How do you rate a lower extremity injury involving a talus fracture and complicated by avascular necrosis following surgery? A 34-year-old female nursery worker mistakenly stepped off the back of a truck while carrying a 50-pound bag of grass seed and sustained a displaced fracture to the neck of the talus.

An open reduction and internal fixation of the talus was undertaken. Unfortunately, the patient did not do well. Fourteen months later, a second procedure was required to remove hardware and debride areas of avascular necrosis of the talar dome. Eight months after this procedure, the patient continues to have moderate ankle pain.

The physical exam revealed the following: gait is mildly antalgic; mild tenderness over the tibiotalar junction is noted; no calf atrophy is noted; strength appears normal; and range of motion reveals 20 degrees of...

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