Medial Swivel Injury: Misdiagnosis in Four Patients Over Three Months

Medial swivel injury is a rare injury among midfoot fracture-dislocations, typically caused by direct and high-energy force applied to the midfoot region. However, it can also develop after minor trauma, like a foot or ankle sprain sustained during sports or walking. Swivel type of injury refers to an isolated dislocation of the talonavicular joint (TNJ) with the calcaneum getting swiveled beneath the talus (i.e., subtalar subluxation), with intact introsseous ligament and intact calcaneocuboid joint. However, in our experience, in practice, it is more commonly associated with fracture-dislocation in the talonavicular area rather than being merely a dislocation or ligamentous injury. Diagnosis of this injury requires meticulous attention during the initial physical examination and appropriate radiological evaluation. Without sufficient care, the diagnosis can easily be missed, leading to a delay in treatment. The clinical literature on swivel fracture dislocation is limited. Following the referral of four cases with missed diagnosis and inadequate treatment over a three‑month period, we present this article to emphasize the significance of this injury and to review the appropriate diagnostic and therapeutic approaches.