1 / 24

Osteochondritis Dissecans of the Ankle

Osteochondritis Dissecans of the Ankle. November 24, 2003 Dr. N.C. Stone. Introduction. Incidence and Presentation Etiology and Mechanism of Injury Pathoanatomy Classification Imaging Treatment and Results. Incidence and Presentation. Osteochondral fracture of the Talar Dome

liam
Download Presentation

Osteochondritis Dissecans of the Ankle

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Osteochondritis Dissecans of the Ankle November 24, 2003 Dr. N.C. Stone

  2. Introduction • Incidence and Presentation • Etiology and Mechanism of Injury • Pathoanatomy • Classification • Imaging • Treatment and Results

  3. Incidence and Presentation • Osteochondral fracture of the Talar Dome • Males avg 25 years • Presents with ankle sprain • Initially missed (75%) • 2-6% of all ankle sprains

  4. Incidence and Presentation • “ankle sprain not improving” • Stiffness, pain, effusion • Localized tenderness • Locking if loose fragment

  5. Etiology and Mechanism of Injury • Inversion injury • Lateral lesion, dorsiflexion, impacts and shears against fibula • Medial lesion, plantar flexed, posterior tibial plafond

  6. Pathoanatomy • Once thought to be non-traumatic/AVN • Most agree now is traumatic • Osteochondral fragment is disrupted • If stable, new capillaries my cross fracture and revascularize fragment • If not stable or displaced, AVN and fragmentation

  7. Classification • Burndt and Hardy (1959) • Many new MRI classifications

  8. Imaging • 70% seen on plain films • Bone scan, CT are all used but MRI superior • Assess cartilegde, stability

  9. Imaging

  10. Imaging

  11. Imaging

  12. Treatment • Stage 1 - rest, cast, non-operative • Stage 2 – same for 6 weeks, 90% good results • Stage 3 - lateral, definitely surgical – medial, more conservative • Stage 4 - surgical

  13. Surgical Treatment • Acute 3 or 4 should have an attempt at repair • Peg, countersunk screws • Necrotic, fragmented, or small fragments • Excision, drill base

  14. Surgical Treatment • Non-responding 1 and 2 • Drill but attempt to preserve articular surface

  15. Surgical Treatment • Most can be done arthroscopically • +/- traction • Medial malleolar osteotomy may be necessary

  16. Arthroscopy

  17. Arthroscopy

  18. Arthroscopy

  19. Surgical TreatmentMosaicplasty

  20. OCD Long term • 88% good – excellent early • Best if < 1 year between injury and treatment • Lower grades do best

  21. OCD Long term • Do poorly over time • Jensen et al. • After 9 years • 60% of patients had pain and stiffess • 90% mild arthrosis on radiographs

  22. Conclusions • Ankle sprain that does not get better • MRI best • Non-surgical then surgical • Arthroscopically • Great early then poor long term prognosis

More Related