total talar dislocations are uncommon injuries and usually seen following high velocity injuries . total talar dislocations
we hereby report a closed total talar dislocation in a 25 year old male without an associated fracture around ankle .
a 25 year old male presented to orthopaedic causality with injury to right ankle following a road traffic accident .
patient complained of severe pain and deformity of ankle following injury . on examination ankle was deformed and swollen .
plain radiographs of right ankle joint revealed total anterolateral dislocation of talus without any accompanying ankle fracture .
total talar dislocations are very rare injuries and should be treated as impending open fractures .
there is no consensus on treatment of such complex injuries as very few cases have been reported in literature .
talar fracture dislocations are very rare injuries accounting for 0.06% of all dislocation and 2% of all talar injuries and are usually associated with malleolar fracture or a talar fracture itself[1 - 2 ] .
total dislocation of the talus bone from all of its three joints ( tibiotalar , subtalar , and talonavicular ) without a fracture is a extremely rare injury[3 - 5 ] .
these type of injuries are usually caused by high velocity injury with disruption of almost all ligaments and capsular attachments of the talus .
it usually leads to degenerative changes in neighbouring joints and frequently avascular necrosis is a predictable outcome .
we present a case of total talus dislocation without any fracture which was treated by closed reduction and immobilization for six weeks .
a 25 years old male presented to orthopaedic causality with injury to right ankle following a road traffic accident .
patient complained of severe pain and deformity of ankle following injury . on examination ankle was deformed and swollen with very tense skin .
plain radiographs revealed total anterolateral i dislocation of talus without accompanying ankle fracture [ fig.3 , 4 ] , ct scan with 3d reconstruction also confirmed our radiographic findings [ fig.5 ] . under spinal anaesthesia and fluoroscopic guidance ,
closed reduction was performed by longitudinal traction and pushing the talus in the posteromedial direction . following
a 3 mm k - wire was passed from calcaneum to tibia through talus [ fig.6 , 7 ] .
plain radiographs at one year follow up showed no signs of avascular necrosis of talus or arthritis of subtalar joint .
pre- operative clinical photograph showing talar dislocation pre operative clinical photograph showing abrasion over lateral malleolus .
proposed treatments for total talus dislocation varied from primary talectomy or arthodesis to closed reduction and below knee cast .
the few case reports found in the literature and the non - existent guidelines add to the confusion regarding the best method of treatment .
depending on whether the foot comes to supination or pronation the dislocation can be either anterolateral ( the most usual ) or posteromedial .
this type of injury is supposed to be in continuation of subtalar dislocation when the force magnifies and continues .
dislocation of subtalar joint is the first stage of the injury . when the force progress , talonavicular joint dislocates and finally tibiotalar joint dislocation occurs . because of all capsular and ligamentous attachments of the talus are ruptured in this injury and dependence of talus bone vascularization on these ligaments , avascular necrosis of the talus is mostly predictable .
there is a deference of opinion regarding best method of treatment for closed talar dislocations .
most of the authors suggest open reduction for open talar dislocations [ table 1 ] .
ritsema et al suggested open reduction as the best choice of treatment for closed injuries .
anterolateral incision is preferred approach for open reduction as it gives an excellent approach to ankle joint .
taymaz and gunal reported a case of closed total talus dislocation treated by closed means with excellent result .
hadji et al . also reported good result after closed reduction of a complete talus dislocation on a three year follow - up .
total talar dislocations are very rare injuries seen following a high velocity injuries and are associated with ankle fractures .
closed reduction at the earliest is the best method of treatment for closed talar dislocations .
 introduction : total talar dislocations are uncommon injuries and usually seen following high velocity injuries . 
 total talar dislocations ( missing talus ) without fractures around the ankle are extremely rare . 
 there are no consensuses on the best treatment of such injuries . 
 to best of our knowledge very few cases have been reported in literature . 
 we hereby report a closed total talar dislocation in a 25 year old male without an associated fracture around ankle . 
 he was managed with emergency closed reduction and below knee splint . at one year 
 follow up there were no complications.case report : a 25 year old male presented to orthopaedic causality with injury to right ankle following a road traffic accident . 
 patient complained of severe pain and deformity of ankle following injury . on examination ankle was deformed and swollen . 
 plain radiographs of right ankle joint revealed total anterolateral dislocation of talus without any accompanying ankle fracture . 
 ct scan with 3d reconstruction also confirmed our radiographic findings . under spinal anaesthesia and fluoroscopic guidance closed reduction 
 was performed . to maintain reduction 
 a 3 mm k - wire was passed from calcaneum to tibia through talus . 
 a posterior below knee splint was applied . 
 patient was followed every three months till one year . at one year follow up 
 patient had good range of motion at ankle and subtalar joint.conclusion:total talar dislocations are very rare injuries and should be treated as impending open fractures . 
 there is no consensus on treatment of such complex injuries as very few cases have been reported in literature . 
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Introduction
Case Report
Discussion
Conclusion