An Isolated Nondisplaced Medial Cuneiform Fracture Following Indirect Trauma: A Rare and Often Missed Injury

Abstract

A 42-year-old female presented with the complaint of acute pain on the medial tarsal region of her left foot. Initial radiographs of the injured foot at that time revealed no significant pathology, and the injury was diagnosed as a “midfoot sprain.” A week later, she presented in the orthopedic outpatient department with persistent pain. Advanced imaging showed an isolated nondisplaced medial cuneiform fracture. Being a nondisplaced fracture, she was treated conservatively, and at 4 months of follow-up, she was pain-free and was able to return to her previous level of activity. Isolated injuries, fractures and/or dislocations of one or more of the three cuneiform bones, are rare. Fractures of the cuneiforms account for only 1.7% of all midfoot fractures. Hence, this fracture is extremely rare, and it can be easily missed at initial admission. Therefore, a high index of suspicion for such mid-foot pain is necessary so that these fractures do not go unnoticed. Plain radiographs are incomplete for diagnosing these fractures, and thus, identification may require more advanced imaging such as computed tomography or magnetic resonance imaging. Prompt diagnosis and appropriate treatment of these isolated medial cuneiform fractures usually heal with a favorable outcome.

Keywords

• cuneiform
• fracture
• indirect trauma
• midfoot
• tarsal bone