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Case Reports   |    
Isolated Plantar Dislocation of the Intermediate Cuneiform BoneA Case Report
Hideaki Nishi, MD1; Masato Takao, MD, PHD1; Yuji Uchio, MD, PHD1; Nobuo Yamagami, MD1
1 Department of Orthopaedic Surgery, Shimane University School of Medicine, Enya, Izumo City, Shimane 693-8501, Japan. E-mail address for M. Takao: mtakao@med.shimane-u.ac.jp
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Shimane University School of Medicine, Izumo City, Shimane, Japan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Aug 01;86(8):1772-1777
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Extract

The intermediate cuneiform bone lies between the medial and lateral cuneiforms and has a strong ligamentous attachment to the first metatarsal. It is recessed to anchor the base of the second metatarsal and forms the keystone of the Lisfranc (tarsometatarsal) joint1. Isolated dislocation of the intermediate cuneiform is regarded as a variation of a Lisfranc fracture-dislocation2,3, and only eight cases have been reported in the literature1-8. Because the intermediate cuneiform is wedge-shaped in the coronal plane with its base positioned dorsally, it has a tendency to dislocate dorsally. In fact, seven of the eight previously reported cases were dorsal dislocations1-6,8, and in only one case was the direction of dislocation plantar7. We report a second case of isolated plantar dislocation of the intermediate cuneiform bone. Our patient was informed that data concerning the case would be submitted for publication.
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    Masato Takao
    Posted on November 18, 2004
    Dr. Takao responds to Dr. Hubbell
    Department of Orthopaedic Surgery, Shimane University School of Medicine

    To the Editor:

    Thank you for your comments regarding our manuscript. We found three additonal reports of isolated plantar dislocation of the intermediate cuneiform after publication of our manuscript ( 1,2,. Therefore, our case report is in fact the fifth example of this injury that has been reported.

    Regarding the mechanism of this rare injury, we agree with the mechanisms you (1) and Dysek (2) proposed that it is caused by blunt trauma to the dorsum of the foot.

    However,our anatomic dissection showed that isolated plantar dislocation of the intermediate cuneiform did not occur only with blunt trauma to the dorsum of the foot. This wedge shaped bone could not displace in a plantar direction without opening the plantar window. Our message was that when the force was applied to the dorsum of the foot, the transverse and longitudinal arches were depressed, thereby widening the plantar window around the intermediate cuneiform sufficiently to allow extrusion of that bone plantarward. We think our speculation gave support your theory.

    1.Hubbell JD, Goldhagen P, O'Connor D, Denton JR. Isolated Plantar Fracture-Dislocation of the Middle Cuneiform. American Journal of Orthopedics.1998;3:234-6

    2.Dysek M, Izolovane' vykloubeni. II. Kostiklinove. Acta Chir Orthop Traumatol Chec. 1975; 42:390-92

    3. Khatri M, Briggs PJ. Isolated plantar dislocation of the intermediate cuneiform. A case report and review of the literature. The Foot 2001; 11: 215-217.

    John D Hubbell
    Posted on September 28, 2004
    Isolated Plantar Dislocation of the Middle Cuneiform Bone
    None

    To the Editor:

    The injury complex described in this case report is truly a rare occurrence and one that we described in a case report in The American Journal of Orthopedics in 1988(1). Our literature review at that time also discovered that this had previously been described in the Czechoslovakian literature by Dysek in 1975(2).

    In both our case report and that of Dysek, the mechanism of injury was due to blunt trauma to the dorsum of the foot. The case reported by Nishi was similar to ours in that the middle cuneiform fracture in figure 2 is an avulsion fracture representing a disruption of the bony attachment of the dorsal naviculcuneiform ligament to the middle cuneiform.

    John D. Hubbell, M.D.

    References:

    1.Hubbell JD, Goldhagen P, O’Connor D, Denton JR. Isolated Plantar Fracture-Dislocation of the Middle Cuneiform. American Journal of Orthopedics.1998;3:234-6

    2.Dysek M, Izolovane’ vykloubeni. II. Kostiklinove. Acta Chir Orthop Traumatol Chec. 1975; 42:390-92

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