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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| A Rare Fracture of the Foot1 (continued) |
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| Answer: Cuboid dislocation of the left foot. | ||
| For larger view, click on image | ||
 Fig. 1-A |
 Fig. 1-B |
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| Figs. 1-A and 1-B Case 1. Fig. 1-A: Plain radiograph demonstrating a disruption in the normal arc of the left foot, formed by drawing a line along the path of the metatarsal heads. The disruption is due to the cuboid dislocation, with resultant proximal subluxation of the fourth and fifth metatarsals. Fig. 1-B: Computed tomographic scan showing the cuboid (arrow) to be dislocated distal to the lateral metatarsal bases. |
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| Discussion | ||
| Isolated dislocations of the midfoot bones in individuals with normal sensation are extremely uncommon. When they occur, they typically involve the medial aspect of the foot2,3. The majority of reported cases of tarsal dislocation have consisted of a complex fracture-dislocation involving multiple articulations4; the clinician must search carefully for associated injuries whenever an apparently isolated injury is identified. Radiographic evaluation of the region is often difficult because of overlap and superimposition of the bones, and a cuboid dislocation can easily be overlooked. Anteroposterior, lateral, and oblique radiographs should be made, and each bone and its articulations should be inspected. | ||
| The exact mechanism of cuboid dislocation remains unclear. Drummond and Hastings5 postulated that a force directed medially and plantarly on the forefoot expels the cuboid in a plantar direction, tearing the interosseous ligaments. Since the time of that case report5, plantar medial displacement of the cuboid has been documented in several additional reports3,4,6-9. In all cases, the force was directed medially and plantarly on the outside of the foot. | ||
| When the injury is recognized acutely, immediate closed reduction under general anesthesia can be attempted by applying force to the cuboid in the opposite direction of the injury. This was reported to be successful in one of the seven cases in the literature9. Open reduction and temporary pin fixation may be required. We are not aware of any reports of irreducible cuboid dislocation. We found that an entrapped peroneus longus tendon can block forceful attempts at closed or open reduction. In both of our patients, the tendon was incarcerated between the distal edge of the cuboid and the overlying bases of the lateral metatarsals. After recognition of the problem and open replacement of the tendon anterior and inferior to the distal edge of the cuboid, complete cuboid reduction proceeded without difficulty; however, the reduction was unstable and required temporary fixation in both patients. | ||
| References | ||
| 1. Dobbs MB, Crawford H, Saltzman C. Peroneus longus tendon obstructing reduction of cuboid dislocation. A report of two cases. J Bone Joint Surg Am. 2001;83:1387-91. 2. Mann RA. Biomechanics. In: Jahss MH, editor. Disorders of the foot. Volume 1. Philadelphia: WB Saunders; 1982. p 52. 3. Littlejohn SG, Line LL, Yerger LB. Complete cuboid dislocation. Orthopedics. 1996;19:175-6. 4. Jacobsen FS. Dislocation of the cuboid. Orthopedics. 1990;13:1387-9. 5. Drummond DS, Hastings DE. Total dislocation of the cuboid bone. Report of a case. J Bone Joint Surg Br. 1969;51:716-8. 6. Gough DT, Broderick DF, Januzik SJ, Cusack TJ. Dislocation of the cuboid bone without fracture. Ann Emerg Med. 1988;17:1095-7. 7. Kollmannsberger A, De Boer P. Isolated calcaneo-cuboid dislocation: brief report. J Bone Joint Surg Br. 1989;71:323. 8. McDonough MW, Ganley JV. Dislocation of the cuboid. J Am Podiatry Assoc. 1973;63:317-8. 9. Fagel VL, Ocon E, Cantarella JC, Feldman F. Case report 183: dislocation of the cuboid bone without fracture. Skeletal Radiol. 1982;7:287-8. |
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