Isolated intermediate cuneiform dislocation: A case report on the surgical considerations for a rare injury of the foot.

Abstract

In this report, a rare case of an isolated dorsal dislocation of the intermediate cuneiform in a 32-year-old woman following a low-energy injury is presented. The patient sustained a direct medial-to-lateral midfoot crush injury. Imaging revealed a dorsal dislocation of the intermediate cuneiform with associated plantar avulsion fractures, indicating ligamentous instability. Closed reduction under general anesthesia was unsuccessful due to soft tissue interpositioning. Open reduction and internal fixation was performed using two lag screws, achieving a stable anatomical alignment. The patient underwent staged immobilization and a structured rehabilitation program. At 9-months follow-up, the patient demonstrated minimal pain and a satisfactory return to function. This case underscores the challenges of closed reduction due to the unique anatomy of the cuneiform complex and possibility of soft-tissue interpositioning, reinforcing the need for early consideration of open reduction and internal fixation. LEVEL OF EVIDENCE: V, case report.