Closed Pantalar Dislocations: Characteristics, Treatment Approaches, and Outcomes

Closed pantalar dislocation mainly occurs among male adults aged 20 to 45 years and is usually associated with high-energy trauma, mostly falls (50.0%). The talus dislocates anterolaterally in about 85% of cases. Pure pantalar dislocation is more common (54.7%) than cases with concomitant fractures (45.3%). Ankle fractures are the most common associated fractures, followed by fractures of the talar posterior process. Among 40 reported cases, 24 had successful closed reduction (60%), 11 had unsuccessful closed reduction (27.5%), and 5 underwent open reduction without attempting closed reduction (12.5%). The success rate for closed reduction of closed pantalar dislocation is 68.5% (24/35 cases). Post-traumatic arthrosis occurs in 32.3%. Osteonecrosis occurs less often than previously reported. Infection after closed reduction of pantalar dislocation is very rare except after open reduction and fixation for concomitant talar fractures. Conclusively, closed pantalar dislocations are very rare injuries and may portend a poor prognosis. Urgent talar relocation restores ankle and hindfoot anatomy and reduces pressure on surrounding soft tissues to optimize outcome. A closed reduction maneuver should be attempted initially, followed by urgent open reduction when the talus is not accurately reduced through closed means.