Osteochondral fractures of the dome of the talus

Fractures of the talor dome are uncommon and may elude diagnosis despite routine roentgenograms of injured ankles. Tomograms are helpful in localizing this lesion. Surgical removal of the osteochondral fragment is often indicated. Medial lesions may be inaccessible except by osteotomy of the medial malleolus which is then fixed with a bone screw. Lateral fragments are approached through anterolateral or posterolateral ankle incisions. Of 9 symptomatic ankles, 6 had satisfactory results following surgery. The other 3 were treated conservatively, one improved; two did not. One additional asymptomatic ankle remained so with no treatment. In one case the talus also contained an unusual cystic lesion; in another there was tarsal coalition.