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Complications and Functional Outcomes After Pantalar Dislocation.

Abstract Pantalar dislocations without associated talar fracture are rare and have high risks of complications, including infection, osteonecrosis, and posttraumatic osteoarthrosis. Limited information on later function exists. This study evaluated complications and outcomes following pantalar dislocation without talar fracture.
PMID
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Journal Title the journal of bone and joint surgery. american volume
Publication Year Start




PMID- 28419034
OWN - NLM
STAT- In-Process
DA  - 20170418
LR  - 20170418
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 99
IP  - 8
DP  - 2017 Apr 19
TI  - Complications and Functional Outcomes After Pantalar Dislocation.
PG  - 666-675
LID - 10.2106/JBJS.16.00986 [doi]
AB  - BACKGROUND: Pantalar dislocations without associated talar fracture are rare and 
      have high risks of complications, including infection, osteonecrosis, and
      posttraumatic osteoarthrosis. Limited information on later function exists. This 
      study evaluated complications and outcomes following pantalar dislocation without
      talar fracture. METHODS: Nineteen patients were identified with open (n = 14) or 
      closed (n = 5) pantalar dislocations without talar fracture. Ten male and 9
      female patients with a mean age of 39.6 years (range, 19 to 68 years) were
      included. Open injuries underwent surgical debridement. Sixteen patients had open
      reduction, and 2 had closed reduction. Fixation was achieved with Kirschner wires
      (n = 4), external fixation (n = 9), or both (n = 3). Two patients did not have
      fixation. Another patient had primary transtibial amputation due to
      nonreconstructible foot trauma. Charts and radiographs were reviewed to identify 
      infection, osteonecrosis, and posttraumatic arthrosis. Data on pain, medications,
      range of motion, and secondary procedures were collected. After a minimum of 1
      year, Foot Function Index (FFI) and Musculoskeletal Function Assessment (MFA)
      surveys were administered. RESULTS: The mean clinical follow-up was 45.1 months. 
      Two patients had superficial wound-healing problems with prolonged drainage,
      which healed with dressing changes and oral antibiotics, and 1 patient developed 
      cellulitis 4 months after injury, which resolved with intravenous antibiotics. No
      deep wound infections occurred. Fourteen (88%) of the 16 patients with a minimum 
      of 11 months of radiographic follow-up developed osteonecrosis, 2 with collapse
      of the talar dome, and 7 (44%) developed arthrosis of >/=1 peritalar
      articulation. Outcome surveys were obtained for 11 (58%) of the 19 patients, at a
      mean of 5.2 years after injury. The mean MFA score was 30.3, and the mean FFI
      score was 25.3. Six of 10 survey respondents had returned to employment, but 88% 
      (14 of 16) of the patients with radiographic and clinical follow-up reported at
      least mild pain and 75% (12 of 16) were taking analgesics. CONCLUSIONS: Urgent
      surgical debridement of open injuries and reimplantation of the talus after
      pantalar dislocation was not associated with deep infection. Osteonecrosis
      occurred in the majority of patients, but collapse was uncommon. Persistent pain 
      and functional limitations are frequent after pantalar dislocation, as reflected 
      in extremity-specific and generalized functional outcome scores. LEVEL OF
      EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete
      description of levels of evidence.
FAU - Boden, Kaeleen A
AU  - Boden KA
AD  - 1Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, Ohio.
FAU - Weinberg, Douglas S
AU  - Weinberg DS
FAU - Vallier, Heather A
AU  - Vallier HA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
EDAT- 2017/04/19 06:00
MHDA- 2017/04/19 06:00
CRDT- 2017/04/19 06:00
AID - 10.2106/JBJS.16.00986 [doi]
AID - 00004623-201704190-00006 [pii]
PST - ppublish
SO  - J Bone Joint Surg Am. 2017 Apr 19;99(8):666-675. doi: 10.2106/JBJS.16.00986.

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