Complete Revascularization of Reimplanted Talus After Isolated Total Talar Extrusion: A Case Report

Abstract

Total traumatic extrusion of the talus is a rare and disabling ankle injury. Treatment may include talar reimplantation or talar body removal, but an optimal treatment protocol has not yet been established. Several case reports showed that disruption of the vascular supply and contamination could lead to major complications, such as infection and avascular necrosis, with the high risk of these complications being associated with both the traumatic ankle injury itself and subsequent talar reimplantation. No report to date has described the revascularization of a completely extruded talus, as shown by serial MRI, a less invasive surgical strategy consisting of immediate reimplantation, early administration of antibiotics, and a short period of cast immobilization followed by early motion exercises. The present study describes complete revascularization and good clinical outcomes in a 30-year-old man who underwent talus reimplantation after isolated total talar extrusion.

Outcomes of a Reimplanted Talus After a Total Open Extrusion

“…In our case, we reduced the risk of infection by following an open fracture protocol: early administration of antibiotics and surgical debridement with a careful soft tissue handling and a rigid fixation [6]. The risk of avascular necrosis of the talus is difficult to predict [19]. It is highest when no soft tissues remain attached to the talus [6].…”

Highly contaminated extruded talus. Is it safe to reimplate? A case report.

“…The failure of the medial bony stabilizer allows talus extrusion. In most of the reported cases, it remained attachments, especially deltoid ligament 2,6 . There was no strong evidence-based procedure.…”

“…This sign appears six to eight weeks after a talar injury as a thin radiolucent line along a part or all talar dome 132,5 . It is a reliably predictable exclusion of talar AVN 2,5,13,14 . If negative Hawkins sign, an MRI check might be undertaken to look for AVN 6 .…”

“…Three joints stabilize the talus : (1)the tibiotalar joint unites the talar body to the inferior surface of the distal tibia and the malleoli, (2)the subtalar joints unites the talar body to the superior aspect of the calcaneus, and (3)the talonavicular joint unites the talar head to the posterior surface of the navicular bone. Arterial sources originated from anterior tibial, posterior tibial, and perforating fibular arteries 2,8,9 . Talus is vulnerable to AVN 2 .…”

“…Open triple talus dislocation or open complete total talus extrusion (TTE) is an exceptional injury 1 . Bone contamination and surgery time may influence bone removal or bone reimplantation 2,3 . Recent studies encourage early reimplantation 2,4-6 .…”