TREATMENT OF OPEN EXTRUDED FRACTURE NECK OF THE TALUS USING THE COMBINED METHOD OF EXTERNAL FIXATION MODIFIED FOR DYNAMIC ANKLE JOINT FIXATION AND KIRSCHNER WIRES

Aleksandar  Božović; Ivica Lalić; Dušan Petrović; Saša Jovanović; Zlatan Elek; Aleksandar  Šipka; Marko Bojović

doi:10.5937/sanamed0-50563

Aleksandar Božović 1.University of Priština in Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia; 2. Clinical Hospital Center, Surgery Clinic, Kosovska Mitrovica, Serbia
Ivica Lalić University Business Academy in Novi Sad, Faculty of Pharmacy, Novi Sad, Serbia
Dušan Petrović 1. University of Priština in Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia; 2. Clinical Hospital Center, Surgery Clinic, Kosovska Mitrovica, Serbia
Saša Jovanović Clinical Hospital Center, Surgery Clinic, Kosovska Mitrovica, Serbia
Zlatan Elek 1. University of Priština in Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia; 2. Clinical Hospital Center, Surgery Clinic, Kosovska Mitrovica, Serbia
Aleksandar Šipka 1. University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; 2. Oncology Institute of Vojvodina, Sremska Kamenica – Novi Sad, Republic of Serbia
Marko Bojović 1. University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; 2. Oncology Institute of Vojvodina, Sremska Kamenica – Novi Sad, Serbia https://orcid.org/0000-0002-4304-8974

DOI: https://doi.org/10.5937/sanamed0-50563

Keywords: accidental falls, ankle joint, Kirschner wires, external fixators, talus

Abstract

Introduction: Open extruded fractures of the talus occur in 2% of talar fractures. These fractures are challenging for surgeons due to complications such as infection, nonunion, and arthritis. The most common treatment method is talus reimplantation and osteosynthesis.

Case report: A 19-year-old presented with an open extruded fracture of the talus, classified as Hawkins II, following a fall from a height. Emergency surgery involved wound debridement, talus reimplantation, osteosynthesis with modified external fixation for dynamic ankle joint fixation (Mitkovic-type), and two Kirschner wires. Fragments were repositioned under C-Arm fluoroscopy. The patient received a 14-day antibiotic regimen (Cephalosporins, Aminoglycoside, Metronidazole) and thromboembolic prophylaxis for 35 days. After 6 weeks we allowed movements in the ankle joint with physical therapy. Gradual weight-bearing was allowed after 8 weeks. The osteosynthetic material was removed after 18 weeks, with full weight-bearing achieved after 6 months. Radiographic follow-up was conducted up to 24 months postoperatively, showing excellent healing with minimal dorsiflexion restriction.

Conclusions: Treating this injury is a significant challenge. External fixation can be a viable method for managing open luxation fractures of the talus.

References

Zhou AK, Jou E, Patel R, Bhatti F, Modi N, Lu V, et al. A retrospective analysis of the definitive management of open talus fractures at a major trauma centre, comparing ORIF to FUSION: cohort study and audit of BOAST 4 guidelines. Eur J Orthop Surg Traumatol Orthop Traumatol. 2023;33(2):393–400. doi: 10.1007/s00590-022-03204-3.

Selim A, Naqvi AZ, Magill H, Smith J. Fracture neck of the talus with isolated talonavicular dislocation: A case report. Medicine (Baltimore). 2022;101(44):e28073. doi: 10.1097/MD.0000000000028073.

Calabrò D, Meliadò G, Biasi M, Topa G, Campo F, Fusini F. Percutaneous treatment of traumatic talus extrusion: a case report. Acta Biomed. 2018;89(1):109–13. doi: 10.23750/abm.v89i1.6178

Moger NM, Pragadeeshwaran J, Verma A, K V A, Aditya KS, Meena PK. Outcome of neglected talus neck fracture and it’s management: a case report. J Orthop Case Rep. 2021;11(4):41–4. doi: 10.13107/jocr.2021.v11.i04.2144.

Moerenhout K, Gkagkalis G, Baalbaki R, Crevoisier X. Association of bosworth, pilon, and open talus fractures: a very unusual ankle trauma. Case Rep Orthop. 2019;2019:6316137. doi: 10.1155/2019/6316137.

Canale ST, Kelly FB. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978;60(2):143–56.

AlMaeen BN, ElMaghrby IS, AlNour MK, Alrefeidi TA, Abu Adas SM. Complete revascularization of reimplanted talus after isolated total talar extrusion: a case report. Cureus. 2020;12(5):e7947. doi: 10.7759/cureus.7947.

Kasha S, Yalamanchili RK. The Masquelet technique in an extruded talus injury after open peri-talar dislocation-A case report. Trauma Case Rep. 2021;36:100559. doi: 10.1016/j.tcr.2021.100559.

Issaoui H, Fekhaoui M-R, Abbassi H, Gargouri M, Ali M. Outcomes of a reimplanted talus after a total open extrusion. Cureus. 2020;12(8):e9678. doi: 10.7759/cureus.9678.

Kwak JM, Heo SK, Jung GH. Six-year survival of reimplanted talus after isolated total talar extrusion: a case report. J Med Case Reports. 2017;11(1):348. doi: 10.1186/s13256-017-1517-7.

Bozović A, Mitković MB, Grbić R, Vasić A, Jaksić L, Petrović D, et al. Stability and quality of osteosynthesis in treatment of tibial pylon fractures with dynamic external fixation typ Mitkovic. Acta Chir Iugosl. 2013;60(2):93–8. [Article in Serbian]. doi: 10.2298/aci1302093b

Božović A. Mogućnosti i prednost dinamičke spoljašnje fiksacije po Mitkoviću u lečenju složenih preloma distalnog okrajka tibije [Doktorska disertacija]. Kosovska Mitrovica: Medicinski fakultet Univerziteta u Prištini; 2010.

Lee C, Brodke D, Perdue PW, Patel T. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2020;28(20):e878–87. doi: 10.5435/JAAOS-D-20-00116.

Tornetta P, Ricci W, Ostrum R, McQue. Rockwood and Green’s fractures in adults. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2019.

Green S, Gordon W. Principles and complications of external skeletal fixation. In: Browner BD, Jupiter J, Krettek C, Anderson PA, editors. Skeletal Trauma: Basic Science, Management, and Reconstruction. Philadelphia, PA: Elsevier; 2020.

Schwartz AM, Runge WO, Hsu AR, Bariteau JT. Fractures of the talus: current concepts. Foot Ankle Orthop. 2020;5(1):2473011419900766. doi: 10.1177/2473011419900766.

Dodd A, Lefaivre KA. Outcomes of talar neck fractures: a systematic review and meta-analysis. J Orthop Trauma. 2015;29(5):210–5. doi: 10.1097/BOT.0000000000000297.

Hama S, Onishi R, Yasuda M, Minato K, Miyashita M. Adolescent talus body fracture with high displacement: a case report. Medicine (Baltimore). 2018;97(35):e12043. doi: 10.1097/MD.0000000000012043.

Biz C, Golin N, De Cicco M, Maschio N, Fantoni I, Frizziero A, et al. Long-term radiographic and clinical-functional outcomes of isolated, displaced, closed talar neck and body fractures treated by ORIF: the timing of surgical management. BMC Musculoskelet Disord. 2019;20(1):363. doi: 10.1186/s12891-019-2738-2.