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Kanemitsu M, Nakasa T, Shiraishi K, Ikuta Y, Adachi N. Nonunion of Isolated Medial Cuneiform Fracture Fixed With a Compression Screw and Compression Staple: A Case Report. Cureus 2024; 16:e58074. [PMID: 38738155 PMCID: PMC11088484 DOI: 10.7759/cureus.58074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Isolated cuneiform fractures are rare and account for only 1.7% of all midfoot fractures. Medial cuneiform fractures can be treated conservatively or surgically, with good clinical outcomes. However, nonunion is a rare complication of medial cuneiform fractures, and only a few cases have been reported in the literature. We report a case of a medial cuneiform fracture requiring surgical treatment that had a good clinical outcome. A 15-year-old boy presented to an orthopedic clinic with a complaint of pain in his right foot. The patient had landed on the foot during a handball game and was treated conservatively for several months. However, his symptoms persisted, and he was referred to our clinic for further evaluation, where he was diagnosed with medial cuneiform nonunion of the right foot. Open reduction and internal fixation surgery using a compression screw and staple and autologous bone grafting were performed. Postoperatively, bone union was observed, and the patient returned to full competition with no complaints of pain during exercise. The Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score at 21 months after surgery was 100.0 for the following subscales: Pain & Pain-Related; Physical Functioning & Daily Living; Social Functioning; Shoe-Related; General Health & Well-Being; and Sport (handball). We encountered a case of an isolated medial cuneiform fracture that required surgical treatment. During the surgical treatment, fixation with a combination of compression staples and screws may be considered simple and useful for achieving strong fixation because the medial cuneiform fracture has a small bone fragment.
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Affiliation(s)
| | - Tomoyuki Nakasa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Katsunori Shiraishi
- Department of Orthopaedic Surgery, Matsuyama Shimin Hospital, Matsuyama, JPN
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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2
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Baltas C, Mylonas T, Lamprou D, Koskiniotis AE, Arnaoutoglou C. Dorsal Dislocation of Intermediate Cuneiform With Multiple Cuneiform and Cuboid Fractures Combined With Lisfranc Injury: A Case Report. Cureus 2023; 15:e50689. [PMID: 38229780 PMCID: PMC10791154 DOI: 10.7759/cureus.50689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/18/2024] Open
Abstract
Multiple cuneiform fractures combined with isolated intermediate cuneiform dorsal dislocation and cuboid fracture, with disruption of the Lisfranc ligament, are rare injuries. In this study, we present a polytrauma patient who sustained these injuries, his treatment course, and the follow-up period. The patient was operated on the day of the injury and six months after that the results are very satisfactory.
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Affiliation(s)
- Christos Baltas
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Theodoros Mylonas
- Department of Orthopaedics and Traumatology, General University Hospital Of Larissa, Larissa, GRC
| | - Dimitrios Lamprou
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Alexandros E Koskiniotis
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Christina Arnaoutoglou
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
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Gooday C, Hardeman W, Poland F, Woodburn J, Dhatariya K. Controversies in the management of active Charcot neuroarthropathy. Ther Adv Endocrinol Metab 2023; 14:20420188231160406. [PMID: 37101723 PMCID: PMC10123890 DOI: 10.1177/20420188231160406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/11/2023] [Indexed: 04/28/2023] Open
Abstract
Charcot neuroarthropathy (CN) was first described over 150 years ago. Despite this there remains uncertanity around the factors that contribute to its development, and progression. This article will discuss the current controversies around the pathogenesis, epidemiology, diagnosis, assessment and management of the condition. The exact pathogenesis of CN is not fully understood, and it is likely to be multifactorial, with perhaps currently unknown mechanisms contributing to its development. Further studies are needed to examine opportunities to help screen for and diagnose CN. As a result of many of these factors, the true prevalence of CN is still largely unknown. Almost all of the recommendations for the assessment and treatment of CN are based on low-quality level III and IV evidence. Despite recommendations to offer people with CN nonremovable devices, currently only 40-50% people are treated with this type of device. Evidence is also lacking about the optimal duration of treatment; reported outcomes range from 3 months to more than a year. The reason for this variation is not entirely clear. A lack of standardised definitions for diagnosis, remission and relapse, heterogeneity of populations, different management approaches, monitoring techniques with unknown diagnostic precision and variation in follow-up times prevent meaningful comparison of outcome data. If people can be better supported to manage the emotional and physical consequences of CN, then this could improve people's quality of life and well-being. Finally, we highlight the need for an internationally coordinated approach to research in CN.
