Cuneiform fractures

Cuneiform injuries are bound by the Lisfranc joint distally and the Chopart joint proximally. They may be isolated or, more commonly, involved in a Lisfranc injury.

There is swelling, bruising, and point tenderness.

Complete intraarticular fractures may be associated with a shortening of the medial column.

In the multi-injured patient, foot fractures are often overlooked and are picked up on the secondary survey. In the unconscious patient, one must rely on a careful physical examination. Swelling, crepitus, or a deformity are suggested signs of underlying injury and should be followed up with appropriate x-rays.

Plain x-rays will often show the injury pattern.
CT with sagittal and coronal reconstruction helps obtain a three-dimensional understanding of the injury. CT protocol should be thin cuts with significant overlap.

These injuries may arise in athletics and be very subtle, or they may result from higher-energy injury and be more obvious. Their mechanism is similar to a Lisfranc midfoot injury, and they may indeed be part of Lisfranc fracture-dislocation.
The high-energy injury is often part of a polytrauma and is often associated with other injuries in the foot and other body parts.

Isolated cuneiform injuries are rare, and they are often a part of a Lisfranc injury. A high index of suspicion is required to exclude a Lisfranc injury.