Transchondral talar dome fractures: not just a sprained ankle

Transchondral talar dome fractures are a rare but not unknown cause of continued disability following a "sprained ankle." The diagnosis is made with standard ankle roentgenograms and an awareness of the lesion. Surgical treatment is recommended in acute and chronic cases, based on the amount of displacement of the fracture and on the persistence of symptoms after nonoperative treatment. Nine patients were surgically treated for symptomatic transchondral talar dome fractures at Brooke Army Medical Center between July 1980 and July 1982. Seven of the nine injuries were initially misdiagnosed as a sprain. Average follow-up for the group was 15.5 months. Seven patients were treated with excision of the fracture fragment, curettement of the donor site, and multiple K-wire drilling of the fracture bed. One patient was treated with open reduction and internal fixation of the fracture fragment. Another was treated with multiple drilling of the cartilage-covered fracture fragment in situ. Postoperatively, all patients were kept non-weight-bearing for six weeks and did active range of motion exercises. After six weeks the patients participated in a supervised functional rehabilitation program. Results were scored by points for functional activity and range of motion. Eight of nine patients had good results and one had a fair result. There were no poor results.