title: An uncommon treatment of totally extruded and lost talus: a case report.
abstract: BACKGROUND
  Total extrusion and loss of the talus is a rare injury with a wide choice of appropriate treatment, but rarely resulting in a fully functional recovery. We report on an uncommon case, both for the severity of the injury and for the uncommon treatment due to the patient's rejection of secondary surgery.
  
  
  METHODS
  We treated a 16-year-old Caucasian man with the most extreme variant of a totally extruded and lost talus, accompanied with complex injury of the soft tissues of the ankle and foot. The treatment included urgent microvascular foot reimplantation, microvascular muscle free flap transfer, and temporary fixation. This kind of injury should typically be treated by tibiocalcaneal arthrodesis. However, this was not performed, as after the successful early stages of the treatment he strongly objected to another surgery due to his fully functional status and the successful therapeutic results of our early treatment.
  
  
  CONCLUSIONS
  The injury described in this case study would ordinarily be treated by amputation, but due to the well-executed treatment in the early stages after the injury, the outcome was satisfying. Surprisingly and against our expectations, the late results of the treatment were successful even without arthrodesis. He is now 37 years old and has a functional foot 21 years after the injury.
authors.affiliation: Department of Traumatology, University Medical Centre Ljubljana, Zaloška 7 Ljubljana, Slovenia. dsmrke@gmail.com.
authors.forename: Dragica Maja
authors.initials: DM
authors.lastname: Smrke
authors.forename: Primož
authors.initials: P
authors.lastname: Rožman
authors.forename: Borut
authors.initials: B
authors.lastname: Gubina
authors.forename: Igor
authors.initials: I
authors.lastname: Frangež
authors.forename: Barbara
authors.initials: B
authors.lastname: Rejec Smrke
authors.forename: Zoran Marij
authors.initials: ZM
authors.lastname: Arnež
mesh_terms: D000293:Adolescent; D000673:Amputation, Traumatic / Q000601:surgery*; D064386:Ankle Fractures / Q000601:surgery*; D001174:Arthrodesis; D005593:Fracture Fixation, Internal / Q000379:methods*; D005597:Fractures, Open / Q000601:surgery; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012092:Replantation / Q000379:methods*; D013628:Talus / Q000293:injuries*; D050277:Toe Phalanges / Q000293:injuries / Q000601:surgery