Reimplantation of a Completely Extruded Talus 8 Days Following Injury: A Case Report

We present the case of a 28-year-old female with 45 months follow-up after reimplantation of a completely extruded talus 8 days following the injury. The extruded talus was recovered at the site of the motor vehicle accident, where it had been embedded in the wreckage and subsequently transported to hospital 3 hours later. Thereafter, the talus was washed in an iodine solution for 5 hours and frozen for a period of 8 days at –80°C, after which reimplantation surgery was undertaken. Throughout the extended follow-up period, no evidence of infection ever developed. Three years following her injury, the patient underwent fusion of the subtalar and talonavicular joints. At 45 months postoperative, imaging revealed avascular necrosis of the talar dome without substantial collapse. The patient progressed to the point where, at last follow-up, she was working in an administrative job and was able to bear full weight on the involved foot, despite development of mild pain on physical exertion. Despite the pain, moreover, she remained able to snow ski and to regularly walk 2 kilometers for cardiovascular fitness. We believe this case demonstrates that, in the apparent absence of deep infection, the development of avascular necrosis need not necessarily lead to a poor clinical outcome. Furthermore, this case showed that even after a period of 8 days in the freezer, and following antiseptic cleansing, the extruded talus could be reimplanted with a reasonable degree of clinical success.