Use of allograft cellular bone matrix in multistage talectomy with tibiocalcaneal arthrodesis: a case report.
Surgical treatment for traumatic dislocation of the talus is a challenging procedure that is often associated with complications. Application of allograft cellular bone matrix with viable mesenchymal stem and osteoprogenitor cells can eliminate the need for autograft and may increase fusion rates in procedures such as tibiocalcaneal arthrodesis. This report describes the treatment of an adult man who presented with a right ankle fracture and subtalar joint dislocation after a motor vehicle accident. After initial treatment with open reduction and internal fixation, the patient developed avascular necrosis of the talus and septic arthritis of the tibiotalar and subtalar joints. After treatment of the infection, the patient was ultimately treated with multistage talectomy and tibiocalcaneal arthrodesis augmented with a cellular bone allograft. Approximately 3 months after the final operation, plain radiographs and computed tomography confirmed solid fusion at the arthrodesis interface. The patient's recovery was uneventful thereafter, and amputation was avoided. This case, which presented additional challenges because of the large defect created by the infection, suggests that use of an allograft cellular bone matrix has the potential to replicate the bone-healing properties of autograft without the constraints and morbidity associated with autograft harvesting.
Virginia Tech-Carilion School of Medicine, Carilion Clinic Orthopaedics, Roanoke, VA 24014, USA. jrclements@carilionclinic.org
J Randolph
JR
Clements
D020341:Absorbable Implants; D000063:Accidents, Traffic; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000382:microbiology / Q000628:therapy; D001174:Arthrodesis; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002111:Calcaneus / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D010019:Osteomyelitis / Q000150:complications / Q000628:therapy; D010020:Osteonecrosis / Q000209:etiology / Q000601:surgery; D013380:Subtalar Joint / Q000293:injuries / Q000601:surgery; D013628:Talus / Q000473:pathology / Q000601:surgery*; D013640:Tarsal Joints / Q000382:microbiology / Q000601:surgery; D013977:Tibia / Q000601:surgery*; D014184:Transplantation, Homologous
D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials