Arch Orthop Trauma Surg (2010) 130:1129–1132 DOI 10.1007/s00402-009-1003-9 123 TRAUMA SURGERY Diagnostic imaging and unforeseen associated lesions in astragalo-scaphoid dislocation: a case report Andrea Emilio Salvi · Giovanni Pietro Metelli · Elio Domeneghini · Anthony Vatroslav Florschutz · Rosita Bettinsoli Received: 25 September 2009 / Published online: 17 November 2009  Springer-Verlag 2009 Abstract A case of an isolated astragalo-scaphoid dis- location following a fall from a motorbike is reported. Due to the diagnostic obscurity of the full extent of the injury, computed tomography (CT) with 3D reconstruction was utilized to precisely visualize the articular condition and revealed the presence of small intra-articular bone frag- ments and calcaneo-cuboid subluxation. Furthermore, the detailed imaging oVered valuable information for preopera- tive planning. Patient has healed without sequelae. In light of the good outcome in this case, we suggest utilizing CT with 3D reconstruction when there is a risk to overlook foot dislocation and potential associated lesions. Keywords Ankle · Fracture · Dislocation · Talus · CT scan · Foot · Chopart · Tendon · 3D reconstruction Introduction The midtarsal or Chopart joint is composed of two adjacent joints: the calcaneal-cuboid and the talo-navicular joints [4, 9]. The calcaneal-cuboid articulation is a very stable arthrodial joint due to the Wrm ligamentous attachments to adjacent bones (calcaneal-navicular, cuboideo-navicular and calcaneo-cuboid ligaments), a close relationship to the peroneus longus tendon, a rigid Wbrous capsule and saddle- shaped joint surface [3]. In contrast, the talo-navicular joint is an enarthrodial joint and possesses more relaxed and thin ligamentous attachments, namely the superior dorsal astragalo-scaphoid ligament [6, 8] that is covered by the extensor tendons. Inferiorly, the talo-navicular joint lacks ligamentous attachment, but is reinforced by the inferior calcaneo-scaphoid (spring) ligament. As such, the talo- navicular joint may be interpreted as the weakest link in the joint complex [8]. Pure dislocations of the midtarsal joint without fracture are very rare [7]. Moreover, as the foot has many joints and bones that superimpose each other on plain radiographs, a CT-scan may be needed to further identify the injury pattern and look for associated fractures [10]. In this case report, we describe a talo-navicular dislocation in a 25-year-old man that required additional in-depth 3D CT imaging and subsequent open surgical intervention to com- pletely restore articular function. Case report In June 2009, a 25-year-old male patient presented to the Orthopaedic and Traumatology Department after falling from his motorbike and sustaining an injury to his left ankle, a bruise to his left elbow and a hematoma to his right thigh. On presentation, the ankle injury was observed to be in Wxed supination (Fig. 1) and was initially imaged using plain Wlm radiographs (Fig. 2) which showed a loss of con- gruity between the head of the talus and the scaphoid. Due to intense pain, the aVected limb was provisionally placed in wire traction through the calcaneus for pain relief and a A. E. Salvi (&) · G. P. Metelli · E. Domeneghini Orthopaedics and Traumatology Department, Mellino Mellini Hospital Trust, Civil Hospital of Iseo, Via Cipro 30, 25124 Brescia, Italy e-mail: andrea@orthopaedics.com A. V. Florschutz Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA, USA R. Bettinsoli Radiology Department, Mellino Mellini Hospital Trust, Civil Hospital of Iseo, Brescia, Italy