4.1.1

Suitable for patients with traumatic talus dislocation or mild to moderate bone necrosis, especially those treated within 12 h after the injury.

4.1.2

The first step involves infection control, including debridement and disinfection. Necrotic tissue and bone fragments are thoroughly removed from the damaged talus, ensuring a smooth bone surface. The talus is then reimplanted using detailed surgical techniques, with metal fixation devices used to stabilize the talus and restore joint anatomical structure. Postoperatively, appropriate weight-bearing management and rehabilitation treatment are essential.Following debridement and reduction, the talar body is typically stabilized using **internal fixation, such as cannulated screws or Kirschner wires**, to prevent displacement and promote healing. This is often supplemented with a period of cast immobilization postoperatively.

4.1.3

Talar reimplantation is typically suitable for patients with talar dislocations caused by trauma, particularly those without severe infection or complete loss of blood supply. The core steps of this procedure include infection control, thorough debridement, and reimplantation of the talus after infection treatment. The main goal is to restore the normal anatomical structure as quickly as possible, rebuild the talus height and bone quality, and thereby restore ankle joint function ^, . However, this treatment method often faces complications such as postoperative infections, bone resorption, or bone necrosis, which can ultimately lead to talar collapse ^, . Therefore, in cases where trauma has occurred for more than 12 h, or in elderly patients or those with underlying conditions like diabetes, talectomy or other alternative treatments may need to be considered. A case series by Mohindra et al. (2014) on early talar reimplantation demonstrated that it is a viable option that can preserve hindfoot anatomy and function, with satisfactory outcomes reported in selected patients .

4.1.4

Infection Risk: Talar reimplantation is commonly associated with a high risk of infection. Since talus dislocations are often accompanied by open wounds, the risk of contamination is high. Consequently, infection can lead to impaired wound healing and even osteomyelitis. Infection is one of the most common postoperative complications and may have long-term negative effects on the surgical outcome. A study by Carla S. Smith et al. following 19 patients for at least one year (average 42 months), reported two infections—one occurring at two weeks and another at 19 months after calcaneal osteotomy. While no infections were reported in the case series by Mohindra et al. (2014) on early talar reimplantation . Early infection risk remains a concern. However, discarding the talus would adversely affect hindfoot function and limit future reconstructive options. Therefore, it is recommended to preserve the talus as much as possible, while controlling infection to maximize ankle function.Risk of Avascular Necrosis (AVN): The talus has a complex blood supply, and after injury, it is prone to avascular necrosis (AVN). AVN can lead to talar collapse and loss of function, representing a major risk of talar reimplantation. In a follow-up study, 2 out of 5 patients (40 %) required secondary ankle arthrodesis due to talar necrosis. Signs of necrosis appeared at 15 months and 24 months postoperatively. The study suggests that despite the risk of necrosis, talar reimplantation should still be attempted because it restores normal hindfoot anatomy and preserves bone stock for future function or subsequent surgeries ^, .

4.1.5

Talar reimplantation offers distinct advantages in certain patients, especially in preserving ankle joint function and bone stock. However, it carries relatively high risks of infection and avascular necrosis. Despite these risks, many retrospective studies still recommend early talar reimplantation, as it contributes to early movement around the ankle joint and prevents additional foot damage ^,,, .

4.2.1

Suitable for patients with severe trauma, bone necrosis, or non-union, especially elderly patients or those with low functional activity demands. For extreme and complex cases such as failed total ankle replacement with severe bone loss, infection, or inadequate soft tissue coverage, salvage arthrodesis (including tibiotalocalcaneal fusion) is also an important treatment option, the principles of which can be borrowed for the management of traumatic talar defects .

4.2.2

Ankle arthrodesis is a surgical procedure used to treat loss of ankle function, severe traumatic talus defects, or joint disease. It involves fusing the tibia, talus, and calcaneus, removing the articular cartilage, and stabilizing the joint using metal fixation devices such as screws or plates. This procedure helps reduce pain and increase joint stability . A retrograde intramedullary nail is a commonly used and effective fixation method for tibiotalocalcaneal arthrodesis, particularly in complex situations such as avascular necrosis of the talus The study by Tenenbaum et al. confirmed that even in cases of extensive talar necrosis, ankle and hindfoot arthrodesis using a retrograde intramedullary nail can achieve a 100 % union rate without the need for structural bone graft . For extreme cases involving infection, talar extrusion, or complex pilon fractures, ankle arthrodesis using a Taylor Spatial Frame (a modern evolution of the Ilizarov technique) is also a reliable option .

