Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions.

摘要: A retrospective study of 22 ankles in patients with osteochondral talar dome lesions between 1975 and 1983 has indicated that surgical treatment yields superior results to conservative therapy. Thirteen male 9 female patients, ages 72 years, average age 28 showed 10 medical (Berndt Harty classification (stage I (one); stage II/III (nine)) 12 lateral (5), IV (7)). Examination follow-up on 19 (86%) averaged 24 months. The initial diagnosis seen retrospectively x-rays was missed 43% the time by emergency room physicians. history trauma verified 100% 80% medial lesions. Of ankles, 14 were isolated injuries, while 8 had concomitant fractures, ligament, or peroneal tendon damage. Surgical consisted removal fragment, curettage, drilling its bed. Two distinct approaches utilized. Lateral approached through standard anterolateral incision, anterior tibial sheath grooving anteromedial distal tibia articular surface. approach allowed somewhat posteriorly placed be reached, negating need for a malleolar osteotomy postoperative immobilization. On follow-up, no untoward ankle arthrosis noted as result tibia. Nineteen therapy 79% excellent good, 21% fair, poor results. Five eight who elected prolonged finally surgery. three remaining conservatively treated, there two fair one result.