Talus Fracture-Dislocations With Talar Body Extrusion Have High Complication Rates, With Uneventful Outcomes in a Minority of Patients After Open Reduction Internal Fixation

Background: Talus fracture-dislocations with talar body extrusion (TBE) are a rare subtype of talus fracture that have been reported to occur in 1.2% of talus fractures. There is limited evidence on the outcomes of these injuries. The purpose of this study was to characterize injury patterns, operative management, and radiographic and reoperation outcomes of TBE. Methods: A retrospective review of talus fractures treated at a level 1 trauma center from 2016 to 2024 was performed. Radiographs and computed tomography scans were screened for TBE. Demographics, injury characteristics, operative details, reoperations, and radiographic complications were recorded. Outcomes were reported descriptively for patients with at least 6 months of follow-up, with a nested subanalysis of those with at least 12 months. Uneventful outcome was defined as no reoperation, no avascular necrosis (AVN) or nonunion, and no greater than grade 2 posttraumatic arthritis (PTA) at final follow-up. Results: Among 178 talus fractures, 18 TBEs were identified. Seventeen patients had at least 6 months of follow-up and 15 had at least 12 months. In the 6-month cohort, mean follow-up was 1.72 years; 15 patients (88%) underwent temporizing reduction with external fixation and/or percutaneous fixation, 16 underwent definitive ORIF, and 1 underwent primary TTC fusion. Reoperation occurred in 7 (41%), AVN in 6 (35%), nonunion in 4 (24%), and grade 3 or 4 PTA in 10 (59%); 4 (24%) had an uneventful outcome. In the 12-month subgroup, reoperation occurred in 7 (47%), AVN in 5 (33%), nonunion in 4 (27%), and grade 3 or 4 PTA in 10 (67%); 3 (20%) had an uneventful outcome. Conclusion: Complications and reoperations were common after open reduction and internal fixation for TBE, although a minority of patients achieved uneventful radiographic and surgical outcomes. Follow-up stratified reporting showed persistently high complication burden at 12 months, although a small subset maintained uneventful radiographic and surgical outcomes, including 3 of 15 patients with at least 12 months of follow-up. Level of Evidence: Level IV, case series.