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Osteochondral Fracture Talus Print

Osteochondral fractures of the talus are commonly associated with ankle sprains. Berndt and Harty classified osteochondral lesions into four stages. 

Stage I lesions have a small area of subchondral compression. Stage II lesions have a partially detached osteochondral fragment creating a "flap". Stage III lesions are completely separated but within the bony crater, and stage IV lesions the fragment is loose within the ankle. This picture demonstrates a stage IV osteochondral fracture of the lateral talus before and after arthroscopic excision.

Osteochondral lesions characteristically cause pain and swelling. The condition may be diagnosed with AP and lateral and oblique xrays. Occasionally, an MRI may be helpful in diagnosing stage I lesions.

The treatment depends upon the age of the patient and stage of the lesion. Skeletally immature patients with undisplaced lesions can be treated conservatively with nonweightinging in a short leg cast. Stage II, III and IV lesions may be treated with curettage and pinning of the fragment in immature patients. All stage III and IV patients should be treated with immediate arthroscopic excision and curettage of the lesion. Delay in treatment results in development osteoarthritis.

 
© Allen F. Anderson, M.D. 2017