Avulsion fractures of the medial tubercle of the posterior process of the talus.

Avulsion fracture of the medial tubercle of the posterior process of the talus occurs after forceful dorsiflexion-pronation of the ankle. We evaluated five patients who had sustained this fracture while participating in sporting activities. Two patients were correctly diagnosed acutely and treated with immobilization and limited weightbearing. Avulsion fractures in the remaining three patients went undiagnosed acutely. This group was treated with delayed operative excision for persistent posteromedial ankle pain. The patients were evaluated at a mean follow-up of 35 months using the AOFAS Ankle-Hindfoot Scale. The two patients diagnosed and treated acutely achieved excellent results. The three patients with missed fractures did poorly, yet achieved comparable results after late excision. Our results suggest that prompt diagnosis and appropriate management yields reliably good outcomes. Untreated avulsion fractures predictably do poorly. For these patients, late excision can provide significant functional and symptomatic improvement.