Split Fracture of the Posteromedial Tubercle of the Talus: Case Report and Proposed Classification System

Watanabe, Hiroshi; Majima, Tokifumi; Takahashi, Kenji; Kawaji, Hidemi; Takai, Shinro

doi:10.1053/j.jfas.2016.02.001

Cited by 14 publications

(16 citation statements)

References 13 publications

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“…Different management strategies for Cedell fracture are reported in the literatures: conservative treatment of nondisplaced or minimally displaced fractures [ 2 ], open reduction internal fixation for displaced fractures [ 6 ], or fracture excision for malunion of displaced fractures by open or arthroscopy [ 9 , 12 ]. Watanabe et al [ 2 ] classified the fracture of PMTT into 3 types according to the mechanism of injury and the fracture configuration: Avulsion type, Split type and Comminuted type. Conservative treatment by cast immobilization is recommended for the split-type or nondisplaced, fresh avulsion-type fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Fracture of posteromedial tubercle of talus (PMTT), first described by Cedell in 1974 [ 1 ], is an uncommon injury caused by dorsiflexion-pronation of the foot and ankle as the posterior talotibial ligament is torn from its attachment to the talus. The early detection of this fracture is difficult [ 2 ]. The displaced, old or nonunited fracture can compress the surrounding structures and elicit the posteromedial impingement syndrome which will require subsequent surgical excision or internal fixation of the fragment [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report

Qin

Jin

Song

2020

BMC Musculoskelet Disord

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Background: Combined anterior and posterior ankle impingement has seldom been reported. Cedell fracture, fracture of posteromedial tubercle of talus, is an uncommon and easily missed injury which may elicit posteromedial ankle impingement. The injury mechanisms and management strategies of these two lesions have been reported individually. But the concurrent lesion of both of them has not been reported. Case presentation: We reported a 58-year-old female with combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in whom open osteophytes debridement, fracture internal fixation and posterior talotibial ligament reconstruction were performed. The AOFAS hindfoot score was 90 at 1 year follow-up. To our knowledge, this was the first reported case with anterior, posterior and posteromedial impingement which was treated operatively with an excellent short-term outcome. Conclusions: To fully recognize this occult lesion and avoid missing is imperative for reducing the morbidities. We suggest CT and MRI as excellent imaging modalities that can help the timely diagnosis and appropriate treatment for this combined impingement with circumferential lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report

Qin

Jin

Song

2020

BMC Musculoskelet Disord

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“…Posteromedial talus fracture has a potential for delayed diagnosis. 2 , 3 , 5 First, it is a rare injury. Second, it shows similarity to an ankle sprain on standard ankle radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…Different treatments of this injury are supported in the literature: conservative treatment of nondisplaced or minimally displaced fractures, open reduction–internal fixation for displaced fractures, or fracture excision for malunion of displaced fractures that cause posteromedial ankle impingement. 2 , 3 …”

mentioning

confidence: 99%

Arthroscopic Treatment of a Malunion of a Posteromedial Tubercle Fracture of the Talus

Martínez¹,

Roman²,

Giménez³

et al. 2017

Arthroscopy Techniques

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“…Cedell suggested forced dorsiflexion in pronation [3] , while Veazey and Dougall proposed acute dorsiflexion following direct trauma causing avulsion of the PTTL and associated fractures of the sustentaculum tali and lateral malleolus [12,16] . In contrast, others proposed that PPTF occurred due to forced plantar flexion with or without inversion of the ankle, resulting in compression of the posterior process between the calcaneus and tibia inversion of the ankle [6,7,17] . Alternatively, it has been hypothesized that this type of talar fracture is a consequence of direct impingement in plantar flexion in which the posterior tibial margin impresses on the posterior talar body [18] .…”

Section: Type and Mechanism Of Injurymentioning

confidence: 99%

Systematic review: Diagnostics, management and outcome of fractures of the posterior process of the talus

Engelmann¹,

Wijers²,

Posthuma

et al. 2020

Injury

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Background: Fractures of the posterior process of the talus are rare and frequently overlooked, possibly leading to pseudo-arthrosis and chronic pain. To gain more insight into the diagnosis, treatment and outcome of fractures of the posterior process of the talus (PPTF), a systematic review of the current literature was performed to provide recommendations for the management of PPTF. Methods: A literature search in the electronic databases of PubMed, EMbase, Google Scholar and Cochrane library was performed in January 2020 to identify all clinical studies on PPTF with more than three patients. Amongst other variables, the type of study, number of patients, mechanism of injury, type of fracture (anatomy), imaging modality, treatment, postoperative protocol, outcomes, complications and duration of follow-up were noted for systematic analysis of the available evidence, adherent to the PRISMA guidelines. Results: Seven original studies were included with a total of 66 patients. More than one third of patients presented with a (sub)talar joint dislocation (n = 25, 37.9%) and 51.5% sustained associated ipsilateral lower extremity fractures (n = 34). Delayed diagnosis occurred in 36.4% of patients (n = 24). Out of 48 patients with outcome data available, 41.7% (n = 20) reported impaired function. In the non-operative group, 64.7% (n = 11) had impaired functional outcome, compared to 33.3% (n = 6) in the ORIF group, and 30.8% (n = 4) in the fragment excision group (p < 0.001). One third of the patients developed one or more complications (n = 25, 37.9%), mostly found in the non-operatively treated group (73.7%, n = 14) compared to ORIF (25.0%, n = 8, p < 0.001). Conclusion: Early recognition and timely treatment is warranted in order to achieve pre-injury functional outcome and reduce morbidity. Given the significantly higher complication rate and lower return to the previous level of functionality reported after non-operative treatment, ORIF is recommended if there is (even minimal) displacement, articular involvement or if the fracture extends into the talus body.

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Split Fracture of the Posteromedial Tubercle of the Talus: Case Report and Proposed Classification System

Cited by 14 publications

References 13 publications

Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report

Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report

Arthroscopic Treatment of a Malunion of a Posteromedial Tubercle Fracture of the Talus

Systematic review: Diagnostics, management and outcome of fractures of the posterior process of the talus

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