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

Lance Mabry, Taylor N Patti, C M Bleakley, Angela Spontelli-Gisselman

Research output: Contribution to journalArticle

Abstract

Background: Isolated medial cuneiform fractures are a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptomology. 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 subjects with a history of traumatic closed medial cuneiform fracture. Studies were excluded if they were open fractures, multi-trauma, or were associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies and a qualitative synthesis was performed. Results: Ten studies were identified totaling fifteen clinical cases. Mean age was 38.0 (± 12.8) years with 86.7% of reported subjects being men. The overall methodological quality was moderate to high while the reporting of the case 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 an axial load (30.8%), and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of cases, with magnetic resonance imaging (MRI) and computed tomography being the most common diagnostic modalities. Diagnostic delay averaged 64.7 (± 89.6) days. Conservative management was pursued in 54.5% of cases with reported resolution of symptoms in three to six months. Surgical intervention occurred in 45.5% of cases and resulted in functional restoration at three to six months in all but one case. 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, MRI may be pursued to minimize diagnostic delay. Conservative management is a viable treatment methodology with expected return to full function in three to six months.
Original languageEnglish
JournalJournal of the American Podiatric Medical Association
Publication statusAccepted/In press - 19 Jun 2020

Keywords

  • Foot Injuries
  • Tarsal Bones
  • Palpation
  • Radiography
  • Tomography
  • Physical Examination
  • Magnetic Resonance Imaging
  • Immobilization

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    Mabry, L., Patti, T. N., Bleakley, C. M., & Spontelli-Gisselman, A. (Accepted/In press). Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies. Journal of the American Podiatric Medical Association.