Talar body fracture nonunion and osteonecrosis with adjacent arthritis can be successfully treated with tibiotalocalcaneal arthrodesis using circular external fixation

Abstract

Fractures of the talar body often result from high-energy trauma. These fractures are at risk for nonunion and put the talus at risk for avascular necrosis due to an inadequate blood supply. We present the case of a 57-year-old male that presented to our practice with talus fracture nonunion, talar body osteonecrosis, ankle and subtalar posttraumatic osteoarthritis, and deformity including a mild equinus contracture and mild hindfoot varus. Successful ankle and subtalar fusion, talus fracture union, and deformity correction were performed using a circular external fixator with fine wire fixation and compression. This is the first reported case where fusion of both the tibio-talar-calcaneal joints and the talar body nonunion was achieved using external fixation. At the time of this report, the patient is over 3 years postfusion, stands with neutral alignment, is relatively pain-free, is able to resume normal daily activities, and has no progression of talar osteonecrosis.

Keywords

• Ankle fusion
• circular external fixator
• talar body nonunion
• osteonecrosis
• tibio-talar-calcaneal fusion
• tibiotalocalcaneal arthrodesis