The extruded talus: results of reimplantation.
BACKGROUND
There is considerable debate regarding the appropriate treatment of the extruded talus regardless of the presence of a fracture. The purpose of this study was to report the clinical results, complications, and functional outcome following reimplantation of the traumatically extruded talus.


METHODS
A database of 119 patients with an open injury of the talus occurring between 1995 and 2003 at a level-I trauma center was reviewed to identify patients with a complete talar extrusion. Demographic, imaging, and treatment data were obtained from a review of the medical records. Follow-up was undertaken during clinic visits or by telephone. Preoperative and follow-up radiographs were reviewed to identify posttraumatic arthritis, osteonecrosis, or talar collapse, and the Musculoskeletal Functional Assessment was used to assess functional outcome.


RESULTS
Twenty-seven patients were identified. A minimum follow-up of one year (average, forty-two months) was obtained for nineteen patients. Infection and the need for a secondary surgical procedure were the primary determinants of clinical outcome. Two of the nineteen patients had documented infections: one had developed at two weeks and one, after a calcaneal osteotomy at nineteen months. Twelve patients had no subsequent surgery, and seven had subsequent procedures (range, one to four procedures). No patient underwent a delayed amputation. The average Musculoskeletal Functional Assessment score at the time of follow-up was 29.8 (range, 5 to 59). With the numbers studied, no association was found between functional outcome and the following variables: ipsilateral lower-extremity injury, associated talar fracture, secondary procedures, osteonecrosis, or age.


CONCLUSIONS
While functional outcome is difficult to assess, salvage of the extruded talus appears to be a relatively safe operation, with a minimal risk of infection, which allows maximal flexibility in aftercare by preserving the most normal ankle anatomy possible.
Smith
Carla S
CS
The Orthopaedic and Neurosurgical Center of the Cascades, 2200 Neff Road, Suite 200, Bend, OR 97701, USA. powersmyth@aol.com
Nork
Sean E
SE
Sangeorzan
Bruce J
BJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation; D012092:Replantation; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome