Twenty-four patients who had an osteochondral fracture of the dome of
the talus were examined by plain radiography, magnetic resonance imaging,
computerized tomography, and, when indicated, scintigraphy. When plain
radiographs of the ankle are relied on for the diagnosis of an
osteochondral fracture of the talus, many lesions remain undiagnosed.
Stage-I osteochondral fractures show no diagnostic changes on plain
radiographs, and Stage-II lesions are usually subtle and, therefore, are
often overlooked by both radiologists and clinicians. The use of
scintigraphy as a screening procedure and of magnetic resonance imaging for
patients who have positive scintiscans showed that osteochondral fractures
are more common than has previously been indicated in the literature.
Scintigraphy should be used to assess patients when there is clinical
suspicion of an osteochondral fracture but the plain radiographs appear to
be negative. Patients who have positive scintiscans should be assessed by
magnetic resonance imaging. Patients who have abnormal plain radiographs
will derive no major benefits from magnetic resonance imaging; for all but
one of these patients, computerized tomography was adequate for staging the
fracture.