Management of exposed talar body fracture-dislocation with bone extrusion: A case report

Talus fractures are often related to high-energy trauma and are associated with exposed lesions in 20-25% of cases. Open fracture dislocations are rare but with potentially devastating consequences, often unsatisfactory outcomes and a high rate of complications. For this reason, the treatment of these injuries is very challenging.We report a case of a 24-year-old man who sustained an exposed fracture-dislocation of the ankle with subtotal extrusion of the talus. Joint stabilization and application of the external fixator were performed immediately. The bone gap was filled with hand-moulded antibiotic-treated cement due to the comminution and contamination of the extruded fragment. Twenty months after injury arthrodesis of the hindfoot was performed with autologous bone graft from the distal fibula. The finding of dehiscence and contamination in the area of the previous exposure required a surgical toilet, and targeted antibiotic therapy. The dehiscence area was covered by transposition of the fasciocutaneous flap from gastrocnemius 2 months after arthrodesis. The patient started weight-bearing 1 month later. One year after surgery, the arthrodesis healed in a good position without any signs of infection of the surrounding tissues, and the patient reported no pain with full weight bearing. Management of the exposed dislocation fractures of the talus is very complex due to the lack of guidelines; the choice of the most appropriate treatment remains controversial and the outcomes are unpredictable. Different treatments have been reported, but early wound debridement, anatomical reduction, and adequate fixation are key components for treating exposed talus lesions.