Case Report

Isolated Medial Cuneiform Fracture: A Special Forces Soldier with a Rare Injury

Authors: Shawn F. Taylor, MD, Danny Heidenreich, MS, PA-C

Abstract

Isolated cuneiform fractures rarely occur, but must be considered in the differential diagnosis for midfoot injuries. Along with other nondisplaced, nondislocated midfoot injuries, these fractures are commonly missed or delayed in diagnosis. A review of the literature reveals only three other reported cases of isolated medial cuneiform fractures. Because of the difficulties with finding nondisplaced, nondislocated cuneiform fractures on plain film, further studies should be considered. Other medial cuneiform fractures found in the literature were nonisolated. This report describes a case of isolated medial cuneiform fracture in a 26-year-old Special Forces soldier that resulted in a significant delay of diagnosis.


Key Points


* Isolated cuneiform fractures rarely occur.


* When they occur, providers often miss the diagnosis or experience a delay in diagnosis.


* Radiographic studies beyond plain films are often required to make the diagnosis.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Brown DC, McFarland GB Jr. Dislocation of the medial cuneiform bone in tarsometatarsal fracture-dislocation. J Bone Joint Surg Am 1975;57:858–859.
 
2.Olson RC, Mendicino SS, Rockett MS. Isolated medial cuneiform fracture: review of the literature and report of two cases. Foot Ankle Int 2000;21:150–153.
 
3.Patterson RH, Peterson D, Cunningham R. Isolated fracture of the medial cuneiform. J Orthop Trauma 1993;7:94–95.
 
4.Arntz CT, Vieth RG, Hansen ST. Fracture and fracture-dislocation of the tarsometatarsal joint. J Bone Joint Surg 1988;70:173–181.
 
5.Bertoldi L, Molinari M, Soldini A, et al. Isolated fracture-dislocation of the second cuneiform bone. Case report. Acta Orthop Scand 1991;62:604–605.
 
6.Bryant MJ, Baird DS. A case of non-union of the medial cuneiform. Injury 1993;24:207–208.
 
7.Goldman F. Fractures of the midfoot. Clin Podiatry 1985;2:259–285.
 
8.Cain PR, Seligson D. LisFranc’s fracture-dislocation with intercuneiform dislocation: presentation of two cases an a plan for treatment. Foot Ankle 1981;2:156–160.
 
9.Giannestras NJ. Foot Disorders: Medical and Surgical Management. Philadelphis, Lea & Febiger, 1976, ed 2.
 
10.Gopal-Krishman S. Dislocation of medical cuneiform in injuries of tarsometatatarsal joints. Int Surg 1973;58:805–806.
 
11.Sangeorzan BJ, Mayo KA, Hansen ST. Intraarticular fractures of the foot: talus and lesser tarsals. Clin Orthop Relat Res 1993;292:135–141.
 
12.Schiller MG, Ray RD. Isolated dislocation of the medial cuneiform bone—a rare injury of the tarsus. A case report. J Bone Joint Surg Am 1970;52:1632–1636.
 
13.Heck CV. Fractures of the bones of the foot. Surg Clin North Am 1965;45:103.
 
14.Wiley JJ. The mechanism of tarso-metatarsal joint injuries. J Bone Joint Surg Br 1971;53:474–482.