Interesting topic to me. It's something unusual, but by chance I've seen it a few times. The one in the xray presented with chronic medial midfoot pain and history of remote injury (MVA Rollover). Initially treated conservatively without relief. He then had a dorsal met-cuneiform exostectomy which helped for about 5-6 months. At that point he was offered fusion of the bipartite medial cuneiform. About 5 months after surgery he was able to return to running and other activities.
A medial approach was taken in surgery, directly over the bipartition. On opening it there was cartilage on both surfaces, which was removed with a rongeour and curettes. Fenestrated both surfaces, and placed the screws percutaneously from dorsal to plantar.
I saw another case which was initially treated as a Lisfranc's injury, with conservative treatment. He also underwent fusion of cuneiform, but also had a screw placed across the cuneiform to the 2nd met base.
Last surgical one was a baseball injury in which the bipartite cuneiform was displaced, so did ORIF with fusion of the bipartition.
Recently I saw another symptomatic bipartite cunieform, but improved with steroid injection done under fluoroscopy.
I think I've seen enough of them that it should be a publishable article, but it's taking me longer to write it than it ought to. BTW in our digital xray system,
I was able to find ~ 40 others, incidental findings. I think it may be more frequent than we think, just overlooked. I have a young active patient population which may be why I've seen it, and I look for it.
I was recently looking at my materials again, and did a search which is how I found the one you mentioned.
Thanks.
Eric
Last edited: Sep 20, 2009