medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2025, Number 6

<< Back Next >>

Acta Ortop Mex 2025; 39 (6)

Diagnostic approach and management in cuneiform fractures. Narrative review of the literature

Romero-Ante J, Abril-Botero C

Language: Spanish
References: 60
Page: 352-362
PDF size: 1415.61 Kb.


ABSTRACT

Introduction: fractures and dislocations of the cuneiform bones represent a diagnostic and therapeutic challenge due to their low incidence and anatomical complexity. The objective of this work focuses on the clinical relevance of the Roman arch of the midfoot and its susceptibility to injuries from direct and indirect trauma. Materials and methods: a review of the literature was carried out by consulting the PUBMED, EMBASE, COCHRANE, in English, Spanish, and French databases, using the MeSH terms: "cuneiform", "fracture", "dislocation", "treatment", "surgery", "rehabilitation", "fixation", "biomechanics", "trauma", and "Lisfranc", a total of 69 articles were obtained, of which 10 were excluded because they were duplicates and one because the full text could not be obtained. for a total of 58 eligible items. Similarly, the search was extended to classic textbooks from June 1990 to June 2024, with no restrictions on the type of study. Results: a narrative review of the literature over the last 34 years is carried out, trying to synthesize the most important aspects in relation to anatomy, epidemiology, trauma mechanism, diagnostic images classification, treatment, and rehabilitation in the approach to cuneiform lesions. Conclusion: this narrative review allows us to conclude that early identification and anatomical reduction are critical to improve functional outcomes and prevent long-term complications, such as osteoarthritis and pseudoarthrosis. The weakness of our work lies in the lack of systematic review studies, cases and controls or large case series, available in the literature that allow us to establish management guidelines for this type of injury.


REFERENCES

  1. Leardini A, Benedetti MG, Berti L, Bettinelli D, Nativo R, Giannini S. Rear-foot, mid-foot and fore-foot motion during the stance phase of gait. Gait Posture. 2007; 25(3): 453-62. doi: 10.1016/j.gaitpost.2006.05.017.

  2. Moore A. Gray's anatomy: the anatomical basis of clinical practice. 41st Ed. Elsevier; 2020.

  3. Asghar A, Naaz S. L'arche transversale du pied humain : une revue narrative de son évolution, de son anatomie, de sa biomécanique et de ses implications cliniques. Morphologie. 2022; 106(355): 225-34. doi: 10.1016/j.morpho.2021.07.005.

  4. Borrelli GJ, Qatu M, Traynor CJ, Weistroffer J, Jastifer JR. Anatomy of the naviculocuneiform joint. Foot Ankle Orthop. 2022; 7(1): 2473011421S00119. doi: 10.1177/2473011421S00119.

  5. Moracia-Ochagavía I, Rodríguez-Merchán EC. Lisfranc fracture-dislocations: current management. EFORT Open Rev. 2019; 4(7): 430-44. doi: 10.1302/2058-5241.4.180076.

  6. Rosskopf AB, Loupatatzis C, Pfirrmann CWA, Boni T, Berli MC. The Charcot foot: a pictorial review. Insights Imaging. 2019; 10(1): 77. doi: 10.1186/s13244-019-0768-9.

  7. Renner K, McAlister JE, Galli MM, Hyer CF. Anatomic description of the naviculocuneiform articulation. J Foot Ankle Surg. 2017; 56(1): 19-21. doi: 10.1053/j.jfas.2016.09.013.

  8. Zwipp H, Rammelt S. Anatomical reconstruction of chronically instable Lisfranc's ligaments. Unfallchirurg. 2014; 117(9): 791-7. doi: 10.1007/s00113-014-2600-9.

  9. Sarrafian SK, Kelikian AS. Anatomy of the foot and ankle. 3rd ed. Lippincott Williams & Wilkins; 2011.

  10. Mason L, Jayatilaka MLT, Fisher A, Fisher L, Swanton E, Molloy A. Anatomy of the lateral plantar ligaments of the transverse metatarsal arch. Foot Ankle Int. 2020; 41(1): 109-14. doi: 10.1177/1071100719873971.

