Fifteen adolescents and adults were assessed an average of eighteen years after a type-III open subtalar dislocation. There were ten lateral and five medial dislocations. Associated injuries included ten injuries of the tibial nerve, seven of which were complicated by causalgia; five ruptures of the posterior tibial tendon; five lacerations of the posterior tibial artery; twelve articular fractures involving the subtalar joint; three articular fractures of the talonavicular joint; three fractures of the talar dome; and three malleolar fractures. Osteonecrosis of the body of the talus was found in five of the fifteen patients. It was treated with a triple arthrodesis in all five patients, one of whom had a subsequent conversion to a pantalar arthrodesis. Subtalar arthrodesis was done, because of post-traumatic osteoarthrosis, in two other patients. On functional assessment at the long-term follow-up examination, all patients reported some pain in the ankle, nine had difficulty climbing stairs, fourteen had difficulty walking on uneven surfaces, and eleven wore modified shoes. The patients who had had a tarsal arthrodesis returned to their pre-injury occupation or to a less strenuous job. Four patients who had persistent causalgia did not return to work. We concluded that open subtalar dislocation is a distinctly severe injury and that only fair functional and poor anatomical results can be expected in most patients.
Division of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina 27710, USA.