Closed reduction of subtalar and talonavicular dislocation: Novel technique description

Background Subtalar dislocations are uncommon, high-energy injuries that frequently occur with associated fractures and significant soft tissue compromise. Prompt closed reduction is essential to prevent avascular necrosis of the talus, neurovascular injury, and post-traumatic arthritis. Purpose Traditional reduction methods are technically demanding, dependent on operator strength, and may endanger already compromised soft tissues. The Quigley method, which applies traction through the toes, can exacerbate deformity and doesn't provide sufficient force to achieve reduction safely, increasing the risk of injury to the toes and forefoot. Similarly, Charnley's technique requires exaggeration of the deformity, which raises the risk of neurovascular damage and conversion of closed to open dislocation, while also relying on operator grip strength that may not always be feasible. Method We present the case with displaced comminuted fractures of the lesser metatarsals and combined subtalar and talonavicular dislocation to support the use of novel technique conceptualized by the authors. This method uses a padded ankle distraction strap secured with kerlix gauze to the surgeon's hips, allowing body weight to generate steady, high force in line traction. With traction maintained, the surgeon's hands are free to correct deformity and apply splinting without loss of distraction. Result Reduction was achieved on the first attempt, achieving reduction on the first attempt reduces the risk of further soft tissue injury, limits the need for repeat sedation and radiation, and decreases the likelihood of requiring urgent operative intervention. Conclusion This Method represents a safe, reproducible, and cost-effective option for closed reduction in both emergency and operative settings.