Open dorsomedial fracture-dislocation of the medial cuneiform with concomitant tibialis anterior tendon rupture: a case report and review of the literature

Medial cuneiform fracture-dislocations are rare and typically occur in the setting of high-energy midfoot trauma. We report the case of a 30-year-old woman who sustained an open dorsomedial fracture-dislocation of the medial cuneiform with concomitant tibialis anterior tendon avulsion after a 6-m fall. She underwent emergent irrigation and debridement, open reduction, and internal fixation of the midfoot, and primary repair of the tibialis anterior tendon. Intraoperatively, a longitudinal split tear with avulsion from the medial cuneiform insertion was identified and repaired through a bone tunnel using nonabsorbable sutures. At 6-month follow-up, radiographs demonstrated maintained reduction without hardware failure or recurrent instability. The patient reported minimal pain, had no evidence of infection, and was ambulating independently. This is the first reported open dorsomedial fracture-dislocation of the medial cuneiform with acute tibialis anterior tendon avulsion.