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Affiliation(s)
| | - Wendy Hardeman
- Behavioural and Implementation Science Group, School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Poland
- Institute for Volunteering Research, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
| | - Jim Woodburn
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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4
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Mabry LM, Patti TN, Ross MD, Bleakley CM, Gisselman AS. Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies. J Am Podiatr Med Assoc 2021; 111:470036. [PMID: 34478529 DOI: 10.7547/20-047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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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Aljawadi A, Jahangir N, Reid A, Wong J, Pillai A. Antibiotic Hydroxyapatite Impregnated Bulk Autograft for Traumatic Large Bone Void. Technique & Case Report. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.05.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Mid-foot open fractures are rare, and usually presents with high energy trauma. Staged approach for the management of open midfoot fractures was described by few authors.
Case presentation: Up to authors best knowledge, this is the first article describing the management of mid-foot open fracture that presented 6 weeks spost injury and had absent medial cuneiform at presentation, with multi-fragmentary fracture of middle and lateral cuneiform associated with fracture of proximal second, third and fourth metatarsals.
Management and Outcomes: Management involved conjoint ortho-plastics care, External fixation, with iliac crest graft covered with Gentamicin Eluting Injectable Bone Graft Substitute (Cerament-G) to replace missing medial cuneiform, free Superficial Circumflex Iliac Artery Perforator (SCIP) Flap. This surgical approach resulted in successful union of iliac crest graft restoring the medial cuneiform alignment, with no evidence of infection.
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Reyes R, Türker T, Latt LD. Spontaneous Regeneration of Medial Cuneiform Following Gunshot Wound. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419876261. [PMID: 35097342 PMCID: PMC8696864 DOI: 10.1177/2473011419876261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Ricardo Reyes
- University of Arizona Medical Center, Tucson, AZ, USA
| | - Tolga Türker
- Banner-University Medical Center, Department of Orthopaedics, University of Arizona, Tucson, AZ, USA
| | - L. Daniel Latt
- Banner-University Medical Center, Department of Orthopaedics, University of Arizona, Tucson, AZ, USA
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Paisan G, Magister S, Bridgforth A, Yarboro S. Non-traumatic isolated medial cuneiform fracture: A unique mechanism of a rare injury. SAGE Open Med Case Rep 2017; 5:2050313X17744483. [PMID: 29238575 PMCID: PMC5721952 DOI: 10.1177/2050313x17744483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 23-year-old woman who sustained a stress fracture to the medial cuneiform. Isolated medial cuneiform fractures are extremely rare with less than 10 cases reported in the literature. The patient initially presented to an urgent care facility complaining of right midfoot pain that occurred while running. Radiographs obtained at the time showed no acute abnormality and the patient was told to resume normal activities. Several weeks later, she presented to urgent care again after exercising, this time unable to bear weight and with swelling and ecchymoses of the right foot. Plain radiographs were again normal, but a high suspicion for injury remained, so a magnetic resonance imaging of the foot was obtained. The advanced imaging showed an acute, non-displaced fracture of the medial cuneiform. Because the fracture was discovered soon after the injury and was non-displaced, she was treated conservatively and at 6-month follow up had returned to all pre-injury activities with no complaints. These rare fractures are often missed at initial presentation because they are usually not evident on plain radiographs. Unless more advanced imaging is obtained to rule out a fracture, a delay of diagnosis can occur resulting in additional morbidity for the patient. Level of clinical evidence: Level 5
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Affiliation(s)
- Gabriella Paisan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Steven Magister
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Seth Yarboro
- University of Virginia School of Medicine, Charlottesville, VA, USA
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8
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Babu NS, Gambardella GV, Bowlby MA. Isolated Fracture of the Medial Cuneiform A Case Report. J Am Podiatr Med Assoc 2017; 107:436-439. [PMID: 29077495 DOI: 10.7547/16-013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An isolated medial cuneiform fracture is a rarely encountered injury of the foot. We present a case of an isolated medial cuneiform fracture in a patient after sustaining a fall from a 15-foot height. Treatment consisted of primary arthrodesis of the first tarsometatarsal joint due to a high degree of comminution and intra-articular pain. When radiographs are inconclusive and the index of suspicion remains high for a lesser tarsus fracture, computed tomography is recommended. In patients with minimal displacement, conservative treatment is usually successful in achieving osseous fusion. When the fracture is displaced, intra-articular, or comminuted, surgical intervention, including open reduction with internal fixation and primary arthrodesis, should be considered.
