Date: Wed, 26 Jul 2000 20:01:38 +0100

From: chris wilson

Subject: missing talus

Dear list members,

These shrunken images are from a 25 year old female army physical education instructor who fell off her motorbike on its first trip out.

There are no other serious injuries. The wound was very contaminated and the ankle washed out and stabilised with a unilateral frame on the night of admission.There has been a second look at 36 hours and the skin flap is still viable. The talus is presumably still in a field somewhere. Options now? We were thinking in terms of a tibio-calcaneal fusion with an iliac crest bone block and ilizarov frame. However, one of our trainees made the interesting observation that she is far more lilely to be able to run again with a good BK amputation with a skew flap and good prosthesis than she is with a tibio-calcaneo-navicular fusion, however sound. All observations gratefully received.

Kind Regards

Chris Wilson
Consultant Trauma and Orthopaedic Surgeon
University Hospital Cardiff

Date: Sat, 29 Jul 2000 13:34:40 -0500

From: Kyle Dickson, MD

If the patient is neurovasculary intact once clean, I would do a tibial calneal fusion with two 6.5 screws from the calcaneus into the tibia. I saw a patient now three years out from this injury who did well but did not like to be short with a lift so I lengthened her 1 3/4 inch. She has a little funny run when her leg goes into external rotation at toe off but she runs and has a normal plantigrade foot.

kyle

Date: Fri, 28 Jul 2000 19:32:29 +0100

From: chris wilson

thank you for all your views. does anyone know where I can obtain an allograft talus?

Kind Regards

Chris Wilson
Consultant Trauma and Orthopaedic Surgeon
University Hospital Cardiff