[Diagnostic approach and management in cuneiform fractures. Narrative review of the literature].

INTRODUCTION: fractures and dislocations of the cuneiform bones represent a diagnostic and therapeutic challenge due to their low incidence and anatomical complexity. The objective of this work focuses on the clinical relevance of the Roman arch of the midfoot and its susceptibility to injuries from direct and indirect trauma. MATERIALS AND METHODS: a review of the literature was carried out by consulting the PUBMED, EMBASE, COCHRANE, in English, Spanish, and French databases, using the MeSH terms: "cuneiform", "fracture", "dislocation", "treatment", "surgery", "rehabilitation", "fixation", "biomechanics", "trauma", and "Lisfranc", a total of 69 articles were obtained, of which 10 were excluded because they were duplicates and one because the full text could not be obtained. for a total of 58 eligible items. Similarly, the search was extended to classic textbooks from June 1990 to June 2024, with no restrictions on the type of study. RESULTS: a narrative review of the literature over the last 34 years is carried out, trying to synthesize the most important aspects in relation to anatomy, epidemiology, trauma mechanism, diagnostic images classification, treatment, and rehabilitation in the approach to cuneiform lesions. CONCLUSION: this narrative review allows us to conclude that early identification and anatomical reduction are critical to improve functional outcomes and prevent long-term complications, such as osteoarthritis and pseudoarthrosis. The weakness of our work lies in the lack of systematic review studies, cases and controls or large case series, available in the literature that allow us to establish management guidelines for this type of injury.