Total talar dislocation
Citation, DOI & article data
Total talar dislocation, also known as extrusion of the talus, is a tri-articular dislocation of talus at the tibiotalar, talonavicular and subtalar joints. Pantalar dislocation and luxatio tali totalis are also used as alternative terms for such a traumatic insult.7 Most injuries are compound.
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
- 1. Burston JL, Isenegger P, Zellweger R. Open total talus dislocation: clinical and functional outcomes: a case series. J Trauma. 2010;68 (6): 1453-8. doi:10.1097/TA.0b013e3181d03b73 - Pubmed citation
- 2. Heylen S, De Baets T, Verstraete P. Closed total talus dislocation: a case report. Acta Orthop Belg. 2012;77 (6): 838-42. Pubmed citation
- 3. Gulan G, Sestan B, Jotanović Z et-al. Open total talar dislocation with extrusion (missing talus). Coll Antropol. 2009;33 (2): 669-72. Pubmed citation
- 4. Xarchas KC, Psillakis IG, Kazakos KJ et-al. Total Dislocation of the Talus without a Fracture. Open or Closed Treatment? Report of Two Cases and Review of the Literature. Open Orthop J. 2009;3 (1): 52-5. doi:10.2174/1874325000903010052 - Free text at pubmed - Pubmed citation
- 6. Kenneth J. Koval, Joseph David Zuckerman. Handbook of Fractures. ISBN: 9780781790093
- 7. Melenevsky Y, Mackey RA, Abrahams RB, Thomson III NB. Talar fractures and dislocations: a radiologist’s guide to timely diagnosis and classification. Radiographics. 2015 May;35(3):765-79.