Antegrade Kirschner wire fixation for small talar osteochondral fractures: a case report

Small acute osteochondral fractures (OCFs) of the talus are rare and often undiagnosed. Inaccurate diagnosis or improper management of these injuries can lead to defects in the talar cartilage, increasing the risk of long-term ankle arthritis. The ideal treatment approach for these fractures continues to be a topic of discussion. This report presents a case of antegrade Kirschner wire fixation for an acute small osteochondral fracture on the medial talus, combined with an undisplaced medial malleolus fracture (MMF). The MMF was surgically opened to achieve optimal exposure of the osteochondral fracture. After anatomical reduction of the osteochondral fragment, two 1.0-mm Kirschner wires were inserted antegrade and passed through the opposite skin. They were then removed retrogradely to ensure that the wire tails were flush with the articular surface. Two months postoperatively, radiological imaging confirmed the healing of both the MMF and the osteochondral fragment. The Kirschner wire was then removed percutaneously. At the final follow-up, imaging showed successful osteochondral healing of the talus, with favorable clinical and radiological outcomes.