A systematic review of total dislocation of the talus

Pantalar Intact Dislocation: A Systematic Review

BACKGROUND

This scoping review analyzes the available literature on pure total talar dislocation, focusing on its epidemiology, clinical presentation, imaging techniques, surgical options, rehabilitation protocols, and complications.

METHODS

Following the PRISMA-ScR guidelines, a comprehensive search was conducted across the PubMed, Web of Science, and Scopus databases. The search yielded 185 articles, of which 30 satisfied the inclusion criteria and focused on pure total talar dislocation without fractures. Data from each study were extracted, including patient demographics, injury characteristics, treatment methods, and outcomes.

RESULTS

The studies included case reports, case series, and reviews. Despite the heterogeneity of the studies, the key findings suggest that early reduction, careful wound management, and soft tissue preservation are crucial in minimizing complications such as avascular necrosis (AVN), post-traumatic arthritis, and infection. The long-term outcomes varied, and the risk of AVN remained high, particularly in cases with compromised blood supply to the talus.

CONCLUSIONS

Pure total talar dislocation is a rare and challenging condition with no established management protocol. While talar reimplantation and joint fixation offer promising outcomes in preserving function, the risk of complications, particularly AVN, remains significant. Additional research is necessary to standardize treatment protocols and improve clinical outcomes for this rare but severe injury.

Early Reduction of an Open Extruded Talus: Case Report

Talar dislocation is an infrequent lesion, with variable outcomes reported in case reports and case series. Its epidemiology has not been elucidated to date, as this lesion is described in different ways: complete talar extrusion, closed or open dislocation, open dislocation with associated talar fracture, or open dislocation with malleolar fracture. Such classifications limit the possibility of evaluating this condition as a single pathology. There is also no consensus on which is the best treatment for this lesion. Many different treatment techniques have been described, including reimplantation with and without external fixation, early osteosynthesis, and even early talectomy and tibiocalcaneal pseudoartrhodesis. The outcomes of this type of injury can be as varied as the treatment options. The complications observed in the first year after the injury can be infection, avascular necrosis (AVN) and early posttraumatic osteoarthritis. The present paper reports adequate functional and radiological outcomes after one year of early reduction of a complete talar extrusion with osteosynthesis of a medial malleolar fracture.

Total Talus Allograft Transplantation With Subtalar Arthrodesis for Missing Talus: A Report of a Rare Case

Post-traumatic missing talus is a rare and severe injury that often results in poor functional outcomes, with no consensus on the optimal treatment approach as strategies vary based on injury severity. We present the case of a 44-year-old male who sustained a missing talus following a high-energy motorcycle accident. After initial wound management and application of an external fixator, the patient underwent size-matched, fresh-frozen talus allograft transplantation combined with subtalar fusion. Postoperative radiography and CT confirmed successful transplantation with solid subtalar fusion, although progressive osteonecrosis was noted in the medial shoulder region of the talus. At the two-year follow-up, the patient exhibited limited ankle and hindfoot motion but was able to bear weight and walk without assistance, reporting no pain in his feet and achieving a final American Orthopaedic Foot & Ankle Society hindfoot score of 72. This case underscores the potential of total talar allograft transplantation with subtalar arthrodesis in treating severe talar bone loss or missing talus, although long-term follow-up is necessary to assess the clinical implications of medial talar collapse and the possible need for revision surgery.

Rearfoot and Ankle Dislocations

Subtalar dislocations, ankle dislocations, and total talar dislocations are high-energy injuries. As such, there may be associated osseous or soft tissue injuries that can be diagnosed with advanced imaging such as computed tomography (CT) or MRI. With closed injuries, closed reduction may require sedation or general anesthesia, flexion of the knee to release the tension of the gastrocnemius-soleus complex, distraction is applied, the deformity is accentuated, then the deformity is corrected. Open injuries are usually associated with a higher level of energy and a higher rate of infection. It is important to thoroughly irrigate and debride open dislocations both before and after reduction.

