Delayed Treatment of a Medial Swivel Talonavicular Dislocation.

This case describes delayed treatment of a medial talonavicular dislocation with a shear fracture of the talar head, a comminuted posterior talar process fracture, and an intra-articular cuboid fracture with subtle medial displacement of the calcaneocuboid joint and the associated treatment. The injury was sustained in a 35-year-old man following a high-energy motor vehicle accident. Three weeks following the injury, delayed treatment was achieved following an attempted closed reduction under general anesthesia followed by open reduction and percutaneous Kirschner wire fixation. After a 12-month follow-up, the patient was able to return to work and regular activities pain-free without complications. Several associated injuries have been described with isolated talonavicular dislocations. This case reviews the technique and care surrounding this injury pattern and its delayed treatment.

Rare Proximal Diaphyseal Stress Fractures of the Fifth Metatarsal Associated With Metatarsus Adductus.

Before the report of English surgeon Robert Jones, who sustained a fracture to his fifth metatarsal while dancing around a tent pole, metatarsal fractures were thought to be the result of direct trauma to the foot. The mechanism of metatarsal fractures, in particular, those involving the fifth metatarsal, is now well understood. Patients with an adducted alignment of their forefoot can overload the fifth metatarsal base, putting them at an increased risk of fractures of this bone. Studies have reported that 2 distinct types of proximal diaphyseal or junctional fractures of the fifth metatarsal occur: the acute proximal diaphyseal or transverse proximal diaphyseal fracture and the proximal diaphyseal stress fracture. The radiographic characteristics associated with proximal diaphyseal stress fractures of the fifth metatarsal can vary by the chronicity; however, the findings typically entail a radiolucent fracture line with surrounding reactive sclerosis. In addition, a reduced medullary canal width can be appreciated. In the present retrospective analysis of patients with stress-related trauma to the fifth metatarsal base with an adducted forefoot, 2012 foot trauma cases were reviewed at 3 separate institutions. Of the 2012 cases, 22 (1.11%) met the outlined criteria of stress fractures of the fifth metatarsal base and underlying metatarsus adductus.