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首页> 外文期刊>Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology >Therapeutic management of complicated talar extrusion: literature review and case report
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Therapeutic management of complicated talar extrusion: literature review and case report

机译：复杂距骨挤压的治疗管理：文献复习和病例报告

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摘要

Total extrusion of the talus with interruption of all ligaments (missing talus) is a rare injury. We describe the case of a 27-year-old man who reported total extrusion of the talus after a motorbike accident with interruption of all talar ligaments. In the first repair effort, the articular void left by the talus was filled with antibiotic cement and the wound was closed primarily. Nevertheless, the skin overlying the talar joint displayed necrosis. In order to cover the cutaneous defect, improve local vascularization, and allow reimplantation of the talus, a sural fasciocutaneous island flap was harvested. Subsequently, the original talus was placed and arthrodesis of the subtalar joint was performed. The patient was able to walk bearing full weight without support equipment after 6?months. Several therapeutic options have been suggested in such cases, including replacing the talus, tibiocalcaneal arthrodesis, and pseudoarthrodesis. The rarity and peculiarity of such cases make the establishment of generalized guidelines an arduous task, leaving the choice of treatment to the surgeon, in conformity with each case’s peculiarity. In this case use of the flap may have promoted the vascularization of the reimplanted talus, thus avoiding avascular necrosis and allowing successful reimplantation of the original talus.
机译：距骨完全挤压而所有韧带中断（距骨缺失）是罕见的损伤。我们描述了一个27岁的男子的案例，该男子报告说摩托车事故后所有距骨韧带均中断，距骨完全挤压。在第一个修复工作中，距骨留下的关节空隙中充满了抗生素胶粘剂，并且伤口基本闭合。然而，距骨关节上方的皮肤显示坏死。为了覆盖皮肤缺损，改善局部血管形成，并允许距骨再植入，收集了腓肠肌筋膜皮瓣。随后，放置原始距骨并进行距下关节的关节固定术。 6个月后，患者无需支撑设备即可步行，能承受全部重量。在这种情况下，已经提出了几种治疗选择，包括更换距骨，胫骨跟骨关节固定术和假性关节固定术。此类病例的稀有性和特殊性使制定通用指南成为一项艰巨的任务，根据每个病例的特殊性，将治疗方法留给外科医生。在这种情况下，皮瓣的使用可能促进了再植入距骨的血管形成，从而避免了无血管坏死并允许成功地重新植入了原始距骨。

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