Total Closed Talar Dislocation without Ankle Fracture: A Case Report

We report a case of a 61-year-old female who presented to the emergency room after a fall from stairs. A total closed talar dislocation without talus or ankle fracture was diagnosed. The treating surgeon indicated an open reduction after an unsuccessful attempt at closed reduction. After six months of follow-up, the patient reported mild pain and partial weight-bearing with no discomfort; however, signs of talar avascular necrosis were present on magnetic resonance images and CT scans.

Early Reimplantation of Open Total Extruded Talus: A Case Report

Introduction

Traumatic open total extrusion of talus without soft-tissue attachment and not associated with surrounding fracture is a very rare injury which requires very high energy impact. In literature, optimal treatment protocols are yet to be established. A few options described in literature are talectomy and tibiocalcaneal arthrodesis or reimplantation of talus which may be immediate or after some interval.

Case Report

A 28-year-old female suffered road traffic accident and had total open extrusion of talus without soft-tissue attachment, and we managed it with thorough debridement of the wound, saline irrigation, and immediate reimplantation of the talus with stabilization by delta frame external fixator. Proper pre- and post-operative antibiotic coverage was given as per protocol. We did not face post-operative infection, wound complication, and until 12 months followed up, there are some signs of avascular necrosis of the talus but the good functional outcome.

Conclusion

With this case experience, we suggest that this is the valid treatment protocol for total extrusion of the talus, and it will provide a better hindfoot mechanism, heel height, and the patient can resume his/her daily routine activity as early as possible.

Extruded Fracture Dislocation of Talus, A Rare and Devastating Injury. A Series of Five Cases

Introduction

Extrusion of the talus with fracture dislocation is a very rare and devastating ankle injury usually caused by high-energy impact. There is no common consensus on the management for this type of injury. We intend to report on our experiences with its management and outcomes.

Case Report

We received a total of five cases of extruded fracture dislocation of the talus between March 2016 and April 2020. All fracture talus was Hawkins Type IV fracture. All five patients were male with an age range between 18 and 54 years and have sustained an injury in road traffic accidents. They were managed with wound debridement, talar preservation open reduction, and internal fixation with an application of an external fixator for wound care. All were followed up for 2 years.

Conclusion

Extruded fracture dislocation of the talus is a rare and devastating ankle injury. Its management is time-dependent and involves meticulous planning for a favorable outcome.

Extruded talus injuries are associated with significant complications: A double center series with minimum 1-year follow up

BACKGROUND

Extruded talus (ET) injuries are rare, but high-energy open pantalar dislocations. Literature on these injuries is sparse and optimal treatment protocols are ill defined. The current study documents the clinical and radiological outcomes in cases seen at 2 centers, in an attempt to determine whether surgeons should choose primary reimplantation or primary talectomy and fusion for these injuries.

METHODS

Patients with ET injuries were identified from the database of two hospitals. Baseline demographics and treatment details were evaluated, and patients were called for follow-up. Radiological evaluation was conducted, and function was evaluated by the AOFAS hindfoot score. Outcomes and complications were compared between patients who had undergone primary talectomy versus primary reimplantation. Predictors of poor functional outcomes were determined.

RESULTS

Of 23 patients seen by us, 15 were available for follow-up at 45.7 ± 22.2 months. Of these 19 had undergone reimplantation and 4 had talectomy with tibio-calcaneal arthrodesis. The mean percentage AOFAS score was 66.2 ± 14.6 at follow up. AVN was noted in 5, ankle arthrosis in 10, subtalar arthrosis in 4 and infection in 4 cases; no patient needed salvage arthrodesis during this time. There was no difference in baseline demographics, range of motion, AOFAS scores or complication rates between patients undergoing primary reimplantation versus primary talectomy. The number of complications per patient showed a negative, moderate correlation with the AOFAS score (Pearson's correlation coefficient 0.6, P value = 0.02).

