Extract
Talar fractures constitute <1% of all
fractures1 and are
associated with a high rate of morbidity due to the limited vascularity of the
talus and frequent substantial posttraumatic loss of function. Especially
challenging are comminuted talar fractures for which reduction and internal
fixation is implausible and a tibiotalar and/or subtalar arthrodesis is
performed at the cost of joint mobility and hindfoot anatomy.The use of autologous bone-tissue allografts (from the iliac crest or
femoral head) to treat talar neck and body fractures has been reported.
However, these allograft procedures have been accompanied by primary fusion of
one or more of the seven articular surfaces of the talus, most commonly the
talocalcaneal, talonavicular, and talotibial joints, leading to considerable
loss of
function2-4.
The use of whole-bone fresh-frozen allografts in the foot has only been
reported for the treatment of bone tumors. Muscolo et al. reported on the use
of whole fresh-frozen calcaneal allografts for the treatment of chondrosarcoma
and giant-cell tumor of the
calcaneus5. We are
unaware of any previous reports on the use of bulk allografts as an
alternative to subtalar arthrodesis for the treatment of severely comminuted
fractures of the talus. In an attempt to minimize loss of function, we
reconstructed a severely comminuted talar fracture with use of a portion of a
fresh-frozen osteochondral talar allograft. We report our results after
twenty-nine months of follow-up. The patient was informed that data concerning
this case would be submitted for publication.