PMC6833435_01
Initial presentation with externalised talar head (arrow).
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The initial examination revealed an open lateral subtalar dislocation of the right foot with the talus and distal tibia completely exposed and contaminated with small pieces of wood and sawdust (Fig. 1).
Initial presentation on computer tomography.
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There was no major fracture of the talus, only small avulsions in the subtalar joint (Fig. 2).
Clinical picture after reduction.
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The tibial nerve was in continuity trifurcating just below the wound, which explains the intact sensation of the sole of the foot (see video included in the supplementary material and Fig. 3, Fig. 4).
Cement spacer in fluoroskopic view and during surgery.
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In preparation for the defect augmentation using the Masquelet technique the joint was debrided, the remaining cartilage in the talar joints was removed and a talus shaped cement spacer was implanted (Fig. 5).
Free gracilis flap before anastomosis proximal to the injured zone and postoperative result after split skin graft and external fixation.
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The patient was discharged three weeks after the accident with the external fixator and non-weight bearing mobilization (Fig. 6).
Harvested bone graft before implantation, fluoroscopic view of arthrodesis and graft, intraoperative view.
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Finally, a 240 mm x 12 mm arthrodesis nail was implanted for fusion of the hindfoot (Fig. 7).
Results after 9 months with full soft tissue coverage and beginning osseous consolidation.
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After nine months a CT scan showed progressive osseous fusion and full weight bearing was allowed (Fig. 8).