Journal of orthopaedic case reports · 2026
Bilateral Cedell Fractures of the Talus Associated with Ankle Fractures in a Polytrauma Patient: A Rare Injury Managed with Damage Control Orthopedics and Staged Fixation.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Sivakumar Sanjey, Pattabiraman Kirubakaran, Salam Nabiel, Chereykkatt Nibras, Dwajan Anirudh, Patel Sandeep
Аннотация
INTRODUCTION: Posteromedial talar process (Cedell) fractures are rare and frequently missed, particularly in polytrauma patients. Bilateral involvement is exceedingly uncommon and presents unique diagnostic and management challenges.
CASE REPORT: A 20-year-old male sustained bilateral posteromedial talar process fractures following a fall from height. Associated injuries included an L3 bony Chance fracture, a right ankle fracture-dislocation with a medial malleolar fracture, and a left distal tibial plafond fracture. Computed tomography (CT) confirmed bilateral posteromedial talar process fractures with extension into the subtalar joints. A staged damage-control orthopedic strategy was adopted. Initial management comprised spinal stabilization, temporary ankle-spanning external fixation, and fixation of the medial malleolar fracture. Following physiological optimization and soft-tissue recovery, definitive fixation of both talar fractures and the associated injuries was performed. At 6 months, complete radiological union was achieved bilaterally without evidence of avascular necrosis. The patient subsequently developed symptomatic post-traumatic arthritis of the right subtalar joint, which was managed with subtalararthrodesis and transosseous lateral ligament repair. At the 1-year follow-up, the patient was pain-free, demonstrated preserved ankle dorsiflexion and plantarflexion bilaterally, and had intact flexor hallucis longus function. His American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 95, and he had returned to his pre-injury functional level.
CONCLUSION: Bilateral Cedell fractures may be overlooked in patients with complex high-energy ankle injuries. Careful CT assessment and staged surgical management can achieve fracture union, preserve talar viability, and provide an excellent functional outcome. Post-traumatic subtalar arthritis may still occur despite fracture union and can be successfully addressed with an appropriate salvage procedure.
CASE REPORT: A 20-year-old male sustained bilateral posteromedial talar process fractures following a fall from height. Associated injuries included an L3 bony Chance fracture, a right ankle fracture-dislocation with a medial malleolar fracture, and a left distal tibial plafond fracture. Computed tomography (CT) confirmed bilateral posteromedial talar process fractures with extension into the subtalar joints. A staged damage-control orthopedic strategy was adopted. Initial management comprised spinal stabilization, temporary ankle-spanning external fixation, and fixation of the medial malleolar fracture. Following physiological optimization and soft-tissue recovery, definitive fixation of both talar fractures and the associated injuries was performed. At 6 months, complete radiological union was achieved bilaterally without evidence of avascular necrosis. The patient subsequently developed symptomatic post-traumatic arthritis of the right subtalar joint, which was managed with subtalararthrodesis and transosseous lateral ligament repair. At the 1-year follow-up, the patient was pain-free, demonstrated preserved ankle dorsiflexion and plantarflexion bilaterally, and had intact flexor hallucis longus function. His American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 95, and he had returned to his pre-injury functional level.
CONCLUSION: Bilateral Cedell fractures may be overlooked in patients with complex high-energy ankle injuries. Careful CT assessment and staged surgical management can achieve fracture union, preserve talar viability, and provide an excellent functional outcome. Post-traumatic subtalar arthritis may still occur despite fracture union and can be successfully addressed with an appropriate salvage procedure.