Os cuneiforme mediale bipartitium

Bipartite
medial cuneiform: congenital variant in a patient with foot trauma. MRI findings. Fig. 1: sagittal T1 (A) and FS FSE T2 (B) MR images show a complete bipartite medial cuneiform (arrow) with dorsal (d) and plantar (p) components. Note subcortical degenerative changes with osseous oedema (asterisk in B).
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Bipartite
medial cuneiform: congenital variant in a patient with foot trauma. MRI findings. Fig. 2: axial PD (A), T2 (B), T1 (C), and STIR (D). Complete bipartite medial cuneiform (large arrows), with degenerative changes (small arrows), osseous oedema (asterisk) and oedema in the subcutaneous tissue (dotted arrow).
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Bipartite
medial cuneiform: congenital variant in a patient with foot trauma. MRI findings. Fig. 4: sagittal T1(A) and STIR(B), showing partial bipartite cuneiform. Note the clefts(arrowheads) and the two segments partially fused in the middle (arrow).
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Bipartite
medial cuneiform: congenital variant in a patient with foot trauma. MRI findings. Fig. 3: sagittal T1 showing dorsal and plantar segments forming the "E" sign.
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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.

Epidemiology

The estimated incidence is thought to be ~1% (range 0.3-2.4%) of the general population with the majority (~85%) reported in males .

Associations

Some patients may have additional associations which include:

Clinical presentation

Most patients are asymptomatic although occasionally some patients can present with pain.

Gross anatomy

Bipartite medial cuneiforms are divided by an oblique/horizontal synchondrosis and/or syndesmosis into a smaller dorsal ossicle and larger plantar ossicle .

Radiographic features

Plain radiograph

A lateral foot radiograph (30° angled) may give an "E" sign with the two bones most often dorsal and plantar viewed end on.

MRI

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.

See also

Siehe auch:
Assoziationen und Differentialdiagnosen zu Os cuneiforme mediale bipartitium:
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