Total talar extrusion without soft tissue attachments

Abstract

Total talar extrusion without a soft tissue attachment is an extremely rare injury and is rarely reported. Appropriate treatment remains controversial. We describe the long-term outcomes of two patients who had complete talar extrusion without remaining soft tissue attachment treated with arthrodesis. Both of our patients had complications such as infection and progressive osteolysis. We suggest reimplantation of the extruded talus after thorough debridement as soon as possible as a reasonable option unless the talus is contaminated or missing, because an open wound may arise from inside to outside.

Keywords: Arthrodesis; Extrusion; Missing talus; Talus.

Fig. 1

Initial radiographs of the ankle, showing complete absence of the talus and fractures of the lateral malleolus and anterior process of the calcaneus.

Fig. 2

Postoperative radiographs after inserting a cement spacer and stabilizing the ankle with an external fixator.

Fig. 3

Postoperative radiographs after compressive tibiocalcaneal arthrodesis using an Ilizarov fixator.

Fig. 4

Lateral radiograph of the ankle 8 years after injury, showing solid fusion.

Fig. 5

Photographs of the ankle and the totally extruded talus. (A) Medial view of the ankle. (B) Distal-dorsal view of the talus. (C) Plantar view of the talus.

Fig. 6

Postoperative radiographs after reimplantation of the talus and subtalar fusion with pin and screws.

Fig. 7

Radiographs of the ankle 7 months after injury, showing osteolysis of the distal tibia and loosening of the screws.

Fig. 8

Radiographs of the ankle 3 years after injury, showing solid fusion.