Total talar extrusion: a case report

Abstract

Total talar extrusion is an extremely rare injury that occurs after a high-energy trauma. There are few reported cases in literature and there is no consensus as to the appropriate treatment of the extruded talus. Historically, the treatment options for open total talar dislocation have been limited to talectomy and fusion or reimplantation after thorough debridement. We report a case of an open dislocation of the talus with total talar extrusion. Immediate surgical debridement, reduction, and external fixation were performed under antibiotic coverage. Antibiotic-impregnated polymethylmethacrylate beads were implanted and the wound underwent a second debridement and delayed primary closure at 48 hours post injury. The patient remained in an external fixator for 6 weeks. She was subsequently placed in a cast and remained non-weight bearing for an additional 6 weeks. Her wound healed uneventfully and she was permitted to begin progressive weight bearing at 12 weeks. The patient did not develop an infection or avascular necrosis. Literature cites infection and avascular necrosis as the main complications associated with a talar extrusion. Good open fracture protocol can reduce the risk of infection. Reduction of the extruded talus is preferable to preserve function and maintain normal hindfoot anatomy. Talectomy should be reserved as a salvage procedure.

Level of clinical evidence: 4.