Non resolving ankle pain? look for Osteochondral fractures

If your patient has non-resolving pain around the ankle after an inversion event, this may be the culprit. 

Osteochondral Fractures: One of the most consistent causes of non-resolving pain after significant inversion injury, is an osteochondral fracture of the talar dome. These may occur either in the posteromedial or anterolateral aspect of the talar dome and should be suspected whenever ankle pain or swelling persist for greater than 6 weeks post-inversion injury.

Anterolateral lesions result from impaction of the anterior lateral aspect of the talar articular surface against the fibula, with an inversion force applied to a dorsiflexed foot. 

Posteromedial talar dome fractures are the result of impaction of the superomedial ridge of the talus against the tibial plafond when a plantarflexed foot is forcibly inverted. It becomes clear then that accurate history taking in terms of the mechanism of injury can deliver important clues to the diagnosis.

You might have heard that from me before on these pages!!

Osteochondral fractures of the talar dome are best visualised by MRI or CT scans and should be ordered whenever pain or abnormality persists after treatment, and in the presence of normal plain x-rays.  MRI and CT scans will give an accurate indication of the size, location and nature of the osteochondral fracture.  Osteochondral fractures of the talar dome have been classified according to Berndt and Harty 1 (1959)  as one of 4 stages of injury.

Simon Bartold
Director of Bartold Clinical