CONCLUSION

Despite best treatment, ET injuries result in significant impairment of functional outcomes and complications. Within the numbers available, no difference in outcomes or complication rates was noted between primary reimplantation or talectomy. However, we recommend reimplantation as the treatment of first choice as this offers the chance to salvage the ankle joint and preserves bone stock for future fusion or arthroplasty.

Total Talar Prosthesis, Learning from Experience, Two Reports of Total Talar Prosthesis after Talar Extrusion and Literature Review

Recently, total talar prosthesis has been proposed to substitute the talus during the management of complex talar lesions such as talar extrusion, comminuted talar fractures, or avascular necrosis. Herein, we report two cases of talar extrusion treated with total talar replacement after a high-intensity trauma. Both cases subsequently required revision surgery due to degenerative changes of the tibial plafond (arthrodesis in the first case, conversion to a total ankle prosthesis in the latter). We report and analyze the literature concerning total talar replacement to discuss strategies that could help improve prosthesis survival and reduce the incidence of osteoarthritis.

Post-traumatic missing talus: Staged allograft interposition and fusion. Should we fuse the "talo-navicular" joint?

Complete talar dislocation-extrusion is an uncommon sequela of high-energy trauma. When the talus is unavailable for reimplantation, a staged treatment plan with the use (a) of an antibiotic cement spacer, followed by (b) tibiotalocalcaneal fusion with bone allograft interposition, may ensure a good clinical outcome.

The stability of total talar prosthesis-How stable to dislocation? Cadaveric study

The aim of this study was to characterize ankle stability of total talar prosthesis (TTP) and to determine the effect of implant sizes on stability as well as the resistance to TTP dislocation. Twelve below-knee cadaveric specimens were divided into two groups. Group 1 received a size matched implant and Group 2 received downsized implant by 5%. The stability assessment under fluoroscopy was performed for each cadaver in its native state. Following TTP insertion process, each then underwent evaluation of the TTP ankle stability. The stability of pre- and post-TTP was compared. (1) Anterior drawer distance. (2) Talar tilt angle under varus and valgus stress. (3) Subtalar tilt angle under varus stress was measured. Finally, the dislocation test was performed using the aforementioned testing conditions, then the stress force was slowly increased from 0 to 350 N, during which time it was observed on fluoroscopy all the time. Compared to pre TTP ankles, varus and anterior drawer stress showed significant instability (p < 0.001-0.031). Only anterior drawer stress in smaller sized implants showed significant instability when compared to identical sized implants (p = 0.008). No dislocation was seen under varus, valgus, and subtalar stress. However, anterior dislocation was observed in all cases of smaller size implant group (p = 0.045). TTP implant was stable under valgus and subtalar stress. However, clinicians should pay attention to anterior instability. Notably, downsized implants should be considered carefully to minimize the chance of anterior dislocation.

Pantalar dislocation: a rare presentation with review of treatment methods

Pantalar dislocation means the simultaneous dislocation of the talocalcaneal, talonavicular, and tibiotalar joint. It is a rare injury comprising only 3.4% of major talar injuries. Treatment of closed Pantalar dislocation is controversial. However, the aim should be to attain a stable anatomic reduction of the Talus in the ankle joint. To prevent further damage to the skin and neurovascular structures, closed reduction of these dislocations should be performed as soon as possible. We report a case of Pantalar dislocation where we tried to reduce the talus both by closed and open methods but it was not possible to reduce the dislocation until the talonavicular joint was reduced first. Intending to improve the clinical knowledge of Pantalar dislocation, we want to convey our clinical experience and results from this rare dislocation.

Lateral Subtalar Dislocation Associated with Cuboid Fracture. Prompt Diagnosis and Initial Management of This Rare Orthopaedic Manifestation at the Emergency Department

Introduction

Subtalar dislocations are rare injuries, representing around 1% of all dislocations. Defined as talonavicular and talocalcaneal separation, occurs in medial, lateral, anterior, or posterior direction. They are more common in young men, usually as a result of high energy trauma and are associated with posttraumatic arthritis, especially when accompanied with peritalar fracture (a cuboid fracture in this case), so prompt recognition is necessary in order all these complications to be avoided.

