Abstract
Introduction:The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection.Materials and methods:Four patients were included in the study from January 2011 to December 2017. In the first stage, all four patients underwent debridement of the ankle, total or partial excision of the talus, and antibiotic-loaded bone cement spacer (ALBC) placement in the ankle joint. The second stage of the arthrodesis procedure was initiated six to eight weeks after the primary procedure, where these patients underwent arthrodesis with hindfoot nail and bone blocks from the iliac crest.Results:All patients were followed-up for an average of 17.6 months (range 12.0 – 32.0 months). The arthrodesis site had united in all these four patients. The AOFAS scores were satisfactory in all patients. One patient underwent nail removal after the arthrodesis site had united.Conclusions:The hind foot nail with iliac crest bone block maintains the ankle height and ensures successful arthrodesis. In patients with partial/ complete bone loss with suspicion or confirmation of infection, staging the arthrodesis procedure minimises the chance of complications.
Highlights
The management of talus bone loss in trauma is difficult and unsatisfactory
The exclusion criteria were patients with prior hind foot arthrodesis or who were unwilling to participate in this study
The arthrodesis site had united in all these patients
Summary
The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection. The resultant combination of gross contamination, soft tissue damage, and attempts at restoring the normal ankle anatomy either by replacing the extruded talus in its original position or by fixation gives a poor outcome[1,2,3] Treatment for these injuries is either retention/ fixation of the talus, preserving the ankle anatomy, or excision of the talus with arthrodesis of the tibio-calcaneal joint[2,4,5,6,7,8]. These contrasting methods of management of talus bone loss have found acceptance in orthopaedic practices worldwide[2,7,8]. Preservation of the talus maintains the ankle architecture and height but is complicated by high rates of infection, latestage osteonecrosis, and multiple procedures[3,8]
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