Plantar lateral dislocation of the medial cuneiform: a case report

Calcaneocuboid and Naviculocuneiform Dislocation: An Unusual Injury of the Midfoot

Introduction. Midfoot dislocations are rare traumatic injuries. The best known patterns involve the Lisfranc and Chopart joints, although some other types have been described. Dislocations that occur at the level of the naviculocuneiform and calcaneocuboid joints simultaneously represent a very rare configuration of dislocation. Case Presentation. A 34-year-old man sustained a crush injury to his left foot causing a complete dislocation through the naviculocuneiform and calcaneocuboid joints. Immediate closed reduction and percutaneous pinning were performed, followed by open reduction and stabilization of both joints two weeks later. Anatomical reduction was obtained, and the clinical outcome remained satisfactory 10 months after surgery. Discussion. Anatomical reduction is essential to obtain favorable outcomes in traumatic midfoot injuries. An unusual pattern of midfoot dislocation can be treated according to the same principles as those for classical Lisfranc or Chopart injuries.

Closed Distal Dislocation of the Intermediate Cuneiform in a Complex Lisfranc Fracture-Dislocation: A Case Report

CASE

A 21-year-old, active duty male sustained an irreducible, complex Lisfranc fracture-dislocation with distal extrusion of his intermediate cuneiform. He was treated in a staged manner with external fixator placement, followed by an extended midfoot fusion with autograft bone. At 19 months, he could perform all activities of daily living independently with minimal pain using an Intrepid Dynamic Exoskeletal Orthosis.

CONCLUSIONS

Complex Lisfranc injuries are severe and often result in chronic pain and disability after operative management. To our knowledge, this is the only case report describing a Lisfranc fracture-dislocation with a distally extruded intermediate cuneiform treated with a fusion.

Classification and Outcome of Fracture-Dislocation of the Cuneiform Bones

Fractures and dislocations of the cuneiform bones are rare injuries to the midtarsal foot. The injury severity is often unclear, and the prognostic factors are unknown. The purpose of the present study was to characterize our insights of the diagnostics, therapy, and fracture patterns. We questioned whether the number of involved cuneiform bones and the type of injury would affect the clinical outcome. With this information, we aimed to develop a classification system for injuries of the cuneonavicular joint. Five patients who had sustained complex fracture-dislocation of the cuneiform bones were prospectively registered, underwent surgery, and were followed. We reviewed the published data and found 47 reports that included 55 patients to improve the informative value of our study. The injury mechanisms and therapy were evaluated, and the postoperative limitations and pain were assessed. The clinical outcome was correlated with the number of involved cuneiforms and the fracture/dislocation pattern. Direct trauma was associated with isolated fracture, and indirect injury was associated with isolated dislocations. Occasionally, these injuries were overlooked on conventional radiographs, and closed reduction frequently failed. The number of cuneiform bones involved and the type of injury were shown to affect the clinical outcome. We devised an easily applicable classification system for injuries to the cuneiform bones using this information. All cases were classified as isolated fractures (1), isolated dislocations (2), or fracture-dislocations (3) involving 1 (A), 2 (B), or 3 (C) cuneiform bones. The classification system we propose will facilitate a better understanding of the fracture patterns at the cuneonavicular joint line and is a good prognostic tool that requires validation in clinical settings.

An Isolated Dorsal Dislocation of the Lateral Cuneiform

We present a case of an isolated dorsal dislocation of the lateral cuneiform bone. This particular injury is extremely rare and quite often escapes the initial assessment of the medical examiner. Timely and accurate diagnosis of the injury is very important as the treatment is usually surgical.

LEVEL OF EVIDENCE

Therapeutic, Level IV: Case Report.

Intercuneiform and Lisfranc Fracture-Dislocation Due to Seizure: A Case Report

Cuneiform dislocation associated with Lisfranc injury is a very rare injury. Dislocation over the midfoot due to a seizure has not been previously reported in published studies. A 35-year-old female presented with an intercuneiform dislocation and Lisfranc fracture-dislocation after a generalized seizure. Immediate close reduction of the dorsally dislocated cuneiforms was performed, followed by definitive treatment to restore the foot arches. A proposed underlying pathophysiology of dislocation due to seizure in terms of the biomechanics is discussed. The purpose of our report was to present the unusual etiology of this form of cuneiform dislocation and Lisfranc joint complex injury.

Dorsomedial fracture dislocation of the first ray and medial cuneiform: a case report

Isolated dislocation of the medial cuneiform is a rare injury. A favorable outcome relies on an accurate and stable reduction. Evidence of residual instability can be subtle. We present 1 such injury whose true extent was not fully appreciated at presentation, despite multiple plain films. Occult fracture of the medial cuneiform contributed to residual instability of the first ray and persistent and progressive symptoms and ultimately necessitated operative stabilization of the medial arch. We recommend the use of computed tomography as an adjunct to plain radiography for all midfoot dislocations to more accurately define the extent of the injury.

Complete medial dislocation of the first cuneiform: a case report

Isolated dislocation of the first cuneiform bone is an extremely rare lesion that can usually be diagnosed on plain radiography. Few cases of this injury have been previously described in the literature. The case presented here resulted from a torsion injury and was treated by means of closed reduction with the aid of pointed reduction forceps. After fixation with Kirschner wires, the foot was immobilized for 6 weeks. The patient recovered uneventfully and remains asymptomatic 3 years later.

Naviculocuneiform dislocations treated with immediate arthrodesis: a report of 2 cases

The authors report on 2 patients who sustained naviculocuneiform dislocations and intercuneiform diastasis, and who were treated with immediate arthrodesis of the midfoot complex. Injury patterns in both cases involved damage to the medial facet of the distal navicular articular surface, separation of the first and second cuneiforms, and an unstable first ray. At the 15- and 18-month follow-up, respectively, both patients attained a stable, solid fusion with maintenance of the medial longitudinal architecture. Both patients returned to their preinjury activity levels with no disability.

Fractures of the tarsal bones

Fractures involving the midtarsal bones are relatively uncommon. The morbidity associated with these injuries can be significant, however. Accurate diagnosis and appropriate treatment can help restore midfoot function and decrease the incidence of chronic pain. Treatment should preserve the function of the talonavicular joint, maintain the relative length of the medial and lateral columns, and protect the ligaments and soft tissues until adequate healing has occurred.

Isolated medial cuneiform fracture: review of the literature and report of two cases

The authors present two unusual cases of isolated medial cuneiform fracture. Both fractures were difficult to see on plain films and therefore diagnosed with ancillary tests (computed tomography and magnetic resonance imaging). Treatment was nonweightbearing cast immobilization, in which both patients healed within twelve weeks of treatment without complication and returned to full work related activities.