Sports Injury to a Bipartite Medial Cuneiform in a Child

Characterization of a Bipartite Medial Cuneiform: Micro-CT and Anatomical Study

“…Although the majority of the reported bipartite medial cuneiforms come from archaeological material (Kjellström, 2004;Jashashvili et al), the use of magnetic resonance imaging and computed tomography in clinical diagnostics of midfoot trauma and pathology has recently resulted in reports of clinical cases (Sener, 1999;Azurza & Sakellariou;Chiodo et al;Bismil et al;Fulwadhva & Parker;Elias et al, 2008;Eves et al, 2014) with only a histological report (O'Neal et al). From the largest series studied, an incidence between 0.27 and 0.31 % has been reported, being a variation most frequently bilateral (Burnett & Case).…”

Symptomatic Bipartite Medial Cuneiform

“…1,5,8,9,11,[15][16][17]19,20 Bilateral occurrence has been shown to be >60%. 1,6,17 Awareness of bipartition of the medial cuneiform as an anatomic variant is important as it can be an incidental or associated finding. In the cases presented here, the initial diagnosis of pain ranged from ankle joint pain, isolated Lisfranc injury, symptomatic dorsal first metatarsal medial cuneiform joint exostosis, and medial cuneiform fracture.…”

“…In most cases of symptomatic bipartite medial cuneiform, the patient presents with either report of an acute injury or participation in high-impact/ sporting activities with repetitive stress occurring over time. 11,12,[14][15][16][17][18]20,21 Pain related to a symptomatic bipartite medial cuneiform is hypothesized to occur secondary to disruption of the fibrocartilaginous articulation between the dorsal and plantar segments. 11,12,17,20 Physical examination will reveal pain localized to the medial cuneiform with direct dorsal and medial pressure applied.…”

Symptomatic Bipartite Medial Cuneiform Treated with Fluoroscopic and Ultrasound-Guided Injections

“…Cross-sectional imaging with CT or MRI is definitive in diagnosis and provides further regional anatomic detail and can be revealing of the "E sign" which is formed by the cleft between each of the segments in the horizontal plane [8]. When observed incidentally, the finding of a BMC often has no clinical significance, but should be differentiated from the numerous fracture dislocation patterns at the TMT joint level, especially the typical vertically oriented isolated fracture of the medial cuneiform that demonstrates irregular and sharp margins in contrast to the horizontally oriented well-corticated margins of the BMC [9]. The combined osseous segmental volume in a BMC is also larger than the volume of the normal medial cuneiform with the dorsal "os cuneiforme dorsale" being slightly smaller in size than the plantar "os cuneiform naviculare" [4].…”

“…Recognizing a BMC on radiographs can be difficult as the osseous segments are typically well corticated and blend with the remainder of the tarsal bones. Additionally, although there are many fracture patterns at the tarsometatarsal (TMT) joint level including Lisfranc injuries, the cleft between the osseous segments lies in the horizontal plane in contrast to the typical vertical orientation of isolated fractures through the medial cuneiform [9]. The cleft is formed by a pseudoarticulation between the osseous segments.…”