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Jurina, Andrija; Delimar, Valentina; Dimnjakovic, Damjan; Bojanic, Ivan
Acta clinica Croatica (Tisak), 06/2018, Letnik: 57, Številka: 2Journal Article
Lateral inverted osteochondral fracture of the talus (LIFT) is a rare variant of stage IV osteochondral lesion of the talus (OLT), where the fragment is inverted in situ by 180degrees. The management of LIFT lesion is very challenging and early recognition crucial, given that treatment options depend on the articular cartilage condition and sufficiency of the adjacent bone of the displaced fragment. We describe two LIFT cases referred from other institutions after unsuccessful conservative treatment of OLT. They presented with pain, swelling and tenderness over the anterolateral aspect of the right ankle. We recognized the LIFT lesion on the magnetic resonance imaging scans in patient 2, while in patient 1 the orientation of the fragment was recognized upon direct visualization during operative treatment. Both patients underwent arthroscopic procedure. Due to articular cartilage damage and insufficiency of the adjacent bone of the fragment, both patients were treated with excision followed by microfracture. Treatment of the LIFT lesion should start arthroscopically to allow clear evaluation of the osteochondral fragment, assessment of the talar defect and identification, as well as treatment of associated disorders. If the articular cartilage appears intact with sufficient subchondral bone, fixation of the fragment is optimal management, otherwise excision and microfracture can be the treatment of choice.Okrenuti kostanohrskavicni fragment na lateralnoj plohi talusa (engl. lateral inverted osteochondral fracture of the talus, LIFT) je rijedak oblik IV. stupnja kostanohrskavicnog ostecenja talusa (engl. osteochondral lesion of the talus, OLT), pri cemu je kostanohrskavicni fragment okrenut u lezistu za 180degrees. Rano prepoznavanje LIFT-a je od presudne vaznosti, jer lijecenje ovisi o ocuvanosti zglobne hrskavice i pripadajuce kosti okrenutog kostanohrskavicnog fragmenta. U nasem radu prikazuj emo dva slucaja LIFT-a koji su upuceni iz drugih ustanova nakon neuspjesnog lijecenja OLT-a konzervativnim metodama. Kod oba bolesnika simptomi su bili bol, oteklina i osjetljivost anterolateralnog dijela desnog gleznja. Ostecenje LIFT je kod drugog bolesnika prepoznato tek na snimkama magnetne rezonance u nasoj ustanovi, dok je kod prvog bolesnika orijentacija fragmenta prepoznata tek za vrijeme operativnog zahvata. Oba bolesnika podrvgnuta su artroskopskom zahvatu. Buduci da su kod oba bolesnika zglobna hrskavica i pripadajuca kost kostanohrskavicnog fragmenta bile znatno ostecene, odlucili smo se za njihovo odstranjenje. Potom smo ocistili nastali defekt na talusu i nacinili mikrofrakture. Danas se savjetuje operativno lijecenje LIFT-a zapoceti artroskopski, jer se na taj nacin omogucava tocna procjena ocuvanosti kostanohrskavicnog fragmenta te se mogu lijeciti pridruzena unutarzglobna ostecenja. Ako je zglobna hrskavica fragmenta ocuvana i ima dovoljno pripadajuce kosti, metoda izbora je fiksacija kostanohrskavicnog fragmenta, dok je u suprotnom moguce odstraniti kostanohrskavicni fragment i naciniti mikrofrakture.Key words: Talus - injuries; Cartilage, Articular; Cartilage Diseases; Conservative Treatment; Magnetic Resonance Imaging; Arthroscopy; Case ReportsKljucne rijeci: talus - ozljede; hrskavica, zglobna; hrskavica, bolesti; konzervativno lijecenje; magnetska rezonancija, snimanje; artroskopija; prikazi slucaja
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