Reverse floating first metatarsal and floating third metatarsal with Lisfranc fracture dislocation: an unusual injury.

A 25-year-old man complained of severe pain in the right foot after a traffic accident. There was a wound on the medial aspect of the foot extending over the length of the first metatarsal. There was no sign of vascular compromise and sensations were intact. Radiographs showed dislocation of the first tarsometatarsal (Lisfranc) and metatarsophalangeal joints with the head of the first metatarsal facing proximally and plantarward (reverse floating first metatarsal), a segmental fracture of the second metatarsal, fracture dislocation of the third metatarsal from the metatarsophalangeal and tarsometatarsal joints (floating third metatarsal), and fractures at the base of the fourth and fifth metatarsals and of cuneiforms. Open reduction and internal fixation were performed. The metatarsal head was buttonholed through the capsule and muscles and was released and reduced. The fractured second metatarsal was reduced and stabilized with a K-wire. The third floating metatarsal was aligned and fixed with a K-wire. A below-knee posterior plaster splint was applied for six weeks. Full weight bearing was started at 10 weeks. The patient returned to his activities with only minimal discomfort. This is the first reported case of plantar Lisfranc dislocation and reverse floating first metatarsal.