Talar dislocations.

From 1987-2003, 36 patients were treated for talar dislocation, 27 patients for subtalar, six for total talar, and three patients for peritalar dislocation. Luxatio pedis sub talo: We found 19 medial closed, seven lateral closed and one third degree open subtalar dislocations. Our therapeutic concept provides for immediate reduction, which is possible by closed procedure for the majority of medial dislocations. If there is a tendency to redislocation, we perform talonavicular K-wire transfixation. In the case of irreducibility, open reduction via lateral approach is the rule. The lateral dislocation type is often accompanied by additional fractures of the hindfoot and tarsus, frequently requiring primary open procedures via medial approach. 32 patients were followed-up in whom we found 17 excellent results, ten good, three mediocre and two poor results. With two thirds of the patients, low grade arthrosis at least was observed and two thirds showed a reduced amplitude of motion in one or more talar joints. A definite correlation between arthrosis and reduced function was not established. We did not find talar necroses, persisting instabilities, or redislocations. Luxatio tali totalis: We found three lateral and three medial complete dislocations. The therapeutic concept consists of immediate reduction-only possible by open procedure. A tendency to redislocation requires K-wire transfixation. All patients were followed-up. We found two good and four poor results, with two total and three partial necroses. As a secondary treatment, two lower ankle joint(LAJ) and two upper ankle joint (UAJ) arthrodeses were performed. There were no talectomies, amputations, or infections. Luxatio pedis cum talo: We found three anterolateral UAJ dislocations. Our therapeutic concept provides for immediate reduction. The whole capsular ligament apparatus was reconstructed by primary or secondary treatment, depending on the degree of soft tissue damage. Follow-up showed two excellent results