Midfoot trauma, bony and ligamentous: evaluation and treatment:

External Fixation Diastasis Management of Kohler's Disease in a 14-Year-Old Boy: A Case Report

A case presentation of an adolescent with tarsal navicular avascular necrosis is presented. External fixation with tarsal navicular diastasis is a simple, straightforward management option to allow osseous regrowth and bone healing. In this case, the external fixator was well tolerated and the patient demonstrated a quick return to function without pain or discomfort. The external fixation technique with tarsal navicular diastasis is an uncommon but effective means of reversing the tarsal navicular avascular process and avoiding an open technique such as arthrodesis.

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

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.

Midfoot fractures

Fractures of the midfoot are uncommon because of the constrained configuration of multiple articular surfaces, which is augmented by capsular attachments and strong ligaments and tendons. Injury patterns usually involve more than one structure, although isolated fractures, dislocations, and sprains can occur. The key to optimal treatment of midfoot fractures is a high index of clinical suspicion because of their rareness. The traumatic midfoot injuries described in this article are categorized as Chopart joint injuries, tarsal scaphoid fractures, cuboid fractures, cuneiform fractures, and Lisfranc joint injuries.