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
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.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.