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Affiliation(s)
- Nina S. Babu
- Department of Podiatry, Kaiser Foundation Hospital, Santa Rosa, CA
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9
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Diagnosis and Rehabilitation of a Middle Cuneiform Fracture in a Hockey Player. Am J Phys Med Rehabil 2016; 95:e98-e102. [PMID: 26945214 DOI: 10.1097/phm.0000000000000459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Isolated cuneiform fractures are rare and are often missed on plain radiographs, leading to delayed diagnosis and delayed return to sport. The authors of this study present a 32-year-old male ice hockey player who sustained trauma to his dorsal midfoot from a slap shot. Radiographs were negative for fracture. After inability to wean out of the controlled ankle movement boot, magnetic resonance imaging was ordered, demonstrating a middle cuneiform fracture. The patient was seen in physical therapy, where aquatic therapy, strength training, and cardiovascular conditioning were progressed. He was able to wean out of the controlled ankle movement boot at 7 weeks after injury and return to playing ice hockey. Here, we outline rehabilitation and a diagnostic and rehabilitative algorithm for those who sustain trauma to the dorsal midfoot with suspected fracture.
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10
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Kiener AJ, Hanna TN, Shuaib W, Datir A, Khosa F. Osseous injuries of the foot: an imaging review. Part 2: the midfoot. Emerg Med J 2016; 34:182-186. [PMID: 26941275 DOI: 10.1136/emermed-2016-205704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 11/03/2022]
Abstract
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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Affiliation(s)
| | - Tarek N Hanna
- Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Waqas Shuaib
- Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abhijit Datir
- Division of Musculoskeletal Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal Khosa
- Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Mehlhorn AT, Schmal H, Legrand MA, Südkamp NP, Strohm PC. Classification and Outcome of Fracture-Dislocation of the Cuneiform Bones. J Foot Ankle Surg 2016; 55:1249-1255. [PMID: 26860043 DOI: 10.1053/j.jfas.2016.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Indexed: 02/03/2023]
Abstract
Fractures and dislocations of the cuneiform bones are rare injuries to the midtarsal foot. The injury severity is often unclear, and the prognostic factors are unknown. The purpose of the present study was to characterize our insights of the diagnostics, therapy, and fracture patterns. We questioned whether the number of involved cuneiform bones and the type of injury would affect the clinical outcome. With this information, we aimed to develop a classification system for injuries of the cuneonavicular joint. Five patients who had sustained complex fracture-dislocation of the cuneiform bones were prospectively registered, underwent surgery, and were followed. We reviewed the published data and found 47 reports that included 55 patients to improve the informative value of our study. The injury mechanisms and therapy were evaluated, and the postoperative limitations and pain were assessed. The clinical outcome was correlated with the number of involved cuneiforms and the fracture/dislocation pattern. Direct trauma was associated with isolated fracture, and indirect injury was associated with isolated dislocations. Occasionally, these injuries were overlooked on conventional radiographs, and closed reduction frequently failed. The number of cuneiform bones involved and the type of injury were shown to affect the clinical outcome. We devised an easily applicable classification system for injuries to the cuneiform bones using this information. All cases were classified as isolated fractures (1), isolated dislocations (2), or fracture-dislocations (3) involving 1 (A), 2 (B), or 3 (C) cuneiform bones. The classification system we propose will facilitate a better understanding of the fracture patterns at the cuneonavicular joint line and is a good prognostic tool that requires validation in clinical settings.
