An Eleven-Year Follow-up of a Custom Talar Prosthesis After Open Talar Extrusion in an Adolescent Patient: A Case Report.

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Talar extrusion is an extremely rare injury; isolated cases are reported in most instances1-8. Because of the paucity of literature pertaining to this injury, no definitive recommendations exist for treatment. General consensus among orthopaedic surgeons mandates that this injury be managed by thorough debridement of the wound and reduction of the extruded talus, if possible9. When complications like osteonecrosis and infection occur, the surgeon is left with few options outside of tibiocalcaneal arthrodesis. Often, this leaves the patient with a shortened limb and altered gait mechanics10. In 2007, Stevens et al. reported a talar extrusion in a fourteen-year-old girl who underwent an excision of the native talus because of infection, followed by replacement with a custom-made cobalt-chrome talar body prosthesis11. That case report was unique because of the age of the patient, the use of a metal implant in a previously infected wound, and the use of a custom-made metal prosthesis with a novel “snap-fit” design for purchase and stability. In this case report, we describe the same patient after eleven years of follow-up. The patient was informed that data concerning the case would be submitted for publication. A fourteen-year-old girl had been involved in a motor vehicle accident. On initial evaluation, there had been total extrusion of the right talus from a 10-cm lacerated wound on the lateral aspect of the ankle. The talus appeared intact but devoid of soft-tissue attachments, with the exception of a few capsular strands at the neck. The wound had been grossly contaminated with dirt and grass. The talus was reduced into the ankle joint in the operating room. The lateral ligaments of the ankle were reconstructed. The wound was left open and dressed under sterile conditions. The patient had debridements on days two, …