Description of patient (type of occupation, indication of age, intensity of sport):
A 37-year-old male patient with complaints of the right ankle.
History and previous treatment:
Was doing martial arts 14 months ago and sustained a comminutted talar body fracture which remained undiagnosed for 12 months (normal X-rays). He had MRI which showed healing talar body fracture with OCD.
Current complaints:
Deep ankle pain, constant, worse with loading of the foot, and also present at night. Feels a "click" and "give way after pain".
Physical examination:
High medial arch, neutral heel, limited eversion. Tender anterolateral talus. Slight laxity to ATFL.
Radiology:
X-ray:
[Picture 1 + 2]
Additional investigation (CT/MRI):
[Picture 3 + 4]
Images:
Case summary:
37-year-old male with a central talar dome OCD.
Question(s) to this case:
Does he require medial malleolar osteotomy for treatment?
Expert:
A CT scan is needed for preoperative planning to determine the exact size and location of the lesion. If the OCD needs treatment, then for 99% you should be able to reach it in plantar flexion from the front (no osteotomy needed).