title: Early reimplantation for open total talar extrusion.
abstract: OBJECTIVE
  To review outcome of early reimplantation for open total talar extrusion in 7 patients.
  
  
  METHODS
  Medical records of 5 men and 2 women aged 19 to 53 years who underwent reimplantation for open total talar extrusion within 6 hours after road traffic accident (n= 6) or industrial injury (n=1) were reviewed. The talus was first irrigated with 9 to 10 litres of saline solution, followed by 10% povidone iodine. It was then reduced after thorough debridement and fixed with tension band wiring or external fixation. Ankle mobilisation exercises were started at week 6 and full weight bearing at week 14. Outcome was assessed using the American Foot And Ankle Society score.
  
  
  RESULTS
  After a mean follow-up of 31.9 (range, 24-46) months, the mean American Foot and Ankle Society score was 81, and the mean dorsiflexion-plantar flexion arc was 36.9º (range, 25º-45º). All patients were able to walk with a balanced, unaided gait with mild-to-moderate pain (n=3) or pain-free (n=4). No patient developed deep infection or instability. Three patients developed avascular necrosis of the talus; restriction of motion was moderate at the ankle joint and severe at the subtalar joint. None of these 3 patients opted for revision surgery, as the pain was tolerable and did not limit their daily activities, but their condition was expected to deteriorate with time.
  
  
  CONCLUSIONS
  Early reimplantation is recommended for open total talar extrusion, as it restores (to some extent) hind foot mechanics, heel height, and bone stock for activities of daily living and future reconstructive options.
authors.affiliation: Department of Orthopaedics, Maulana Azad Medical College and associated Hospitals, New Delhi, India.
authors.forename: Mukul
authors.initials: M
authors.lastname: Mohindra
authors.affiliation: Department of Orthopaedics and Rehabilitation, Pt B.D Sharma Post graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Paritosh
authors.initials: P
authors.lastname: Gogna
authors.affiliation: Department of Orthopaedics, Maulana Azad Medical College and associated Hospitals, New Delhi, India.
authors.forename: Ankit
authors.initials: A
authors.lastname: Thora
authors.affiliation: Department of Orthopaedics, Maulana Azad Medical College and associated Hospitals, New Delhi, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Tiwari
authors.affiliation: Department of Orthopaedics and Rehabilitation, Pt B.D Sharma Post graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Singla
authors.affiliation: Department of Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Mahindra
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery; D003646:Debridement; D005260:Female; D005592:Fracture Fixation; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012092:Replantation; D012189:Retrospective Studies; D013628:Talus / Q000293:injuries / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
keywords: replantation; talus