Endoscopically Assisted Reduction and Screw Fixation of Acute Fracture of the Posteromedial Talar Process (Cedell Fracture)

Abstract

Fracture of the posteromedial talar process (Cedell fracture) is a rare injury and is usually associated with other injuries such as medial subtalar dislocation. Diagnosis of the fracture necessitates a heightened clinical suspicion, and computed tomography should be performed in any suspicious cases. Timely treatment is important for restoration of proper anatomy and function of the subtalar joint. Significant morbidity is associated with an undiagnosed or nonoperatively treated fracture of the posteromedial talar process, especially in a larger fracture that is intra-articular at both the ankle and subtalar joints. In this Technical Note, the technical details of endoscopically assisted reduction and screw fixation of acute posteromedial talar fracture is described. This can allow fracture reduction and fracture fixation under endoscopic visualization.

Use of an aiming drill guide and ankle arthroscopy for reduction of depressed articular surface in posterior malleolar fractures

“…[32][33][34][35] Arthroscopy may offer the advantages of reduced pain and a more rapid, complete, and functional recovery. [35][36][37][38][39][40] Another benefit of arthroscopy-assisted fracture surgery is that a targeting device can be used to approach the depressed fragment and elevate and reduce the depressed articular surface. [33][34][35] In an arthroscopy-assisted tibial plateau fracture surgery, an anterior cruciate ligament (ACL) tunnel guide developed to target the footprint of ACL was applied to approach the depressed fragment.…”

Arthroscopic treatment for posteromedial talar process fracture (Cedell fracture): a case report

“…These fractures could be misdiagnosed as severe ankle sprains, mostly due to poor visualization on routine radiographs. Timely diagnosis and treatment of such an injury is of great importance in restoring subtalar joint anatomy and function, as minimal displacement can lead to posttraumatic arthritis, painful nonunion, or posterior impingement (2,8,9) . The real challenge is to choose appropriate treatment after recognizing a Cedell fracture.…”

“…Most of these publications also lack a detailed description of the patients and their management (3,4) . In general, there are three strategies for treatment of Cedell fractures: conservative treat ment with immobilization alone; excision of the fragment; or osteosynthesis, which may be performed by open or arthroscopic approaches (3,4,(8)(9)(10) . The optimal treatment for fractures of the posteromedial talar process is still unclear, and depends on the fracture pattern.…”

“…Nevertheless, percutaneous screw fixation can be difficult as a minimally invasive surgical approach. The posterior screw may injure the posterior subtalar joint, the FHL tendon, and the tibial neurovascular bundle (8) . The posterior arthroscopic approach is proving to be an interesting treatment alternative.…”

“…The choice of optimal treatment method for posteromedial talar process fractures is unclear, and depends on subtalar joint involvement, fragment size, degree of displacement, and comminution (2,6) . Various treatments for this injury are advocated in the literature: conservative treatment of minimally or nondisplaced fractures, with non-weight-bearing cast immobilization for 4 to 6 weeks; fracture excision in painful nonunion, highly comminuted fractures, or malunions causing posteromedial ankle impingement (7,8) ; primary open reduction and internal fixation (ORIF), which is recommended for the majority of Cedell fractures that are less than 4 weeks old, with fracture fragments >1cm, displaced (>2mm) and with disruption of the subtalar joint (6) ; arthroscopic approaches for screw fixation or excision of the fragment have also been described (3,(8)(9)(10) . The purpose of this article is to raise physician suspicion of this uncommon fracture and present a case of arthroscopy-assisted reduction and screw fixation of acute posteromedial talar fracture.…”