4.2.3

Pain Relief and Improved Functional Stability: Ankle arthrodesis is a well-established surgical technique. While early studies such as Kitaoka et al. primarily focused on fusion rates, modern research confirms that this technique reliably alleviates pain and improves functional stability. Its core mechanism involves eliminating pain generated by arthritic or unstable joint surfaces through solid fusion, while simultaneously significantly enhancing ankle stability. This effectively prevents joint dislocation and instability, thereby reducing the risk of further injury. Specific clinical evidence shows: Tenenbaum et al. confirmed that tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail significantly improved multiple outcome measures—the VAS pain score decreased from 6.9 to 1.7, the AOFAS hindfoot score increased from 32.7 to 72.1, and the SF-36 physical component score improved from 30.5 to 42.8 . For complex cases with massive bone defects, the systematic review by Cifaldi et al. indicated that tibiotalocalcaneal arthrodesis with structural allograft achieved a limb salvage rate of 92.5 %, providing patients with a stable and functional limb . These principles are equally applicable in salvage arthrodesis (such as for failed total ankle replacement) and can be borrowed for the management of traumatic talar defects .

4.2.4

Long Recovery Time: Ankle arthrodesis is associated with a range of potential complications, including infection, non-union (fusion failure), vascular or nerve injury, and poor wound healing. Additionally, a prolonged recovery period is often required, which may include activity restrictions and the use of assistive devices. Postoperative rehabilitation typically involves the use of external fixation devices and physical therapy. The recovery period is lengthy, and patients may need gait retraining during rehabilitation . Although techniques like the Taylor Spatial Frame can effectively manage complex cases, the treatment process can be prolonged (mean external fixation time 11.1 months) and may require multiple surgeries (mean 5.9 procedures) .

Possible Degeneration of Adjacent Joints: Although ankle arthrodesis stabilizes the joint, patients may experience excessive wear and tear of adjacent joints (such as the knee or hip) due to the long-term lack of ankle movement. This can lead to joint degeneration or dysfunction in those regions ^, .

Limitations for Young, Active Patients: For younger, more active patients, joint fusion may not be the ideal option, as it limits the range of motion and could affect their daily activities or sports participation.

4.2.5

Ankle arthrodesis has significant advantages in treating traumatic talus defects and severe ankle joint degeneration, particularly in terms of effectively relieving pain and restoring joint stability. However, patients need to be aware of the loss of joint mobility and potential decrease in quality of life that come with this procedure. For young and highly active patients, alternative treatments such as talar reimplantation or ankle joint replacement may need to be considered. Each patient’s individual situation should be carefully evaluated to determine the most suitable treatment plan ^, .

4.3.1

Used for large bone defects, infectious bone defects, and cases requiring bone regeneration, especially in patients with complex trauma or infections.

4.3.2

The Ilizarov technique is a treatment method for fractures, bone defects, and deformities, using external fixation devices to treat traumatic bone defects. The technique is based on the tension-stress theory, where tissue regenerates under gradually applied, stable tensile forces. In limb salvage surgeries, bones and soft tissues regenerate via movable bone segments extended by the external fixator. Through rings and connecting rods, the Ilizarov device provides excellent stability, allowing patients to bear weight early and engage in muscle activity, promoting local blood supply and reducing bone healing time . Additionally, the thin diameter of the inserted pins and wires causes minimal tissue invasion . A case report by Gaorui Cai et al. described a 43-year-old male patient who underwent foot and ankle reconstruction with the Ilizarov technique. After 15 months of follow-up, the patient reported satisfactory functional recovery.

4.3.3

Promotes Bone Regeneration: The Ilizarov technique promotes bone regeneration through bone lengthening or repair, which is especially useful for managing traumatic bone defects, particularly in complex cases where surgery is difficult. A retrospective analysis by Meng Li et al. (2012–2016) found that the Ilizarov technique effectively corrected post-traumatic distal radius deformities and promoted bone regeneration Reduces Damage to Surrounding Tissue, Strong Anti-Infection Capability: Compared with traditional surgery, the Ilizarov technique reduces damage to surrounding soft tissues, blood vessels, and nerves through external fixation, thereby lowering the risk of complications. A study by Ashraf A Khanfour et al. evaluated 30 patients with end-stage arthritis or unstable conditions who underwent ankle arthrodesis. The use of Ilizarov technology for tibio-talar fusion in 22 cases and tibio-calcaneal fusion in 8 cases resulted in a 97 % success rate with minimal complications such as pin site infections and wound dehiscence, which were effectively treated with local wound care and oral antibiotics.

Personalized Treatment: The external fixator can be adjusted and optimized based on the specific needs of the patient, allowing for flexible treatment. The device can be fine-tuned through regular adjustments to achieve more precise bone healing, aligning with the direction of digital orthopedic advancements .

4.3.4

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