# Case Report: Arthroscopic treatment of cedell fracture, shepherd fracture, and avulsion fracture at the insertion of the calcaneofibular ligament

## TL;DR

This case report describes a rare talar fracture treated with arthroscopy, showing successful healing and suggesting a new treatment approach.

## Contribution

Presents a novel arthroscopic treatment for a rare combined talar fracture pattern with successful clinical outcomes.

## Key findings

- Arthroscopy provided a clear surgical field and aided in accurate reduction and fixation of complex talar fractures.
- The patient showed favorable healing after 4 years of postoperative follow-up.
- This case represents the first documented use of arthroscopy for this specific combined fracture pattern.

## Abstract

Talar fractures represent less than 1% of all fractures, and combined fractures involving the posteromedial and posterolateral talar processes along with a lateral process fracture are exceptionally rare. These fractures are considered severe injuries that may lead to prolonged disability and persistent pain. The intricate anatomical configuration and the proximity of nerves and blood vessels surrounding the talus present substantial challenges in the management of posterior talar process fractures. Surgical procedures in this area are rare, and inadequate treatment may lead to significant discomfort and limitations in daily functioning for patients. In this case report, we describe a 45-year-old male who experienced a fall from a 2-meter height, leading to persistent right ankle swelling for 6 days. Radiographs, CT scans, and 3D-CT reconstructions identified fractures involving the posteromedial and posterolateral talar processes, as well as an avulsion fracture at the calcaneofibular ligament attachment site. To the best of our knowledge, there are no previously documented reports of this combined injury. We conducted arthroscopically assisted reduction and internal fixation through a posterior approach utilizing Herbert screw. The patient underwent a 4-year postoperative follow-up, during which favorable fracture healing was observed. The objective of this report is to demonstrate that arthroscopy offers a well-defined surgical field, aids in reduction and internal fixation, and to suggest a novel treatment approach for this uncommon fracture pattern.