Osteochondral Fractures: Causes, Symptoms, Diagnosis, and Treatment

What Is an Osteochondral Fracture?

Injuries or damage on the articular surface of a joint are known as osteochondral fractures or transchondral fractures. An osteochondral fracture is an injury that damages the cartilage and underlying subchondral bone. Osteochondral fractures are linked to trauma and can present acutely. Osteochondral fractures, although relatively common, are frequently initially missed, misdiagnosed by clinicians as a pure soft tissue injury, and present as chronic lesions. Attention to osteochondral fractures is essential because they may cause the affected joint to degenerate into osteoarthritis. This is because articular cartilage has limited potential for self-repair. This may be a problem in weight-bearing joints. To reduce the progression of arthritis, it is important to identify and treat osteochondral fractures early; however, little has been known about diagnosing and managing acute osteochondral fractures.

Which Joints Are Most Often Affected by Osteochondral Fractures?

Osteochondral fractures can occur in various joints of the body, but the most common joints affected are the knee and ankle. In the knee joint, the most common site of osteochondral fractures is around the lateral aspect of the medial femoral condyle (inside part of the knee), followed by the lateral tibial plateau. The talus bone in the ankle joint is the most common site of osteochondral fractures. Other joints that can be affected by osteochondral fractures include the elbow, shoulder, and wrist.

What Causes Osteochondral Fractures?

While osteochondral fractures most commonly occur in the shoulder (known as Hill Sachs lesions). They have also been registered in the distal humerus, distal radius, and wrist. The progression to osteoarthritis may not be as frequent, rapid, or disabling as in joints of the lower extremity. This mechanism of injury is mostly observed in a weight-bearing position with a torquing or twisting force on the joints. Another potential cause of these fractures is lateral dislocation of the patella. When the patella is forced back into place, the quadriceps will fire, causing a compressive force as the patella moves over the lateral femoral condyle and causing a fragment of the bone to fracture.

What Are the Symptoms of Osteochondral Fractures?

Osteochondral fractures can cause a range of symptoms based on the location as well as the severity of the injury. Common symptoms include:

1. Pain: It is one of the most common symptoms of an osteochondral fracture. Pain is usually sharp or dull and may aggravate with movement.

2. Swelling: Swelling around the affected joint is also common. The joint may appear swollen and feel warm to the touch.

3. Stiffness: Osteochondral fractures can result in joint stiffness in the affected area which makes the joint movement tough and cause difficulty in performing certain activities.

4. Clicking or Locking: In some cases, the joint may make clicking or popping noises when moved. This can be accompanied by a feeling of the joint "locking up" or getting stuck in a certain position.

5. Limited Range of Motion: As a result of pain, swelling, and stiffness, the affected joint may have a limited range of motion. This can make it difficult to perform certain movements or activities.

How Are Osteochondral Injuries Diagnosed?

Typically, if a person complains of the above-listed symptoms, a healthcare provider performs a physical exam and advises on the most appropriate treatment. Normally, an X-ray is performed to determine if an osteochondral fracture has occurred. Sometimes the healthcare provider may order scanning (magnetic resonance imaging or computed tomography) to obtain a more in-depth look at the fracture to determine the precise location, size, and the extent of injury to any adjacent joints to determine the next course of action.

How Are Osteochondral Fractures Treated?

Once diagnosed, several options for both acute and chronic lesions can improve pain and loss of function while potentially slowing or preventing the onset of osteoarthritis. Depending on the severity of the fracture, the person's activity level, and the symptoms present, the treatment options are either conservative or surgical. Conservative treatment is a period of immobilization in a splint or cast. Along with immobilizing, taking proper rest, and not allowing weight to be put on the joint, a course of physiotherapy can be adequate in allowing the bone and cartilage to recover.

• Conservative Treatment of Osteochondral Defects or Fractures: Sometimes, younger people whose growth plates have not yet closed can avoid arthroscopic surgery and treat osteochondral fractures through physical therapy. This treatment often begins with rest and ice to reduce pain and inflammation. Then, therapeutic interventions are implemented to encourage the return to the full range of motion, strengthening the muscles around the fractured joint to provide stability with everyday activities. Further therapy would be required if the person is required to be able to play a sport or do other activities to ensure that they are safe to do so.
• Surgical Treatment of Osteochondral Defects or Fractures: An osteochondral fracture that requires surgery is the arthroscopic repair of the injured site and removal of the loose body. One such example of arthroscopic surgery is microfracture surgery. Microfracture surgery is an articular cartilage repair surgical procedure that works by making tiny fractures in the underlying bone. After surgery, a person can expect to undergo a rehabilitation program developed to improve the range of motion, decrease pain, and strengthen the joint to return to their previous functional level. Athletes can expect a long rehabilitation process to prepare them to return to sport. Much more investigation is needed into the optimal treatments for osteochondral fractures in different joints.

Conclusion

Osteochondral fractures are important injuries because they can cause pain and dysfunction and often progress to osteoarthritis. These injuries can be initially misdiagnosed, which may impact the healing potential and result in poor long-term outcomes. Osteochondral fractures are common with joint injuries, and early diagnosis and prompt treatment should limit progression to osteoarthritis and improve long-term effects. Various methods can be used to fix these fractures. Immobilization and adequate rest followed by a course of physiotherapy can allow the bone and cartilage to heal. Suppose this is ineffective or in the case of serious injury. In that case, the consultant may recommend arthroscopic surgery to remove the injured cartilage and bone and remodel the bone’s surface to decrease pain and cut the risk of arthritis developing.