Anatomical background of the "Cunéo and Picot" fracture with posterior dislocation and report of a case. Could it be treated conservatively?

Background: The "Cuneo and Picot" is a particular lesion of the malleoli. If misdiagnosed, it could be a serious factor of instability, having an impact on the posterior continence of the mortice. Case description: The present work reports the successful management of a "Cuneo-Picot" isolated fracture with posterior sub-luxation. The patient was treated conservatively with closed reduction under general anesthesia, and a circumferential cast immobilization for six weeks, followed by a functional rehabilitation protocol. The "Cuneo and Picot" osteochondral fragment potentially exhibits instability, even if the posterior fragment malleolar fragment is small, making them difficult to recognize through conventional X-rays, demanding Computer Tomography (CT) scan. In this case, the post-reduction CT scan showed stable syndesmosis and at the final follow-up X-ray showed adequate bone healing. The patient was able to return to physical activities and presented satisfactory functional outcomes. Conclusion: This report highlights the identification of this distinct fracture-dislocation through X-ray and CT imaging, emphasizing the importance of documenting such cases for better understanding and management, and noting the utility of CT scans for morphological analysis and surgical planning if required.