CT density analysis of the medial cuneiform

Area of Science:

• Orthopedic surgery
• Podiatric medicine
• Bone biomechanics

Background:

• Lisfranc injuries and midfoot arthrodesis often require secure implant fixation in the medial cuneiform.
• The medial cuneiform's cancellous bone density varies, impacting implant purchase.
• Understanding density variations can guide implant design and surgical technique.

Purpose of the Study:

• To investigate the density variations within the medial cuneiform bone.
• To identify optimal areas for implant fixation in the medial cuneiform.
• To inform the development of specialized implants for foot and ankle surgery.

Main Methods:

• Computed tomography (CT) intensity (Hounsfield units) measured bone density at 12 sites in the medial cuneiform of 60 patients.
• Analysis of Variance (ANOVA) assessed the influence of age, gender, race, and sample site on bone density.
• Statistical significance was determined at a 95% confidence level.

Main Results:

• Bone density was significantly affected by age, gender, and sample site (P < .001), but not race (P = .28).
• The distal-dorsal-lateral (DDL) site exhibited the highest bone density.
• A trend of increasing density towards the distal, dorsal, and lateral aspects of the medial cuneiform was observed.

Conclusions:

• This study provides the first in-vivo measurements of medial cuneiform bone density.
• The anterior, dorsal, and lateral portion of the medial cuneiform is the densest area.
• These findings suggest optimal locations for implant purchase during surgical procedures involving the medial cuneiform.