Simultaneous Shepherd, Cedell, and lateral process talar fractures: A case report

Synchronous fractures of the lateral tubercle (Shepherd), the medial tubercle (Cedell), and the lateral process of the talus, associated with a hallux fracture-dislocation, represent a rare and complex injury pattern. Few cases have been reported in the literature. We present the case of a 40-year-old male patient involved in a motorcycle accident who sustained blunt trauma to his left ankle. Initial plain radiographs and subsequent computed tomography (CT) confirmed displaced fractures involving both tubercles of the posterior process of the talus as well as the lateral process, along with a fracture-dislocation extending into the tibial condyle of the proximal phalanx at the hallux interphalangeal joint. Surgical fixation was performed, including anatomical reduction and internal fixation. Clinical and radiological follow-up over 18 months demonstrated satisfactory functional recovery and bone union, with the patient scoring 70/100 on the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, 42% on the Foot Function Index (FFI), and 4/10 on the Visual Analog Scale (VAS) for pain. For the hallux, the AOFAS hallux score was 69 points. This case underscores the clinical importance of recognizing peripheral talar fractures, which are frequently overlooked on radiographs and require CT imaging for accurate diagnosis and appropriate management. Level of Evidence IV; Case report