Osteochondral Fracture

ExitCare ImageAn osteochondral fracture is a break in the surface of a joint that involves the cartilage and underlying bone. The most commonly affected joint is the knee joint. The injury is also most common in adolescent males. Cartilage has a limited blood supply, which makes healing this type of injury difficult.

SYMPTOMS

  • Swelling and pain in the area of injury.

  • Aching, giving way, and locking or catching of joints. Feeling a piece of bone floating in the joint.

  • Crackling sound (crepitation) within the joint, with motion.

  • Injuries to other structures within the knee, including tears of ligaments and meniscus cartilage, due to the great force required to cause this injury.

CAUSES

An osteochondral fracture may occur from various types of forces. These include: impaction (broken ends of bone driven together), avulsion (bone fragment pulled off along with a tendon), shearing (fracture from stress applied parallel to the bone), and rotational forces caused by direct injury (trauma) to the joint. A fracture occurs if the force of injury is greater than the cartilage and bone can handle. Often, the cartilage will separate from the bone. This type of fragment in the joint space may cause the joint to lock up or result in other negative symptoms.

RISK INCREASES WITH:

  • Contact and collision sports. Sports that involve playing on and possibly falling on hard surfaces.

  • Adolescents.

  • Other injury to knee structures (ligaments or menisci).

PREVENTION

Wear properly fitted and padded protective equipment.

PROGNOSIS

The ability of this type of fracture to heal depends greatly on the severity of the injury. A small fracture will usually heal and not cause problems. However, large and/or deep osteochondral fractures are less likely to heal because of the minimal blood flow to joint cartilage. If treated properly, symptoms will go away in most cases.

RELATED COMPLICATIONS

  • Frequently recurring symptoms, resulting in chronic pain and swelling.

  • Arthritis of the affected joint.

  • Loose fragments, with locking of the affected joint.

TREATMENT

Treatment first involves ice and medicine, to reduce pain and inflammation. If the injury occurs in a joint of the lower limb, you may be advised to walk with crutches. Non-surgical treatment includes restraining the affected joint for a period of time, to allow healing. Restraint is often followed by strengthening and stretching exercises, to regain strength and a full range of motion. If non-surgical treatment is unsuccessful, surgery may be needed. Surgery for osteochondral fractures is usually performed through an incision near the joint (arthroscopically). The surgeon will reattach any large, loose fragments, or remove any that cannot be reattached. The surgeon may also perform a procedure to promote healing in the area. After surgery, strengthening and stretching exercises are often needed. Exercises may be performed at home or with a therapist.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be advised. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • Any of the following occur after surgery:

  • You develop signs of infection: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • You experience pain, numbness, or coldness in the foot.

  • Blue, gray, or dark color appears in the toenails.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)