Twelve patients had ankle arthrodesis between the years 1984 to 1987 at one facility. In each case, the Calandruccio triangular compression device (Richards Medical Co., Memphis, Tennessee) and a two-incision technique were used to achieve maximum cancellous apposition and compression. Eleven patients (92%) achieved solid bony fusion. Two patients were deceased and one was lost to follow-up evaluation at the time of this study. These three patients were evaluated from clinical records and roentgenograms alone. Nine patients (mean age, 49 years), however, returned for evaluation by the authors (average postsurgery period, 1.7 years). A questionnaire, clinical exam, and a series of roentgenograms were obtained. An ankle rating scale was utilized and six patients were rated good or excellent. Two were rated poor and one was not rated because of underlying disease causing a weakened ambulatory status. Pain was the main determinant in placing a patient in the poor category. Both patients who rated poor had acceptable function. In this population, the hybrid combination of bimalleolar onlay grafting and triangular compression was found to be satisfactory in achieving a high degree of fusion and patient gratification.
Total dislocation of the talonavicular joint is rare. Detection of a major tarsal bone extrusion is simple. However, its management and treatment are not. We present a case of a total extrusion of the talus and navicular of an open dislocation and the reconstruction options that subsequently followed. In spite of a well-perfused foot, our patient decided to undergo a below the knee amputation after an infection.