  11. Jin L, Guo J, Chang H, Xing E, Ju L, Tian Y, et al. Epidemiological investigation of adult single fractures of cuneiform in the east and west areas in China from 2010 through 2011. Chin J Orthop Trauma. 2018; 20(2): 152-6. doi: 10.3760/CMA.J.ISSN.1671-7600.2018.02.011.

  12. Papanikolaou A, Maris J, Arealis G, Papadimitriou G, Charalambidis C. Dislocation of the lateral cuneiform: report of two cases. Foot Ankle Surg. 2010; 16(4): e91-5. doi: 10.1016/j.fas.2009.11.006.

  13. Fitschen-Oestern S, Lippross S, Lefering R, Besch L, Klüter T, Schenzer-Hoffmann E, et al. Missed foot fractures in multiple trauma patients. BMC Musculoskelet Disord. 2019; 20(1): 121. doi: 10.1186/s12891-019-2501-8.

  14. David JS, Gelas-Dore B, Inaba K, Levrat A, Riou B, Gueugniaud PY, et al. Are patients with self-inflicted injuries more likely to die? J Trauma. 2007; 62(6): 1495-500. doi: 10.1097/01.ta.0000250495.77266.7f.

  15. Smith BR, Begeman PC, Leland R, Meehan R, Levine RS, Yang KH, et al A mechanism of injury to the forefoot in car crashes. Traffic Inj Prev. 2005; 6(2): 156-69. doi: 10.1080/15389580590931635.

  16. 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(5): 306-9. doi: 10.1177/1938640011416354.

  17. Eraslan A, Ozyurek S, Erol B, Ercan E. Isolated medial cuneiform fracture: a commonly missed fracture. BMJ Case Rep. 2013; 2013: bcr2013010093. doi: 10.1136/bcr-2013-010093.

  18. Aggarwal PK, Singh S, Kumar S. Isolated dorsal dislocation of the intermediate cunieform: a case report and review of the literature. Arch Orthop Trauma Surg. 2003; 123(5): 252-3. doi: 10.1007/s00402-003-0503-2.

  19. Saxby TS, Sharp RJ, Rosenfeld PF. Plantar fracture-dislocation of the intermediate cuneiform: case report. Foot Ankle Int. 2006; 27(9): 742-5. doi: 10.1177/107110070602700916.

  20. 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(6): 1249-55. doi: 10.1053/j.jfas.2016.01.019.

  21. Liszka H, Gadek A. Isolated bilateral medial cuneiform fracture: a case report. Przegl Lek. 2012; 69(9): 708-10.

  22. Yamauchi K, Miyake S, Kato C, Kato T. Isolated, non-displaced medial cuneiform fractures: report of two cases. Foot Ankle Online J. 2017; 10(2): 1. doi: 10.3827/faoj.2017.1002.0001.

  23. 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. doi: 10.1177/2050313X17744483

  24. Orozco-Villaseñor SL, Turrubiates-Lucero E, Miguel-Andrés I. Luxación expuesta de la primera y segunda cuña y fractura in situ de la tercera cuña del pie: caso clínico y revisión de la literatura. Acta Ortop Mex. 2019; 33(4): 256-60.

  25. Keijzers GB, Campbell D, Hooper J, Bost N, Crilly J, Steele MC, et al. A prospective evaluation of missed injuries in trauma patients, before and after formalizing the trauma tertiary survey. World J Surg. 2014; 38(1): 222-32. doi: 10.1007/s00268-013-2226-z.

  26. Joannas G, Filippi J. How to identify unstable Lisfranc injuries? Review of diagnostic strategies and algorithm proposal. Foot Ankle Clin. 2020; 25(4): 697-710. doi: 10.1016/j.fcl.2020.08.011.

  27. Kim D, Berkowitz M, Hrutkay J. "Fleck Sign": traumatic avulsion fracture of the medial cuneiform by anterior tibialis tendon. Int J Foot Ankle. 2017; 1 (1): 10.23937/ijfa-2017/1710001. doi: 10.23937/ijfa-2017/1710001.

