Primary talectomy for severe fracture-dislocation of the talus with a 15-year followup: case report

Open Fracture Dislocation of the Talus With Partial Talar Extrusion: A Case Report

We report a case of open talar fracture-dislocation (Gustilo-Anderson type IIIA) associated with a posterior tibial artery injury. The limb was aligned and splinted in the emergency department. In the operating theater, the posterior tibial artery was ligated, the talar neck fracture was reduced, and it was fixed with two Kirschner wires (K-wires). After K-wire removal, the patient underwent rehabilitation to regain function and resumed activities of daily living (ADL). At nine months of follow-up, the patient has a good ankle range of motion (ROM) and a congruent ankle joint but has developed avascular necrosis (AVN) of the talus. This case report highlights the high risk of talus AVN after open talar fracture dislocation. Preservation of the extruded talus and anatomical reduction can maintain ankle alignment, which is essential for arthrodesis in cases of AVN complications.

Talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for treatment of equinus deformity in adults

BACKGROUND

Severe equinovarus foot deformity in adults is a challenging problem. Conservative treatment rarely is effective, and operative options are limited. The aim of this study was to evaluate the results of talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for the treatment of severe equinovarus deformity in adults.

METHODS

Twelve patients (average age 39 years, range 15-70 years) with severe equinovarus deformities of the foot were treated with talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation between March 2010 and February 2013. Average follow-up was 20 months (range 10-37 months).

RESULTS

Tibiocalcaneal fusion was achieved in all patients at an average of 12 weeks (range 8-17 weeks). Preoperatively, all patients had severe, irreducible equinovarus deformities; at last follow-up, almost all feet had mild residual deformity, but were plantigrade and did not require a brace or orthosis. The average AOFAS ankle score improved from 41.1 (range 8-66) preoperatively to 78.4 (range 67-86) postoperatively (P = .02). There was a similar improvement in the average VAS score from 6.3 (range 2-10) preoperatively to 0.8 (range 0-4) postoperatively (P = .02).

CONCLUSION

The combination of talectomy and tibiocalcaneal arthrodesis was effective in correcting severe rigid equinovarus deformity in adults. Removal of the talus resulted in laxity of the soft tissues, making correction of the deformity easier. Tibiocalcaneal arthrodesis achieved a stable foot without the problems associated with talectomy alone.

LEVEL OF EVIDENCE

Level IV, case series.

Post-traumatic talectomy: a 60-year follow-up

The long-term outcome of primary talectomy for trauma without tibiocalcaneal fusion has not been reported in the literature. We report a case of a primary talectomy for trauma in a 10-year-old patient with 60-year follow-up. The patient had minimal symptoms during this period which suggests that this procedure can have the desired effect in providing good long-term quality of life.