Level III, retrospective comparative study.

Background: Comminuted talar fractures are rare. Generally, this fracture occurs as a result of high-energy injuries. Therefore, this operation is challenging for the surgeon. We started to replace the whole talus with a total talar prosthesis in cases of aseptic talar necrosis in 2005. Based on these results, replacement with a ceramic artificial talus was performed as the initial treatment for comminuted talar fractures. Methods: From 2009 to 2016, a total of 6 feet of 6 patients with comminuted talar dome fractures or talar body defects were replaced with a ceramic artificial talus. The patients’ mean age was 40.3 years (range, 19-59). Postoperative assessments were performed in accordance with the American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot score system. Postoperative range of motion and sports activities were also evaluated. Follow-up ranged from 12 to 84 (mean, 46.8) months. Results: The postoperative AOFAS score was on average 78.8 (64-100). The postoperative range of motion was on average 10 degrees (5-20) for dorsiflexion and 31 degrees (15-50) for plantarflexion. Three patients had returned to sport activities. Conclusion: Prosthetic total talar replacement was a useful procedure for patients with comminuted talar fractures, which had good congruency of the custom-made implant with the adjacent joints, resulting in stability, and maintained ankle function. Furthermore, this procedure could prevent the complications of long-term external fixation and non-weight-bearing walking seen after open reduction and arthrodesis. Level of Evidence: Level IV, retrospective comparative study.

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Category: Trauma Introduction/Purpose: Open reduction is most difficult to perform in comminuted talar fractures, because it necessitates osteotomy of the lateral or medial malleolus. Furthermore, the incidence of aseptic talar necrosis after a comminuted fracture is extremely high. Fifty-seven tali in 55 patients with aseptic necrosis of the talus underwent replacement with an artificial ceramic whole talus from 2005 to 2015, and we obtained excellent and good results. Based on the results, we performed replacement with an artificial ceramic talus, as the initial treatment, for 6 patients with comminuted talar fractures with bony destruction or defects. Methods: From 2009 to 2016, six feet in 6 patients with comminuted talar fractures were replaced with ceramic whole-talus prostheses as the initial treatment. Of them, 5 were male and one was female, with a mean age of 40.3 years (range, 19–59 years). The causes of the fractures were fall from a high place in 2 patients and traffic accident in 4. The ceramic prosthesis was made based on the computed tomographic scan of the normal opposite talus. The production of the custom-made prosthesis required a period of 5 weeks. In 3 patients, the capacity of the original talus was acquired by external fixation before replacement. Plaster cast immobilization was retained for 2 weeks each of non-weight bearing and weight-bearing. Preoperative and postoperative assessments were performed in accordance with the American Orthopaedic Foot and Ankle Society ankle/hindfoot score system. Results: Follow-up was conducted for 12 to 84 months (mean, 53.8 months). The postoperative AOFAS score was 68-100 (mean, 81.8). The result of the replacement with ceramic whole-talus prosthesis was excellent in 4, good in one, and fair in one. Three patients had resumed participation in sports activities (golf, aerobics, and jogging). However, 2 patients with open fracture and bony defects had limitation of the range of motion of the ankle. The patient with a fair result is still undergoing therapy for femoral and tibial fractures. Conclusion: A ceramic whole-talus prosthesis was used to replace 6 comminuted talar fractures as the initial treatment. The results using these prostheses were excellent, and good except one patient with open fracture and bony defects. Replacement with a ceramic whole-talus prosthesis should be indicated for comminuted fractures with bony destruction or defects.