Case Presentation

This study presents a rare case of subtalar dislocation associated with cuboid fracture in a young male adult as a result of a Motor Vehicle Accident (MVA) as treated in the Accident & Emergency (A&E) Department, and discuss the diagnostic protocols, the reduction technique and the initial management as performed. A 21-year-old man was transferred to the Emergency Department of our hospital after a MVA (driver of a motorbike). After the initial management of the patient according to the ATLS, deformity on the foot was observed and a lateral subtalar dislocation was suspected. Prompt closed reduction achieved, avoiding skin complications. The limb was immobilized in a bellow knee splint and plain radiographs confirmed the reduction. A CT scan was performed to evaluate entrapped intraarticular fragments or associated fractures and the patient was referred to the Orthopaedic department for final treatment.

Conclusion

Emergency and Trauma teams should be aware of these rare injuries during the initial management of a patient particularly a poly-trauma one. Delayed diagnosis or misdiagnosis are common especially when more serious and life-threatening injuries are present in the same patient. Proper initial assessment of the patient and high incidence of suspicious is the key for an early diagnosis. When the suspected dislocation is confirmed, closed reduction, post reduction evaluation and immobilization is important to reduce complications as skin necrosis, neurovascular injuries, or post traumatic arthritis.

Closed Pantalar Dislocation With Checkrein Deformity: A Unique Case Report and Literature Review

Closed pantalar dislocations are a rare variant of an uncommon injury. Pantalar dislocations are typically caused by high-energy trauma resulting in an open injury with associated fracture of the articulating bones. Given its obscurity, the literature on closed pantalar dislocations is scarce, and no standard treatment protocol has been accepted. This case report chronicles the treatment and outcome of a 29-year-old man who presented with a checkrein deformity of all digits after a closed pantalar dislocation with 6-month follow-up. A comprehensive literature review found 28 articles representing 39 patients with closed pantalar dislocations without talar neck or body fractures. Roughly equal numbers of closed and open reduction techniques were performed with avascular necrosis occurring in 7 of 36 patients. Although outcome measures and follow-up were variable, what can be considered a suitable outcome was seen in approximately 83% of patients, with only 3 of 35 requiring a secondary operation. Long-term studies with well-defined outcome measures are needed to adequately predict the prognosis of this rare injury and efficacy of treatment protocols.

Closed total talar dislocation without fracture in a rare college athlete case

Total talar dislocation without a fracture is an extremely rare injury. It is often the result of high-energy trauma, such as that incurred after a fall, or owing to motor or vehicular accidents. Talar dislocations have poor outcomes owing to the frequent complications of infection, avascular necrosis and osteoarthritis attributed to open dislocations.

We report herein a closed total talar dislocation without a fracture in a college athlete who was injured during sports activities. Specifically, a 20-year-old man was injured during a soccer game this led to a closed total talar dislocation. We performed closed reduction with image guidance subject to a popliteal sciatic nerve block, and placed a plaster cast below the knee. Radiographic studies after reduction revealed no associated fractures. After an eight week no-weight bearing period, we confirmed that there were no avascular necrosis signs on magnetic resonance images. Based on these findings, partial weight bearing was allowed. At 18 months post trauma, the athlete continues to play soccer despite the fact that he experiences a slight pain and limited range of motion. The blood supply to the talus is limited, and trauma, such as dislocation, can easily injure the blood supply, thus resulting in complications, such as avascular necrosis. The talus vascularity of the presented case was maintained by superior branches. We think that it is important to a) perform closed reduction early on, b) avoid any type of surgical operation that damages the limited talus blood supply, and c) allow weight bearing after the lack of avascular necrosis signs is confirmed. Although there is no standardized treatment, the talar dislocation treatment should be chosen to preserve the blood supply to the talus as much as possible.

