![]() Motion on this irregular surface creates pain and inflammation within the joint. As a result, the surface of the ankle joint becomes irregular. As the force of an injury is applied to the cartilage, the subchondral bone collapses in a localized fracture. This example is very similar to what happens in a transchondral talar dome fracture. The skin of the apple appears normal, yet the underlying supporting structure of the flesh of the apple is damaged. As an analogy, think of the injury sustained by an apple when it falls from a tree. "Across the cartilage" is actually a very accurate description of how transchondral fractures occur. The term transchondral refers to an injury applied to the bone across the cartilage. This mechanism of injury accounts for the fact that the 56.3% of talar dome fractures are found on the posterior medial aspect of the talar dome.(5) 43.7% of remaining transchondral fractures of the talus occur in the middle third of the lateral talar dome.(5) As the talus rocks out of position during the sprain, the position of the foot and ankle places the posterior medial aspect of the talar dome in a position where focused load is applied by the tibia to the talus as the body weight pushes down, compressing the ankle and talar dome. In an inversion sprain of the ankle, the typical position of the foot and ankle at the time of injury is with the foot inverted and the ankle slightly plantarflexed. The mechanism of injury of a talar dome fracture involves focused load in one specific spot of the talar dome. The talus is designed to carry load evenly distributed over the entire surface of the talus, thus decreasing load in any one particular spot. The Bristol classification was described by Hepple et.al. Stage IV - Focal compression of the subchondral bone with a fully detached fragment of cartilage, detached from the site of injury and floating in the joint space.Ī newer method of classification of transchondral talar dome fractures which uses MRI as the basis of classification is called the Bristol classification. Stage III - Focal compression of the subchondral bone with a fully detached fragment of cartilage, still situated in place at the site of injury Stage II - Focal compression of the subchondral bone with partial detachment of a fragment of cartilage Stage I - Focal compression of the subchondral bone (bone beneath the cartilage) Berndt and Hardy described four stages of transchondral fractures.īerndt and Harty Classification of Talar Dome Fractures: What Berndt and Hardy described was a classification of fractures found immediately beneath the surface of the cartilage of the talar dome. Injuries of the talar dome were first discussed in the medical literature by Kappis in 1922.(4) In 1959, Berndt and Harty were the first to recognize the unique nature of these injuries.(5) They called these injuries transchondral fractures. The talar dome is the rounded portion on the top of the talus that articulates with the bones of the leg (tibia and fibula.) This article discusses injuries of the talar dome. Injuries of the ankle joint can be complex and debilitating. ![]() These three unique bones work in conjunction to provide the range of motion necessary to complete our daily activities such as walking, jumping, or running. These three bones are the tibia, fibula, and talus. In case of persistence and aggravation of the pain, surgery can be decided.The human ankle is a complex, load-bearing joint that consists of just three bones. To relieve the painful phenomena, an injection of corticoids or hyaluronic acid can also be considered. Inquire in advance is mandatory in order to perform the most suitable examination Treatment optionsĪnalgesics and anti-inflammatories as well as the wearing of an orthopedic sole constitute the first instance treatment. Your surgeon will need a an X-ray with specific profiles as well as an MRI or CT-arthrography in order to evaluate the lesions on soft tissue. The development is painful, swelling and blockages of the joint can make sporting or even walking difficult. These lesions may be of traumatic origin (sprains, instability) but also metabolic or genetic and will alter the shape and structure of the bone and cartilage (cyst, necrosis). The osteochondral lesions of the Talar dome (also called LODA) are located at the level of the bone of the foot called the talus, situated between the heel and the tibia and used to extend or flex the ankle. ![]()
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