Open subtalar dislocation treated by distractional external fixation.

Abstract

Subtalar dislocation is a rare injury, constituting approximately 1% of acute dislocations, and often is the result of high-energy trauma, particularly falls from heights. We present a case of a 33-year-old man who sustained a Gustilo type IIIB open subtalar dislocation when he fell 4 m from a scaffold. After irrigation and debridement, a Mitkovic distractional external fixator was applied medially for 6 weeks while the wound healed by secondary intention. Physical therapy was initiated along with partial to full weight bearing during the next 3 months. The patient returned to work at 8 months postinjury. At 24 months, the patient had a normal gait with pain only during prolonged periods of standing or walking. X-rays and MRI were normal with no signs of avascular necrosis or posttraumatic arthritis. Ankle joint range of motion was dorsiflexion 5 degrees and plantar flexion 45 degrees with moderately limited subtalar joint motion. The distractional external fixator allowed for complete wound care and unburdening of the talus, which perhaps reduced the possibility of avascular necrosis.