Total Talus Allograft Transplantation With Subtalar Arthrodesis for Missing Talus: A Report of a Rare Case

Post-traumatic missing talus is a rare and severe injury that often results in poor functional outcomes, with no consensus on the optimal treatment approach as strategies vary based on injury severity. We present the case of a 44-year-old male who sustained a missing talus following a high-energy motorcycle accident. After initial wound management and application of an external fixator, the patient underwent size-matched, fresh-frozen talus allograft transplantation combined with subtalar fusion. Postoperative radiography and CT confirmed successful transplantation with solid subtalar fusion, although progressive osteonecrosis was noted in the medial shoulder region of the talus. At the two-year follow-up, the patient exhibited limited ankle and hindfoot motion but was able to bear weight and walk without assistance, reporting no pain in his feet and achieving a final American Orthopaedic Foot & Ankle Society hindfoot score of 72. This case underscores the potential of total talar allograft transplantation with subtalar arthrodesis in treating severe talar bone loss or missing talus, although long-term follow-up is necessary to assess the clinical implications of medial talar collapse and the possible need for revision surgery.