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 finger breadth 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]
Schematic drawing showing the position of the avulsion fragment belonging to the medial tubercle of the talus 
Dorsal extension and pronation trauma with rupture of the posterior talotibial ligament. 
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
Associated Persons
- Carl-Axel Cedell (1932 – )
- Francis John Shepherd (1851-1929) 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
- 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.
- 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.
- 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
- Eponymythology: Eponymous ankle and talus injuries. LITFL
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