Clin Orthop Surg.  2014 Jun;6(2):236-241. 10.4055/cios.2014.6.2.236.

Total Talar Extrusion without Soft Tissue Attachments

Affiliations
  • 1Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
  • 2Department of Orthopedic Surgery, Gangneung Medical Center, Gangneung, Korea.
  • 3Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea. sjs0506@paik.ac.kr

Abstract

Total talar extrusion without a soft tissue attachment is an extremely rare injury and is rarely reported. Appropriate treatment remains controversial. We describe the long-term outcomes of two patients who had complete talar extrusion without remaining soft tissue attachment treated with arthrodesis. Both of our patients had complications such as infection and progressive osteolysis. We suggest reimplantation of the extruded talus after thorough debridement as soon as possible as a reasonable option unless the talus is contaminated or missing, because an open wound may arise from inside to outside.

Keyword

Talus; Extrusion; Missing talus; Arthrodesis

MeSH Terms

Arthrodesis
Debridement
Foot Injuries/*surgery
Humans
Male
Middle Aged
Replantation
Soft Tissue Injuries/*surgery
Surgical Flaps
Talus/*injuries/surgery
Therapeutic Irrigation
Young Adult

Figure

  • Fig. 1 Initial radiographs of the ankle, showing complete absence of the talus and fractures of the lateral malleolus and anterior process of the calcaneus.

  • Fig. 2 Postoperative radiographs after inserting a cement spacer and stabilizing the ankle with an external fixator.

  • Fig. 3 Postoperative radiographs after compressive tibiocalcaneal arthrodesis using an Ilizarov fixator.

  • Fig. 4 Lateral radiograph of the ankle 8 years after injury, showing solid fusion.

  • Fig. 5 Photographs of the ankle and the totally extruded talus. (A) Medial view of the ankle. (B) Distal-dorsal view of the talus. (C) Plantar view of the talus.

  • Fig. 6 Postoperative radiographs after reimplantation of the talus and subtalar fusion with pin and screws.

  • Fig. 7 Radiographs of the ankle 7 months after injury, showing osteolysis of the distal tibia and loosening of the screws.

  • Fig. 8 Radiographs of the ankle 3 years after injury, showing solid fusion.


Reference

1. Assal M, Stern R. Total extrusion of the talus: a case report. J Bone Joint Surg Am. 2004; 86(12):2726–2731.
2. Brewster NT, Maffulli N. Reimplantation of the totally extruded talus. J Orthop Trauma. 1997; 11(1):42–45.
3. Detenbeck LC, Kelly PJ. Total dislocation of the talus. J Bone Joint Surg Am. 1969; 51(2):283–288.
4. Hiraizumi Y, Hara T, Takahashi M, Mayehiyo S. Open total dislocation of the talus with extrusion (missing talus): report of two cases. Foot Ankle. 1992; 13(8):473–477.
5. Jaffe KA, Conlan TK, Sardis L, Meyer RD. Traumatic talectomy without fracture: four case reports and review of the literature. Foot Ankle Int. 1995; 16(9):583–587.
6. Montoli C, De Pietri M, Barbieri S, D'Angelo F. Total extrusion of the talus: a case report. J Foot Ankle Surg. 2004; 43(5):321–326.
7. Palomo-Traver JM, Cruz-Renovell E, Granell-Beltran V, Monzonis-Garcia J. Open total talus dislocation: case report and review of the literature. J Orthop Trauma. 1997; 11(1):45–49.
8. Ries M, Healy WA Jr. Total dislocation of the talus: case report with a 13-year follow up and review of the literature. Orthop Rev. 1988; 17(1):76–80.
9. Smith CS, Nork SE, Sangeorzan BJ. The extruded talus: results of reimplantation. J Bone Joint Surg Am. 2006; 88(11):2418–2424.
10. Maffulli N, Francobandiera C, Lepore L, Cifarelli V. Total dislocation of the talus. J Foot Surg. 1989; 28(3):208–212.
Full Text Links
  • CIOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr