Chronic closed talus dislocation: a rare presentation and treatment dilemma

Area of Science:

• Orthopedic Surgery
• Traumatology
• Rheumatology

Background:

• Chronic closed dorsolateral talus dislocation is an exceptionally rare injury, often presenting with significant pain and deformity.
• Rheumatoid arthritis and corticosteroid treatment can predispose patients to complex foot and ankle pathologies.
• Accurate diagnosis distinguishing talus dislocation from ankle fracture-dislocation is crucial for appropriate management.

Observation:

• A 35-year-old woman with rheumatoid arthritis presented with a 6-month history of right foot pain and deformity.
• Radiographic and CT imaging revealed dorsolateral talar dislocation with a medial malleolus fracture.
• The talus was dislocated from the tibiotalar, talocalcaneal, and talonavicular joints.

Findings:

• Closed reduction was not feasible due to the chronic nature of the dislocation.
• Open total talectomy was performed to address the talus dislocation and associated medial malleolus fracture.
• At 2-year follow-up, the patient achieved an American Orthopaedic Foot & Ankle Society (AOFAS) score of 78, with corrected varus deformity and improved ambulation.

Implications:

• This case suggests that open total talectomy is a viable and effective treatment for chronic closed isolated dorsolateral talus dislocation.
• Surgical correction can significantly improve functional outcomes and patient satisfaction in cases of severe foot deformity.
• Further research is warranted to establish long-term outcomes and refine surgical techniques for this rare injury.