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Affiliation(s)
- Alexander T Mehlhorn
- Department of Orthopedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany.
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Maria Anna Legrand
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Peter C Strohm
- Department of Orthopedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
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12
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Steen EF, Brancheau SP, Nguyen T, Jones MD, Schade VL. Symptomatic Bipartite Medial Cuneiform: Report of Five Cases and Review of the Literature. Foot Ankle Spec 2016; 9:69-78. [PMID: 25784458 DOI: 10.1177/1938640015576788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Bipartition of the medial cuneiform is a well-described but rarely seen anatomic variant. The majority of literature focuses on anatomic description and incidents based on studies of archeological collections. Symptomatic cases can be overlooked or misdiagnosed initially given the vague complaint of pain either chronic in nature or following an acute injury that could result in a myriad of foot conditions. Treatment ranges from orthotics, immobilization, injection therapy, and surgery. Presented here is a series of 5 cases treated successfully with conservative and surgical measures. LEVELS OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Eric F Steen
- Hunt Regional Medical Center, Greenville, Texas (SPB)Department of Veterans Affairs Palo Alto Healthcare, Palo Alto, California (TN)Madigan Army Medical Center, Tacoma, Washington (MDJ, VLS)
| | - Steven P Brancheau
- Hunt Regional Medical Center, Greenville, Texas (SPB)Department of Veterans Affairs Palo Alto Healthcare, Palo Alto, California (TN)Madigan Army Medical Center, Tacoma, Washington (MDJ, VLS)
| | - Tho Nguyen
- Hunt Regional Medical Center, Greenville, Texas (SPB)Department of Veterans Affairs Palo Alto Healthcare, Palo Alto, California (TN)Madigan Army Medical Center, Tacoma, Washington (MDJ, VLS)
| | - Marc D Jones
- Hunt Regional Medical Center, Greenville, Texas (SPB)Department of Veterans Affairs Palo Alto Healthcare, Palo Alto, California (TN)Madigan Army Medical Center, Tacoma, Washington (MDJ, VLS)
| | - Valerie L Schade
- Hunt Regional Medical Center, Greenville, Texas (SPB)Department of Veterans Affairs Palo Alto Healthcare, Palo Alto, California (TN)Madigan Army Medical Center, Tacoma, Washington (MDJ, VLS)
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13
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Sargiotis NV, Korres N, Anagnostakos KD, Tsifetakis S, Baltopoulos P. An Isolated Dorsal Dislocation of the Lateral Cuneiform. Foot Ankle Spec 2015; 8:525-8. [PMID: 25655518 DOI: 10.1177/1938640015569765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED We present a case of an isolated dorsal dislocation of the lateral cuneiform bone. This particular injury is extremely rare and quite often escapes the initial assessment of the medical examiner. Timely and accurate diagnosis of the injury is very important as the treatment is usually surgical. LEVEL OF EVIDENCE Therapeutic, Level IV: Case Report.
