Presentation, Diagnostic Dilemma, and a Novel Approach of Fixing a Cedell's Fracture - A Case Report

Fractures of the posteromedial tubercle of talus are one of the rarer fractures encountered in clinical practice. They mostly present like an ankle sprain which often leads to missed injuries and delayed diagnosis. We present one such case, incorporating the dilemmas associated with its diagnosis, treatment, approach to the treatment and a novel way of fixation and the outcome. Not much of literature has been published in this regard.

A 38-year-old Indian military man presented with pain and swelling over posteromedial aspect of his right ankle for 7 days, following an awkward landing during one of his training drills. He was unable to bear weight on the affected limb. On examination, passive flexor hallucis longus tendon movement was painful. A 30° external rotation lateral view radiograph of the ankle showed a hypolucent shadow posterior to the posterior talar process. An avulsion fracture of the posteromedial tubercle of talus was confirmed on computed tomography scan. Internal fixation for the fracture was done by a novel mini open technique and a strict rehabilitation protocol was followed. Twelve weeks postoperatively, he was allowed to resume his work and X-ray confirmed complete bony union. The patient at 6 months follow-up did well with full range of ankle motion.

First, a high clinical suspicion and vigilance are required for the diagnosis of a Cedell's fracture. Missing such injuries could lead to varied morbidities. There is no blanket treatment protocol for such fractures. The ideal treatment should be customized as per the fracture morphology; and internal fixation is one of the options. The mini open technique is a viable approach to fix such fractures.