Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.

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Isolated fracture of the posterior medial tubercle of the talus is a rare injury, generally thought to result from a pronation-dorsiflexion force causing avulsion of the insertion of the posterior talotibial ligament. Originally described by Cedell, the fracture has subsequently been reported three times to our knowledge, with all cases being attributed to indirect trauma. We describe an isolated fracture of the posterior medial tubercle of the talus caused by direct trauma. The fracture of the posterior medial tubercle remained ununited, failed to respond to conservative therapy, and was treated successfully with surgical excision.

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