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.

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.