1. Home
  2. Skeleton
  3. Diagnosis
  4. Indications
  5. Treatment

Authors of section

Authors

Daniel Green, Philip Henman, Mamoun Kremli

Executive Editor

James Hunter

General Editor

Fergal Monsell

Open all credits

Excision

1. General considerations

Reconstruction vs excision

Reasonable attempts should be made to repair the articular surface, but there may be small osteochondral defects that are not reconstructable.

A small, loose osteochondral fragment in the ankle may cause more symptoms than a small articular defect.

Small articular fragments that are not amenable to reconstruction may be removed arthroscopically or with an open approach.

Arthroscopically assisted removal of a small osteochondral fragment of the distal tibia

2. Patient preparation and approaches

Patient positioning

Place the patient in a supine position on a radiolucent table.

Supine patient position

Approaches

When appropriate resources are available, arthroscopically assisted excision is recommended.

If arthroscopy is not available, small osteochondral fragments can be excised through an open approach that depends on the location of the fracture.

Arthroscopically assisted removal of a small osteochondral fragment of the distal tibia

3. Excision

Fragment removal assisted by arthroscopy

Identify and grasp the fragment under arthroscopic control.

Arthroscopically assisted removal of a small osteochondral fragment of the distal tibia

4. Final assessment

Carefully examine the range of motion and ligament stability.

5. Aftercare

Immediate postoperative care

The patient should get out of bed and begin ambulation with crutches on the day of surgery or the first postoperative day.

In most cases, the patient is mobilized without a cast.

Pain control

Routine pain medication is prescribed for 3–5 days after surgery.

Neurovascular examination

The patient should be examined frequently to exclude neurovascular compromise or evolving compartment syndrome.

Discharge care

Discharge follows local practice and is usually possible within 48 hours.

Mobilization

Graduated weight-bearing is usually possible.

Patients are encouraged to start range-of-motion exercises. Physiotherapy supervision may be required in some cases but is not mandatory.

Sports and activities that involve running and jumping are not recommended until full recovery of local symptoms.

Range-of-motion exercises of the ankle

Follow-up

The first follow-up is usually undertaken 5–7 days after surgery to check the wound.