CASE 16192 Published on 24.10.2018

Traumatic isolated medial cuneiform fracture: A commonly missed fracture

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

Dr. Manish Malik

Ganesh diagnostic and imaging centre, C-1/8, Yamuna Vihar, New Delhi-110053.
Email:DRMALIKMANISH@GMAIL.COM
Patient

29 years, male

Categories
Area of Interest Musculoskeletal joint, Musculoskeletal system, Musculoskeletal bone ; Imaging Technique Conventional radiography
Clinical History

A young man presented in the casualty department following a road traffic accident with difficulty in walking and pain at the dorsum of the right foot.

Imaging Findings

AP & lateral radiographs of the right foot showed no obvious fracture. CT of the axial, coronal & sagittal sections of the right foot showed an undisplaced fracture of the medial cuneiform bone.

Discussion

Traumatic as well as stress-induced isolated medial cuneiform fractures are rare [1, 2]. Only few cases have been reported in the literature [3]. They are commonly associated with metatarsal injuries, such as Lisfranc dislocation fractures and other tarsal bone fractures. The mechanism of injury is usually direct blow or axial load through the foot.

The patient usually presents with pain, swelling, restricted movements and difficulty in walking. Isolated medial cuneiform fractures may be easily overlooked on plain radiographs especially in emergency services. Non-displaced, nondislocated fractures are even more difficult to diagnose on radiographs [4]. In our case, the patient presented with right foot pain and swelling following a road traffic accident. Initial radiographs showed soft tissue injury with no obvious fracture. The patient visited the orthopaedic OPD after 5 days with no relief in symptoms. Local examination reveals tender medial aspect of the right mid-foot. CT was advised to rule out any underlying fracture. CT shows an isolated medial cuneiform fracture. Cross-sectional imaging like CT or MRI should be considered in cases of persistent symptoms and high clinical suspicion of fracture.

Computed tomography or magnetic resonance imaging is helpful in diagnosing the isolated medial cuneiform fracture and guiding further management.

Patients can be treated conservatively with no weight bearing activity for two to four weeks without immobilisation. As mid-tarsal joint has limited movements; complications are infrequent and include non-union. In differential diagnosis bipartite medial cuneiform can be considered [5].

Take home message:

CT or MRI should be done in trauma cases with high clinical suspicion of fracture but normal radiographs to rule out underlying injury.

Written informed patient consent for publication has been obtained

Differential Diagnosis List
Isolated medial cuneiform fracture
Bipartite medial cuneiform
Lisfranc fracture dislocation
Final Diagnosis
Isolated medial cuneiform fracture
Case information
URL: https://www.eurorad.org/case/16192
DOI: 10.1594/EURORAD/CASE.16192
ISSN: 1563-4086
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