Transcuneiform Crush Injury: A Case Report

The tarsometatarsal joints consist of articulations between the metatarsal bases, cuneiforms and the cuboid. This joint complex is primarily stabilized by the position of the second metatarsal base into the intercuneiform recess. The second metatarsal is considered the keystone in maintaining the tarsometatarsal joint. Cuneiform fractures are rare and account for approximately 4.2% of all tarsal bone fractures. Transcuneiform fracture patterns involve more than one cuneiform and are more commonly associated with compression injuries.

Isolated cuneiform fractures are uncommon and considered highenergy injuries. Although the medial cuneiform is the most injured cuneiform, dislocations are very rare with the high-energy injuries due to the strong ligamentous attachment. Medial cuneiform fracture patterns are most commonly characterized as small, avulsion injuries. Fracture displacement occurs through the pull of the tibialis anterior tendon.

Foot examination should be performed to rule out any bony or ligamentous injury. A complete plain radiographic work up can identify fractures and/or dislocations. On weight bearing radiographs, a gap sign between the first and second digits may represent intercuneiform instability.