Subtalar dislocation: two cases requiring surgery and a literature review of the last 25 years.

BACKGROUND

Subtalar dislocations are uncommon, representing ~1% of all traumatic dislocations. We present two cases of closed medial subtalar dislocation and a systematic literature review of the last 25 years.

METHODS

We performed an Embase, Medline, Pubmed and Cochrane search of the literature written in English between January 1988 and December 2012. Keywords used were subtalar, peritalar, subastragalar, luxatio pedis sub talo, dislocation and dislocations. All articles presenting original patient data were included. All available data regarding gender, age, direction, affected side, open or closed injury, accompanying fractures, reduction, time of immobilization and outcomes were collected in a database.

RESULTS

Seventy-six articles were included with a total of 528 reported cases. Males (318/419 = 76%) and the right foot (122/200 = 61%) were affected more often than females and the left foot. Average age was 33.8 years (range 19 months-86 years). Cause of injury was a traffic accident in 43.7% (157/359), a fall in 32.9% (118/359), sports injuries in 13.9% (50/359), sprain injuries in 5.3% (19/359) and other causes in 4.2% (15/359). The direction of the dislocation was medial in 71.5 % (352/492), lateral in 26.0% (128/492), posterior in 1.6% (8/492) and anterior in 0.8% (4/492). Open dislocation was reported in 22.5% (67/298). In 61.4% (216/352) an additional osseous injury was diagnosed. Closed reduction was unsuccessful in 14.0% (51/364) requiring immediate open reduction. Overall outcomes in the literature were good in 52.3% (172/329), fair in 25.2% (83/329) and poor in 22.5% (74/329).

LEVEL OF CLINICAL EVIDENCE: 4.