[Homologous talus replacement after talectomy in infection and septic talus necrosis. Experiences with 3 cases]

Severe infections of the talus are often associated with complete septic collapse of the talus. In this connection, open fractures with defects or significant comminution have a bad prognosis is as far as reconstruction of the talus is concerned. In the Department of Traumatology, Braunschweig, in 1995 three patients (all male, average age 35.3 +/- 10.2 years) were treated with cancellous bone grafting after talectomy performed because of infection and complete septic collapse of the talus. In two of these cases third-degree open total dislocation of the talus had been sustained. The third patient came to us after undergoing arthroscopy of the ankle region in another hospital. In each case a fulminating infection was the outcome. Following a step-by-step algorithm, in a first step urgent radical debridement with talectomy was done. To maintain approximation between the tibia and calcaneus on one side and the os naviculare on the other, the bony defect was filled with PMMA chains and the external fixateur technique was used for immobilization during treatment of the infection. After second- and third-look procedures a free flap was grown for soft tissue coverage within the first 10 days. After 17.6 +/- 3.3 days the talus was replaced with a cancellous bone graft, combined with double arthrodesis in two cases, and external fixation for the next 4-5 weeks. In the third patient a triple arthrodesis was done. At follow-up after an average of 12 months (range 8-17 months), the bone graft with arthrodesis had been completely integrated in all cases. All patients are free of symptoms in normal life. In the case of severe open fractures of the talus with significant comminution combined with infection and septic bone collapse conservation of the talus is often impossible. The combination of homologous cancellous bone grafting and arthrodesis after talectomy is therefore a good method of keeping any decrease in the function of the foot to a minimum.