Extruded talus

Case contributed by Craig Hacking

Presentation

Jump off fence.

Patient Data

Age: 25 years
Gender: Male
x_ray

Open fracture and anterolateral total dislocation (extrusion) of the talus with severe rotation. Fracture fragment within the expected location of the talus. No fracture of the talar dome or visualized tibia or fibula. Tibiofibular alignment is normal. Extensive gas within the soft tissues.

ct

Open fracture and total dislocation (extrusion) of the talus anterolaterally with 90 degrees rotation. Fracture fragments within the expected location of the talus. One of these is well corticated and therefore likely represents a displaced os trigonum (especially given the absence of the lateral talar tubercle). No fracture of the talar dome or visualized tibia or fibula.

Extensive gas and hematoma within the ankle joint.

No fracture of the visualized mid and hindfoot.

Intraoperative image intensifier during relocation

Fluoroscopy

The talus is normally located and alignment of the ankle is normal. Lateral malleolar screw suggests ligamentous repair.

The lateral projection confirms the large well corticated fragment on the XR and CT is the os trigonum.

Case Discussion

This is a significant injury and usually the talus dies due to total disruption of its blood supply and the ankle needs surgical fusion. There have been cases where the talus has been found under the pedals in the foot well of a car following MVA.

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