Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1850
Peer-review started: February 11, 2019
First decision: April 18, 2019
Revised: May 2, 2019
Accepted: May 23, 2019
Article in press: May 23, 2019
Published online: July 26, 2019
Total talar dislocation (TTD) is very uncommon for many orthopedic surgeons and emergency/trauma specialists. Scarce cases of TTD have been reported, mainly in the form of open fracture-dislocation injury.
We report a very rare injury of closed TTD with a follow-up period of 36 mo. Initial closed reduction was not successful because of a fractured highly unstable medial malleolus displaced into the ankle mortise, blocking the relocation of the talus. The patient was able to walk pain-free after the 3rd month of surgery. At the 36-mo follow-up, there were 10 degrees of flexion loss and 10 degrees of extension loss in the tibiotalar joint. Furthermore, 5 degrees of subtalar joint inversion-eversion loss was present.
Open reduction should be performed for closed TTDs unless closed reduction is successful.
Core tip: Total talar dislocation occurs as a result of high energy trauma and may lead to permanent disability or amputation. A non-displaced medial malleolus may prevent closed reduction of the talus if it displaces in the ankle mortise. Therefore, open reduction may be needed. Successful results are possible, ensuring that the remaining vascular supply is not harmed. Additionally, a negative Hawkins sign might not indicate talar avascular necrosis with certainty.