Bipartite medial cuneiform
Citation, DOI & article data
A bipartite medial cuneiform is an anatomical variant where there are two ossification centers involving the medial cuneiform. In many cases, the overall shape of the medial cuneiform is conserved, although the size of the two combined bones is larger than that of a normal medial cuneiform.
The estimated incidence is thought to be ~1% (range 0.3-2.4%) of the general population with the majority (~85%) reported in males 7.
Some patients may have additional associations which include:
- os intermetatarseum
- accessory navicular bone
- spinal segmentation anomalies
- lunotriquetral coalition
- an accessory temporal bone suture
- bipartite temporal bone
Most patients are asymptomatic although occasionally some patients can present with pain.
A lateral foot radiograph (30° angled) may give an "E" sign with the two bones most often dorsal and plantar viewed end on.
May also give an "E" sign when viewed on sagittal images. MRI also allows direct visualization of anatomy as well as an appreciation of any signal abnormality along the synchondrosis.
Treatment and prognosis
Symptomatic cases may benefit from intervention ranging from various nonoperative measures to surgical excision.
- 1. Brookes-Fazakerley SD, Jackson GE, Platt SR. An additional middle cuneiform?. J Surg Case Rep. 2015;2015 (7): . doi:10.1093/jscr/rjv076 - Free text at pubmed - Pubmed citation
- 2. Chang GH, Chang EY, Chung CB et-al. Bipartite Medial Cuneiform: Case Report and Retrospective Review of 1000 Magnetic Resonance (MR) Imaging Studies. Case Rep Med. 2014;2014: 130979. doi:10.1155/2014/130979 - Free text at pubmed - Pubmed citation
- 3. Burnett SE, Case DT. Bipartite medial cuneiform: new frequencies from skeletal collections and a meta-analysis of previous cases. Homo. 2011;62 (2): 109-25. doi:10.1016/j.jchb.2011.01.002 - Pubmed citation
- 4. Chiodo CP, Parentis MA, Myerson MS. Symptomatic bipartite medial cuneiform in an adult athlete: a case report. Foot Ankle Int. 2002;23 (4): 348-51. Pubmed citation
- 5. Dellacorte MP, Lin PJ, Grisafi PJ. Bilateral bipartite medial cuneiform. A case report. J Am Podiatr Med Assoc. 1992;82 (9): 475-8. doi:10.7547/87507315-82-9-475 - Pubmed citation
- 6. O'Neal ML, Ganey TM, Ogden JA. Fracture of a bipartite medial cuneiform synchondrosis. Foot Ankle Int. 1995;16 (1): 37-40. Pubmed citation
- 7. Serfaty et al. Bipartite Medial Cuneiform: Magnetic Resonance Imaging Findings and Prevalence of This Rare Anatomical Variant. (2020) Skeletal radiology. doi:10.1007/s00256-019-03353-3 - Pubmed