Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated With Ankle Fractures.
BACKGROUND
Osteochondral lesions (OCLs) associated with ankle fracture correlate with unfavorable outcome. The goals of this study were to detect OCLs following ankle fracture, to associate fracture type to OCLs and to investigate whether OCLs affect clinical outcome.


METHODS
100 ankle fractures requiring operative treatment were prospectively included (46 men, 54 women; mean age 44 ± 14 years, range 20-77). All ankle fractures (conventional radiography; 71 Weber B, 22 Weber C, 1 Weber A, 4 isolated medial malleolus and 2 isolated posterior malleolus fractures) were treated by open reduction and internal fixation. Multidetector computed tomography (CT) was performed postoperatively. For each OCL, the location, size, and Loomer OCL classification (CT modified Berndt and Harty classification) were determined. The subjective Foot and Ankle Outcome Scoring (FAOS) was used for clinical outcome at 1 year.


RESULTS
OCLs were found in 10/100 ankle fractures (10.0%). All OCLs were solitary talar lesions. Four OCLs were located posteromedial, 4 posterolateral, 1 anterolateral, and 1 anteromedial. There were 2 type I OCLs (subchondral compression), 6 type II OCLs (partial, nondisplaced fracture) and 2 type IV OCLs (displaced fracture). Mean OCL size (largest diameter) was 4.4 ± 1.7 mm (range, 1.7 mm to 6.2 mm). Chi-square analysis showed no significant association between ankle fracture type and occurrence of OCLs. OCLs did occur only in Lauge-Hansen stage III/IV ankle fractures. There were no significant differences in FAOS outcome between patients with or without OCLs.


CONCLUSIONS
Ten percent of investigated ankle fractures had associated OCLs on CT. Although no significant association between fracture type and OCL was found, OCLs only occurred in Lauge-Hansen stage III/IV ankle fractures. With the numbers available, OCLs did not significantly affect clinical outcome at 1 year according to FAOS.


METHODS
Level IV, observational study.
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands t.nosewicz@gmail.com.
Tomasz L
TL
Nosewicz
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
M Suzan H
MS
Beerekamp
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Robert-Jan O
RJ
De Muinck Keizer
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Tim
T
Schepers
Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.
Mario
M
Maas
Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands.
C
C
Niek van Dijk
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
J Carel
JC
Goslings
D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D000843:Ankle Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D013628:Talus / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed
ankle fracture; osteochondral lesions; talus