title: Classification and Outcome of Fracture-Dislocation of the Cuneiform Bones.
abstract: Fractures and dislocations of the cuneiform bones are rare injuries to the midtarsal foot. The injury severity is often unclear, and the prognostic factors are unknown. The purpose of the present study was to characterize our insights of the diagnostics, therapy, and fracture patterns. We questioned whether the number of involved cuneiform bones and the type of injury would affect the clinical outcome. With this information, we aimed to develop a classification system for injuries of the cuneonavicular joint. Five patients who had sustained complex fracture-dislocation of the cuneiform bones were prospectively registered, underwent surgery, and were followed. We reviewed the published data and found 47 reports that included 55 patients to improve the informative value of our study. The injury mechanisms and therapy were evaluated, and the postoperative limitations and pain were assessed. The clinical outcome was correlated with the number of involved cuneiforms and the fracture/dislocation pattern. Direct trauma was associated with isolated fracture, and indirect injury was associated with isolated dislocations. Occasionally, these injuries were overlooked on conventional radiographs, and closed reduction frequently failed. The number of cuneiform bones involved and the type of injury were shown to affect the clinical outcome. We devised an easily applicable classification system for injuries to the cuneiform bones using this information. All cases were classified as isolated fractures (1), isolated dislocations (2), or fracture-dislocations (3) involving 1 (A), 2 (B), or 3 (C) cuneiform bones. The classification system we propose will facilitate a better understanding of the fracture patterns at the cuneonavicular joint line and is a good prognostic tool that requires validation in clinical settings.
authors: Department of Orthopedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany. Electronic address: alexander.mehlhorn@uniklinik-freiburg.de.
authors: Alexander T
authors: AT
authors: Mehlhorn
authors: Department of Orthopedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany.
authors: Hagen
authors: H
authors: Schmal
authors: Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany.
authors: Maria Anna
authors: MA
authors: Legrand
authors: Department of Orthopedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany.
authors: Norbert P
authors: NP
authors: Südkamp
authors: Department of Orthopedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany.
authors: Peter C
authors: PC
authors: Strohm
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D000072039:Fracture Dislocation / Q000145:classification* / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013639:Tarsal Bones / Q000293:injuries*; D016896:Treatment Outcome; D055815:Young Adult
keywords: classification; cuneiform bones; dislocation; foot; fracture