The 3D reconstruction revealed the spatial location and orientation of the dislocated astragalo-scaphoid joint elements and the partial dislocation of the calcaneocuboid joint. The small intra-articular bone fragments are visible (arrow) 

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... 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 CT with 3D reconstruction (Aquilion™, Toshiba Medical Systems Corporation) was obtained to better visualize the injured region (Fig. 3). Analysis of the 3D reconstructed image demonstrated the presence of small intra-articular bone fragments and an overlooked partial dislocation of the calcaneo-cuboid joint (possibly enhanced by calcaneal trac- tion). Using the 3D image, careful preoperative assessment was carried out to plan the surgical approach which was determined to be a medial perimalleolar approach with an osteotomy of the medial malleolus. Surgery was performed 5 days later by the Wrst author. The level of malleolar oste- otomy was carefully checked under Xuoroscopy control and performed by mean of an oscillating saw. Intraoperatively, the approach exposed a tendon (not identiWed but supposed to be the extensor hallucis longus [1] within the intra-artic- ular space (Fig. 4) that impeded manual reduction. This ten- don was dorsally retracted followed by removal of the intra-articular bony fragments, and Wnally the reduction of the talus was carried out. In consideration of the compression achieved by its dual-pitch design, a Herbert cannulated bone screw, inserted over a pre-inserted guidewire, was used for precise and stable synthesis of the medial malleo- lus followed by careful fascial, subcutaneous, and cutane- ous suturing to close the site. Immediate postoperative radiographs conWrmed the anatomic reduction of the articu- lations (astragalo-scaphoid and calcaneal-cuboid) and accurate synthesis of the medial malleolus (Fig. 5). The leg was immobilized for 30 days in a non-weight-bearing well-molded above-knee cast. An elastic adhesive bandage (Tensoplast™) was applied after this time period, and progressive weight-bearing and early range of motion was encouraged to improve subtalar motion [4]. On last clinical evaluation in late October 2009 (follow-up = 120 days) the patient was able to freely bear weight on the foot and ankle, had full range of motion, and was ...