Infected pseudarthrosis after Hawkins IV talar neck fracture dislocation resolved with iliac crest free flap

Vascularized iliac osteocutaneous flap (VIOF) can be used to treat small bony losses in the inferior limb as in talar osteonecrosis following Hawkins IV fracture-dislocations. A 39-year-old man with a talar Hawkins IV fracture-dislocation was treated in acute with closed reduction and pinning of the neck. Five months later, he developed osteonecrosis. After two procedures of bone graft and a MSSA osteomyelitis treated with broad debridement, external fixation and antibiotics, the bony gap was filled with a VIOF. Six months later the complete bony union was obtained, and the patient gradually resumed his everyday activities; after 13 years the AOFAS score was 77. The tricortical structure of VIOF provides good strength and can reach 4×8 cm size without risk of bone necrosis. It may be an alternative at the fibular flap when the gap is small, it is not recommended in older patients with peripheral blood vessels pathology, in neurological disorders and in smokers. The VIOF can be considered a valid and valuable tool to treat avascular necrosis (AVN) of small bones like the talus and is associated with low comorbidity of the donor site.