Closed posteromedial total talus and fibula dislocation without fracture

Total dislocation of talus is an extremely rare injury. It can be found few reports about dislocations in distal tibiofibular joint without accompanying fibular or medial malleolus fracture. In this case we report about a young patient with high energy trauma who presents a close total talar posteromedial dislocation associated with a fibula posteromedial dislocation. We perform an open reduction temporarily fixed with K wires and finally with 2 trans-syndesmotic screws.

Talar Dislocation: Is Reimplantation a Safe Procedure?

Total or complete dislocation of the talus is a triple dislocation of the tibiotalar, talocalcaneal, and talonavicular joints. It is a rare injury and is considered to be 1 of the most disabling ankle injuries. In light of the literature, there is a lack of consensus on their surgical treatment. The primary objective of this retrospective case series was to assess the long-term clinical and radiological outcomes of 5 patients who underwent talar reimplantation for total talar dislocation. From 2005 to 2011, 5 patients were admitted in emergency care unit with a total talar dislocation. The talar dislocation was surgically reduced and stabilized by a temporary internal fixation. Patients were reviewed with a mean follow-up of 60 months (48-70 months). Clinical and radiological evaluations were performed at the last follow-up. Despite 3 opened-dislocation (60%), none had infection. Three patients obtained subnormal biomechanical function with an American Orthopedic Foot and Ankle Score of 60 to 70/100. Two others patients (40%) underwent a secondary ankle arthrodesis because of avascular necrosis of the talus. Signs of necrosis appeared at 15 months and 24 months. Talar reimplantation should be attempted despite the risk of avascular necrosis: restoration of the talus in the ankle maintains normal hindfoot anatomy and preserves bone stock for future function or a subsequent surgical procedure. Patients should be informed of the risk of secondary surgery. Opened-dislocation seems to be a major risk factor of avascular necrosis, and surgeon must take care to keep soft tissues attached.

Metallic 3D Printed Total Talus Replacement: A Case Study

Total talar replacement is a viable treatment option for talar injuries and pathologies. We present a single case study of a 73-year-old female with idiopathic necrosis of the talar which was treated with a total talar replacement prosthesis. A patient specific custom talar prosthesis was created using the mirror image of the contralateral healthy talus obtained using a CT scan of the contralateral limb. The patient underwent surgical resection of the pathologic talus with implantation of the custom talar prosthesis. At the 12 month mark the foot function index (FFI) score improved from 95.9% pre-op to 4.7% post op and american orthopedic foot and ankle score 0 pre-op to 94 post op. Further research and longer followup will be needed, but the current results are very favorable.

Total Talus Replacement: Case Series and Literature Review

Custom 3D printed total talus implants have been used successfully as a functional alternative to arthrodesis or amputation in cases of severe talar destruction or loss. However, the ideal material and construct still remains to be elucidated. Current models have been made from aluminum ceramic, cobalt chrome, stainless steel, titanium, or metal combinations. The implants may be constrained (subtalar arthrodesis) or unconstrained (press fit within mortise). They may also be combined with a tibial prosthesis or used in isolation. The majority of currently published case studies examine unconstrained and isolated implants. This case study presents satisfactory 1-y outcomes in 3 cobalt chrome constrained total talar implants used in combination with a tibial prosthesis, and a literature review of total talus replacements.

Sixteen-Year Follow-up of Talar Body Prosthesis and Total Ankle Arthroplasty After Traumatic Talar Extrusion: A Case Report

CASE

We report a case of an extruded talus treated with an agility custom talar body prosthesis with total ankle arthroplasty 2 years after the injury. At the 16-year follow-up, the patient has performed remarkably well. At postoperative year 15, she required 1 additional surgery in which the polyethene was exchanged and the medial and lateral gutters were debrided.

CONCLUSION

Talar body prothesis with total ankle arthroplasty may be a viable option for extrusion of the talus.

