Total extrusion of the talus in an adolescent: a case report

Complete Revascularization of Reimplanted Talus After Isolated Total Talar Extrusion: A Case Report

Total traumatic extrusion of the talus is a rare and disabling ankle injury. Treatment may include talar reimplantation or talar body removal, but an optimal treatment protocol has not yet been established. Several case reports showed that disruption of the vascular supply and contamination could lead to major complications, such as infection and avascular necrosis, with the high risk of these complications being associated with both the traumatic ankle injury itself and subsequent talar reimplantation. No report to date has described the revascularization of a completely extruded talus, as shown by serial MRI, a less invasive surgical strategy consisting of immediate reimplantation, early administration of antibiotics, and a short period of cast immobilization followed by early motion exercises. The present study describes complete revascularization and good clinical outcomes in a 30-year-old man who underwent talus reimplantation after isolated total talar extrusion.

Early reimplantation for open total talar extrusion

PURPOSE

To review outcome of early reimplantation for open total talar extrusion in 7 patients.

METHODS

Medical records of 5 men and 2 women aged 19 to 53 years who underwent reimplantation for open total talar extrusion within 6 hours after road traffic accident (n= 6) or industrial injury (n=1) were reviewed. The talus was first irrigated with 9 to 10 litres of saline solution, followed by 10% povidone iodine. It was then reduced after thorough debridement and fixed with tension band wiring or external fixation. Ankle mobilisation exercises were started at week 6 and full weight bearing at week 14. Outcome was assessed using the American Foot And Ankle Society score.

RESULTS

After a mean follow-up of 31.9 (range, 24-46) months, the mean American Foot and Ankle Society score was 81, and the mean dorsiflexion-plantar flexion arc was 36.9º (range, 25º-45º). All patients were able to walk with a balanced, unaided gait with mild-to-moderate pain (n=3) or pain-free (n=4). No patient developed deep infection or instability. Three patients developed avascular necrosis of the talus; restriction of motion was moderate at the ankle joint and severe at the subtalar joint. None of these 3 patients opted for revision surgery, as the pain was tolerable and did not limit their daily activities, but their condition was expected to deteriorate with time.

CONCLUSION

Early reimplantation is recommended for open total talar extrusion, as it restores (to some extent) hind foot mechanics, heel height, and bone stock for activities of daily living and future reconstructive options.

Open talar dislocations without associated fractures

AIM

Total dislocation of the talus first reported in 1680. It is a rare injury and without associated fractures is even rarer. Is generally considered to be one of the most disabling ankle injuries and occurs after high energy trauma. The primary goal of our study is the retrospective evaluation of complete talar extrusion without associated fractures and immediate reimplantation.

MATERIALS AND METHODS

In the past nine years, nine patients with mean age 31.7 years were admitted to our center with a complete open talar extrusion. The dislocated talus was reduced and held in place with two Steinmann pins placed from the inferior aspect of the calcaneus, through the talus and into the inferior aspect of the tibia. An external fixator was used to stabilize the limb. The mean follow up time was 21.1 months. At the last follow up visit, six patients were evaluated both radiographically and functionally with the AOFAS score.

RESULTS

Six patients were free of complications and the mean AOFAS Ankle-Hindfoot Scale score at the time of the last follow up visit was 82.5. Two patients had an infection, one had avascular necrosis of the talus and one had signs of subtalar joint arthritis. Two patients had to undergo arthrodesis.

CONCLUSIONS

It is important to attempt reimplantation of the talus since a good final outcome is to be expected. Even in the case of a catastrophic complication this technique will ensure adequate bone stock for additional surgical procedures.

Total extrusion of the cuboid: a case report

The incidence of total extrusion of the cuboid is rare, without any known published data or surgical guidelines. This case report describes the management of an open extruded cuboid by staged surgical interventions. Arthrodesis of the lateral column with a structural bone graft is a viable option to address the shortening, instability, and severe bone loss caused by the total cuboid extrusion.