Complete Talar Extrusion Treated With an Antibiotic Cement Spacer and Staged Femoral Head Allograft.

Abstract

Complete talar extrusion is rare and usually associated with a high-energy mechanism of injury causing complete dissociation of the talus from the surrounding bony and soft-tissue structures with enough force to expel the talus out of the body. Treatment can be complicated by infection, osteonecrosis, posttraumatic osteoarthritis, and leg length discrepancy, which may require multiple subsequent surgeries for improved outcome and quality of life. Reimplantation of the native talus affords maintenance of joint height and favorable outcomes have been reported. Failed reimplantations have been successfully managed with arthrodesis with or without a bone allograft. We report a case of talar extrusion initially treated with a talus-shaped impregnated antibiotic spacer, followed by femoral head allograft and tibiocalcaneal fusion. This treatment resulted in radiographic evidence of bony fusion at 12 weeks without subsequent infection and good clinical outcome at 2-year follow-up.