  28. Ahn SH, Kim HC, Kim KY, Yoon HJ, Kim IY. Avulsion fracture of medial cuneiform by tibialis anterior tendon (A case report). J Korean Foot Ankle Soc. 2010; 14(2): 194-6.

  29. Shanmugasundaram K, Thangaraj A, Sivasenthil A. An isolated middle cuneiform dislocation with a rare violence: case report and literature review. J Clin Orthop Trauma. 2014; 5(3): 167-71. doi: 10.1016/j.jcot.2014.07.001.

  30. Verma A, Sharma VK, Batra S, Rohria MS. Neglected isolated plantar dislocation of middle cuneiform: a case report. BMC Musculoskelet Disord. 2007; 8: 5. doi: 10.1186/1471-2474-8-5.

  31. Taylor SF, Heidenreich D. Isolated medial cuneiform fracture: a special forces soldier with a rare injury. South Med J. 2008; 101(8): 848-9. doi: 10.1097/SMJ.0b013e31817dae10.

  32. Haapamaki V, Kiuru M, Koskinen S. Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. Foot Ankle Int. 2004; 25(9): 614-9. doi: 10.1177/107110070402500903.

  33. Hofbauer MH, Babu SS, Vonasek A. Lisfranc injuries. Clin Podiatr Med Surg. 2024; 41(3): 407-23. doi: 10.1016/j.cpm.2024.01.014.

  34. Talaski GM, Baumann AN, Walley KC, Anastasio AT, de Cesar Netto C. Weightbearing computed tomography vs conventional tomography for examination of varying degrees of Lisfranc injuries: a systematic review of the literature. Foot Ankle Orthop. 2023; 8(4): 24730114231209767. doi: 10.1177/24730114231209767.

  35. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018; 32(Suppl 1): S1-170. doi: 10.1097/BOT.0000000000001063.

  36. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33(1): 159-74.

  37. Choi JY, Lee DJ, Ngissah R, Nam BJ, Suh JS. Categorization of single cuneiform fractures and investigation of related injuries: a 10-year retrospective study. J Orthop Surg (Hong Kong). 2019; 27(3): 2309499019866394. doi: 10.1177/2309499019866394.

  38. Yan A, Chen SR, Ma X, Shi Z, Hogan M. Updates on Lisfranc complex injuries. Foot Ankle Orthop. 2021; 6(1): 2473011420982275. doi: 10.1177/2473011420982275.

  39. Olson RC, Mendicino SS, Rockett MS. Isolated medial cuneiform fracture: review of the literature and report of two cases. Foot Ankle Int. 2000; 21(2): 150-3. doi: 10.1177/107110070002100210.

  40. Akan B, Yildirim T. Dorsal dislocation of the intermediate cuneiform with a medial cuneiform fracture: A case report and review of the literature. Case Rep Orthop. 2013; 2013: 238950. doi: 10.1155/2013/238950.

  41. 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(12): e50689. e50689.

  42. Can E, Dincel YM. Plantar dislocation of the middle cuneiform bone with medial cuneiform subluxation: a case report. Cureus. 2023; 15(11): e49505. doi: 10.7759/cureus.49505.

  43. Bumann H, Wonerow M. The forgotten brick: case report of a Lisfranc injury with "Pericuneiform" dislocation. Int J Foot Ankle. 2021; 5: 57. doi: 10.23937/2643-3885/1710057.

  44. Asuma MP, Mansfield TD, Turner EK, Robbins J. Closed distal dislocation of the intermediate cuneiform in a complex lisfranc fracture-dislocation: a case report. JBJS Case Connect. 2019; 9(3): e0332. doi: 10.2106/JBJS.CC.18.00332.

  45. Hensley CP, Dirschl DR. Diagnosis and rehabilitation of a middle cuneiform fracture in a hockey player. Am J Phys Med Rehabil. 2016; 95(7): e98-e102. doi: 10.1097/PHM.0000000000000459.