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Affiliation(s)
- Nikolaos V Sargiotis
- First Surgical Department, First Orthopaedical Clinic, General Hospital of Attica KAT, Attica, Greece
| | - Nektarios Korres
- First Surgical Department, First Orthopaedical Clinic, General Hospital of Attica KAT, Attica, Greece
| | | | - Stavros Tsifetakis
- First Surgical Department, First Orthopaedical Clinic, General Hospital of Attica KAT, Attica, Greece
| | - Panagiotis Baltopoulos
- First Surgical Department, First Orthopaedical Clinic, General Hospital of Attica KAT, Attica, Greece
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14
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15
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Nonunion of the medial cuneiform: a rare case. Case Rep Med 2013; 2013:215756. [PMID: 23983703 PMCID: PMC3745877 DOI: 10.1155/2013/215756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/11/2013] [Indexed: 11/17/2022] Open
Abstract
Isolated medial cuneiform fractures are quite rare. Conservative treatment is adequate in most cases, while deplaced or unstable fractures are treated surgically. Nonunion is seen extremely rarely after medial cuneiform fractures. There is only one case report in the literature. This case presented here is a 62-year-old male patient who had an isolated medial cuneiform fracture resulting from the impact of a falling metal object. Conservative treatment was performed initially. The patient was diagnosed as nonunion after physical and radiological examinations nine months after he presented to the outpatient clinic. Internal fixation with a mini plate and one staple after reduction was performed surgically. Defective region was filled with a 2 mL of autograft, and the operation was terminated.
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16
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Aitken SA, Shortt N. Dorsomedial fracture dislocation of the first ray and medial cuneiform: a case report. J Foot Ankle Surg 2012; 51:795-7. [PMID: 22824318 DOI: 10.1053/j.jfas.2012.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Indexed: 02/03/2023]
Abstract
Isolated dislocation of the medial cuneiform is a rare injury. A favorable outcome relies on an accurate and stable reduction. Evidence of residual instability can be subtle. We present 1 such injury whose true extent was not fully appreciated at presentation, despite multiple plain films. Occult fracture of the medial cuneiform contributed to residual instability of the first ray and persistent and progressive symptoms and ultimately necessitated operative stabilization of the medial arch. We recommend the use of computed tomography as an adjunct to plain radiography for all midfoot dislocations to more accurately define the extent of the injury.
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Affiliation(s)
- Stuart A Aitken
- Department of Trauma and Orthopaedics, Queen Margaret Hospital, Dunfermline, Fife, United Kingdom.
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17
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Guler F, Baz AB, Turan A, Kose O, Akalin S. Isolated medial cuneiform fractures: report of two cases and review of the literature. Foot Ankle Spec 2011; 4:306-9. [PMID: 21926363 DOI: 10.1177/1938640011416354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures.
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Affiliation(s)
- Ferhat Guler
- Antalya Education and Research Hospital, Orthopaedics and Traumatology Clinic, Antalya, Turkey
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20
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Affiliation(s)
- Eric Thomas Warren
- Family Medicine Residency Program, Carolinas Medical Center, Charlotte, NC, USA.
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21
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Enns P, Pavlidis T, Stahl JP, Horas U, Schnettler R. Sonographic detection of an isolated cuboid bone fracture not visualized on plain radiographs. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:154-157. [PMID: 14994258 DOI: 10.1002/jcu.20009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report the case of an isolated cuboid bone fracture in a child that was missed on radiography but was diagnosed on sonography. Plain radiographs of the patient's right foot showed no fracture, whereas sonograms demonstrated a fracture of the cuboid bone that appeared as a steplike discontinuity in the cortical bone. The diagnosis was confirmed on MRI. The fracture was treated with cast immobilization and no weight bearing for 4 weeks. In 8 weeks, the patient had no symptoms and good motor and sensory function of her right foot. Other imaging modalities are usually advocated for diagnosing fractures that are missed by radiography. Over the last decade, sonography has been increasingly used for diagnosing occult fractures. Although its use in such cases is not yet fully established, we believe that in the future, the sonographic detection of an injury that corresponds to the site of the reported pain will be adequate for initiating treatment of many types of fractures.
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Affiliation(s)
- Peter Enns
- Department of Trauma Surgery, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
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22
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Abstract
Bipartition of the medial cuneiform is uncommon and often not recognized on plain radiographs. It is usually asymptomatic and rarely, if ever, requires surgery. Injury to the synchondrosis of a bipartite medial cuneiform is rare and has, to our knowledge, been reported only once. We describe such a case with chronic disabling midfoot pain after remote trauma.
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Affiliation(s)
- K Azurza
- Frimley Park Hospital, Camberley, Surrey, UK
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