TRAUMATIC DORSAL DISLOCATION OF INTERMEDIATE CUNEIFORM : A RARE MIDFOOT INJURY

Dislocation of the intermediate cuneiform is a rare injury, and only a few cases have been reported .Cuneiforms dislocations have been treated in a variety of methods, ranging from open or closed reduction, without or with fixation such as Krischner wires or screws. METHODS: A 24 years old female presented with right foot pain following fall from motorbike after got hit by a car from back. She related a history that her right foot was forced into torsion and plantarflexion at impact . On examination there was a bony protuberance on the dorsal surface, at cuneiform area . Radiograph showed dorsal dislocation of intermediate cuneiform. CT scan was performed and supported the radiographical findings. Manipulation under sedation was attempted, but was unsuccessful. RESULTS: Patient was placed supine under spinal anesthesia . A dorsal incision was made centering over the protuberance proceeded distally up to the base of the second-metatarsal. The dislocated middle cuneiform was identified. There was proximal soft tissue attachment to the middle cuneiform which was carefully preserved. It temporarily reduced with Krishner wires and a 2.7 mm variable angle locking plate was fixed dorsally to butress the bone dislocation . The foot was immobilized with a boot slab for 6 weeks and subsequently physiotherapy was instituted and gradual weight-bearing started. Postoperative follow-up was uneventful. DISCUSSION: Intermediate cuneiform is a part of the transverse and medial longitudinal arches of the foot and the stability is achieved by the deep transverse, dorsal, and plantar ligaments. It’s shaped like a wedge, the thin end pointing downwards, situated between medial and lateral cuneiforms, and articulates with the navicular posteriorly, the second metatarsal anteriorly and with the other cuneiforms on either side. Because it is wedge shaped and positioned dorsally, it has a tendency to dislocate dorsally, particularly when a plantar flexion force is applied to the midfoot. Immediate reduction and maintaining in reduced position is needed for good ligamentous healing. CONCLUSION: Intermediate cuneiform dislocation is a rare injury to encounter due to stable articulation of joints and ligament. Significant trauma is required for these injuries to take place. Open reduction is the gold standard treatment for these injuries. REFERENCES: 1. Kumaravel S et al An isolated middle cuneiform dislocation with a rare violence Journal of clinical orthopaedic and trauma 5 (2014) 161-171 Name;