From Midwestern University, Olympia Fields, IL (Dr. Huang and Dr. Lundgren), and the John H. Stroger Hospital of Cook County, Chicago, IL (Dr. Garapati).
J Am Acad Orthop Surg. 2018 Aug 1;26(15):e324-e328. doi: 10.5435/JAAOS-D-16-00748.
Complete talar extrusion is rare and usually associated with a high-energy mechanism of injury causing complete dissociation of the talus from the surrounding bony and soft-tissue structures with enough force to expel the talus out of the body. Treatment can be complicated by infection, osteonecrosis, posttraumatic osteoarthritis, and leg length discrepancy, which may require multiple subsequent surgeries for improved outcome and quality of life. Reimplantation of the native talus affords maintenance of joint height and favorable outcomes have been reported. Failed reimplantations have been successfully managed with arthrodesis with or without a bone allograft. We report a case of talar extrusion initially treated with a talus-shaped impregnated antibiotic spacer, followed by femoral head allograft and tibiocalcaneal fusion. This treatment resulted in radiographic evidence of bony fusion at 12 weeks without subsequent infection and good clinical outcome at 2-year follow-up.
距骨完全挤出非常罕见，通常与高能损伤机制有关，这种损伤机制导致距骨与周围的骨和软组织结构完全分离，产生足以将距骨挤出体外的力量。治疗可能会因感染、骨坏死、创伤后骨关节炎和肢体长度差异而变得复杂，这可能需要多次后续手术以改善预后和生活质量。原位距骨再植入可维持关节高度，已有报道称可获得良好的结果。对于再植入失败的病例，采用或不采用同种异体骨的关节融合术成功进行了治疗。我们报告了 1 例距骨挤出的病例，最初采用距骨形状的抗生素浸渍 spacer 治疗，随后采用股骨头同种异体骨和距跟骨融合术。这种治疗在 12 周时显示出影像学证据表明有骨融合，没有随后的感染，并且在 2 年随访时临床结果良好。
