Kayaththery VarathanThe Royal London Hospital, United Kingdom
Title: Open talar dislocation injuries with total or partial extrusion of the talus – A case series with mid-term functional results
Introduction Open talar dislocations with total or partial extrusion are rare high energy injuries associated with major complications .Historically these were treated with talectomy and tibiocalcaneal arthrodesis but debridement and reimplantation is preferred with preservation of the extruded talus. We evaluated mid-term functional outcomes, complications and need for secondary surgery treated with reimplantation to provide prognostic information associated with this management strategy. Methods Level 1 major trauma centre, UK database search was performed (2015-2018). Inclusion criteria included open talar dislocations with either complete or partial extrusion of the talus. Case-note review was performed collecting data including demographic, injury mechanism, Gustilo-Anderson grade and surgical management timing. Follow-up included a combination of outpatient and telephone review. Complications including avascular necrosis, infection and need for secondary surgery were recorded. Functional outcome scores were collected using the Manchester-Oxford Foot Questionnaire (MOx-FQ) and results grouped by the Hawkins classification. 12 patients were identified with a mean follow-up of 3 years (minimum 26 months). Results Mean age at injury was 37.8 years (range 17-74 years). All were Gustilo-Anderson grade III and reimplanted with 8/12 undergoing single stage surgery and 4/12 having staged surgery upon admission. During follow-up one patient developed avascular necrosis, three developed infection and one underwent secondary surgery. The mean MOx-FQ scores for total versus partial talar extrusions with fracture were 79 vs 41 for walking, 65 vs 42 for pain and 63 vs 48 for social. Conclusion Persistent functional deficit and pain should be expected at mid-term follow-up. The low incidence of complications supports reimplantation as treatment strategy. Our data demonstrates better functional outcomes in patients who have partial extrusion of the talar dome with associated fractures, compared to ligamentous total talar extrusion injuries. Given the range of functional scores and rare nature of this injury, we recommend multi-centre studies to help identify modifiable factors influencing outcomes.
Kaya is a senior house officer working in London. She graduated from University of Leeds Medical school and secured a distinction in her Masters, Laparoscopic surgery and surgical skills at the prestigious Barts and London Medical school. Kaya has presented to a wide range of audience from aspiring medical students to experienced consultants. Whilst her interests lie within Orthopaedic surgery, she also enjoys teaching medical students across the UK.