Cedell fracture

Description

Cedell fracture: Posterior talar process fracture with injury to the posteromedial tubercle caused by forced dorsiflexion and pronation.

Fracture of the posterior process of the talus is an uncommon injury that is often missed on plain X-Ray and misdiagnosed as ankle sprain. In one case series, 17 of 20 patients with fractures were misdiagnosed as an ankle sprain.

Missed diagnosis can lead to long term complications, as the fracture becomes more displaced the likelihood of the flexor hallucis longus tendon becoming stuck between the fracture fragments increases [PMID 6650722]

Key to suspecting a fracture of the posteromedial tubercle is pain and oedema localized to the posteromedial aspect of the ankle, one finger breadth posteroinferior to the medial malleolus. Additionally flexor hallucis longus motion may elicit pain. [PMID 25179454]

History of the Cedell fracture

1974 – Carl-Axel Cedell described a fracture of the medial tubercle of the posterior talus in four athletes with medial ankle pain.

Isolated rupture of the posterior talotibial ligament is probably a very rare injury. The author has diagnosed this ligament injury in four sportsmen, who had a chronic state of insufficiency with medial pain and swelling in the ankle joint. Clinical examination revealed the occurrence of a bony and tender formation behind the medial malleolus which at operation was found to be an unhealed avulsion fragment belonging to the medial tubercle of the talus

Cedell 1974

2017 – Watanabe further define fracture of the posteromedial tubercle (Cedell fracture) into three types according to the mechanism of injury and the fracture configuration

1. Avulsion type
2. Split type
3. Comminuted type

2019 – Wijers et al reviewed outcomes after nonoperative and operative management of posterior process fractures of the talus. They found that fractures of the posterior process of the talus are frequently overlooked, possibly leading to nonunion, arthritis, and chronic pain. They concluded that operative management of extended posterior talar fractures was found to provide good functional outcome, quality of life, and patient satisfaction

Associated Persons

• Carl-Axel Cedell (1932-2021)
• Francis John Shepherd (1851-1929)

References

Original articles

• Cedell CA. Rupture of the posterior talotibial ligament with the avulsion of a bone fragment from the talus. Acta Orthop Scand. 1974;45(3):454-61
• Watanabe H, Majima T, Takahashi K, Kawaji H, Takai S. Split Fracture of the Posteromedial Tubercle of the Talus: Case Report and Proposed Classification System. J Foot Ankle Surg. 2017; 56(1): 187-190

Review articles

• Paulos LE, Johnson CL, Noyes FR. Posterior compartment fractures of the ankle. A commonly missed athletic injury. Am J Sports Med. 1983; 11(6): 439-43.
• Ebraheim NA, Padanilam TG, Wong FY. Posteromedial process fractures of the talus. Foot Ankle Int. 1995 Nov;16(11):734-9
• Summers NJ, Murdoch MM. Fractures of the Talus: A Comprehensive Review. Clinics in Podiatric Medicine and Surgery, 2012; 29(2): 187–203
• Albert P et al. Magnetic resonance imaging, computed tomography, and radiographic correlation of nonunion of the posteromedial tubercle of the talus: a case report. J Foot Ankle Surg. 2014; 53(6): 787-90.
• Wijers O, Engelmann EWM, Posthuma JJ, Halm JA, Schepers T. Functional Outcome and Quality of Life After Nonoperative Treatment of Posterior Process Fractures of the Talus. Foot Ankle Int. 2019 Dec;40(12):1403-1407.
• McKennedy C. Cedell fracture. Eponym A Day. Instagram
• Eponymythology: Eponymous ankle and talus injuries. LITFL

Mike Cadogan

Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |