Complete talectomy for post-traumatic osteomyelitis (and/or avascular necrosis): report of a new technique

Abstract

The main complications after complex talar fractures, especially with respect to open injuries, are avascular necrosis (AVN) and fracture-related infection (FRI) Their treatment is a source of discussion, and reconstruction options are scarce. A descriptive longitudinal study of three cases with a two-stage tibiocalcaneal (TC) arthrodesis (talectomy followed by a retrograde nailing and two tantalum spacers) is presented. Information on infection relapse and fusion of the arthrodesis was collected, along with demographic, radiological, and functional variables (such as Manchester-Oxford Foot Questionnaire, MOXFQ, values; EuroQol index values; and visual analogue scale for pain, VAS-pain, values) After a minimum of 3 years, no infection relapse or pseudoarthrosis was observed. Leg alignment was comparable to the contralateral side. Functional and pain tests showed optimal values: MOXFQ index of 16.6, mean EuroQol index of 0.782, and mean VAS-pain of 19. For a salvage procedure in FRI $+$ AVN of the talus, this two-stage TC arthrodesis is a safe procedure in terms of infection and provides good functional outcomes.

Figure 1

Intraoperative images. In this composed image, the following are presented: the arthrodesis nail (a), tantalum spacers in the void left by the talus (b), the remaining void filled with CERAMENT^® (c), and the autograft and closure of the Masquelet membrane (d).

Figure 2

MRI images of the preoperative state of the talus. Sagittal MRI images showing signs of avascular necrosis and osteomyelitis: (a) T1 and (b) STIR images.

Figure 3

Postoperative alignment. Standing long-leg images corresponding to cases 1 (a), 2 (b), and 3 (c), respectively

Figure 4

In spite of the image distortion due to radiolucent osteosynthetic material, signs of consolidation and the absence of indirect signs of pseudoarthrosis can be noted in the 1-year control CT scan of one of the patients (Case 2). This image, along with a painless weight-bearing ambulation, is enough to consider a consolidation of the defect.