![]() ![]() This incision is usually made in the front of the ankle to allow the surgeon to see into the joint. If the defect is in an area of the ankle difficult to reach with the arthroscope, an open incision may be required. The ankle is a small joint, so it is sometimes difficult to get the arthroscope into certain areas. By watching on the TV screen, the surgeon removes the fragment and drills the defect. Special instruments are inserted into the ankle through other small incisions. An arthroscope is a special miniature TV camera that is inserted into the joint through a very small incision. In some cases the surgery may be done using an arthroscope. Eventually this new scar tissue smoothes out the defect and allows the ankle to move more easily. The drill holes allow new blood vessels to grow into the defect and help to form scar tissue to fill the area. It is this area where the drill holes are made. When the fragment is removed, a defect shaped like a small crater is left in the talar dome. Surgery usually involves removing the loose fragment of cartilage and bone from the ankle joint and drilling small holes in the injured bone. Surgery may be required to try to reduce your symptoms at this point. If the problem is not recognized early, the bone fragment may not heal and may continue to cause problems. You may need to keep weight off the foot and use crutches during this period of immobilization. If the problem is discovered immediately after a twisting injury to the ankle, immobilization in a cast for six weeks may be suggested to see if the bone injury heals. Treatment for OCD depends on when the problem is discovered. What can be done for my pain? Nonsurgical Treatment Special tests such as a computerized tomography (CT) or a magnetic resonance imaging (MRI) scan may be necessary to determine the full extent of the area involved. X-rays of the ankle will usually show a problem on the top of the talus (sometimes called the talar dome). The diagnosis of OCD may be suggested by the history and physical examination. This is because the chip can get caught in the ankle joint as it moves, causing pain and the sensation of catching. You may also feel a catching sensation with the ankle in certain positions. Later, continued problems with the fragment may cause swelling and a generalized ache in the ankle. X-rays are the best way to determine whether a chip fracture has occurred. No special symptoms suggest a chip fracture has occurred inside the joint. You will feel swelling and pain and have difficulty placing weight on the ankle. Initially, OCD behaves like any other ankle sprain injury. This may explain some cases of OCD that appear without a well-defined history of a recent serious twisting injury. However, it may injure the bone’s blood supply, leading to an area of the bone actually dying. There is some evidence that the twisting injury may not cause a chip fracture initially. The fragment loses its blood supply and actually dies. If the fragment displaces, these blood vessels cannot grow back. If the articular cartilage is broken as well, the bone fragment may move out of position, or displace, making healing less likely and later problems more likely.īecause the bone chip is separated from the rest of the talus, the blood vessels traveling to the fragment through the bone of the talus are torn, and the blood supply of the bone fragment is lost. If the bone underneath the cartilage is crushed or cracked and the articular cartilage is intact, the fragment is less likely to move. The chip fracture can vary in size and severity. Which side of the talus the chip is on depends on how the ankle was twisted during the initial injury. These fractures occur with severe ankle sprains. The cause of most cases of OCD are thought to be actual chip-type fractures. Related Document: A Patient’s Guide to Foot Anatomy Causes Right below the articular cartilage is the bone of the talus. This material allows the bones of the joint to slide against each other without much friction. On the talus, this covering is about one-eighth of an inch thick. The top of the talus is part of the joint and is covered with articular cartilage, the white, slippery material that covers all joint surfaces. Depending on how the ankle is injured, the problem can occur on the side of the talus closest to the other foot or on the outside part. The area where OCD occurs is located at the top of the talus. The talus is one of the large bones in the back part of the foot that helps form the ankle joint. ![]()
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