Dumbre Patil Sampat Shivajirao, Abane Sachin Ramdas, Dumbre Patil Vaishali Sampat, Nande Prasanna Narendra
Orthopaedic Department, Noble Hospital (SSDP, VSDP), Hadapsar, Pune, Maharashtra, IndiaAbane Accident Hospital (SRA), Hadapsar, Pune, Maharashtra, IndiaNande Accident Hospital, Gadital (PN), Hadapsar, Pune, Maharashtra, India
Orthopaedic Department, Noble Hospital (SSDP, VSDP), Hadapsar, Pune, Maharashtra, IndiaAbane Accident Hospital (SRA), Hadapsar, Pune, Maharashtra, IndiaNande Accident Hospital, Gadital (PN), Hadapsar, Pune, Maharashtra, India.
Foot Ankle Spec. 2014 Oct;7(5):427-31. doi: 10.1177/1938640014528040. Epub 2014 Mar 30.
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.
Therapeutic, Level IV: Case study.
距骨完全脱出的开放性骨折属于高能损伤。在治疗这些损伤时，骨折愈合、身体的血运以及感染可能性是预测预后较差的主要问题。目前，对于此类损伤的处理尚无推荐的治疗方案。早期清创、伤口护理、解剖复位和充分固定是距骨复合伤处理的关键因素。文献中关于距骨完全脱出后成功再植的报道很少。距骨再植取得的令人鼓舞的功能结果表明，无论有无胫跟融合，距骨切除都应作为一种挽救性手术保留。我们报告一例农民发生距骨颈骨折的病例。头部和体部骨折块均从踝关节前外侧伤口完全脱出。患者在受伤18小时后接受治疗。对伤口和骨碎片进行了彻底清创。将距骨再植并用克氏针固定。在3年随访时，美国矫形足踝协会（AOFAS）评分为83分，曼彻斯特-牛津足部问卷（MOXFQ）量表评分为23分，功能结果令人满意。展示该病例的目的是证明距骨再植的成功结果。
治疗性，IV级：病例研究。
