Complete talar dislocation

Case contributed by Dr Matt Skalski

Presentation

The patient jumped from a height.

Patient Data

Age: 25 years
Gender: Male
X-ray

There is complete dislocation of the talus medially, and the talar head is facing dorsally. There are also multiple fracture fragments noted at the posterior tibia and fibula, as well as the navicular. 

CT

There is medial dislocation of the talus, with several small  comminuted fragments anteriorly.

Comminuted fractures of the navicular, cuboid and lateral cuneiform are noted. There is a moderately displaced fracture of the distal fibula, with posteroproximal migration of the fragment from the posterior lateral malleolar fracture site. There is a minimally displaced comminuted intraarticular fracture of the distal anterior tibia. The calcaneus and metatarsals are intact. There is soft tissue swelling throughout the ankle.

Case Discussion

This case represents a complete, closed dislocation of the talus, which is an extremely rare injury, although not as rare as those occurring without fracture. With these types of injuries the talus is at significant  risk for avascular necrosis.  This case is especially interesting as the talus is not only completely dislocated, but also reversed in its normal AP orientation. 

Talar dislocations and talar neck fractures of any type have historically been referred to as aviator's astragalus, although the value in assigning this term is only for reading-room entertainment.

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