UNASSIGNED: Traumatic open total extrusion of talus without soft-tissue attachment and not associated with surrounding fracture is a very rare injury which requires very high energy impact. In literature, optimal treatment protocols are yet to be established. A few options described in literature are talectomy and tibiocalcaneal arthrodesis or reimplantation of talus which may be immediate or after some interval.
UNASSIGNED: A 28-year-old female suffered road traffic accident and had total open extrusion of talus without soft-tissue attachment, and we managed it with thorough debridement of the wound, saline irrigation, and immediate reimplantation of the talus with stabilization by delta frame external fixator. Proper pre- and post-operative antibiotic coverage was given as per protocol. We did not face post-operative infection, wound complication, and until 12 months followed up, there are some signs of avascular necrosis of the talus but the good functional outcome.
UNASSIGNED: With this case experience, we suggest that this is the valid treatment protocol for total extrusion of the talus, and it will provide a better hindfoot mechanism, heel height, and the patient can resume his/her daily routine activity as early as possible.

UNASSIGNED: To summarize the surgical treatment methods for avascular necrosis of the talus.
UNASSIGNED: The recent domestic and international literature related to avascular necrosis of the talus was extensively conducted. The pathogenesis, surgical treatment methods, and prognosis were summarized.
UNASSIGNED: The clinical symptoms of avascular necrosis of the talus at early stage are not obvious, and most patients have progressed to Ficat-Arlet stages Ⅲ-Ⅳ and require surgical treatment. Currently, surgical treatments for this disease include core decompression, vascularized bone flap transplantation, arthroplasty, and arthrodesis, etc. Early avascular necrosis of the talus can be treated conservatively, and if treatment fails, core decompression can be considered. Arthrodesis is a remedial surgery for patients with end-stage arthritis and collapse, and in cases of severe bone loss, tibiotalocalcaneal arthrodesis and bone grafting are required. Vascularized bone flap transplantation is effective and plays a role in all stages of avascular necrosis of the talus, but the appropriate donor area for the flap still needs further to be studied.
UNASSIGNED: The surgical treatment and the system of treatment for different stages of avascular necrosis of the talus still need to be refined.
UNASSIGNED: 对距骨缺血性坏死手术治疗研究进展进行综述。.
UNASSIGNED: 广泛查阅近年来国内外距骨缺血性坏死相关文献，从发病机制、手术治疗方式及预后等方面进行总结。.
UNASSIGNED: 距骨缺血性坏死早期临床症状不明显，患者就诊时大多已进展至Ficat-ArletⅢ～Ⅳ期，需要手术治疗。目前，该病手术治疗方法主要包括髓芯减压、带血管蒂骨瓣移植、关节置换术及关节融合术等。早期距骨缺血性坏死可保守治疗，如治疗失败可以考虑髓芯减压。关节融合术应作为终末期骨关节炎和塌陷患者的补救手术，存在严重骨丢失时需行胫距跟融合术和植骨。带血管蒂骨瓣移植效果良好，对各期距骨缺血性坏死均有一定治疗效果，但合适骨瓣供区仍需进一步研究。.
UNASSIGNED: 距骨缺血性坏死手术方法以及不同分期治疗体系均有待完善。.

Total talar replacement is a viable treatment option for talar injuries and pathologies. We present a single case study of a 73-year-old female with idiopathic necrosis of the talar which was treated with a total talar replacement prosthesis. A patient specific custom talar prosthesis was created using the mirror image of the contralateral healthy talus obtained using a CT scan of the contralateral limb. The patient underwent surgical resection of the pathologic talus with implantation of the custom talar prosthesis. At the 12 month mark the foot function index (FFI) score improved from 95.9% pre-op to 4.7% post op and american orthopedic foot and ankle score 0 pre-op to 94 post op. Further research and longer followup will be needed, but the current results are very favorable.

Displaced talar neck fractures no longer constitute a surgical emergency; timing of definitive surgery has no bearing on the risk of osteonecrosis. Amount of initial fracture displacement is best predictor of osteonecrosis. Grossly displaced fractures or fracture-dislocations should be provisionally reduced, with or without temporary external fixation. Periosteal stripping should be limited to only that necessary to obtain anatomic reduction. Dissection within the sinus tarsi or tarsal canal should be avoided. Rigid internal fixation with solid cortical screws countersunk within the talar head and placed below the \"equator\" of the talar head is imperative for optimum stability.

BACKGROUND: The purpose of this study was to evaluate the clinical outcome of a two staged approach of subtalar arthrodesis followed by TAR for patients with ankle arthritis and AVN talus.
METHODS: Out of total 210 TARs performed at our institute; 7 patients underwent a two staged procedure between 2006 and 2010. All patients had over 3 years of follow up (except one). The clinical results were assessed using AOFAS, WOMAC, SF-36 and patient satisfaction scores.
RESULTS: The mean follow up was 3 years. There was significant improvement in AOFAS and WOMAC (pain and stiffness) from pre-op to 3 years post-op (P<0.05). SF 36 scores improved from pre-op to 3 years post-op for 6/8 domains. 5 patients were satisfied at 3 years for overall surgical outcomes, 4 were satisfied with pain relief. Radiological signs of talar subsidence were noted in 2 patients at year 1. This did not progress at 3 years and did not deteriorate clinical outcome.
CONCLUSIONS: We recommend our two staged approach to deal with this difficult clinical problem. We believe this approach is safe for TAR surgery where talar vascularity and bone quality is questionable leading to reduced talar subsidence, ischaemic pain and improvement in longevity of TAR.
METHODS: Evidence IV (Retrospective case series).

BACKGROUND: Fracture-dislocation of the talus is one of the most severe injuries of the ankle. Opinion varies widely as to the proper treatment of this injury. Since Blair\'s original description of the tibiotalar fusion in 1943, there is little mention in the literature of his method. The present study reports the results of tibiotalar arthrodesis with modification in Blair\'s technique.
METHODS: Eleven cases of modified Blair\'s tibiotalar arthrodesis were retrospectively studied. The average age was 32.4 years (range, 26-51 years). Six patients had posttraumatic avascular necrosis; five had neglected fracture-dislocation of the talus.
RESULTS: The mean followup is 8 years (range 3-12 years). Tibiotalar fusion was achieved in all the ankles at an average of 20.5 weeks (range 16-28 weeks). Nine cases having 15 degrees -20 degrees tibiopedal motion had excellent results and two ankles having 10 degrees -15 degrees of tibiopedal motion had good result.
CONCLUSIONS: We achieved good long term results with tibiotalar arthrodesis with modification in Blair technique. The principal modification in the present study is retention of the talar body while performing arthrodesis with anterior sliding graft. The retention of the talar body provides intraoperative stability and in the long term, the retained talar body shares the load transmitted to the anterior and middle subtalar joints thus resulting in improved hind foot function and gait.