External fixation of open subtalar dislocation Sasa Milenkovic a, * , Milorad Mitkovic a , Marko Bumbasirevic b a Orthopaedic and Traumatology Clinic, Nis, Serbia and Montenegro b Institute for Orthopaedic and Trauma Surgery, Belgrade, Serbia and Montenegro Accepted 27 February 2006 Introduction Subtalar dislocation is a rare injury involving the talocalcaneous and talonavicular joints and caused by high-energy trauma such as fall from a height or traffic accident. The injury was first described by Judcy and Dafaurets in 1811. 3,7 Smith reports 1.3% of subtalar dislocations, and Leitner 1%, in their series of 535 and 4215 acute dislocations, respectively. 8,14 The anatomy, pathophysiology, treatment and prog- nosis of subtalar dislocation are well described in the literature. 1 The mechanism of injury is trauma to a plantar-flexed foot either in inversion, resulting in medial subtalar joint dislocation (85%), or in ever- sion, resulting in lateral dislocation (15%). Anterior and posterior dislocations have been described but are exceedingly rare. 6,15 Most subtalar dislocations occur in young men. Between 10% and 40% of these injuries are open. 9,10 In open subtalar dislocation, associated fractures, avascular necrosis of the talus and infection are not rare 9 . Materials and methods This prospective study included 11 individuals (9 males and 2 females) with open subtalar disloca- tions, Gustilo types II and III, admitted to the Injury, Int. J. Care Injured (2006) 37, 909—913 www.elsevier.com/locate/injury KEYWORDS External fixation; Open subtalar dislocation Summary Subtalar dislocation is a rare and severe injury, caused by high-energy trauma such as fall from a height or traffic accident. Infection and avascular necrosis are not rare sequelae of open subtalar dislocation, and the outcome may be poor. External fixation allows complete wound care, and moderate distraction of the ankle joint should unload the talus, which may reduce the risk of avascular necrosis. We treated 11 open subtalar dislocations by distractional external fixation. The series involved nine males and two females, of average age 30.39 years. In nine cases the injury was caused by falling from a height, and in two by a traffic accident. The follow- up period ranged from 18 to 28 months. The final functional results were good, with no infection and one case of avascular necrosis of the talus. Pain after a longer period of walking or standing was experienced by eight patients, and movement of the subtalar joint was limited in nine patients. Immediate distractional external fixation of open subtalar dislocation may prevent infection and avascular necrosis of the talus. # 2006 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +381 18 230 184; fax: +381 18 230 184. E-mail address: sasa65@bankerinter.net (S. Milenkovic). 0020–1383/$ — see front matter # 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2006.02.051