Osteochondral fractures of the talar dome
Talus accounts for 4% of all osteochondral lesions.
Medial more common than lateral lesions
Aetiology:
Usually trauma.
Clinical features:
Deep aching pain in ankle – aggravated by exercise. Sometimes get crepitus clicking, locking or catching sensation.
Joint line tenderness. Decreased range of motion.
Activity aggravates symptoms.
Most have history of ankle sprain(s).
Classification:
Berndt & Harvey’s 4 radiographic stages:
1) Small area of subchondral compression
2) Partially detached fragment
3) Completely detached non-displaced fragment
4) Completely displaced fragment
Ferkel & Sgaglione’s staging classification based on CT:
I) Cystic lesion within dome of talus
IIa) Cystic lesion with communication to talar dome surface
IIb) Open articular surface lesion with overlying non-displaced fragment
III) Non-displaced lesion with lucency
IV) Displaced fragment
Treatment:
Nonsurgical for Stages I and II of both classifications – cast immobilisation for 8-12 weeks
Surgery if nonsurgical failure and for stages III to IV.
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Related Topics:
Talar Osteochondral Defects: Diagnosis, Planning, Treatment, and Rehabilitation (book)
Cartilage Lesions of the Ankle (book)
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