Open Fracture Dislocation of the Talus With Total Extrusion

Abstract

UNLABELLED: Open fractures with complete extrusion of talus are high-energy injuries. While treating these injuries, union of the fracture, vascularity of the body, and possibility of infection are main issues predicting less favorable outcomes. At present, there are no recommended treatment protocols for the management of such injuries. Early debridement, wound care, anatomic reduction, and adequate fixation are key factors in the management of compound injuries of the talus. There are few reports in the literature on successful reimplantation of talus when it is completely extruded. Encouraging functional outcomes of reimplantation of extruded talus suggest that excision of the talus with or without tibiocalcaneal fusion should be kept as a salvage procedure. We report a case of a farmer who sustained fracture of the talar neck. Both head and body fragments were completely extruded from the wound on the anterolateral aspect of the ankle. The patient was treated 18 hours postinjury. Thorough debridement of wound and bony fragments was done. Talus was reimplanted and fixation was performed with Kirschner wires. At 3-year follow-up, satisfactory functional outcome was noted with AOFAS (American Orthopaedic Foot and Ankle Society) score of 83 and MOXFQ (Manchester-Oxford Foot Questionnaire) scale score of 23. The purpose of presenting this case is to demonstrate the successful outcome of reimplantation of talus. LEVEL OF EVIDENCE: Therapeutic, Level IV: Case study.