[Open talar dislocation].

PURPOSE OF THE STUDY: Total talar extrusion is a rare injury. It is frequently associated with severe soft tissue injury. There is no consensus about an appropriate treatment for an extruded talus. Total extrusion of the talus has a high possibility of avascular necrosis of the talus or infection. The primary goal of this study is a retrospective evaluation of the patients with open total talar dislocation treated by immediate reimplantation.

MATERIALS AND METHODS: We evaluated six patients (mean age, 29.6 years) with an open total talar dislocation treated in the Traumatological Hospital Brno. The dislocated talus, after debridement, was reduced, held in the correct position by Kirschner wires and spanned by external fixation, with two pins placed in the calcaneus and two in the distal tibia. The patients were evaluated on the basis of clinical and radiographic examination. Two patients underwent secondary reconstruction procedures. The four remaining patients were evaluated using the AOFAS score.

RESULTS: The mean follow-up period was 24.2 months (range, 18-32). Two patients had an infection and one developed avascular necrosis of the talus. One patient required arthrodesis of the subtalar joint and one talectomy with tibiocalcaneal arthrodesis and callus distraction of the tibia.

CONCLUSIONS: A primary reimplantation of the talus can produce good functional outcome. It is reasonable to replace an extruded talus as soon as possible after debridement. Infection and avascular necrosis of the talus seem to be difficult to predict.