobilization after Uncomplicated Medial Subtalar Dislocation Provides Successful Functional Results. Journal of Orthopaedics and Traumatology, 12, 37-43.
http://dx.doi.org/10.1007/s10195-011-0126-2

[13]   Jungbluth, P., Wild, M., Hakimi, M., Gehrmann, S., Djurisic, M., Windolf, J., et al. (2010) Isolated Subtalar Dislocation. Journal of Bone and Joint Surgery (American), 92, 890-894.
http://dx.doi.org/10.2106/JBJS.I.00490

[14]   Milenkovic, S., Mitkovic, M. and Bumbasirevic, M. (2006) External Fixation of Open Subtalar Dislocation. Injury, 37, 909-913.
http://dx.doi.org/10.1016/j.injury.2006.02.051

[15]   De Palma, L., Santucci, A., Marinelli, M., Borgogno, E. and Catalani, A. (2008) Clinical Outcome of Closed Isolated Subtalar Dislocations. Archives of Orthopaedic and Trauma Surgery, 128, 593-598.
http://dx.doi.org/10.1007/s00402-007-0459-8

[16]   Garofalo, R., Moretti, B., Ortolano, V., Cariola, P., Solarino, G., Wettstein, M. and Mouhsine, E. (2004) Peritalar Dislocations: A Retrospective Study of 18 Cases. Journal of Foot and Ankle Surgery, 43, 166-172.
http://dx.doi.org/10.1053/j.jfas.2004.03.008

[17]   Wagner, R., Blattert, T.R. and Weckbach, A. (2004) Talar Dislocations. Injury, 35, 36-45.
http://dx.doi.org/10.1016/j.injury.2004.07.010

[18]   Tucker, D.J., Burian, G. and Boylan, J.P. (1998) Lateral Subtalar Dislocation: Review of the Literature and Case Presentation. Journal of Foot and Ankle Surgery, 37, 239-247.
http://dx.doi.org/10.1016/S1067-2516(98)80118-X

[19]   Hoexum, F. and Heetveld, M.J. (2014) Subtalar Dislocation: Two Cases Requiring Surgery and a Literature Review of the Last 25 Years. Archives of Orthopaedic and Trauma Surgery, 134, 1237-1249.
http://dx.doi.org/10.1007/s00402-014-2040-6

[20]   Simon, L.C., Schulz, A.P., Faschingbauer, M., Morlock, M. and Jürgens, C. (2008) “Basketball Foot”—Long-Time Prognosis after Peritalar Dislocation. Sportverletzung Sportschaden, 22, 31-37.
http://dx.doi.org/10.1055/s-2008-1027208

 
 
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