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Year |
2001 |
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Question Number |
12 |
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Category |
Select |
Question
A 13-year-old football player who is scheduled to attend summer football camp reports continued popping of the ankle joint. History reveals that the patient sustained an ankle sprain last season that was managed with taping. A radiograph and MRI scan are shown in Figures 2a and 2b. The next step in management should consist of
1 – an ankle brace.
2 – an incisional biopsy of the talus.
3 – a total body bone scan and radiographs directed at abnormal areas.
4 – a CBC and serum alkaline phosphatase, calcium, and phosphorus levels
5 – arthroscopic examination and possible drilling.
Figures
Answer (click for answer)
Correct Answer: 5- arthroscopic examination and possible drilling. Figure 2a and Figure 2b show classic radiographic findings of osteochondritis dessicans of the medial talus. Berndt and Harty have classified the lesion into four stages. Stage I indicates a small area of compression of subchondral bone. In Stage II the osteochondral fragment is partially detached. In Stage III the fragment is completely detached but remains in the talar crater. In Stage IV the fragment isdisplaced. This patient has an intact fragment which is nondisplaced. Kumai et.al. studied seventeen patients with OCD of the talus and concluded that early lesions with only a mild osteosclerosis of the surrounding talar bone, a continuous cartilaginous surface, and a stable osteochondral fragment benefit from arthroscopic drilling as treatment for the lesion.
Reference: Reference: Kumai T et. al. JBJS Am 1999; 81: 1229-1235.