Wooly Sameer, Kumar Sachin, Mane Akash Nagnath, Kumar Jayant, Pandey Prabhat
Department of Orthopedic Surgery, Manipal Tata Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Orthopedic surgery, Tata Main Hospital, Jamshedpur, Jharkhand, India.
J Orthop Case Rep. 2024 May;14(5):50-55. doi: 10.13107/jocr.2024.v14.i05.4430.
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.
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.
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.
距骨创伤性完全开放性脱位且无软组织附着且不伴有周围骨折是一种非常罕见的损伤,需要非常高能量的撞击。在文献中,尚未确立最佳治疗方案。文献中描述的一些选择包括距骨切除术、胫跟关节融合术或距骨再植术,再植术可以是立即进行或间隔一段时间后进行。
一名28岁女性遭遇道路交通事故,发生距骨完全开放性脱位且无软组织附着,我们对伤口进行了彻底清创、生理盐水冲洗,并立即将距骨再植,用三角架外固定器进行固定。按照方案给予了适当的术前和术后抗生素覆盖。我们没有遇到术后感染、伤口并发症,并且在随访12个月时,距骨有一些缺血性坏死的迹象,但功能结果良好。
基于该病例经验,我们认为这是距骨完全脱位的有效治疗方案,它将提供更好的后足机制、足跟高度,并且患者可以尽早恢复日常活动。