Subtalar dislocation: management and prognosis for an uncommon orthopaedic condition

Subtalar dislocations were first described in 1811 as the simultaneous dislocation of the talo-calcaneal and talonavicular joints without any tibio-talar or talar neck associated fractures. They were classified in 1853 as: medial, lateral, posterior and anterior based on the displacement of the foot in relationship to the talus. These are uncommon injuries, representing approximately 1 % of all traumatic injuries of the foot and 1-2 % of all dislocations, being associated with high energy trauma. Closed reduction of these dislocations should be performed as early as possible to avoid further damage to the skin and neurovascular structures. If this is not possible, then open reduction without further delay is recommended. Irreducible injuries have been reported in 0 to 47 % of cases. Open dislocations represent between 46 and 83% of all cases, and have been associated with poor prognosis. Associated fractures have a high incidence, the most frequent ones are the posterior process of the talus, talar head, external malleolus, medial malleolus and the tubercle of the fifth metatarsal. These types of injuries are not faced by orthopaedic surgeons on a daily basis and having a source of information on how to manage and what to expect is important. We present an up-to-date literature review on the epidemiology, clinical presentation, radiologic assessment, treatment options and prognostic factors of these uncommon injuries.