Surgical Reconstruction of a Crush Injury of the Talar Body

Abstract

Fractures of the talar body can have devastating results despite treatment. While talar body fractures are uncommon, they have worse outcomes than do other fractures of the talus, including more osteonecrosis and posttraumatic arthritis1,2. Crush injuries are the most difficult to treat as a result of a very constrained anatomy, the comminution of the fracture fragments, and articular cartilage damage. These fractures are challenging to reconstruct and stabilize and often have poor outcomes3. Conservative treatment does not appear to be better than operative treatment for talar body fractures4. For crush injuries, very aggressive techniques such as primary fusion of the talocrural joint, primary tibiotalar arthrodesis and subtalar arthrodesis, and salvage ankle fusion techniques with structural bone blocks are usually used3,5,6. There have been isolated reports of surgical treatment for crush injuries of the talar body with open reduction and internal fixation; however, these procedures either have had unsatisfactory outcomes2 or were used when there was comminution of only part of the talar dome7. It is generally accepted that severe crush fractures cannot be treated satisfactorily with open reduction and fixation5,8. We describe a case of a severely comminuted talar body and neck fracture treated effectively with surgical reconstruction with a satisfactory result. The patient gave permission for this information to be submitted for publication. A twenty-three-year-old man injured the right ankle in a high-speed motorcycle accident. At the time of admission, the patient had local swelling and varus deformity of the ankle, severe pain, and an inability to actively and passively move the ankle and subtalar joints. He had no neurovascular deficit, tension of the surrounding soft tissue was noted, and there was no open skin lesion. Anteroposterior and …