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

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.

Traumatic Open Extrusion of the Posterior Facet of the Calcaneus: A Case Report

CASE

Traumatic extrusion of the posterior facet of the calcaneus is a rare phenomenon that has seldom been reported on. In this report, we describe a 46-year-old woman who sustained an open right calcaneal fracture with extrusion of the posterior facet after motor vehicle collision. The fragment was reinserted, then underwent definitive fixation. Postoperatively, patient went on to radiographic union and with return to work with little to no residual pain.

CONCLUSION

Reinsertion of the fragment with temporary fixation with subsequent definitive fixation is a viable option for extrusion a tarsal bone, specifically of the posterior facet of the calcaneus.

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.

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.

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.

Total Talar and Navicular Extrusions: A Case Report

CASE

A 15-year-old adolescent boy sustained both talar and navicular extrusions after a dirt-bike accident. The talus and navicular were discarded during initial debridement because of contamination. Given extensive soft-tissue injury and bone loss, the patient's family opted for transtibial amputation, as described by Ertl, over limb salvage. Simultaneous osteomyoplastic reconstruction and acute targeted muscle reinnervation were performed.

CONCLUSION

Transtibial amputation is a viable treatment option for total talar and navicular extrusions, particularly if an optimal functional outcome is unachievable with limb salvage. Simultaneous osteomyoplastic reconstruction and acute targeted muscle reinnervation can potentially decrease neuroma formation and phantom limb pain.

Outcomes of a Reimplanted Talus After a Total Open Extrusion

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.

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.

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.