Nutcracker Cuboid Fractures are never Isolated Injuries

Abstract

ABSTRACT Background Cuboid fractures are rare injuries, and treatment methods are ill-defined. The term ‘nutcracker’ fracture denotes a comminuted fracture of the cuboid which can lead to significant lateral column shortening and pain if treated improperly. The published literature discusses these injures with implications of such fractures being isolated injuries, and little mention is made of the complex forefoot injuries associated. We believe that such fractures cannot occur in isolation and due attention is often not paid to associated foot instabilities/injuries which may be subtle at times. To validate our hypothesis, we present our evaluation of 12 such cases, all of which were part of a complex foot injury pattern and emphasize on appropriate treatment of associated foot injuries in such cases. Materials and methods From the trauma database of a level 1 trauma center, all cases of cuboid fracture were retrospectively identified, investigated for mechanism of injury, radiographs were reviewed, associated injuries in the foot were documented, and treatment methods applied were recorded. Results We identified 12 cases of cuboid fracture. There were 10 males and 2 females, mean age being 20.2 years (14-32 years). No cuboid fracture was found to be an isolated injury, and associated foot injuries included calcaneus fracture in 3 cases, Lisfranc injury in 3 cases and complex midfoot-forefoot injury in 6 cases. Eight cases (66.7%) were open and 4 (33.3%) were closed. Complications included superficial wound infection in 2 cases, deep infection in 1 case and reflex sympathetic dystrophy along with nonunion of the 1st and 2nd metatarsals in one case. Conclusion Our results substantiate the hypothesis that nutcracker cuboid fractures cannot occur in isolation and represent one part of a complex, high energy foot injury. In addition to maintaining length of the lateral column and fixing the cuboid, due attention must also be paid to the associated foot injuries, especially the medial column, so as to have a properly aligned, functional and painless foot. How to cite this article Sharma S, Dhillon MS, Sharma G, John R. Nutcracker Cuboid Fractures are never Isolated Injuries. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):9-11.