The Masquelet technique in traumatic loss of the talus after open lateral subtalar dislocation-A case report

Ahmed Nabil Abdulazim; Martina Reitmaier; Henrik Eckardt; Rik Osinga; Franziska Saxer

doi:10.1016/j.ijscr.2019.10.029

The Masquelet technique in traumatic loss of the talus after open lateral subtalar dislocation-A case report

Int J Surg Case Rep. 2019:65:4-9. doi: 10.1016/j.ijscr.2019.10.029. Epub 2019 Oct 21.

Authors

Ahmed Nabil Abdulazim¹, Martina Reitmaier¹, Henrik Eckardt¹, Rik Osinga², Franziska Saxer³

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
² Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
³ Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Crossklinik, Swiss Olympic Medical Center, Bundesstr. 1, 4054, Basel, Switzerland. Electronic address: franziska.saxer@crossklinik.ch.

Abstract

Introduction: Subtalar dislocations are rare injuries and treatment recommendations missing. Gross contamination and devascularisation are aspects supporting talectomy as potential treatment choice. Reconstruction in these cases can be challenging. The Masquelet technique presents one viable option.

Presentation of case: A carpenter sustained a high energy chrush injury with traumatic open lateral talar dislocation qualifying as Gustillo Anderson type IIIc injury, a mangeled extremity index of 7 and gross contamination. The severity of soft tissue damage and contamination prompted the decision for talectomy before plastic coverage with a gracilis flap. Additionally a Masquelet procedure with cement spacer was initiated. After consolidation of the soft tissues a hindfoot arthrodesis with approximate preservation of leg length could be performed. In the course of treatment, the patient suffered no infection and could resume full weight bearing after nine months. The patient resumed his previous occupation with adapted workload and is satisfied with the treatment result.

Discussion: In the present case the principle options were talus preservation or talectomy with reconstruction. Talus preservation in the presence of gross contamination can be associated with the risk of infection, in addition there is a risk to develop secondary arthritis. For this individual patient the a fast and definite solution was important at this point in life. Surgeons therefore opted for talectomy. To optimally reconstruct leg length and optimize for arthrodesis the Masquelet technique was employed.

Conclusion: The Masquelet technique is a viable option also in the emergency situation to preserve extremity length and optimize tissue viability.

Keywords: Case report; Hindfoot arthrodesis; Masquelet technique; Traumatic loss talus.