This report discusses an unusual case of a 23-year-old woman with a painful bipartite medial cuneiform and severe arthritic and cystic changes at the partition with no history of trauma. Magnetic resonance imaging confirmed a large cyst with subchondral erosions at the dorsal and plantar segments with significant bone marrow edema. Definitive treatment consisted of arthrodesis on the dorsal to plantar segments using one lag screw, demineralized bone matrix grafting, and a bone stimulator.
An isolated medial cuneiform fracture is a rarely encountered injury of the foot. We present a case of an isolated medial cuneiform fracture in a patient after sustaining a fall from a 15-foot height. Treatment consisted of primary arthrodesis of the first tarsometatarsal joint due to a high degree of comminution and intra-articular pain. When radiographs are inconclusive and the index of suspicion remains high for a lesser tarsus fracture, computed tomography is recommended. In patients with minimal displacement, conservative treatment is usually successful in achieving osseous fusion. When the fracture is displaced, intra-articular, or comminuted, surgical intervention, including open reduction with internal fixation and primary arthrodesis, should be considered.