An unusual case report: Dorsal dislocation of the intermediate cuneiform associated with a lateral cuneiform fracture

Abstract

Introduction: The intermediate cuneiform, positioned between the medial and lateral cuneiform bones, takes on a wedge shape and is firmly connected to the first metatarsal through robust ligaments. It is recessed at the second metatarsal base and forms the “keystone” of the Lisfranc tarsometatarsal joint complex. An isolated dislocation of the cuneiform is an exceedingly uncommon injury. Dislocation of intermediate cuneiform with non-displaced lateral cuneiform fracture is so rare that is worthy of report. Case report: A 35-year-old man, presented to the emergency department, after a closed trauma to the left foot resulting from a sport accident, involving a mechanism of plantar hyperflexion. The initial clinical examination of his foot revealed swelling and tenderness on dorsomedial aspect of the left foot. An initial plain radiograph showed dorsal dislocation of the intermediate cuneiform bone and a nondisplaced fracture of the lateral cuneiform. Discussion: Closed reduction has little chance in these injuries. Although the failure rates of closed reduction are high, it should be attempted before open procedures. In this case, closed reduction was successful. Due to the rarity of this injury and technique, our case adds to the literature a novel reduction method.