Nonunion of Isolated Medial Cuneiform Fracture Fixed With a Compression Screw and Compression Staple: A Case Report

TL;DR

A 15-year-old boy with a nonunion medial cuneiform fracture achieved full recovery after surgery using a compression screw and staple.

Contribution

Reports a rare case of nonunion in an isolated medial cuneiform fracture successfully treated with a combination of compression staples and screws.

Findings

Nonunion of the medial cuneiform fracture was successfully treated with open reduction and internal fixation.

The patient returned to full competition with no pain and achieved a perfect SAFE-Q score 21 months post-surgery.

Combining compression staples and screws provided strong fixation for the small bone fragment.

Abstract

Isolated cuneiform fractures are rare and account for only 1.7% of all midfoot fractures. Medial cuneiform fractures can be treated conservatively or surgically, with good clinical outcomes. However, nonunion is a rare complication of medial cuneiform fractures, and only a few cases have been reported in the literature. We report a case of a medial cuneiform fracture requiring surgical treatment that had a good clinical outcome. A 15-year-old boy presented to an orthopedic clinic with a complaint of pain in his right foot. The patient had landed on the foot during a handball game and was treated conservatively for several months. However, his symptoms persisted, and he was referred to our clinic for further evaluation, where he was diagnosed with medial cuneiform nonunion of the right foot. Open reduction and internal fixation surgery using a compression screw and staple and autologous bone grafting were performed. Postoperatively, bone union was observed, and the patient returned to full competition with no complaints of pain during exercise. The Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score at 21 months after surgery was 100.0 for the following subscales: Pain & Pain-Related; Physical Functioning & Daily Living; Social Functioning; Shoe-Related; General Health & Well-Being; and Sport (handball). We encountered a case of an isolated medial cuneiform fracture that required surgical treatment. During the surgical treatment, fixation with a combination of compression staples and screws may be considered simple and useful for achieving strong fixation because the medial cuneiform fracture has a small bone fragment.

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