The treatment for an osteochondral fracture typically depends on the severity of the injury. This type of fracture involves a piece of cartilage and sometimes bone breaking from the end of a bone, creating a fragment or fragments in a joint, typically the knee or ankle. If the fragment remains attached to the end of the bone and is not loose in the joint, it may simply be necessary to cast it and allow the patient to rest and heal naturally. Fragments that break off and get into the joint typically require arthroscopic surgery to remove. There may also need to be drilling or cartilage transplants at the site of the fracture.
A relatively simple osteochondral fracture, where the cartilage fragment does not break completely away from the bone, is typically treated very conservatively. The injured joint will usually be put into a cast so the fragment will be kept in place and grow back together with the bone on its own. This method is particularly effective with children and adolescents, who are typically more prone to this type of injury anyway.
When an osteochondral fracture is more severe, surgery often becomes necessary to repair the problem. Small broken fragments of bone and cartilage that are loose in the knee or ankle can catch in the joint, causing it to lock up, so they typically should be removed. Usually this is achieved through arthroscopic surgery, which only requires a small cut to the joint. The surgeon then uses a camera and small instruments to locate the fragments and extract them.
If the osteochondral fracture results in larger fragments of cartilage or bone, roughly the size of a dime or larger, it may be possible to reattach them, which can help improve the stability of the joint after healing. In order to stimulate growth of new cartilage under the broken fragment and allow it to grow back together, the doctor may go in arthroscopically and drill into the bone a bit. Another possibility is that he or she may need to take some cartilage from another part of the joint, preferably one that is not weight-bearing, and graft it to the damaged area. Once this is done, and any irreparable bone fragments have been removed, the patient will likely need to wear a cast for a period of time to allow everything to heal properly.