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Magnetic resonance imaging findings in bipartite medial cuneiform - a potential pitfall in diagnosis of midfoot injuries: a case series.

Elias I, Dheer S, Zoga AC, Raikin SM, Morrison WB - J Med Case Rep (2008)

Bottom Line: The bipartite medial cuneiform is an uncommon developmental osseous variant in the midfoot.It is important for orthopaedic foot and ankle surgeons, musculoskeletal radiologists, and for podiatrists to identify this osseous variant as it may be mistakenly diagnosed as a fracture or not recognized as a source of non-traumatic or traumatic foot pain, which may sometimes even require surgical treatment.A bipartite medial cuneiform is a rare developmental anomaly of the midfoot and may be the source of midfoot pain.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA. ilanelias@hotmail.com.

ABSTRACT

Introduction: The bipartite medial cuneiform is an uncommon developmental osseous variant in the midfoot. To our knowledge, Magnetic Resonance Imaging (MRI) characteristics of a non-symptomatic bipartite medial cuneiform have not been described in the orthopaedic literature. It is important for orthopaedic foot and ankle surgeons, musculoskeletal radiologists, and for podiatrists to identify this osseous variant as it may be mistakenly diagnosed as a fracture or not recognized as a source of non-traumatic or traumatic foot pain, which may sometimes even require surgical treatment.

Case presentations: In this report, we describe the characteristics of three cases of bipartite medial cuneiform on Magnetic Resonance Imaging and contrast its appearance to that of a medial cuneiform fracture.

Conclusion: A bipartite medial cuneiform is a rare developmental anomaly of the midfoot and may be the source of midfoot pain. Knowledge about its characteristic appearance on magnetic resonance imaging is important because it is a potential pitfall in diagnosis of midfoot injuries.

No MeSH data available.


Related in: MedlinePlus

Sagittal T1 spin echo MR image (TR/TE = 700/9 ms) of case #3 demonstrates an oblique, hypointense fracture line (arrow) through the medial cuneiform, without significant displacement.
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Figure 4: Sagittal T1 spin echo MR image (TR/TE = 700/9 ms) of case #3 demonstrates an oblique, hypointense fracture line (arrow) through the medial cuneiform, without significant displacement.

Mentions: A 44-year-old male with a history of multiple sclerosis presented to his orthopedist with left midfoot pain following a motorcycle accident. Radiographs performed at this time were interpreted as a minimally displaced medial cuneiform fracture and therapy with a short leg, non-weight bearing cast for 6 weeks was suggested. The patient continued to bear weight and experience pain, then sought a second opinion, at which time an MRI examination of the ankle was performed (Figure 4). Following the MRI, the patient was advised to stop weight bearing, which resulted in a resolution of his symptoms. No further MR imaging follow-up was obtained in this case.


Magnetic resonance imaging findings in bipartite medial cuneiform - a potential pitfall in diagnosis of midfoot injuries: a case series.

Elias I, Dheer S, Zoga AC, Raikin SM, Morrison WB - J Med Case Rep (2008)

Sagittal T1 spin echo MR image (TR/TE = 700/9 ms) of case #3 demonstrates an oblique, hypointense fracture line (arrow) through the medial cuneiform, without significant displacement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2542399&req=5

Figure 4: Sagittal T1 spin echo MR image (TR/TE = 700/9 ms) of case #3 demonstrates an oblique, hypointense fracture line (arrow) through the medial cuneiform, without significant displacement.
Mentions: A 44-year-old male with a history of multiple sclerosis presented to his orthopedist with left midfoot pain following a motorcycle accident. Radiographs performed at this time were interpreted as a minimally displaced medial cuneiform fracture and therapy with a short leg, non-weight bearing cast for 6 weeks was suggested. The patient continued to bear weight and experience pain, then sought a second opinion, at which time an MRI examination of the ankle was performed (Figure 4). Following the MRI, the patient was advised to stop weight bearing, which resulted in a resolution of his symptoms. No further MR imaging follow-up was obtained in this case.

Bottom Line: The bipartite medial cuneiform is an uncommon developmental osseous variant in the midfoot.It is important for orthopaedic foot and ankle surgeons, musculoskeletal radiologists, and for podiatrists to identify this osseous variant as it may be mistakenly diagnosed as a fracture or not recognized as a source of non-traumatic or traumatic foot pain, which may sometimes even require surgical treatment.A bipartite medial cuneiform is a rare developmental anomaly of the midfoot and may be the source of midfoot pain.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA. ilanelias@hotmail.com.

ABSTRACT

Introduction: The bipartite medial cuneiform is an uncommon developmental osseous variant in the midfoot. To our knowledge, Magnetic Resonance Imaging (MRI) characteristics of a non-symptomatic bipartite medial cuneiform have not been described in the orthopaedic literature. It is important for orthopaedic foot and ankle surgeons, musculoskeletal radiologists, and for podiatrists to identify this osseous variant as it may be mistakenly diagnosed as a fracture or not recognized as a source of non-traumatic or traumatic foot pain, which may sometimes even require surgical treatment.

Case presentations: In this report, we describe the characteristics of three cases of bipartite medial cuneiform on Magnetic Resonance Imaging and contrast its appearance to that of a medial cuneiform fracture.

Conclusion: A bipartite medial cuneiform is a rare developmental anomaly of the midfoot and may be the source of midfoot pain. Knowledge about its characteristic appearance on magnetic resonance imaging is important because it is a potential pitfall in diagnosis of midfoot injuries.

No MeSH data available.


Related in: MedlinePlus