Introduction: Total extrusion and loss of the talus is a rare injury with a wide choice of appropriate treatment, but
rarely resulting in a fully functional recovery. We report on an uncommon case, both for the severity of the injury and
for the uncommon treatment due to the patient’s rejection of secondary surgery.
Case presentation: We treated a 16-year-old Caucasian man with the most extreme variant of a totally extruded and
lost talus, accompanied with complex injury of the soft tissues of the ankle and foot. The treatment included urgent
microvascular foot reimplantation, microvascular muscle free flap transfer, and temporary fixation. This kind of injury
should typically be treated by tibiocalcaneal arthrodesis. However, this was not performed, as after the successful early
stages of the treatment he strongly objected to another surgery due to his fully functional status and the successful
therapeutic results of our early treatment.
Conclusions: The injury described in this case study would ordinarily be treated by amputation, but due to the
well-executed treatment in the early stages after the injury, the outcome was satisfying. Surprisingly and against our
expectations, the late results of the treatment were successful even without arthrodesis. He is now 37 years old and
has a functional foot 21 years after the injury.
