Session I - Foot & Ankle

Fri., 10/8/04 Foot & Ankle, Paper #3, 9:34 am

Open Fractures and Dislocations of the Talus

Allison Paige Whittle, MD (n);

Bradley D. Dresher, MD (n); Thomas Giel (n);

University of Tennessee - Campbell Clinic, Memphis, Tennessee, USA

Purpose: Open fractures and dislocations of the talus are severe injuries which lead to a high incidence of infection. Some investigators have suggested that partial or total excision of the talus in such cases may decrease the incidence of infection. The purpose of this study was to compare the incidence of infection in open talar fractures and dislocations treated with preservation of the talus with those treated with partial or total talectomy.

Methods: A retrospective review was undertaken of open fractures and dislocations of the talus treated between November 1999 and October 2003. Twelve male patients and 15 female patients with 24 open talar fractures and three open talar dislocations were identified. Twenty-three injuries were caused by motor vehicle accidents, two by motorcycle accidents, one from a jump from a building, and one from a high-velocity gunshot wound. Twelve were Gustilo type II, 5 were Gustilo type IIIA, and 10 were Gustilo type IIIB open injuries. Three-quarters of the fractures were comminuted. Twenty-three (85%) patients had additional injuries. Twenty-four patients were treated initially with internal fixation, two with partial talectomy, and one with complete talectomy. The three patients treated with partial or total talectomy all had type-III open injuries. Three patients required skin grafts, and three required flaps for closure.

Results: Deep infection occurred in 4 of 27 (15%) patients. All infections were in type-III open injuries treated with internal fixation (4 of 12, 33%). One of three open dislocations and 3 of 24 open fractures became infected. Two of the 10 patients with type-IIIB fractures required below-knee amputation. One deep infection was treated with delayed talectomy and long-term antibiotics, and one was treated with antibiotics alone. No infection occurred in the three type-III open injuries treated with partial or total talectomy.

Conclusion/Significance: Although the number of partial and total talar excisions was small, the data suggest that primary partial or total talectomy in patients with type-IIIB open talar injuries should be considered to prevent infection and amputation.