Traumatic expulsion of the astragalus

Abstract

HISTORY.-R. A., aged 28, of Fleetwood, Lancashire, boatswain on a steam-trawler, was admitted to the Royal Sussex County Hospital on June 13, 1940, with an injury to his right foot as the result of his ship being mined.Subsequently I obtained the following account of his injury: He told me that his ship had just finished sweeping for mines and he had removed his lifebelt and was aft, giving directions to his men. His language in describing what he was doing was too technical for me to follow, having no experience of mine-sweeping, but there appears to have been some object called a ' skid ' which they were preparing to haul on board.He does not remember hearing any noise and this I have found to be a curious feature constantly described by many patients wounded as the result of bombs or shells bursting close to them. The trawler had evidently struck an unsuspected mine.The next thing that he remembers is seeing a flash come through the deck. FIGS. 422, 423.-Antero-posterior and lateral radiographs.The patient remembers being blown into the air and falling into the water. He came up amongst some pieces of wood, one of which he placed under each armpit. He was in the water for about 10 to 15 minutes before being rescued; he cannot swim. He was wearing ankle shoes.In addition to his injured foot, he says he got " a clout " on the left shoulder, and this caused him more pain than the foot. There was no bony injury in the shoulder region, nor was the skin broken, and the condition gradually cleared up without treatment. Probably he had sustained a tearing of a few muscle-fibres and an intramuscular hrematoma-a very painful condition. ON EXAMINATION.-^ saw the patient for the first time in the operating theatre, together with the X-ray pictures (Figs. 422, 423).The astragalus was completely absent, and there was a fracture of the external malleolus.He could not remember what happened to his shoes or socks.

Reimplantation of total talar extrusions

“…13 There is no clear consensus on the appropriate treatment of total talar dislocations due to the paucity of cases reported in literature. [1][2][3][4][5][6][7][10][11][12]14,16 Treatment modalities have varied from talectomy with tibiocalcaneal arthodesis in the earlier days 4 to reimplantation after thorough debridement more recently. 1,2,5,6,13 We present the clinical results, complications, and functional outcome of three patients who underwent debridement and reimplantation of the traumatically extruded talus.…”