Treatment of closed subtalar joint dislocation: A case report and literature review

Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations, commonly caused by high-energy mechanisms, which include falls from height, motor vehicle crashes, and twisting leg injuries. The dislocations are divided into medial, lateral, anterior, and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus. The most common type is medial dislocation resulted from inversion injury. Subtalar dislocation may accompany with other fractures. Physical examination must be performed carefully to assess for neurovascular compromise. Most of the subtalar dislocations can be treated with closed reduction under sedation. If this is not possible, open reduction without further delay should be conducted. After primary treatment, X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures. We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football. The patient was successfully treated by closed reduction, and a good alignment was observed at the last follow-up. The pathogenesis and treatment method of this case were analyzed, and the related literature were reviewed, which provided a reference for future clinical treatment.

A Case Report of an Open Pan-Talar Dislocation

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.

Primary Triple Arthrodesis Equivalent for Complete Extruded Missing Talus with Associated Midfoot Instability: A Case Report

CASE

Complete extrusion of the talus is rare and associated with high rates of complications including infection, osteonecrosis, persistent pain and stiffness, and post-traumatic arthritis. Less well described is associated midfoot instability. We report a case of a complete extruded missing talus that resulted in significant midfoot instability treated with a modified triple arthrodesis of the tibiocalcaneal, tibionavicular, and calcaneocuboid joints.

CONCLUSIONS

This approach resulted in a radiographic fusion at 3 months without complication, acceptable subjective and Patient-Reported Outcome Measurement System (PROMIS) scores at the 18-month follow-up, and presents a viable treatment strategy in the case of a complete extruded missing talus.

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

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.

Simultaneous Pantalar Dislocation and Bimalleolar Ankle Fracture

A 17-year-old boy presented with a totally dislocated talus and open bimalleolar ankle fracture dislocation. After thorough debridement and irrigation, the talus and bimalleolar fracture were reduced and fixed. At 21 months after surgery, he could walk using regular shoes without any aid but with moderate pain in the sinus tarsi during activities. No evidence of osteonecrosis or infection was seen in the last radiograph, except for a small degree of narrowing in the talonavicular joint. Reimplantation and fixation of pantalar dislocation seems to have an acceptable outcome.

The Masquelet technique in traumatic loss of the talus after open lateral subtalar dislocation-A case report

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

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The Masquelet technique is an option even in presence of contamination and vascular impairment.

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In case of traumatic bone loss, the Masquelet technique can preserve leg length not only in long-bone defects.

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For grafting procedures the Masquelet technique can improve the viability at the recipient site.

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The biologic activity of the Masquelet membrane facilitate union at challenging graft-sites.

Introduction

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.

Presentation of case

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.

Discussion

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.

Conclusion

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

Open reduction of a total talar dislocation: A case report and review of the literature

BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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

Open Talus Fractures: Early Infection and Its Epidemiological Characteristics

Open talus fractures are relatively rare and severe open injuries with a high risk of severe infection. To better understand the epidemiological characteristics of this kind of injury, a monocentric case review was conducted among open talus fracture patients admitted in West China Hospital of Sichuan University between January 2010 and December 2014. Fifty-one (N = 51) patients were recruited to the study, including 44 (86.3%) males and 7 (13.7%) females. Fifty-two cases of open talus fractures were diagnosed among the patients (1 patient had bilateral fractures). The primary cause of open talus fracture was a fall from a height. The rate of concurrent injuries associated with open talus fracture was 84.3%. The overall infection rate was 41.2%, rising with the increase of injury severity classified by Gustilo-Anderson classification and the existence of peritalar dislocation. Therefore, it can be concluded that open talus fractures are at high risk of concurrent complications and early infection. It is necessary to perform a complete physical examination to search for possible concurrent injuries. When evaluating the risk of infection, in addition to the severity of open talus fracture, the existence and severity of peritalar dislocation should also be taken into consideration.

Primary Arthrodesis in Severely Comminuted Fractures

At present there is controversy regarding the appropriate treatment of severely comminuted fractures of the lower extremity. Even with near-perfect anatomic reduction of severely comminuted fractures, development of posttraumatic arthritis is still present at an increased rate. Primary fusion of comminuted fractures of the foot and ankle creates successful and predictable outcomes, which dismisses the chance of developing posttraumatic arthritis and decreases complications and the need for revisional procedures.

