• Chopart
• Complications
• Dislocation
• Fracture
• Navicular
• Tarsal fracture

• Humans
• Tarsal Bones/injuries
• Tarsal Bones/surgery
• Fractures, Bone/complications
• Fractures, Bone/surgery
• Fracture Fixation, Internal/methods
• Fractures, Ununited/etiology
• Foot Injuries/complications
• Foot Injuries/surgery
• Postoperative Complications

• clinical presentation
• outcomes
• pantalar dislocation
• talar dislocation
• talar injury

• Ankle dislocation
• Subtalar dislocation
• Talar extrusion

• Humans
• Joint Dislocations/diagnostic imaging
• Ankle Injuries/diagnostic imaging
• Subtalar Joint/diagnostic imaging
• Subtalar Joint/injuries
• Tomography, X-Ray Computed

• Body
• Fracture
• Neck
• Talus
• Trauma

• Humans
• Fracture Fixation, Internal/methods
• Fractures, Bone/surgery
• Fractures, Bone/diagnostic imaging
• Osteonecrosis/etiology
• Osteonecrosis/surgery
• Osteonecrosis/diagnostic imaging
• Talus/injuries
• Talus/surgery

• Avascular necrosis
• Ilizarov method
• Talar extrusion
• Tibiocalcaneal fusion

• open talus fracture
• talus avascular necrosis
• talus extrusion
• talus fixation
• talus fracture dislocation

• Male
• Adolescent
• Humans
• Amputation, Surgical
• Talus/diagnostic imaging
• Talus/surgery
• Plastic Surgery Procedures
• Limb Salvage

The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection.

Four patients were included in the study from January 2011 to December 2017. In the first stage, all four patients underwent debridement of the ankle, total or partial excision of the talus, and antibiotic-loaded bone cement spacer (ALBC) placement in the ankle joint. The second stage of the arthrodesis procedure was initiated six to eight weeks after the primary procedure, where these patients underwent arthrodesis with hindfoot nail and bone blocks from the iliac crest.

All patients were followed-up for an average of 17.6 months (range 12.0 – 32.0 months). The arthrodesis site had united in all these four patients. The AOFAS scores were satisfactory in all patients. One patient underwent nail removal after the arthrodesis site had united.

The hind foot nail with iliac crest bone block maintains the ankle height and ensures successful arthrodesis. In patients with partial/ complete bone loss with suspicion or confirmation of infection, staging the arthrodesis procedure minimises the chance of complications.

• hind foot arthrodesis
• infection
• staged management
• talar bone loss

Total traumatic extrusion of the talus is a severe and disabling ankle injury that requires a high energy trauma. Many treatment options exist and none of them guarantee a successful result. Here, we present the case of a 67-year-old woman who experienced an open total traumatic extrusion of the talus. Based on the principles of open fracture management, we have realized an early administration of antibiotics and tetanus toxoid booster followed by an urgent debridement of the wound. Next, the talus was reimplanted and fixed with a K-wire. This allowed us to avoid the common complication and achieving good clinical outcomes. In our opinion, this is an encouraging and reasonable treatment option unless the talus is grossly contaminated or missing.

• open
• reimplantation
• talus
• total traumatic extrusion

Total talar extrusion is a rare injury that most commonly occurs secondary to high-energy trauma. There are few reported cases of open dislocations in literature and still, there is no consensus regarding the appropriate treatment of the extruded talus. In this case report, we present a 12-month follow-up of a patient with an open talar dislocation with extrusion treated with immediate surgical debridement, reduction and temporary fixation with one Steinmann pin. No infection was reported, although the patient developed avascular necrosis.

• avascular necrosis
• foot injury
• open injury
• talar dislocation

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.

• complete revascularization
• early reimplantation
• total talar extrusion

•

The Masquelet technique is suitable for emergency treatment and later reconstruction.

Subtalar dislocations are rare injuries and treatment recommendations missing. Gross contamination and devascularisation are aspects supporting talectomy as potential treatment choice. Reconstruction in these cases can be challenging. The Masquelet technique presents one viable option.

A carpenter sustained a high energy chrush injury with traumatic open lateral talar dislocation qualifying as Gustillo Anderson type IIIc injury, a mangeled extremity index of 7 and gross contamination. The severity of soft tissue damage and contamination prompted the decision for talectomy before plastic coverage with a gracilis flap. Additionally a Masquelet procedure with cement spacer was initiated.

After consolidation of the soft tissues a hindfoot arthrodesis with approximate preservation of leg length could be performed.

