Total Talar Extrusion with Medial Malleolar Fracture

Abstract

Background: Total extrusion of the talus with disruption of all the ligaments is called “missing talus”. It is a rare injury, associated with severe soft tissue damage and/or fracture. It is a tri-articular dislocation involving talotibial dislocation from above, subtalar joint below and talonavicular joint anteriorly. We present a report of a patient treated with immediate reimplantation and K-wire stabilisation leading to a successful outcome. Case presentation: A 57-year-old tourist had a closed anterolateral extrusion of the talus with a displaced medial malleolar fracture. There was no associated talar fractures. Initial attempts at closed reduction failed. He underwent immediate reimplantation surgery and K wire stabilisation across the talo-calcaneal (sub-talar) and talo-navicular joints. There was a soft tissue interposition preventing initial reduction by the extensor digitorum tendon. This had to be released to secure accurate anatomical reduction. He had a good outcome with full function of the ankle joint. Conclusion: The preferred surgical approach in the management of total extrusion of the talus is immediate reimplantation to ensure minimal disruption to the blood supply. However, it must be emphasised that soft tissue interposition prevents timely reimplantation and is likely to delay definitive treatment.