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Complications and Functional Outcomes After Pantalar Dislocation

Boden, Kaeleen A. BA1; Weinberg, Douglas S. MD1; Vallier, Heather A. MD1,a

Journal of Bone & Joint Surgery - American Volume: 19 April 2017 - Volume 99 - Issue 8 - p 666–675
doi: 10.2106/JBJS.16.00986
Scientific Articles
Disclosures

Background: Pantalar dislocations without associated talar fracture are rare and have high risks of complications, including infection, osteonecrosis, and posttraumatic osteoarthrosis. Limited information on later function exists. This study evaluated complications and outcomes following pantalar dislocation without talar fracture.

Methods: Nineteen patients were identified with open (n = 14) or closed (n = 5) pantalar dislocations without talar fracture. Ten male and 9 female patients with a mean age of 39.6 years (range, 19 to 68 years) were included. Open injuries underwent surgical debridement. Sixteen patients had open reduction, and 2 had closed reduction. Fixation was achieved with Kirschner wires (n = 4), external fixation (n = 9), or both (n = 3). Two patients did not have fixation. Another patient had primary transtibial amputation due to nonreconstructible foot trauma. Charts and radiographs were reviewed to identify infection, osteonecrosis, and posttraumatic arthrosis. Data on pain, medications, range of motion, and secondary procedures were collected. After a minimum of 1 year, Foot Function Index (FFI) and Musculoskeletal Function Assessment (MFA) surveys were administered.

Results: The mean clinical follow-up was 45.1 months. Two patients had superficial wound-healing problems with prolonged drainage, which healed with dressing changes and oral antibiotics, and 1 patient developed cellulitis 4 months after injury, which resolved with intravenous antibiotics. No deep wound infections occurred. Fourteen (88%) of the 16 patients with a minimum of 11 months of radiographic follow-up developed osteonecrosis, 2 with collapse of the talar dome, and 7 (44%) developed arthrosis of ≥1 peritalar articulation. Outcome surveys were obtained for 11 (58%) of the 19 patients, at a mean of 5.2 years after injury. The mean MFA score was 30.3, and the mean FFI score was 25.3. Six of 10 survey respondents had returned to employment, but 88% (14 of 16) of the patients with radiographic and clinical follow-up reported at least mild pain and 75% (12 of 16) were taking analgesics.

Conclusions: Urgent surgical debridement of open injuries and reimplantation of the talus after pantalar dislocation was not associated with deep infection. Osteonecrosis occurred in the majority of patients, but collapse was uncommon. Persistent pain and functional limitations are frequent after pantalar dislocation, as reflected in extremity-specific and generalized functional outcome scores.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, Ohio

E-mail address for H.A. Vallier: hvallier@metrohealth.org

Copyright 2017 by The Journal of Bone and Joint Surgery, Incorporated
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