In the course of treatment, the patient suffered no infection and could resume full weight bearing after nine months. The patient resumed his previous occupation with adapted workload and is satisfied with the treatment result.

In the present case the principle options were talus preservation or talectomy with reconstruction. Talus preservation in the presence of gross contamination can be associated with the risk of infection, in addition there is a risk to develop secondary arthritis. For this individual patient the a fast and definite solution was important at this point in life. Surgeons therefore opted for talectomy. To optimally reconstruct leg length and optimize for arthrodesis the Masquelet technique was employed.

The Masquelet technique is a viable option also in the emergency situation to preserve extremity length and optimize tissue viability.

• Case report
• Hindfoot arthrodesis
• Masquelet technique
• Traumatic loss talus

Total talar dislocation (TTD) is very uncommon for many orthopedic surgeons and emergency/trauma specialists. Scarce cases of TTD have been reported, mainly in the form of open fracture-dislocation injury.

We report a very rare injury of closed TTD with a follow-up period of 36 mo. Initial closed reduction was not successful because of a fractured highly unstable medial malleolus displaced into the ankle mortise, blocking the relocation of the talus. The patient was able to walk pain-free after the 3^rd month of surgery. At the 36-mo follow-up, there were 10 degrees of flexion loss and 10 degrees of extension loss in the tibiotalar joint. Furthermore, 5 degrees of subtalar joint inversion-eversion loss was present.

Open reduction should be performed for closed TTDs unless closed reduction is successful.

• Total talar dislocation
• Pan-talar dislocation
• Talus
• Case report

• 3
• Gustilo-Anderson classification
• concurrent injury
• infection
• peritalar dislocation

Background and aim of work: Total traumatic extrusion of talus with interruption of all ligaments (missing talus) is a very rare injury. We represent the case of a 44-years-old male who reported total extrusion of talus and Lisfranc dislocation after a motorbike accident. This rare injury has a wide choice of treatment but usually there is not a successful functional restore. Methods: We decided to treat the patient with an immediate reimplantation of extruded talus using 3 Kirschner wires and antibiotic therapy. We performed a temporary fixation of talus with calcaneus, tibia and scaphoid. Results: Usually, this kind of injuries are treated with a tibiocalcaneal arthrodesis and show common complications such as avascular necrosis and infection. Against our expectations we managed to treat successfully our patient. Conclusions: After 5 years of follow up the patient reported good clinical outcomes without performing arthrodesis and recording major complications. (www.actabiomedica.it)

• extruded talus
• limb salvage
• tibiocalcaneal arthrodesis

• Fracture Dislocation/diagnostic imaging
• Fracture Dislocation/surgery
• Fracture Fixation, Internal/methods
• Humans
• Humeral Head/blood supply
• Humeral Head/diagnostic imaging
• Humeral Head/surgery
• Male
• Middle Aged
• Range of Motion, Articular
• Replantation
• Shoulder Fractures/diagnostic imaging
• Shoulder Fractures/surgery

• Delayed fixation
• Surgical timing
• Talus fracture

• replantation
• talus

Total extrusion and loss of the talus is a rare injury with a wide choice of appropriate treatment, but rarely resulting in a fully functional recovery. We report on an uncommon case, both for the severity of the injury and for the uncommon treatment due to the patient’s rejection of secondary surgery.

We treated a 16-year-old Caucasian man with the most extreme variant of a totally extruded and lost talus, accompanied with complex injury of the soft tissues of the ankle and foot. The treatment included urgent microvascular foot reimplantation, microvascular muscle free flap transfer, and temporary fixation. This kind of injury should typically be treated by tibiocalcaneal arthrodesis. However, this was not performed, as after the successful early stages of the treatment he strongly objected to another surgery due to his fully functional status and the successful therapeutic results of our early treatment.

The injury described in this case study would ordinarily be treated by amputation, but due to the well-executed treatment in the early stages after the injury, the outcome was satisfying. Surprisingly and against our expectations, the late results of the treatment were successful even without arthrodesis. He is now 37 years old and has a functional foot 21 years after the injury.

• injury
• medial talar dislocation
• open dislocation
• talus
• tibia
• trauma

• Dislocation
• External fixation
• Reimplantation
• Talar

• Adult
• Ankle Injuries/surgery
• Ankle Joint
• Female
• Humans
• Joint Dislocations/surgery
• Male
• Subtalar Joint
• Talus/injuries
• Talus/surgery

• External fixation
• Open talar extrusion
• Reimplantation

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.

