Irreducible Lisfranc dislocation due to the interposition of the tibialis anterior tendon: Case report and literature review

We report a case of a lateral type A (according to Myerson) Lisfranc dislocation irreducible by closed manipulation. Upon surgical exploration the lateral slip of the tibialis anterior tendon was found trapped between the medial and the middle cuneiform. Once the tendon was reduced, the dislocated first ray spontaneously reverted to its anatomical position and the joint was fixed with Kirschner wires. Seven similar cases have been reported in the literature. After analysis of all the reported cases we were able to describe a pattern of injury that may predict tibialis anterior interposition: (a) lateral type A according to Myerson dislocation; (b) after closed manipulation the 1st ray remains dislocated while the 5th metatarsal reduces; (c) there is a gap between the medial and the middle cuneiform or a fracture at the base of the 2nd metatarsal.