Cedell fracture

Description

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. [PMID 6650722]

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

History

1974 Fracture of the posteromedial tubercle of the talus first described in 4 patients by Cedell in 1974

Isolated rupture of the posterior talotibial ligament is probably a very rare injury. The author has diagnosed this ligament injury in four portsmen, 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]

$Cedell CA Cedell fracture figure 7$
Schematic drawing showing the position of the avulsion fragment belonging to the medial tubercle of the talus
$Cedell CA Cedell fracture figure 2$
Dorsal extension and pronation trauma with rupture of the posterior talotibial ligament.
$Cedell fracture Watanabe 2017$
Fracture posteromedial tubercle (A) Axial slice CT (B) 3D recon

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

Avulsion type
Split type
Comminuted type

posteromedial tubercle frqacture classification watanabe 2017

Associated Persons

Carl-Axel Cedell

Note: **Shepherd fracture – Posterior talar process fracture with injury to the lateral tubercle caused by inversion or extreme equinus

References

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. [PMID 4209771]
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. [PMID 4209771]
Paulos LE, Johnson CL, Noyes FR. Posterior compartment fractures of the ankle. A commonly missed athletic injury. Am J Sports Med. 1983 Nov-Dec;11(6):439-43. [PMID 6650722]
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 Nov-Dec;53(6):787-90. [PMID 25179454]
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 Jan – Feb;56(1):187-190 [PMID 26947002]