title: Treatment and outcome of open dislocation of the ankle with complete talar extrusion: a case report.
abstract: BACKGROUND
  Open total talar extrusion is a severe, disabling ankle injuries. The most appropriate treatment (reimplantation versus talar body removal and tibiocalcaneal arthrodesis) is still a controversial challenge; outcomes and fearful potential complications are not predictable.
  
  
  OBJECTIVE
  To report the case of an open ankle dislocation with talar extrusion, focusing on treatment modality and outcomes.
  
  
  METHODS
  Immediate reduction, surgical debridement and external fixation were performed under antibiotic coverage. Wound closure was achieved with accurate debridement, postoperative strict clinical surveillance and meticulous handling of medications. The patient maintained external fixator for three weeks, then kept non-weight bearing with a cast for an additional four weeks.
  
  
  RESULTS
  The patient's wound healed with no complications. Full weight-bearing was gained at 12 weeks postoperation. At 18 months postoperatively, the patient did not develop any infection or a vascular necrosis, which are the major complications associated to talar extrusion.
  
  
  CONCLUSIONS
  Good treatment procedure for a such severe open trauma, based on accurate debridement, wound care and stable temporary immobilization with external fixation allow reduction of infection risk and made preservation of extruded talus a successful option to preserve function and normal hindfoot anatomy at first instance. Talectomy should be considered as a salvage procedure.
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital "Agostino Gemelli", Rome 00168, Italy. Electronic address: m1breccia@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Breccia
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital "Agostino Gemelli", Rome 00168, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Peruzzi
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital "Agostino Gemelli", Rome 00168, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Cerbarano
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital "Agostino Gemelli", Rome 00168, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Galli
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D013628:Talus / Q000293:injuries* / Q000601:surgery
keywords: External fixation; Open talar extrusion; Reimplantation