Fractures and Dislocations of the Talus and Calcaneus: A Case-Based Approach

  • Michael JungEmail author
  • Joseph Galloway
  • Jonathan Eastman


Peritalar fracture dislocations are relatively uncommon. They usually occur as a result of high-energy trauma and are frequently associated with concomitant bony injuries. If not treated appropriately, these injuries can lead to significant morbidity. Appropriate management includes a meticulous physical examination focused on the condition of the skin and soft tissues, and a thorough understanding of fracture morphology utilizing plain X-ray and computed tomography. Dislocations must be diagnosed and reduced promptly. If closed reduction is unsuccessful, then open reduction is indicated. Peritalar fractures, especially those involving the subtalar joint, can cause residual instability and lead to post-traumatic arthrosis if not accurately reduced. Common complications following subtalar fracture dislocations include hindfoot stiffness, subtalar and/or tibiotalar arthrosis, and soft tissue injuries. Accurate diagnosis, expeditious reduction, and anatomic fixation are essential tenets to lessen long-term sequelae in the management of these complex fracture patterns.


Subtalar Peritalar Fracture-dislocation Talus dislocation Calcaneus dislocation Talus fracture Calcaneus fracture 


  1. 1.
    Dale JD, Ha AS, Chew FS. Update on talar fracture patterns: a large level I trauma center study. AJR Am J Roentgenol. 2013;201(5):1087–92.CrossRefGoogle Scholar
  2. 2.
    Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ. Talar neck fractures: results and outcomes. J Bone Joint Surg Am. 2004;86-A(8):1616–24.CrossRefGoogle Scholar
  3. 3.
    Elgafy H, Ebraheim NA, Tile M, Stephen D, Kase J. Fractures of the talus: experience of two level 1 trauma centers. Foot Ankle Int. 2000;21(12):1023–9.CrossRefGoogle Scholar
  4. 4.
    Rammelt S, Bartoníček J, Park KH. Traumatic injury to the subtalar joint. Foot Ankle Clin. 2018;23(3):353–74.CrossRefGoogle Scholar
  5. 5.
    Rammelt S, Grass R, Zawadski T, Biewener A, Zwipp H. Foot function after subtalar distraction bone-block arthrodesis. A prospective study. J Bone Joint Surg Br. 2004;86(5):659–68.CrossRefGoogle Scholar
  6. 6.
    Rammelt S, Biewener A, Grass R, Zwipp H. Foot injuries in the polytraumatized patient. Unfallchirurg. 2005;108(10):858–65.CrossRefGoogle Scholar
  7. 7.
    Chan G, Sanders DW, Yuan X, Jenkinson RJ, Willits K. Clinical accuracy of imaging techniques for talar neck malunion. J Orthop Trauma. 2008;22(6):415–8.CrossRefGoogle Scholar
  8. 8.
    Broden B. Roentgen examination of the subtaloid joint in fractures of the calcaneus. Acta Radiol. 1949;31(1):85–91.CrossRefGoogle Scholar
  9. 9.
    Goldner JL, Poletti SC, Gates HS, Richardson WJ. Severe open subtalar dislocations. Long-term results. J Bone Joint Surg Am. 1995;77(7):1075–9.CrossRefGoogle Scholar
  10. 10.
    LEITNER B. Obstacles to reduction in subtalar dislocations. J Bone Joint Surg Am. 1954;36(A:2):299–306.CrossRefGoogle Scholar
  11. 11.
    Bibbo C, Lin SS, Abidi N, Berberian W, Grossman M, Gebauer G, et al. Missed and associated injuries after subtalar dislocation: the role of CT. Foot Ankle Int. 2001;22(4):324–8.CrossRefGoogle Scholar
  12. 12.
    Dürr C, Zwipp H, Rammelt S. Fractures of the sustentaculum tali. Oper Orthop Traumatol. 2013;25(6):569–78. Epub 2013/12/06CrossRefGoogle Scholar
  13. 13.
    Giuffrida AY, Lin SS, Abidi N, Berberian W, Berkman A, Behrens FF. Pseudo os trigonum sign: missed posteromedial talar facet fracture. Foot Ankle Int. 2003;24(8):642–9.CrossRefGoogle Scholar
  14. 14.
    Rammelt S, Goronzy J. Subtalar dislocations. Foot Ankle Clin. 2015;20(2):253–64. Epub 2015/03/29CrossRefGoogle Scholar
  15. 15.
    Jungbluth P, Wild M, Hakimi M, Gehrmann S, Djurisic M, Windolf J, et al. Isolated subtalar dislocation. J Bone Joint Surg Am. 2010;92(4):890–4.CrossRefGoogle Scholar
  16. 16.
    Bibbo C, Anderson RB, Davis WH. Injury characteristics and the clinical outcome of subtalar dislocations: a clinical and radiographic analysis of 25 cases. Foot Ankle Int. 2003;24(2):158–63.CrossRefGoogle Scholar
  17. 17.
    Heppenstall RB, Farahvar H, Balderston R, Lotke P. Evaluation and management of subtalar dislocations. J Trauma. 1980;20(6):494–7.CrossRefGoogle Scholar
  18. 18.
    Vallier HA, Nork SE, Benirschke SK. Sangeorzan BJ. Surgical treatment of talar body fractures. J Bone Jt Surg Am. 2004;86-A(Suppl 1 (Pt 2)):180–92.CrossRefGoogle Scholar
  19. 19.
    Lindvall E, Haidukewych G, DiPasquale T, Herscovici D, Sanders R. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am. 2004;86-A(10):2229–34.CrossRefGoogle Scholar
  20. 20.
    Milenkovic S, Mitkovic M, Bumbasirevic M. External fixation of open subtalar dislocation. Injury. 2006;37(9):909–13.CrossRefGoogle Scholar
  21. 21.
    Maher MH, Chauhan A, Altman GT, Westrick ER. The acute management and associated complications of major injuries of the talus. JBJS Rev. 2017;5(7):e2.CrossRefGoogle Scholar
  22. 22.
    Dodd A, Lefaivre KA. Outcomes of Talar neck fractures: a systematic review and meta-analysis. J Orthop Trauma. 2015;29(5):210–5.CrossRefGoogle Scholar
  23. 23.
    Della Rocca GJ, Nork SE, Barei DP, Taitsman LA, Benirschke SK. Fractures of the sustentaculum tali: injury characteristics and surgical technique for reduction. Foot Ankle Int. 2009;30(11):1037–41.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Michael Jung
    • 1
    Email author
  • Joseph Galloway
    • 1
  • Jonathan Eastman
    • 2
  1. 1.Orthopaedic SurgeryRutgers New Jersey Medical SchoolNewarkUSA
  2. 2.Orthopaedic SurgeryUniversity of CaliforniaSacramentoUSA

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