BACKGROUND: This case series reviews open total talar dislocations, the subsequent development of infection and avascular necrosis of the talar dome, and the clinical and functional outcomes associated with this injury. Open total talar dislocation is a relatively rare but debilitating injury. Techniques for managing such injuries include reimplantation of an extruded talus, open reduction internal fixation, and fusion (immediate or delayed). METHODS: An operating theater database search from 2002 to 2007 was conducted to identify cases of open total talar dislocations at a major trauma center in Western Australia. Forty-one cases were initially identified, and from these, a total of eight cases were selected, which represented open dislocations of the talus. Parameters measured include postinjury development of infection and avascular necrosis, and clinical and functional outcome measurements. RESULTS: Four of the eight patients achieved an overall good outcome, two had a fair outcome, one patient had a poor outcome, and one patient was lost to follow-up after 4 months. Five of the patients developed avascular necrosis, and two patients developed postoperative infections (one joint infection, one superficial infection around a K-wire site). CONCLUSIONS: Postinjury joint infection is the single most significant factor associated with poor clinical and functional outcome of open total talar dislocation. The impact of avascular necrosis on functional outcome cannot be fully demonstrated nor has its development with such injuries been proven inevitable.
BACKGROUND: This case series reviews open total talar dislocations, the subsequent development of infection and avascular necrosis of the talar dome, and the clinical and functional outcomes associated with this injury. Open total talar dislocation is a relatively rare but debilitating injury. Techniques for managing such injuries include reimplantation of an extruded talus, open reduction internal fixation, and fusion (immediate or delayed). METHODS: An operating theater database search from 2002 to 2007 was conducted to identify cases of open total talar dislocations at a major trauma center in Western Australia. Forty-one cases were initially identified, and from these, a total of eight cases were selected, which represented open dislocations of the talus. Parameters measured include postinjury development of infection and avascular necrosis, and clinical and functional outcome measurements. RESULTS: Four of the eight patients achieved an overall good outcome, two had a fair outcome, one patient had a poor outcome, and one patient was lost to follow-up after 4 months. Five of the patients developed avascular necrosis, and two patients developed postoperative infections (one joint infection, one superficial infection around a K-wire site). CONCLUSIONS:Postinjury joint infection is the single most significant factor associated with poor clinical and functional outcome of open total talar dislocation. The impact of avascular necrosis on functional outcome cannot be fully demonstrated nor has its development with such injuries been proven inevitable.
Authors: Dragica Maja Smrke; Primož Rožman; Borut Gubina; Igor Frangež; Barbara Rejec Smrke; Zoran Marij Arnež Journal: J Med Case Rep Date: 2014-09-29