Dipartimento di Scienze Medico Chirurgiche, Università degli studi di Milano; IRCCS Policlinico San Donato, Piazza Malan, 20097, San Donato Milanese, Milano, Italy.
J Orthop Traumatol. 2011 Mar;12(1):61-4. doi: 10.1007/s10195-011-0129-z. Epub 2011 Feb 25.
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.
距骨完全挤出伴有所有韧带中断（距骨缺失）是一种罕见的损伤。我们描述了一例 27 岁男性病例，该患者因摩托车事故导致距骨完全挤出，所有距骨韧带中断。在第一次修复过程中，用抗生素水泥填充距骨留下的关节间隙，并进行一期闭合伤口。然而，距骨关节上方的皮肤出现坏死。为了覆盖皮肤缺损、改善局部血运并允许距骨再植入，我们采用腓肠筋膜皮瓣进行修复。随后，将原来的距骨放置并进行距下关节融合。6 个月后，患者无需任何支撑设备即可完全负重行走。在这种情况下，已经提出了几种治疗选择，包括替代距骨、跟距关节融合和假关节融合。由于这种情况非常罕见且特殊，因此制定普遍的治疗指南是一项艰巨的任务，这使得治疗方法的选择取决于外科医生，根据每个病例的特点来决定。在这种情况下，使用皮瓣可能促进了再植入距骨的血运，从而避免了缺血性坏死，并允许成功地再植入原来的距骨。
