PMC7539103_01
(a) Anteroposterior X-rays of the left foot show a dislocation through the naviculocuneiform joint with bony avulsions. (b) Frontal and (c) lateral X-rays of the ankle show a bifocal fracture of the fibula.
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Standard X-rays showed a dislocation between the navicular and the three cuneiforms, a lateral displacement of the cuboid (Figure 1(a)), and a bifocal fracture of the fibula (Figures 1(b) and 1(c)).
Oblique multiplanar reconstruction CT of the left foot shows dislocation of the (a) naviculocuneiform joint and of the (b) calcaneocuboid joint.
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Computed tomography of the foot confirmed the naviculocuneiform dislocation with an associated calcaneocuboid dislocation, as well as a marginal fracture of the medial cuneiform and an avulsion fracture of the anterior calcaneal process (Figure 2).
(a) Anteroposterior, (b) oblique, and (c) lateral X-rays of the left foot after closed reduction and percutaneous pinning.
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Due to residual instability, percutaneous pinning was performed between the navicular and the medial cuneiform (N-C1), between the navicular and the intermediate cuneiform (N-C2), and between the cuboid and the navicular (Figure 3).
(a) Dorsolateral volume-rendered CT of the left foot shows the incomplete reduction of the calcaneocuboid joint. (b) Oblique and (c) lateral multiplanar reformatted CT show the incomplete naviculocuneiform reduction (white arrowheads).
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A second computed tomography was performed after the reduction, showing incomplete reduction between the cuboid and the calcaneus (Figure 4(a)) as well as at the level of the naviculocuneiform joint (Figures 4(b) and 4(c)).
(a) Anteroposterior, (b) oblique, and (c) lateral X-rays of the left foot after open reduction, showing internal fixation of N-C1 and N-C2 joints, and pinning of the calcaneocuboid joint.
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Postoperative X-rays showed optimal reduction (Figure 5).
(a) Anteroposterior weight-bearing, (b) oblique, and (c) lateral weight-bearing X-rays of the left foot 10 months after the surgery. Black arrowheads show the osseous fragment next to the N-C1 joint responsible for the discomfort at the medial side of the midfoot.
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Conventional weight-bearing X-rays at 10 months show anatomical alignment (Figure 6).