Six-year survival of reimplanted talus after isolated total talar extrusion: a case report

Background

Open total extrusion of the talus without concomitant fracture is an extremely rare injury. We present 6-year follow-up data of a patient treated using a temporary spanning external fixator and less invasive single K-wire fixation.

Case presentation

A 55-year-old Asian man who had a totally extruded talus without fracture underwent immediate reimplantation surgery. A spanning external fixator with single antegrade K-wire fixation was applied to maintain the reimplanted talus. During 6 years of follow-up, he could walk without aids and could squat, corresponding to an American Orthopaedic Foot and Ankle Society score of 85. We found that the suspect lesion that was evident at 6 months after surgery had disappeared at 12 months postoperatively on the basis of sequential follow-up magnetic resonance imaging. There was no evidence of osteonecrosis of the dislocated talus at the final follow-up.

Conclusions

In patients with a totally extruded talus, a surgical strategy including immediate reimplantation of the talus and a temporary spanning fixator with single K-wire fixation might be useful to allow early mobilization around the ankle joint and to prevent additional damage of the foot without significant complications.

Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)

Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English language articles published in the last 12 years that addressed the acute assessment, management or prognosis in the ED were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1242 articles, of which 71 were included in the review (n = 22 primary articles, n = 35 systematic reviews and n = 14 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the ankle and foot in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. Following a thorough history and physical examination, including the application of the Ottawa ankle rules, ED clinicians should not only provide a diagnosis, but rate the severity of soft tissue injuries, or stability of fractures and dislocations, which are the pivotal decision points in guiding ED treatment, specialist referral and the follow-up plan.

Total Talar Prosthesis Replacement after Talar Extrusion

Dislocation of the talus is a serious and extremely rare injury, with 86 cases reported in the published data in 20 years. The reference standard for case management involves replacement of the dislocated talus to restore the height and function of the tibiotalar joint. The risk of avascular necrosis remains very high, and the standard treatment in such cases is tibiotalar arthrodesis. We report the case of total dislocation of the talus, which was treated with the insertion of a custom total talar prosthesis affixed directly to the tibial cartilage at 6 months after injury. At the 2-year follow-up point, the preliminary results were rather encouraging, with well-functioning activity and an improved American Orthopaedic Foot and Ankle Society foot function scale score increasing from 11 to 77 of 100 and a Short-Form 36-item Health Survey score increasing from 17 to 82. Much longer follow-up periods are necessary to evaluate longer term trends.

Extruded talus treated with reimplantation and primary tibiotalocalcaneal arthrodesis

Extruded talus is a rare serious result from a high-energy injury to a supinated and plantar flexed foot. Treatment remains controversial with a lack of congruent evidence for talar reimplantation. A 34-year-old woman was involved in a road traffic accident at 40 mph. Imaging revealed a left talus extruded anterolaterally with a talar neck fracture. Additional injuries included right acetabular fracture, transverse process fractures and rib fractures, which were treated conservatively. The talus was reimplanted and the talar neck fixed with a cortical screw. A hindfoot nail was used to fuse the calcaneus, talus and tibia. Follow-up at two years showed solid tibiotalocalcaneal fusion, with no evidence of avascular development, and the patient was fully weight bearing without pain. We believe this is the first published case of successful primary tibiotalocalcaneal fusion for extruded talus injuries.

Recent Advances in Foot and Ankle Surgery in Mainland China: Correction of Severe Foot and Ankle Deformities

Foot and ankle physicians in China encounter quite a large amount of severe and complex deformities. The main cause of severe ankle and foot deformity is trauma, while the other causes may be neuromuscular diseases, improper reduction and fixation and so on. Staged procedure may sometimes be a safer way to correct deformities in the presence of severe soft tissue contracture. Periarticular osteotomy combined with soft tissue balancing can be used in treating severe varus ankle arthritis, including stage IIIb cases and patients with talar tilt of more than 10 degrees.