Posterior talar process fracture
Citation, DOI & article data
Posterior talar process fractures may involve the medial or lateral tubercle of the posterior process of the talus. The posterior talofibular ligament attaches to the lateral tubercle and flexor hallucis longus runs between these two tubercles. The unfused ossification center of the lateral tubercle forms the os trigonum.
A Shepherd fracture refers to a fracture of the lateral tubercle of the posterior process. An elongated lateral tubercle of the posterior process of the talus is referred to as a Stieda process, so occasionally these fractures are described as Stieda process fractures.
A Cedell fracture is a fracture of the medial tubercle of the posterior process.
Fractures of the entire posterior process of the talus are extremely rare.
Mechanism of injury
- injury to lateral tubercle is caused by inversion or extreme equinus
- injury to medial tubercle is uncommon and is caused by forced dorsiflexion and pronation
Lateral process fractures are best visualized on lateral projections. The os trigonum may be mistakenly identified as a fracture on plain radiograph.
Best imaging modality for identifying posterior process fractures. CT is indicated when clinical suspicion is high but radiographs are negative.
Treatment and prognosis
Short leg cast or ankle brace is used until signs of union appear. If there is non-union, then excision of the fragment is undertaken.
- 1. Ahmad R, Ahmed SM. Fracture of the posterior process of the talus: an unusual injury. Emerg Med J. 2007;24 (12): 867. doi:10.1136/emj.2006.045609 - Free text at pubmed - Pubmed citation
- 2. Blanchette MA, Grenier JM. Fracture of the lateral tubercle of the posterior talar process caused by a rock-climbing fall: a case report. J Can Chiropr Assoc. 2014;58 (3): 286-90. Free text at pubmed - Pubmed citation
- 3. O'Loughlin P, Sofka CM, Kennedy JG. Fracture of the medial tubercle of the posterior process of the talus: magnetic resonance imaging appearance with clinical follow-up. HSS J. 2009;5 (2): 161-4. doi:10.1007/s11420-009-9113-z - Free text at pubmed - Pubmed citation
- 4. Majeed H, McBride DJ. Talar process fractures: An overview and update of the literature. (2018) EFORT open reviews. 3 (3): 85-92. doi:10.1302/2058-5241.3.170040 - Pubmed