A Rare Midfoot Injury Pattern: Navicular—Cuneiform and Calcaneal—Cuboid Fracture—Dislocation

Abstract

A rare midfoot injury pattern of navicular—cuneiform and calcaneal—cuboid fracture—dislocation is presented with two typical cases and a systematic review of the literature. This injury usually occurs as a result of high-energy crushing trauma and most often causes plantarly directed dislocation of the midfoot. Initial diagnosis includes a thorough physical examination and adequate radiological imaging, comprising anteroposterior, oblique and lateral X-radiography and computed tomography with three-dimensional reconstruction. Care should be taken to determine any injury to adjacent midfoot joints, in particular the Lisfranc joint. Intrasurgical protection of soft tissue is essential. Open reduction using two parallel incisions with minifragment plate fixation is recommended in more comminuted injuries. The navicular—cuneiform and calcaneal—cuboid joints play important roles in maintaining the arch of the foot and in weight-bearing during locomotion. Without proper therapy in the immediate post-traumatic phase, the long-term results are generally unsatisfactory.