Shepherd fracture

Description

Sherpherd fracture: Posterior talar process fracture with injury to the lateral tubercle caused by inversion or extreme equinus. Otherwise known as fracture of the lateral tubercle of the posterior process of the talus

• Fracture usually seen on lateral XR, however sensitivity only 78%. In cases of significant trauma and suspicion CT should be considered.
• Complications: include chronic pain, arthrosis, and occasionally avascular necrosis
• Treatment: immobilization, although rarely delayed excision of the fragments may be necessary

History

1882 – Described by FJ Shepherd, initially as a single dissection and later as a series of three such fractures

Associated Persons

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

Controversies

Shepherd fracture may be mistaken for an os trigonum (secondary ossification center accessory ossicle) which lies posterior to the lateral tubercle and which is a normal finding. The os trigonum is usually round/oval with smooth well corticated edges as opposed to the sharply marginated non-corticated irregular outline of a fracture

Note: **Cedell fracture – posterior talar process fracture with injury to the medial tubercle caused by forced dorsiflexion and pronation

References

• Shepherd FJ. A Hitherto Undescribed Fracture of the Astragalus (talus). J Anat Physiol. 1882 Oct; 17(Pt 1): 79–81. [PMC1310130]
• Hodge JC. Clinics in diagnostic imaging (42). Shepherd’s fracture. Singapore Med J. 1999 Oct;40(10):666-8.[PMID 10741198]
• Haddad FS, Bartlett M, Singh D. The sequelae of posterior talar fractures. Injury. 2000 Mar;31(2):107-11. [PMID 10748813]
• Ahmad R, Ahmed AMY. Fracture of the posterior process of the talus: an unusual injury. Emerg Med J. 2007 Dec; 24(12): 867. [PMC2658382]
• Early JS. Talus fracture management. [PMID 19013400]
• Kou JX, Fortin PT. Commonly missed peritalar injuries. J Am Acad Orthop Surg. 2009 Dec;17(12):775-86. [PMID 19948702]
• Summers NJ, Murdoch MM. Fractures of the talus: a comprehensive review. Clin Podiatr Med Surg. 2012 Apr;29(2):187-203, vii [PMID 22424484]
• Dale JD, Ha AS, Chew FS. Update on talar fracture patterns: a large level I trauma center study. AJR Am J Roentgenol. 2013 Nov;201(5):1087-92. [PMID 24147480]
• Eponymythology: Eponymous ankle and talus injuries. LITFL