Complete talar dislocation without late osteonecrosis: clinical case and anatomic study.

Avascular necrosis is a well-known, severe complication postfracture or subluxation of the talus. Type and localization of injury often permit conclusions regarding the probability of bone necrosis. In the following case, talar neovascularization was demonstrated after severe trauma, resulting in an open pilon fracture of the right tibia and complete talar dislocation with consequent destruction of the most relevant blood supply. This example shows that even after apparently irreversible injury to the arterial circulation, immediate bony reconstruction with comprehensive soft tissue management is indicated and can lead to bony healing. The anatomy of intraosseus vascularization is reviewed and discussed.