SLR - September 2017 - Eric L. Woolley
Complications and Functional Outcomes After Pantalar Dislocation
Reference: Boden KA, Weingberg DS, Vallier HA. Complications and Functional Outcomes After Pantalar Dislocation. J Bone Joint Surg Am. 2017 Apr 19; 99(8):666–675.
Scientific Literature Review
Reviewed By: Eric L. Woolley, DPM
Residency Program: Northern Colorado Medical Center, Greeley, CO
Podiatric Relevance: This article addresses functional outcomes related to patients who have experienced a pantalar dislocation. We often discuss the potential complications of these injuries but have little documented reports of functional outcome.
Methods: The authors of this study looked at 19 patients who had experienced either an open or closed pantalar dislocation without fracture. The majority underwent ORIF, while only two were treated with a closed reduction procedure. Data on the patient’s pain level, medication, range of motion and need for additional procedures was collected.
Results: Average follow-up period was 45 months. Two patients had wound healing complications. One developed cellulitis, which responded to oral antibiotic therapy. None developed deep wound infections. Eighty-eight percent developed radiographic signs of osteonecrosis, and 44 percent developed arthrosis of at least one joint adjacent to the talus. Patient satisfaction surveys were completed at an average of 5.2 years after injury. Musculoskeletal Function assessment survey score was 30.3 and Foot Function Index score was 25.3. Only 60 percent of patients returned to work, and of the patients with clinical follow-up, 75 percent were taking analgesics.
Conclusions: Most patients with pantalar dislocation will develop osteonecrosis; however, collapse is uncommon. Even with open injuries, deep infection was not a common occurrence. Pain and functional limitations should be expected.
This article confirmed the overall severity and morbidity associated with pantalar dislocations. This information is beneficial in aiding practitioners in managing expectations of patients undergoing surgical correction of these injuries.