Closed Pantalar Dislocation With Checkrein Deformity: A Unique Case Report and Literature Review

Abstract

Closed pantalar dislocations are a rare variant of an uncommon injury. Pantalar dislocations are typically caused by high-energy trauma resulting in an open injury with associated fracture of the articulating bones. Given its obscurity, the literature on closed pantalar dislocations is scarce, and no standard treatment protocol has been accepted. This case report chronicles the treatment and outcome of a 29-year-old man who presented with a checkrein deformity of all digits after a closed pantalar dislocation with 6-month follow-up. A comprehensive literature review found 28 articles representing 39 patients with closed pantalar dislocations without talar neck or body fractures. Roughly equal numbers of closed and open reduction techniques were performed with avascular necrosis occurring in 7 of 36 patients. Although outcome measures and follow-up were variable, what can be considered a suitable outcome was seen in approximately 83% of patients, with only 3 of 35 requiring a secondary operation. Long-term studies with well-defined outcome measures are needed to adequately predict the prognosis of this rare injury and efficacy of treatment protocols.

Figure 1

Prereduction anteroposterior ankle radiograph showing medial dislocation of the talus.

Figure 2

Prereduction lateral ankle radiograph showing anterior dislocation of the talus.

Figure 3

Prereduction photograph showing gross deformity of the ankle and rearfoot with plantar flexion checkrein deformity of the digits.

Figure 4

Photograph showing the hand position of the pushup type maneuver used for reduction.

Figure 5

Postreduction and splinting of pantalar dislocation with resolution of digital checkrein deformity.

Figure 6

Immediate postreduction coronal CT image showing realignment of the ankle and subtalar joints with fracturing of the posterolateral fibula.

Figure 7

Immediate postreduction sagittal CT image showing realignment of the ankle, subtalar, and talonavicular joints.

Figure 8

Immediate postreduction axial CT image showing comminuted fracture of the posterolateral talar process and posterolateral fibula.

Figure 9

Anteroposterior weight-bearing radiograph image 6 months postreduction without signs of avascular necrosis of the talus.

Figure 10

Ankle mortise weight-bearing radiograph image 6 months postreduction without signs of avascular necrosis of the talus.

Figure 11

Lateral weight-bearing radiograph image 6 months postreduction showing maintained joint alignment and posterior fibula fracture union.