Surgical Discussion

Patient positioning:  Supine position with the affected foot elevated on a padded support to facilitate access to the lateral aspect of the foot.

Anatomical surgical approach:  A lateral approach to the foot was utilized, with an incision extending from the distal fibula to the base of the fourth metatarsal. Subperiosteal dissection was performed to expose the cuboid and adjacent structures. The calcaneocuboid joint was accessed, and attention was given to restoring the length of the lateral column by bridging fixation.

The surgeon noted significant comminution of the cuboid, which necessitated meticulous reconstruction to restore the lateral column length. Due to the poor condition of the cuboid-metatarsal joints, achieving articular congruity was challenging. The decision to bridge from the calcaneus to the fourth metatarsal was made to provide stable fixation and maintain column length, as the external fixator pins were compromising the integrity of the fourth and fifth metatarsals.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing for 8 weeks, followed by progressive weight bearing as tolerated. Range of motion exercises for the ankle and subtalar joint were initiated early to prevent stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Internal fixation with a bridging plate from calcaneus to fourth metatarsal.