Mechanism of injury
Total talar dislocation is a rare injury caused by the combination of tibiotalar plantar flexion, and either excessive subtalar supination or pronation (commonly from motor vehicle accident or fall from height). It results in complete disruption of blood supply and extensive contamination.
The classic scenario is a high energy motor vehicle accident where the driver's foot is plantarflexed, such as when rapidly applying the foot brake, causing the talus to extrude anteriorly. If a severe open injury results, the talus may be found in the foot well of the driver's compartment.
Plain radiograph and CT
Dislocation of the talus from the mortise joint above, the subtalar joints below and the talonavicular joint anteriorly. The talus usually extrudes anteriorly. There is usually extensive soft tissue injury.
Treatment and prognosis
- wound irrigation, debridement and temporary stabilization of the ankle
- if unable to find talus, tibiocalcaneal fusion and fibular graft is a surgical option
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