Transchondral fractures of the dome of the talus

Osteochondritis dissecans of the talus is a well documented entity, defined as a transchondral fracture of the dome of the talus. As a fracture, it should heal with immobilization; however, this lesion often causes severe disability and, more often than not, the fragment will not unite with conservative treatment. There is much debate concerning operative versus nonoperative treatment, and the purpose of this paper is to discuss the salient points of the controversy, review literature on the subject, and present a case with a follow-up of 4.5 years.