The challenging missing talus, surgical treatment and clinical outcomes: a review

Total talus extrusion, a rare and debilitating ankle injury, leads to severe pain, instability, and functional impairment. Its rarity complicates treatment and established guidelines are lacking. This review, adhering to PRISMA criteria, analyzed 113 cases from 53 articles (PubMed, Cochrane, CINAHL) which were retrieved using the keywords: “missing talus”, “total talar extrusion”, “talar extrusion”, “open talar dislocation”, and “open talus dislocation”. The text was submitted to PROSPERO with registration number CRD42023385242. Primary talus reimplantation occurred in 86 cases, talectomy and tibio-calcaneal arthrodesis were alternatives. Avascular necrosis, arthritis, infections, and second surgical revision are the most frequent complications in both cases. The management debate centers on reimplantation versus removal. The evidence suggests immediate reimplantation, coupled with thorough debridement, antibiotics, and tetanus prophylaxis, mitigates complications and restores ankle anatomy. This review aims to establish comprehensive surgical guidelines for missing talus, optimizing recovery and function while minimizing long-term sequelae.