title: A transcuneiform fracture-dislocation of the midfoot.
abstract: Isolated fractures of the ossa cuneiformia are rare fractures of the foot and they usually occur in the context of a direct trauma. We report about a patient with a dislocation of the midfoot and concomitant fractures of the cuneiforme bones I-III due a car traffic accident. X-rays of the foot confirmed a lateral dislocation of the midfoot with multiple fractures of all ossa cuneiformia. An anterior-longitudinal approach was performed to access the ossa cuneiformia and the bases of the metatarsalia. Comminuted fractures of all ossa cuneiformia, a dislocation of the metatarsal bones I-III and a disruption of the Lisfranc ligament were found. The metatarsal bones I-III were stabilized by K-wires through the bases of the metatarsal bones into the os cuneiform. 6 months later the patient reached 92 points in the AOFAS-Score which correlates with a very good clinical result. We recommend a CT scan for the assessment of this injury since of the complex anatomy of the midfoot. Aim of all surgical procedures should be the restoration of anatomy, in particular of the longitudinal and the diagonal arch of the foot. The anterior, longitudinal approach provides a good overview and permits a direct access even to comminuted fractures.
authors.affiliation: Heinrich Heine Universitätsklinik Düsseldorf, Klinik für Hand- und Unfallchirurgie, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Miersch
authors.forename: Michael
authors.initials: M
authors.lastname: Wild
authors.forename: Pascal
authors.initials: P
authors.lastname: Jungbluth
authors.forename: Marcel
authors.initials: M
authors.lastname: Betsch
authors.forename: Joachim
authors.initials: J
authors.lastname: Windolf
authors.forename: Mohssen
authors.initials: M
authors.lastname: Hakimi
mesh_terms: D000063:Accidents, Traffic; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008875:Middle Aged; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013640:Tarsal Joints / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed