Retrograde Tibial Nail and Trabecular Titanium Spacer Block for the Treatment of Missing Talus: A Rare Case Report.

Astragalus enucleation with complete bone loss is a rare pathology, and there is no current classification or treatment protocol. A 34-year-old woman sustained an open total enucleation of the talus without bone recovery in a motorcycle accident. Initially, she was treated at the emergency department with wound cleaning, surgical debridement, and external fixation with intravenous antibiotic therapy. Definitive treatment was delayed 8 weeks because of acute infection, which was treated with lavage, surgical debridement, and specific antibiotic therapy. To avoid leg-length discrepancy, we performed a tibiocalcaneal arthrodesis using a trabecular titanium spacer block with retrograde intramedullary nailing. We report satisfactory clinical, functional, and radiological results at 24 months after surgery. No complications or dysmetria was reported. The treatment of choice after an open talar enucleation with bone loss is the tibiocalcaneal arthrodesis, and it can be done isolated or with an associated autologous bone graft or allograft. The most frequent complications are infection, pseudoarthrosis, and, if the talar space is not adequately filled, dysmetria. We present a new way of filling this defect, which is not described in the current literature, using a trabecular titanium spacer block (indicated for revision of ankle arthrodesis of the hindfoot) together with retrograde intramedullary nailing, with promising results.