  46. Hidalgo-Ovejero AM, García-Mata S, Ilzarbe-Ibero A, Gozzi-Vallejo S, Martínez-Grande M. Complete medial dislocation of the first cuneiform: a case report. J Foot Ankle Surg. 2005; 44(6): 478-82. doi: 10.1053/j.jfas.2005.08.004.

  47. Franssen BB, Schuurman AH, Van der Molen AM, Kon M. One century of Kirschner wires and Kirschner wire insertion techniques: a historical review. Acta Orthop Belg. 2010; 76(1): 1-6.

  48. Jastifer JR, Gustafson PA, Silva LF, Noffsinger S, Coughlin MJ. Nitinol, stainless steel, and titanium Kirschner wire durability. Foot Ankle Spec. 2021; 14(4): 317-23. doi: 10.1177/1938640020914677.

  49. Schildhauer TA, Nork SE, Sangeorzan BJ. Temporary bridge plating of the medial column in severe midfoot injuries. J Orthop Trauma. 2003; 17(7): 513-20. doi: 10.1097/00005131-200308000-00007.

  50. Astion DJ, Deland JT, Otis JC, Kenneally S. Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg Am. 1997; 79(2): 241-6. doi: 10.2106/00004623-199702000-00012.

  51. Rozell JC, Chin M, Donegan DJ, Hast MW. Biomechanical comparison of fully threaded solid cortical versus partially threaded cannulated cancellous screw fixation for Lisfranc injuries. Orthopedics. 2018; 41(2): e222-7. doi: 10.3928/01477447-20180103-03.

  52. Chen J, Sagoo N, Panchbhavi VK. The Lisfranc injury: a literature review of anatomy, etiology, evaluation, and management. Foot Ankle Spec. 2021; 14(5): 458-67. doi: 10.1177/1938640020950133.

  53. Gu W, Xu H, Shi Z, Zhang H, Mei G, Xue J, et al. Clinical evaluation and management for Lisfranc injury with cuneiform fracture. Foot Ankle Orthop. 2019; 4(4): 2473011419S00191. doi: 10.1177/2473011419S00191.

  54. Hamilton GA, Ford LA. External fixation of the foot and ankle. Elective indications and techniques for external fixation in the midfoot. Clin Podiatr Med Surg. 2003; 20(1): 45-63. doi: 10.1016/s0891-8422(02)00053-8.

  55. Tarkin IS, Murawski CD, Mittwede PN. Temporizing care of acute traumatic foot and ankle injuries. Orthop Clin North Am. 2022; 53(1): 95-103. doi: 10.1016/j.ocl.2021.09.002.

  56. Pablo-Randolino J, Gaitán L, Slullitel G, Gonzalez E, Lopez V. A novel uni- and biplanar external fixator for initial and definitive complex foot trauma. Foot Ankle Orthop. 2024; 9(3): 24730114241265113. doi: 10.1177/24730114241265113.

  57. Grambart S, Patel S, Schuberth JM. Naviculocuneiform dislocations treated with immediate arthrodesis: a report of two cases. J Foot Ankle Surg. 2005; 44(3): 228-35. doi: 10.1053/j.jfas.2005.05.005.

  58. Budny AM, Grossman JP. Naviculocuneiform arthrodesis. Clin Podiatr Med Surg. 2007; 24(4): 753-63. doi: 10.1016/j.cpm.2007.06.001.

  59. Fraser TW, Miles DT, Huang N, Davis FB, Dunlap BD, Doty JF. Radiographic outcomes, union rates, and complications associated with plantar implant positioning for midfoot arthrodesis. Foot Ankle Orthop. 2021;6(3):24730114211027115. doi: 10.1177/24730114211027115.

  60. Ahn BJ, Quinn M, Zhao L, He EW, Dworkin M, Naphade O, et al. Statistical fragility analysis of open reduction internal fixation vs primary arthrodesis to treat lisfranc injuries: a systematic review. Foot Ankle Int. 2024; 45(4): 298-308. doi: 10.1177/10711007231224797.



EVIDENCE LEVEL

IV




2020     |     www.medigraphic.com