A chimeric medial femoral condyle chondro‐osseus flap with two thin periosteal flaps to reconstruct partial necrosis of talar body: A case report

Abstract

AbstractTotal talar extrusion is a rare complication of high‐energy traumas. A consequence of this injury can be avascular necrosis (AVN) of the talus. Patients are confronted with pain, limited range of motion and post‐traumatic arthritis. As AVN progresses the talus is gradually destroyed. This report presents the use of a chimeric medial femoral condyle chondro‐osseus flap with two thin periosteal flaps to increase vascular supply to the traumatized area, accelerate bone formation, flap integration, and restore articular surfaces in a patient with partial necrosis of talar body. The patient was a 26‐year‐old female with open left lateral talar extrusion after a motor‐vehicle accident that developed a partial avascular necrosis, at the level of the subtalar and ankle joint with altered talar dome surface with partial depression of 2 cm. The patient was in pain and not able to walk. The medial femoral condyle chondro‐osseus portion was placed in the talar dome depression to restore the subtalar joint, the periosteal flaps were placed on top to reconstruct the ankle joint restoring the articular surfaces and the correct weight‐bearing distribution. No complications or morbidity of donor site were observed. One year after the operation, the patient walks free, without pain. Post‐operatory x‐ray performed, evidenced progressive bone healing and reduction of the AVN. In the intent of performing a joint‐saving procedure, the presented chimeric flap might be effective in the short‐term with excellent clinical and radiographic outcomes.