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Case Reports
. 2017 Apr;99(4):e115-e117.
doi: 10.1308/rcsann.2017.0042.

Extruded talus treated with reimplantation and primary tibiotalocalcaneal arthrodesis

H R Mohammad  1   2 , J A'Court  1 , A Pillai  1
Affiliations
Case Reports

Extruded talus treated with reimplantation and primary tibiotalocalcaneal arthrodesis

H R Mohammad et al. Ann R Coll Surg Engl. 2017 Apr.

Abstract

Extruded talus is a rare serious result from a high-energy injury to a supinated and plantar flexed foot. Treatment remains controversial with a lack of congruent evidence for talar reimplantation. A 34-year-old woman was involved in a road traffic accident at 40 mph. Imaging revealed a left talus extruded anterolaterally with a talar neck fracture. Additional injuries included right acetabular fracture, transverse process fractures and rib fractures, which were treated conservatively. The talus was reimplanted and the talar neck fixed with a cortical screw. A hindfoot nail was used to fuse the calcaneus, talus and tibia. Follow-up at two years showed solid tibiotalocalcaneal fusion, with no evidence of avascular development, and the patient was fully weight bearing without pain. We believe this is the first published case of successful primary tibiotalocalcaneal fusion for extruded talus injuries.

Keywords: Extruded talus; Internal fixation; Primary tibiotalocalcaneal arthrodesis; Talus neck fracture; Talus reimplantation.

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Figures

Figure 1
Figure 1
Plain radiographs showing talus fracture dislocation sustained from initial road traffic accident injury: a) anteroposterior view; b) lateral view.
Figure 2
Figure 2
Ankle showing extruded talus and soft tissue damage.
Figure 3
Figure 3
Intraoperative fluoroscopy images. Talar reimplantation was conducted in theatre with cortical screw fixation of talar neck. A Hindfoot nail was used posteriorly to fuse calcaneus, talus and tibia: a) anteroposterior view; b) Lateral view.
Figure 4
Figure 4
Plain radiographs on discharge six weeks post-surgical intervention. No evidence of avascular necrosis of the talus and fixation remains as was achieved intraoperatively: a) anteroposterior view; b) lateral view.
Figure 5
Figure 5
Plain radiographs at seven months post injury. Solid tibiotalocalcaneal fusion has been achieved: a) anteroposterior view; b) lateral view.
Figure 6
Figure 6
Plain radiographs at two years post injury. Solid tibiotalocalcaneal fusion with no collapse around the nail visible. No avascular changes are visible on comparison with the seven-month radiographs (Fig 5): a) anteroposterior view; b) lateral view.
See this image and copyright information in PMC

References

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