Isolated medial cuneiform fracture: a commonly missed fracture

Eraslan, Ali; Özyürek, Selahattin; Erol, Bekir; Ercan, Emrah Cevat

doi:10.1136/bcr-2013-010093

Cited by 10 publications

(10 citation statements)

References 3 publications

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“…Regarding the isolated medial cuneiform fracture, some case reports have been already presented. Eraslan et al 11 reported that the isolated medial cuneiform fractures were extremely rare and might be missed and underestimated with conventional radiographs at initial evaluation in the emergency department. Tai 12 also reported a case report of the isolated medial cuneiform open fracture caused by direct blow injury (metallic board).…”

Section: Discussionmentioning

confidence: 99%

Categorization of single cuneiform fractures and investigation of related injuries: A 10-year retrospective study

Choi

Lee

Ngissah³

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: The purpose of this study was to define the fracture type and investigate the injuries related to single medial, intermediate, or lateral cuneiform fracture. Methods: From January 2008 to December 2018, 30 consecutive patients (30 cases) who were treated in the single institution for the single cuneiform fractures were reviewed retrospectively. Each fracture was categorized by location and type (intra- or extra-articular avulsion, axial compression, and direct blow). We also investigated the related foot bone fractures or dislocations on the affected side. Results: Twenty-one, one, and eight cases with single medial, intermediate, and lateral cuneiform bone fractures, respectively, were identified. More than two-thirds of the single cuneiform fractures were observed in the medial cuneiform bone. The single medial cuneiform fracture was associated with various types of foot injuries including Lisfranc injury, naviculo-cuneiform joint dislocation, or calcaneo-cuboidal dislocation. Single lateral cuneiform fractures were more frequently observed than single intermediate cuneiform fractures. Conclusion: More than two-thirds of the single cuneiform fractures were observed in the medial cuneiform bone. Most intra-articular avulsion fractures were associated with high-energy trauma. Level of Evidence: 4

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Section: Discussionmentioning

confidence: 99%

Categorization of single cuneiform fractures and investigation of related injuries: A 10-year retrospective study

Choi

Lee

Ngissah³

et al. 2019

J Orthop Surg (Hong Kong)

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“…Fifteen patient cases from these ten peerreviewed publications were found. [22][23][24][31][32][33][34][35][36][37]…”

Section: Study Selectionmentioning

confidence: 99%

“…Baseline radiographs were reported in 11 of the 15 patients, and of these, eight were occult (72.7%). Of the eight patients with occult imaging, three with MRI, 22,23,33 four with CT, 32,[34][35][36] one with bone scan, and one of three with repeated radiographs (33.3%) 22,36 were diagnostic. In the patient with the bone scan, CT was also ordered due to the inherent low specificity of bone scan.…”

Section: Study Characteristicsmentioning

confidence: 99%

Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies

Mabry¹,

Patti²,

Ross³

et al. 2021

Journal of the American Podiatric Medical Association

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Background Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach. Methods Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed. Results Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient. Conclusions Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months.

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“…Only a handful of case reports of isolated cuneiform fractures are present in the literature15 (figure 4). Mechanisms of these fractures are usually due to significant amounts of force as an indirect axial load12 or due to crush injuries to the midfoot 14 16. These fractures can be detected on standard foot radiographs with careful examination, but CT is useful in confirming the presence of a cuneiform injury, evaluating fracture extent, and also identifying additional fractures which may be occult by radiography 12…”

Section: Isolated Midfoot Injuriesmentioning

confidence: 99%

Osseous injuries of the foot: an imaging review. Part 2: the midfoot

et al. 2016

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Injuries to the foot are a common cause for presentation to the emergency department (ED), and imaging is often used to aid in the diagnosis. The foot can be divided into three distinct anatomic regions: the forefoot, midfoot and hindfoot. Our manuscripts comprise a three-part imaging review in which we address the use of radiography as well as advanced imaging modalities. We provide pearls to radiographic interpretation and discuss prognostic implications and classification systems. Part 1 addressed forefoot injuries, Part 2 reviews midfoot injuries and Part 3 covers the hindfoot.

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Isolated medial cuneiform fracture: a commonly missed fracture

Cited by 10 publications

References 3 publications

Categorization of single cuneiform fractures and investigation of related injuries: A 10-year retrospective study

Categorization of single cuneiform fractures and investigation of related injuries: A 10-year retrospective study

Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies

Osseous injuries of the foot: an imaging review. Part 2: the midfoot

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