Management of exposed talar body fracture-dislocation with bone extrusion: A case report

Filippo  Calderazzi; Francesco  Pogliacomi; Paolo Bastia; Antonio Carolla; Cristina Galavotti; Francesco Ceccarelli

doi:10.23750/abm.2026.14774

Management of exposed talar body fracture-dislocation with bone extrusion: A case report

Authors

Filippo Calderazzi Orthopaedics and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy https://orcid.org/0000-0002-9087-5147
Francesco Pogliacomi Orthopaedics and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
Paolo Bastia Orthopaedics and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
Antonio Carolla Orthopaedics and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy https://orcid.org/0000-0002-2917-1263
Cristina Galavotti Orthopaedic and Traumatology Unit, ASST Cremona, Cremona, Italy https://orcid.org/0000-0001-9828-9882
Francesco Ceccarelli Orthopaedics and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy https://orcid.org/0000-0002-4457-0457

Keywords:

avascular necrosis, bone extrusion, foot, infection, open injury, talus

Abstract

Talus fractures are often related to high-energy trauma and are associated with exposed lesions in 20-25% of cases. Open fracture dislocations are rare but with potentially devastating consequences, often unsatisfactory outcomes and a high rate of complications. For this reason, the treatment of these injuries is very challenging.We report a case of a 24-year-old man who sustained an exposed fracture-dislocation of the ankle with subtotal extrusion of the talus. Joint stabilization and application of the external fixator were performed immediately. The bone gap was filled with hand-moulded antibiotic-treated cement due to the comminution and contamination of the extruded fragment. Twenty months after injury arthrodesis of the hindfoot was performed with autologous bone graft from the distal fibula. The finding of dehiscence and contamination in the area of the previous exposure required a surgical toilet, and targeted antibiotic therapy. The dehiscence area was covered by transposition of the fasciocutaneous flap from gastrocnemius 2 months after arthrodesis. The patient started weight-bearing 1 month later. One year after surgery, the arthrodesis healed in a good position without any signs of infection of the surrounding tissues, and the patient reported no pain with full weight bearing. Management of the exposed dislocation fractures of the talus is very complex due to the lack of guidelines; the choice of the most appropriate treatment remains controversial and the outcomes are unpredictable. Different treatments have been reported, but early wound debridement, anatomical reduction, and adequate fixation are key components for treating exposed talus lesions.

References

Santavirta S, Seitsalo S, Kiviluoto O, Myllynen P. Fractures of the talus. J Trauma 1984;24(11):986-989. doi:10.1097/00005373-198411000-00011.

Dale JD, Ha AS, Chew FS. Update on talar fracture patterns: a large level I trauma center study. AJR Am J Roentgenol 2013;201(5):1087-1092. doi:10.2214/AJR.12.9918.

Annappa R, Jhamaria N, Dinesh K, Devkant, Ramesh R, Suresh P. Functional and radiological outcomes of operative management of displaced talar neck fractures. Foot (Edinb) 2015;25:127-130. doi:10.1016/j.foot.2015.03.004.

Vallier HA. Fractures of the talus: state of the art. J Orthop Trauma 2015;29:385-392. doi:10.1097/BOT.0000000000000378.

Joshi AK, Joshi C, Singhc S, Singhd V. Traumatic loss of talus: a rare injury. Foot (Edinb) 2012;22:319-321. doi:10.1016/j.foot.2012.08.001.

Jordan RK, Bafna KR, Liu J, Ebraheim NA. Complications of talar neck fractures by Hawkins classification: a systematic review. J Foot Ankle Surg 2017;56:817-821. doi:10.1053/j.jfas.2017.04.013.

Van Opstal N, Vandeputte G. Traumatic talus extrusion: case reports and literature review. Acta Orthop Belgica 2009;75(5):699-704.

Assal M, Stern R. Total extrusion of the talus. a case report. J Bone Joint Surg Am 2004;86:2726-2731. doi:10.2106/00004623-200412000-00021.

Montoli C, De Pietri M, Barbieri S, D’Angelo F. Total extrusion of the talus: a case report. J Foot Ankle Surg 2004;43:321-326. doi:10.1053/j.jfas.2004.07.008.

Smith CS, Nork SE, Sangeorzan BJ. The extruded talus: results of reimplantation. J Bone Joint Surg Am 2006;88:2418-2424. doi:10.2106/JBJS.E.00471.