• Arthrodesis
• Extrusion
• Missing talus
• Talus

Total talar dislocations are uncommon injuries and usually seen following high velocity injuries. Total talar dislocations (missing talus) without fractures around the ankle are extremely rare. There are no consensuses on the best treatment of such injuries. To best of our knowledge very few cases have been reported in literature. We hereby report a closed total talar dislocation in a 25 year old male without an associated fracture around ankle. He was managed with emergency closed reduction and below knee splint. At one year follow up there were no complications.

A 25 year old male presented to orthopaedic causality with injury to right ankle following a road traffic accident. Patient complained of severe pain and deformity of ankle following injury. On examination ankle was deformed and swollen. Plain radiographs of right ankle joint revealed total anterolateral dislocation of talus without any accompanying ankle fracture. CT scan with 3D reconstruction also confirmed our radiographic findings. Under spinal anaesthesia and fluoroscopic guidance closed reduction was performed. To maintain reduction a 3mm K-wire was passed from calcaneum to tibia through talus. A posterior below knee splint was applied. Patient was followed every three months till one year. At one year follow up patient had good range of motion at ankle and subtalar joint.

Total talar dislocations are very rare injuries and should be treated as impending open fractures. There is no consensus on treatment of such complex injuries as very few cases have been reported in literature.

• Malleolar fracture
• Missing talus
• Talar dislocation

• forefoot
• general disorders
• talar fractures
• toe, midfoot
• trauma

A completely extruded talus without any remaining soft tissue attachments is extremely rare. The present report describes treatment of a 45-year-old man who sustained a completely extruded talus injury following a rock-climbing fall. Upon admission, the extruded talus was deep-frozen in our bone bank. The open ankle joint underwent massive wound debridement and irrigation for 3 days. Four days later we performed a primary subtalar fusion between the extruded talus and the calcaneus, anticipating revascularization from the calcaneus. However, aseptic loosening and osteolysis developed around the screw and talus. At 12 months post-trauma we performed a tibiocalcaneal ankle fusion with a femoral head allograft to fill the talar defect. Follow-up at 24 months post-trauma showed the patient had midfoot motion, tibio-talar-calcaneal fusion, and was able partake in 4-hour physical activity twice per week.

• completely extruded talus
• osteolysis.
• primary subtalar fusion

Total extrusion of the talus with interruption of all ligaments (missing talus) is a rare injury. We describe the case of a 27-year-old man who reported total extrusion of the talus after a motorbike accident with interruption of all talar ligaments. In the first repair effort, the articular void left by the talus was filled with antibiotic cement and the wound was closed primarily. Nevertheless, the skin overlying the talar joint displayed necrosis. In order to cover the cutaneous defect, improve local vascularization, and allow reimplantation of the talus, a sural fasciocutaneous island flap was harvested. Subsequently, the original talus was placed and arthrodesis of the subtalar joint was performed. The patient was able to walk bearing full weight without support equipment after 6 months. Several therapeutic options have been suggested in such cases, including replacing the talus, tibiocalcaneal arthrodesis, and pseudoarthrodesis. The rarity and peculiarity of such cases make the establishment of generalized guidelines an arduous task, leaving the choice of treatment to the surgeon, in conformity with each case’s peculiarity. In this case use of the flap may have promoted the vascularization of the reimplanted talus, thus avoiding avascular necrosis and allowing successful reimplantation of the original talus.

Total dislocation of the talus from all of its joints is a rare injury specially when the talus and malleoli are not fractured and frequently it is as a result of a high-energy trauma. It usually leads to degenerative changes in neighboring joints and frequently avascular necrosis is a predictable outcome. We present a case of total talus dislocation because of a high-energy trauma in association with other major fractures resulting from a fall from height, but no fracture could be detected in the talus and any of malleols. Closed reduction was unsuccessful and we performed open reduction. At 6 month post operation follow-up, the talus didn't show subluxation and avascular necrosis could not be detected.

• Talus
• total dislocation
• treatment.

• Ankle Injuries/classification
• Ankle Injuries/surgery
• Calcaneus/blood supply
• Calcaneus/injuries
• Calcaneus/surgery
• Debridement
• Foot Injuries
• Fracture Fixation, Internal
• Fractures, Bone/classification
• Fractures, Bone/surgery
• Humans
• Orthopedic Procedures
• Soft Tissue Injuries/therapy
• Talus/injuries
• Therapeutic Irrigation
• Treatment Outcome

• Adult
• Female
• Fractures, Bone/etiology
• Humans
• Joint Dislocations/surgery
• Osteonecrosis
• Talus/blood supply
• Talus/injuries
• Talus/pathology