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The Journal of Bone and Joint Surgery (American) 86:1336 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

JBJS Classic

Transchondral Fractures (Osteochondritis Dissecans) of the Talus

Albert L. Berndt, MD, MSc(Med)1 and Michael Harty, FRCS2

1 Portsmouth, Ohio
2 Philadelphia, Pennsylvania

Appeared in JBJS, Vol. 41-A, pp. 988-1020, September 1959

A PDF file of this JBJS Classics is available on our web site, at www.jbjs.org (go to the article citation and click on "Supplementary Material"), and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Many classic, landmark articles have been published in The Journal in the past. Quarterly, we will be publishing summaries of selected articles, along with a contemporary commentary by a knowledgeable member of the editorial board identifying the article's significance in orthopaedics and its continuing relevance to our practices. Please let us know of a classic Journal article that you believe should be summarized and commented upon in the future.

J.D.H.

Abstract

"This report is intended to draw attention to the points of misunderstanding and to clarify them in the light of the information gained from a thorough study [of transchondral fractures of the talus].... A transchondral fracture is a fracture of the articular surface of a bone, produced by a force transmitted from the articular surface of a contiguous bone across the joint and through the articular cartilage to the subchondral trabeculae of the fractured bone. Either of two physical types of fracture may result. First, the fracture may result in a small area of compressed trabeculae, with or without demonstrable damage to the overlying cartilage. Or it may be an avulsion of an osteocartilaginous flake." Anatomic studies on cadaver limbs demonstrated the etiological mechanism of transchondral fractures of the lateral border of the talar dome. As the foot is inverted on the leg, the lateral border of the dome is compressed against the face of the fibula (Stage One), while the collateral ligament remains intact. Further inversion ruptures the lateral ligament and begins avulsion of the chip (Stage Two), which may be completely detached but remain in place (Stage Three) or be displaced by inversion (Stage Four). We believe that the traumatic etiology of the lesion has been confirmed both clinically and experimentally. The problems of clinical and roentgenographic diagnosis are discussed and illustrated by case histories. Various forms of treatment are evaluated, and the prognosis appraised.


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