Stevens BW, Dolan CM, Anderson JG, Bukrey CD. Custom talar prosthesis after open talar extrusion in a pediatric patient. Foot Ankle Int 2007;28:933-938. doi:10.3113/FAI.2007.0933.

Koller H, Assuncao A, Kolb K, Holz U. Reconstructive surgery for complete talus extrusion using the sandwich block arthrodesis: a report of 2 cases. J Foot Ankle Surg 2007;46:493-498. doi:10.1053/j.jfas.2007.08.008.

Gulan G, Sestan B, Jotanovi´c Z, et al. Open total talar dislocation with extrusion (missing talus). Coll Antropol 2009;33:669-672. PMID: 19662796.

Memisoglu K, Hürmeydan A. Total extrusion of the talus in an adolescent: a case report. J Am Podiatr Med Assoc 2009;99:431-434. doi:10.7547/0990431.

Sutipornpalangkul W, Pornrattanamaneewong C, Sangthongsil P, Harnroongroj T. Open total talus dislocation: a case report. Siriraj Med J 2009;61:147-149.

Fleming J, Hurley KK. Total talar extrusion: a case report. J Foot Ankle Surg 2009;48(3):690.e19-23. doi:10.1053/j.jfas.2009.06.005.

Ramesh P, Avadhani A, Dheenadhayalan J, Rajasekaran S. Reimplantation of total talar extrusions. Injury Extra 2010;41:53-57. doi:10.1016/j.injury.2010.02.001.

Apostle KL, Umran T, Penner MJ. Reimplantation of a totally extruded talus: a case report. J Bone Joint Surg Am 2010;92:1661-1665. doi:10.2106/JBJS.I.00867.

Burston JL, Isenegger P, Zellweger R. Open total talus dislocation: clinical and functional outcomes: a case series. J Trauma 2010;68(6):1453-1458. doi:10.1097/TA.0b013e3181d03b73.

Choi YR, Jeong JJ, Lee HS, Kim SW, Suh JS. Completely extruded talus without soft tissue attachments. Clin Pract 2011;1(1):e12. doi:10.4081/cp.2011.e12.

Burston JL, Brankov B, Zellweger R. Reimplantation of a completely extruded talus 8 days following injury: a case report. J Foot Ankle Surg 2011;50(1):104-107. doi:10.1053/j.jfas.2010.10.009.

Vaienti L, Maggi F, Gazzola R, Lanzani E. Therapeutic management of complicated talar extrusion: literature review and case report. J Orthop Traumatol 2011;12(1):61-64. doi:10.1007/s10195-011-0129-z.

Marsh JL, Saltzman CL, Iverson M, Shapiro DS. Major open injuries of the talus. J Orthop Trauma 1995;9(5):371-376. doi:.1097/00005131-199505000-00002.

Mohindra M, Gogna P, Thora A, Tiwari A, Singla R, Mahindra P. Early reimplantation for open total talar extrusion. J Orthop Surg 2014;22(3):304-308. doi:10.1177/230949901402200307.

Palomo-Traver JM, Cruz-Renovell E, Granell-Beltran V, Monzonis-Garcia J. Open total talus dislocation: case report and review of the literature. J Orthop Trauma 1997;11(1):45-49. doi:10.1097/00005131-199701000-00014.

Hiraizumi Y, Hara T, Takahashi M, Mayehiyo S. Open total dislocation of the talus with extrusion (missing talus). Foot Ankle 1992;13(8):473-477. doi:10.1177/107110079201300808.

Hidalgo Ovejero AM, Garcia Mata S, Heras Izaguirre J, Martinez Grande M. Posteriormedial dislocation of the talus: a case report and review of the literature. Acta Orthop Belg 1991;57(1):63-67.

Detenbeck LC, Kelly PJ. Total dislocation of the talus. J Bone Joint Surg 1969;51(2):283-288.

Brewster NT, Maffulli N. Reimplantation of the totally extruded talus. J Orthop Trauma 1997;11(1):42-45. doi:10.1097/00005131-199701000-00011.

Lee J, Hamilton G. Complete talar extrusion: a case report. J Foot Ankle Surg 2009;48(3):372-375. doi:10.1053/j.jfas.2009.01.008.

T. Sanders RW, Lindvall E. Fractures and fracture-dislocations of the talus. In Coughlin MJ, Mann RA, Saltzman CL, editors. Surgery of the foot and ankle. Elsevier, 2007, p. 2074-2136