Arthroscopic treatment of transchondral talar dome fractures.

Flake fractures of the talar dome involving the cartilaginous surface and subchondral bone have been called transchondral talar dome fractures, a term specific for both anatomical and traumatic etiology of this lesion, and more descriptive than the previously used "osteochondritis dissecans" of the talus. The diagnosis is made by standard ankle radiographs and the lesion should be suspected in all "sprained ankles" that have continued disability following standard treatment. Surgical treatment has been recommended for Stage 3 and Stage 4 (detached/displaced fragments). Surgical treatment for removal of symptomatic lesions has, in the past, involved an arthrotomy for exposure with removal of the fracture fragment and curetting and drilling of the donor bed. Posteromedial fractures are often hard to reach through a standard approach and exposure may require an osteotomy of the medial malleolus. The use of the arthroscope in both confirmation of diagnosis and surgical treatment has proved to be beneficial in the treatment of these symptomatic fractures. The technique allows direct visualization of the pathology with adequate debridement with minimal iatrogenic trauma and early mobilization and return to preinjury status. The series includes 10 ankles in nine patients with eight posteromedial lesions, six Stage 3 and two Stage 4, and two anterolateral lesions, both Stage 4. All patients were treated arthroscopically for removal of the loose fragment and curettage of the osteochondral bed. Subjective and objective follow-up at a minimum of 6 months revealed good results in nine of the ten patients.