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Cuneiform Fracture
From WikiSM
Contents
Other Names
- Medial Cuneiform Fracture
- Intermediate Cuneiform Fracture
- Lateral Cuneiform Fracture
- Isolated Cuneiform Fracture
- Cuneiform Dislocation
- Isolated medial cuneiform fracture
- Cuneiform Stress Fracture
Background
- This page refers to fractures of the medial, intermediate and/or lateral cuneiform
History
Epidemiology
- Rare in isolation, representing 1.7% of all tarsal bone fractures[1]
- Another study estimates they make up 0.1 to 0.5% of all fractures[2]
Pathophysiology
- General
- Rarely occurs in isolation
- Literature is generally limited to case reports
- Diagnostically challenging on plain radiographs, often leading to delay in treatment
- Medial cuneiform is most commonly fractured
Etiology
- Direct trauma
- Indirect trauma
- Axial and rotational forces transmitted through the foot
- Stress fractures
- Case reports in track and field athletes
Associated Conditions
- Other midtarsal and tarsometatarsal fracture dislocations
- Plantar Fasciitis
- Relationship not well understood
- Lisfrancy Injury
Pathoanatomy
- Cuneiforms
- Three: medial, intermediate and lateral
- Wedge-shaped and add structure to the medial column of the foot
Risk Factors
- Unknown
Differential Diagnosis
- Fractures & Osseous Disease
- Traumatic/ Acute
- Stress Fractures
- Other Osseous
- Dislocations & Subluxations
- Muscle and Tendon Injuries
- Ligament Injuries
- Plantar Fasciopathy (Plantar Fasciitis)
- Turf Toe
- Plantar Plate Tear
- Spring Ligament Injury
- Neuropathies
- Mortons Neuroma
- Tarsal Tunnel Syndrome
- Joggers Foot (Medial Plantar Nerve)
- Baxters Neuropathy (Lateral Plantar Nerve)
- Arthropathies
- Hallux Rigidus (1st MTPJ OA)
- Gout
- Toenail
- Pediatrics
- Fifth Metatarsal Apophysitis (Iselin's Disease)
- Calcaneal Apophysitis (Sever's Disease)
- Freibergs Disease (Avascular Necrosis of the Metatarsal Head)
Clinical Features
- History
- Most patients are able to walk on affected limb following injury
- Pain over dorsal or dorsomedial foot
- Physical Exam: Physical Exam Foot
- Edema
- Tenderness to cuneiform
- Antalgic gait
- Special Tests
Evaluation
Radiographs
- Standard Radiographs Foot
- Initial imaging study of choice
- Frequently occult
- Likely miss isolated fractures due to anatomy of midtarsal region
- One review found only 3 of 11 patients with isolated medial cuneiform fracture were positive on xray[3]
- Bipartate medial cuneiform
- Uncommon developmental osseous variant of the midfoot
- Can be misdiagnosed as a fracture[4]
CT
- Provides accurate assessment, displacement, adequate cortical detail
MRI
- Consider if radiographs negative and high index of suspicion
Classification
Mehlhorn Classification for Fracture–Dislocation
- Type 1: isolated fracture
- Type 2: isolated dislocation
- Type 3: fracture–dislocations
- Any of the above can involve involving 1, 2, or 3 cuneiform bones
AO/OTA Classification for Cuneiform Fracture
- Classified based on[5]
- Location (medial, intermediate, or lateral)
- Articular surface involvement (avulsion, partial articular, or complete articular
Management
Nonoperative
- Indications
- Stable, nondisplaced fractures
- Immobilization
Operative
- Indications
- Displaced fractures
- Technique
- Open reduction, internal fixation
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Complications and Prognosis
Prognosis
- Return to baseline
- Expected return to full function occurs in 3 to 6 months (need citation)
Complications
- Needs to be updated
See Also
- Internal
- External
- Sports Medicine Review Foot Pain: https://www.sportsmedreview.com/by-joint/foot/
References
- ↑ Banks, Alan S. McGlamry's comprehensive textbook of foot and ankle surgery. Vol. 1. Lippincott Williams & Wilkins, 2001.
- ↑ Court-Brown, Charles M., and Ben Caesar. "Epidemiology of adult fractures: a review." Injury 37.8 (2006): 691-697.
- ↑ Mabry, Lance M., et al. "Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies." Journal of the American Podiatric Medical Association 111.4 (2021): Article_12.
- ↑ Manoj, Edirisooriya Maddumage, Rajini Srigrishna, and Murugapillai K. Ragunathan. "Hepatic tuberculosis presenting with extreme hyperferritinemia masquerading as adult-onset Still’s disease: a case report." Journal of medical case reports 6.1 (2012): 1-5.
- ↑ Choi, Jun Young, et al. "Categorization of single cuneiform fractures and investigation of related injuries: A 10-year retrospective study." Journal of Orthopaedic Surgery 27.3 (2019): 2309499019866394.