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High incidence of wound infection with salvage
5%
73/1534
Acute reimplantation of the talus is safe and can be successful
61%
931/1534
High incidence of osteonecrosis and collapse with salvage
32%
494/1534
Acute triple arthrodesis is the treatment of choice
1%
20/1534
Acute transtibial amputation is the treatment of choice
0%
4/1534
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This patient presents with an open talus fracture and complete talar extrusion. Reimplantation of the talus after wound debridement has been reported to be a safe and successful treatment option for these rare injuries. Open pantalar dislocation, or talar extrusion, is a rare complication that can been seen with high-energy talus injuries. While definitive management and reconstruction of talar extrusion is controversial, emergent irrigation and debridement of the wound and talus is indicated in this injury pattern. Although the blood supply to the talus, especially the talar neck, is tenuous, recent literature has demonstrated salvage of the extruded talus is both safe and effective. Smith et al. performed a retrospective review on 27 patients who sustained an extruded talus injury. Twelve (63%) of these patients did not require additional surgery, 7 patients (37%) required secondary surgery, and only 2 patients (10%) developed an infection. Fourteen patients developed osteonecrosis without collapse. They concluded salvage of the extruded talus is a safe, effective operation with low risk of infection. Brewster and Maffulli present two case reports of total talar extrusion treated with reimplantation after thorough irrigation and debridement. Both of these patients' tali revascularized and did not go on to collapse. The authors concluded that talus reimplantation is a viable option in the management of total talus extrusion. Figures A (clinical photo) and B (lateral radiograph) demonstrate a total talus extrusion. Incorrect Answers: Answer 1: Talus extrusion treated with emergent irrigation and debridement and appropriate antibiotics results in a low incidence of infection Answer 3: While osteonecrosis of the talus is common after this injury (~90%), most tali do not collapse Answers 4 & 5: While this patient is likely to develop post-traumatic arthritis, and may require reconstructive procedures in the future, salvage of the hindfoot should be attempted acutely.
2.5
(2)
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