Six months ago I thought I just sprained my ankle but not until having an MRI this week was I diagnosed with an OCD fracture. Anyone ever have this type of ankle fracture. Here’s a site about OCD fractures:
The pain isn’t unbearable at work and I can even ride w/o feeling uncomfortable most of the time but there has been a dull pain for the past few months.
Has anyone ever have ankle surgery to correct this type of fracture? Can anyone tell me about the rehab? My doc, who I really respect, said a time table to recovery is really impossible to set and very unpredictable.
Need to know where it is first. OCD (osteochondral defects), I’m assuming your is on the dome of the talus can be easy or hard. There are 2 main types that I see. The lateral talar dome lesions are easier to get to through an arthroscope, but are also usually more shallow (just some cartilage injury) and are often better left alone if your symptoms aren’t too bad. If the lesion is more medial along the medial gutter or behind the shoulder, it is very hard to get at this through the scope, and often the ankle needs to be opened, and even an osteotomy through the distal tibia (medial malleolus) needs to be performed just to get exposure. Not a great option, but sometimes necessary.
You can look up the Berndt and Hardy classification system for these, grade yours, and see the treatment options. If yours is bad, displaced and floating around the ankle joint - it needs to come out as further damage is eminent. If is is shallow and really just osteochondritis dessicans, I would leave it.
Years ago as a chiro student I worked my way through college as an orthopedic tech in a busy hospital. I was the guy who put on the casts,etc. The treatment at that time was a below the knee walking cast for six weeks.
If you read the site it states they can become more problematic if bone necrosis was to occur. Hopefully that hasn’t happened and all you have to worry about is six weeks in a cast. You’ll lose some muscle mass and ankle mobility for sure, but can gain tha back in a few months after the cast comes off.
There are a couple of ortho surgeons on ST. Hopefully they can give you more info.
I personally have had this surgery to fix a lateral talar dome defect and removal of the chunk of cartilage that was locking my ankle up. The chip had been in there for about 10 years or so from an old injury in my college soccer days.
The surgery itself is fairly painless as compared to say an ACL surgery, of which I have had 2. The rpair involves either microfracture or cadaver graft. The cadver graft option is relatively new but has some real promise to repairs of this type. I had micro fracture
The rehab is fairly simple as well, ice, rest, elevate for the first week or so. Range of motion work and then some strength and proprioception/balance work to restore normal function.
I was able to run about 3-4 months after surgery.
It has now been about 2.5 years and my ankle is great, no pain, no locking, no swelling. But ask me again in maybe another 10 years…
I thinking I’m experiencing a similar pain/situation with my sprained ankle (early Jan). Dull pain in that talus area. Stability is actually not that bad. I can ride just fine.
You needed an MRI to discover this? I had an xray done at the time and fracture was negative. After so many weeks and persistant pain (still aquajogging), I’m wondering if an MRI is in order, then I saw this post - interesting.
Thanks for all of the ankle advice. If any of the medical professionals still want to comment here is some more info I just got.
Again, thank you all for your help and I look forward to reading your comments. I’m trying now to decide what I’m going to have done. I also have to figure out if I choose surgery when I will get it done based on my work schedule.
Do you think I can come back to work on crutches after a few days if I can be put on desk duty and keep it elevated? My doc said it could be done through a “scope” but if he has to open up the ankle it will be a longer recovery. He also said he won’t know until he looks inside.
Thanks again,
Pat
Here is what the MRI report stated:
Evaluation of the ankle mortise demonstartes a focal region of osteochondral defect best identified in series 4 image 2 involving the medial dome. This region of irregularity measure 5.67 mm in the transverse demension and measures approximately 9.70 mm in AP dimension.
There may be some small amount of debris in the posterior aspect of the ankle joint.
Posterior tibialis tendon demonstrates mild tendinopathy and flexor hallucis longus tendon is somewhat thickened.
Impression: Osteochondral defect involving the medial aspect of the talus. There is cartlage thinning and loss and there is bome marrow edema subjacent to the region of ocd. The ocd measures 5.67 mm in transverse measurement and approximately 9.70 mm in AP dimension. There may be a small amount of debris in the posterior ankle joint.
Well, the biggest problem with yours is location. I find it hard to get at posterior-medial lesions through an arthroscope. Size of your defect is about average, not small or large. If a simple scope, you should be able to return to work at a desk job after 3 days. Opening the ankle - much longer. Again, won’t know until you get in there, but your location is much harder to get at than the lateral (and usually more anterior too) lesions.
Well, the biggest problem with yours is location. I find it hard to get at posterior-medial lesions through an arthroscope. Size of your defect is about average, not small or large. If a simple scope, you should be able to return to work at a desk job after 3 days. Opening the ankle - much longer. Again, won’t know until you get in there, but your location is much harder to get at than the lateral (and usually more anterior too) lesions.
Best of luck to you!
What would you say is much longer with regards to opening the ankle recovery times…2 weeks…4 weeks…2 months. I’m sure its impossible to say. I really appreciate your insight.
Depends upon what you mean by recovery time. Back to work - say, 2 weeks until the desk job. In extreme cases, an osteotomy of the medial malleolus has to be performed to get to the lesion. Now, you effectively have an ankle fracture with 4-6 weeks in a cast. Don’t rush revcovery. Might as well accept the fact that it takes time (assuming you elect this route) and it is easier that way.
Back to running - won’t even venture unless I was looking through the scope.
Not so worried about training, more worried about work and a summer program I work at. I’ve already come to grips with te injury and didin’t set any goals other than enjoying more time running (err “limping”) after my 1 year old daughter.