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Case Reports
. 2017 Dec 15;11(1):348.
doi: 10.1186/s13256-017-1517-7.

Six-year survival of reimplanted talus after isolated total talar extrusion: a case report

Jae-Man Kwak  1 , Sung-Keun Heo  2 , Gu-Hee Jung  3
Affiliations
Case Reports

Six-year survival of reimplanted talus after isolated total talar extrusion: a case report

Jae-Man Kwak et al. J Med Case Rep. .

Abstract

Background: Open total extrusion of the talus without concomitant fracture is an extremely rare injury. We present 6-year follow-up data of a patient treated using a temporary spanning external fixator and less invasive single K-wire fixation.

Case presentation: A 55-year-old Asian man who had a totally extruded talus without fracture underwent immediate reimplantation surgery. A spanning external fixator with single antegrade K-wire fixation was applied to maintain the reimplanted talus. During 6 years of follow-up, he could walk without aids and could squat, corresponding to an American Orthopaedic Foot and Ankle Society score of 85. We found that the suspect lesion that was evident at 6 months after surgery had disappeared at 12 months postoperatively on the basis of sequential follow-up magnetic resonance imaging. There was no evidence of osteonecrosis of the dislocated talus at the final follow-up.

Conclusions: In patients with a totally extruded talus, a surgical strategy including immediate reimplantation of the talus and a temporary spanning fixator with single K-wire fixation might be useful to allow early mobilization around the ankle joint and to prevent additional damage of the foot without significant complications.

Keywords: Osteonecrosis; Reimplantation; Revascularization; Talus; Total extrusion.

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Conflict of interest statement

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a and b The talus was completely extruded without significant fracture to the anterolateral direction. c The open wound showed a small focal lesion of chondral injury
Fig. 2
Fig. 2
After immediate reimplantation of the extruded talus, its position around the ankle joint was maintained using a single K-wire fixation and spanning external fixator. Postoperative radiographs show the anatomical reduction of the ankle joint, including the subtalar joint and tibiotalar joint
Fig. 3
Fig. 3
a Magnetic resonance imaging scan obtained 6 months after surgery shows high intensity at the anterior aspect of the talar body, which was caused by the vascular insufficiency. b After 12 months, the suspected lesion of talus had disappeared and had returned to nearly the normal signal compared with adjacent bones. c After 5 years, the reimplanted talus had a small-sized subchondral lesion without osteonecrosis
Fig. 4
Fig. 4
The patient’s condition returned to the preinjury level without motion limitation of the ankle joint, and he was able to squat for 5 minutes with mild pain. His American Orthopaedic Foot and Ankle Society score was 85 (pain 30, function 45, alignment 10)
Fig. 5
Fig. 5
a This plain radiograph obtained at 8 weeks postoperatively did not show the Hawkins sign in the reimplanted talus. b After 24 months, the anterior osteophyte appeared without narrowing at the ankle joint surface. c At the last follow-up at 6 years, the reimplanted talus was well positioned in the ankle joint without avascular necrosis
See this image and copyright information in PMC

References

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