A 19 year old boy presented with chief complaints of insidious onset pain in the right ankle since the last two years, swelling in the right ankle since the last six months and inability to bear weight on right side since the last six months. There was no history of fever, loss of appetite, loss of weight, similar complaints in other joints or history of similar complaints in the past. The family, occupational, recreational and drug histories were not significant. The general physical and systemic examinations were within normal limits.
On local examination, the attitude of the limb was neutral. There was a 5 × 4 cm swelling over dorsum of right foot and anterior aspect of ankle joint. There were no visible veins, sinus or discharge from the swelling. The local temperature was increased and the swelling was tender. All movements at the ankle joint were painfully restricted.
Serum biochemistry studies were within normal limits. AP and lateral radiographs of the ankle showed a radiolucent lesion occupying the whole of talus with expansion and thinning of the cortex (Figure ). CT scan revealed an expansile soft tissue mass in the talus causing cortical destruction and extension into soft tissues. The joint space between calcaneum and talus was well preserved (Figure ). A Fine Needle Aspiration Cytology study of the swelling was done and a provisional diagnosis of Giant Cell Tumor was made.
Lateral radiograph of ankle showing a radiolucent lesion occupying the talus with expansion and thinning of the cortex.
CT scan of ankle showing an expansile lytic lesion in the talus causing cortical destruction and extending into soft tissues.
The condition, its prognosis and various treatment modalities were discussed at length with the patient. In view of the extensive involvement of talus, total talectomy with tibio – calcaneal arthrodesis was planned. The patient was a manual laborer and therefore chose the option of a stiff but painless joint.
Total talectomy was performed via the standard anterior approach. Fusion was achieved by autologous iliac crest graft and stabilization with a Steinmann pin (Figure ). Histopathological examination of the talectomy material confirmed the diagnosis of Giant Cell Tumor. The patient was advised not to bear weight on the affected limb for 8 weeks and mobilized in a short leg walking cast thereafter. The Steinmann pin and cast were removed after 4 months. At 6 months of follow-up, the patient had a smooth healed scar with a painless and well arthrodesed ankle with no evidence of recurrence (Figure ). There was no evidence of recurrence at 18 months of followup.
Immediate postoperative radiograph showing talectomy, bone grafting and stabilization with a Steinmann pin.
Radiograph at 6 months follow-up showing a well arthrodesed ankle.