An uncommon treatment of totally extruded and lost talus: a case report

Abstract

IntroductionTotal 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.Case presentationWe 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.ConclusionsThe 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.

Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report

“…Primary bone loss can occur in primary bone diseases, such as bone fracture due to trauma or malignancy where bone destruction can lead to bone loss, whereas secondary bone loss is most commonly due to external factors such as infection or tumor resection [2], [8].…”

“…Bone loss is a widely used term referring to structural defects and regions of missing bone caused by external factors (true defects) and structural loss within existing bone, such as in osteopenia. Primary bone loss can occur in primary bone diseases, such as bone fracture due to trauma or malignancy where bone destruction can lead to bone loss, whereas secondary bone loss is most commonly due to external factors such as infection or tumor resection [2] , [8] .…”

“…We consider our procedure to be a modified Masquelet technique due to the fact that we use UC-MSCs implantation as a replacement of autogenous and synthetic bone graft. Current studies suggest that the induced membrane plays a role in osteogenesis and vascularization of bone graft [4] , [6] , [8] , [10] , [12] , [14] , [15] , [16] . In our case, clinical union was achieved at 6 months post operatively and patient was able to mobilize with the help of axillary crutches.…”

Combination of bone marrow aspirate, cancellous bone allograft, and platelet-rich plasma as an alternative solution to critical-sized diaphyseal bone defect: A case series

“…It lacks osteogenesis and osteoinduction capacity. Therefore, it is mandatory to provide additional osteoprogenitor cells and growth factors upon the application of bone allograft [[10], [11], [12]].…”

Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot

“…Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot with asymptomatic tibiocalcaneal pseudoarthrosis. [5][6][7] However, the typical AVN patient undergoing talectomy will simultaneously undergo tibiocalcaneal or bone block tibiotalocalcaneal arthrodesis. 1,4,[8][9][10] Joint-sparing management of end-stage talar AVN remains controversial, but the use of synthetic talar implants internationally is beginning to demonstrate longevity.…”