Extruded talus treated with reimplantation and primary tibiotalocalcaneal arthrodesis

Use of a modified retrograde femoral rod as a custom length tibiotalocalcaneal nail

There has been increasing interest in the use of hindfoot tibiotalocalcaneal (TTC) nails to treat ankle and distal tibia fractures in select patient populations who are at increased risk for soft tissue complications after open reduction and internal fixation with traditional plate and screw constructs. We describe a technique which uses a retrograde femoral nail as a custom length TTC nail. By using a simple modification of the insertion jig, we are able to achieve safe screw trajectories that allow for robust distal interlocking fixation. Review of implantation in multiple cadaveric specimens demonstrates safe placement of distal screw fixation in the calcaneus without risking injury to important neurovascular structures. Because of the 2-cm incremental length options of this particular device, we are able to achieve supraisthmal fixation in the tibia which may lessen the risk for fracture that may be more likely to occur at the tip of a short TTC nail option. Furthermore, a custom length TTC nail is more costly and also requires advanced notice to acquire for the case; retrograde femoral nails are readily stocked and accessible at our level 1 trauma center. This TTC technique offers anatomic restoration while also offering convenience, instrument familiarity, cost savings, and increased patient safety.

The Masquelet technique in an extruded talus injury after open peri-talar dislocation-A case report

Extruded talus is a rare injury pattern that occurs following a high velocity injury loading on a supinated and plantar flexed foot. Treatment for such rare presentation varies from talectomy to arthrodesis. Reimplantation than excision has been favoured in literature, but it carries its own subset of issues to tackle from avascular necrosis to infection. Masquelet technique has been a saviour for open injuries most of the time in tackling both bone defects and infections. We present a case of open ankle injury with talar extrusion and assosciated talar bone loss along with calcaneum fracture, treated by masquelet technique.

Retrograde Hindfoot Nailing for Acute Trauma

PURPOSE OF REVIEW

The role of retrograde hindfoot nailing in the treatment of acute orthopedic trauma is explored.

RECENT FINDINGS

Tibio-talar calcaneal (TTC) nailing is an acceptable treatment alternative for the low-demand geriatric patient with peri-articular ankle trauma permitting immediate weight-bearing with low rates of complication and return to functionality. Hindfoot nailing can be used for limb salvage in the younger active patient; yet, joint-preserving reconstruction is preferred when feasible. Retrograde TTC nailing is a reliable option for hindfoot/distal tibia stabilization especially in the elderly frail population. Hindfoot nailing is reserved for a select subset of active patients when severity of bone, joint, and soft tissue injury are not amenable to more conventional reconstruction.

Critical-Sized Bone Defects: Sequence and Planning

Bone defects associated with open fractures require a careful approach and planning. At initial presentation, an emergent irrigation and debridement is required. Immediate definitive fixation is frequently safe, with the exception of those injuries that normally require staged management or very severe type IIIB and IIIC injuries. Traumatic wounds that can be approximated primarily should be closed at the time of initial presentation. Wounds that cannot be closed should have a negative pressure wound therapy dressing applied. The need for subsequent debridements remains a clinical judgment, but all nonviable tissue should be removed before definitive coverage. Cefazolin remains the standard of care for all open fractures, and type III injuries also require gram-negative coverage. Both induced membrane technique with staged bone grafting and distraction osteogenesis are excellent options for bony reconstruction. Soft tissue coverage within 1 week of injury seems critical.