Talar dome osteochondral injury with detached fragment

Case contributed by Magdalena Chmiel-Nowak
Diagnosis certain


Ankle trauma one month ago.

Patient Data

Age: 20 years
Gender: Male

Ankle joint effusion is visible.

There is an osteochondral fracture of the posterolateral part of the talar dome; the fractured fragment is detached and flipped upside down, so that the articular cartilage is visible at its inferior surface. There is also reactive bone marrow edema of the distal tibia and the talus.

The anterior talofibular ligament appears intact but slightly blurred, most likely in keeping with its sprain.

Bone marrow edema of the cuboid and the base of the 4th metatarsal bone is also noted (most likely post-traumatic).

Case Discussion

In case of osteochondral fracture/injury, it is sometimes hard to tell if the fractured fragment is stable or not. The presence of fluid surrounding the fragment is very helpful, indicating its instability. In the presented case the fragment was frankly displaced, making it without doubt stage IV osteochondral injury.

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