Treatment of talar neck fracture with avascular necrosis with a vascularized cuboid bone graft: case report and literature review

Abstract

The talus is the second most fractured tarsal bone, accounting for 3% of foot fractures. Approximately 17% of these fractures develop osteonecrosis, increasing the incidence as thedislocation and the comminution of the fracture become more evident. In recent studies, it was observed that there was is no correlation between the period of fracture fixation and the presence of osteonecrosis, but there is an association of osteonecrosis and the presence of comminuted fractures and compound fractures.Treatment of talus neck fractures by use of a vascularized pedicle bone graft taken from the cuboid bone with technical description and case report.Not all cases of avascular necrosis lead to bone breakdown and change the prognosis. However, once bone collapse occurs, the functional prognosis worsens. Various procedures have been described in the literature to change this prognosis. With a vascularized bone graft, it is possible to establish a new vascularization to the donated area, resulting in osteoinductive cells that can speed up fracture healing and prevent osteonecrosis. In talus fractures, the use of the cuboid vascular pedicle is well studied, with known vascular anatomy, and good results in preliminary studies. The cuboid vascularized bone graft may be used in the treatment of dislocated fractures of the talus with a high possibility of vascular necrosis, decreasing the possibility of this complication and subsequent bone collapse.