Subtalar dislocations: a prognosticating classification.
A review of the literature and analysis of eight cases of subtalar dislocations was undertaken to correlate our experience with others and to determine a classification for prognostication. Our findings corresponded with those found by others. A 75% incidence of associated injuries was present in our series and these represented a continuum of varying degrees of complication. A new system was devised whereby increasing severity of associated injuries correlated with increasing rate of complications, including loss of motion, arthritis, pain and avascular necrosis. Dislocations were classified according to: no associated injuries, those with soft tissue injuries, extra-articular fractures, intra-articular fractures and those prone to development of avascular necrosis, ie, open dislocations and fractures of the body of the talus. It was found that associated fractures increased the immobilization period as well as the incidence of complications. Intra-articular fractures have demonstrated increased rates of arthroses in the subtalar joint. Avascular necrosis, an infrequent but devastating complication, is primarily associated with open dislocations and dislocations with concomitant fractures of the body of the talus. Our series had two open subtalar dislocations, neither of which developed avascular necrosis.