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Cuneiform Fracture

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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

Pathoanatomy

  • Cuneiforms
    • Three: medial, intermediate and lateral
    • Wedge-shaped and add structure to the medial column of the foot

Risk Factors

  • Unknown

Differential Diagnosis


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

Proposed management algorthm for isolated medial cuneiform fractures. Can likely be applied all 3.<ref name="mabry">

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


References

  1. Banks, Alan S. McGlamry's comprehensive textbook of foot and ankle surgery. Vol. 1. Lippincott Williams & Wilkins, 2001.
  2. Court-Brown, Charles M., and Ben Caesar. "Epidemiology of adult fractures: a review." Injury 37.8 (2006): 691-697.
  3. 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.
  4. 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.
  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.
Created by:
John Kiel on 11 October 2021 07:55:12
Authors:
Last edited:
24 October 2021 01:05:02
Categories:
Lower Extremity | Trauma | Foot | Fractures | Acute