Cuboid Fracture Research Articles

Cuboid fracture: surgical treatment, midterm follow-up, and management algorithm

Objectives: Describe the epidemiology of cuboid fracture, the mechanisms of injury and associated injuries, the progression to osteoarthritis, and propose a surgical management algorithm. Methods: A retrospective and descriptive study of patients with cuboid fractures operated on between 2009 and 2014. The variables analyzed were age, sex, mechanism of injury, classification, associated fractures, and osteoarthritis changes, among others. Results: Twenty-seven patients were included: 19 men and eight women. The mean age was 41.3 years (range 25 - 62). The mean followup was 3.3 years. The mechanisms of injury were motor vehicle accidents and falls from height. Among the patients, 44.4% had lateral column shortening, and 81.5% involved calcaneal cuboid articular surface. Cuboid locking plates were used in 15 patients, and single screw fixation was used in four patients. Three patients required a bone graft. Degenerative changes were observed in calcaneocuboid and cuboid-metatarsal joints. Conclusions: Cuboid fracture is an uncommon injury. In general, the injuries are caused by high-energy accidents. In our study, 40.7% of patients had an injury to the medial column. It is recommended the use of a cuboid locking plate for comminuted fractures, screw fixation for simple fractures, and a bridging plate or external fixation can be considered for most complex cases. Level of Evidence IV; Retrospective Case Series.

A rare case of an isolated traumatic cuboid dislocation treated with a novel technique

Complete cuboid dislocation without cuboid fracture are rare injuries and there is a paucity of literature describing their management. Previous studies have reported on the use of closed reduction casting, internal fixation, and Kirschner wire fixation in the treatment of such injuries. This case report presents the successful management of a complete cuboid dislocation in a healthy 42-year-old man following a motorcycle accident. The dislocation was reduced and stabilized using a novel mini-open approach that involved distraction of the lateral column complex through the use of an external fixator, followed by percutaneous Kirschner wire fixation to reinforce the area. The patient was monitored for 46 months and continues to function without limitation. This case report highlights the successful application of a novel fixation construct using an external fixator device and percutaneous Kirschner wire fixation for the treatment of a complete cuboid dislocation without cuboid fracture. The technique presented in this report could offer a valuable additional option for physicians treating patients with these rare injuries.

Treatment of Extensive Soft Tissue Injury with Polypropylene Prosthesis: A Case Study.

Injuries with exposure of soft tissue are frequent in orthopaedics. Innovative therapies using prosthesis as an auxiliary material to treat this type of injury are under development, aiming to overcome applicability and execution limitations of myocutaneous flap techniques. Figueiredo's technique uses a polypropylene prosthesis extracted from sterile saline to treat trauma at the fingertip. It is an alternative technique with a high success rate, reproducible, low cost and easy to apply. This article reports a case of foot injury with exposure of soft tissue treated with a treatment similar to Figueiredo's technique. The patient was admitted with a large and contaminated skin wound, muscle damage, tendon exposure, cuboid fracture and bone loss. Initially, debridement was performed. After 72 hours, a polypropylene prosthesis extracted from a sterile saline bottle was implanted and subsequently replaced after 60 days. After 76 days, the prosthesis was removed. There was no infection. 8 months later, there was total healing by second intention. The patient's motor and sensory functions were preserved. This case study shows that Figueiredo's technique can also be employed in more extensive injuries, representing an alternative to using myocutaneous flaps. The polypropylene prosthesis is extremely affordable, which enables resolution of cases in a greater number of services. This technique still offers the best aesthetic result and does not compromise other body regions.

Treatment Of Complex Open Lisfranc Injury In A Professional Bull Rider

HISTORY: An otherwise healthy 30-year-old male professional bull rider presented to our hospital as a transfer for an open left foot fracture after a bull stepped on his left foot during a professional competitive rodeo event. He immediately experienced pain in the affected foot. He denied any other injuries including trauma to the head or loss of consciousness. Although he has had multiple orthopedic injuries in the past, he denied any previous foot injuries to the left foot. PHYSICAL EXAMINATION: Physical examination revealed a large laceration on the medial aspect of the left foot over the 1st metatarsal with an open dislocation of the MT head. The open laceration site was 9 cm x 4 cm. The patient had mild loss of sensation and was unable to elicit movement in his toes. There was no trauma or tenderness present on the left hip, femur, knee or lower leg. DIFFERENTIAL DIAGNOSIS: 1. Open Lisfranc injury 2. Tarsometatarsal dislocation TEST AND RESULTS: Anterior-Posterior, lateral & oblique radiographs: 1. Complete dislocation of the first metatarsophalangeal joint 2. Lisfranc fracture/dislocation 3. Neck and base fractures of the second, third, and fourth metatarsals, base of fifth metatarsal 4. Cuboid fracture FINAL WORKING DIAGNOSIS: Open left first metatarsophalangeal dislocation and Lisfranc fracture-dislocation with multiple metatarsal fractures TREATMENT AND OUTCOMES: 1. Surgical irrigation & debridement of the wound, followed by open or closed fixation of fractures and dislocations. 2. Pin removal at 6 weeks post op and negative pressure wound therapy for 9 months postoperative. 3. Non-weight bearing for the first 8 weeks postoperative followed by progression to weight bearing as tolerated. 4. At 18 months post-operative, the patient was able to return to professional bull riding. 5. At 3.5 years from injury, there is residual pain and swelling present with development of hallux valgus. The foot/ankle is otherwise functioning appropriately and does not inhibit him from professional bull riding.

Lateral subtalar dislocation associated with a lateral malleolus and a nutcracker cuboid fracture: Case report of a rare pattern of lesion.

Introduction and importanceCombined fracture of the lateral malleolus and cuboid due to a lateral subtalar dislocation is an uncommon injury. Literature is scarce on this trauma association. To the best of our knowledge, this represents a new lesion pattern. Hereby we describe its mechanism, management and outcomes.Case presentationWe report a case of a 58-year-old woman, who fell from the stairs and presented with pain and an acute deformity of the left foot and ankle. Plain radiographs and CT scan revealed a lateral subtalar dislocation with a lateral malleolus and cuboid fractures. After a failed closed reduction, the patient underwent an open reduction and fixation of the talonavicular joint. An external fixator was applied to address the cuboid fracture. The lateral malleolus was treated conservatively with 5.5 weeks of immobilization. At 38 months of follow-up, the patient scored 87% on the AOFAS ankle-hindfoot scale and returned to normal daily activity. Radiographs demonstrate signs of posttraumatic arthritis at the subtalar and talonavicular joints.Clinical discussionAfter reduction of the lateral subtalar dislocation, addressing the nutcracker cuboid fracture was essential, since it can contribute to a flatfoot deformity. Although the patient progressed to posttraumatic arthritis, the sequelae are usually well tolerated and a good outcome was achieved.ConclusionThe rarity of this pattern of lesion is related to the necessary multidirectional forces. Correct management of the associated fractures is essential.Our study demonstrates a new lesion pattern of lateral subtalar dislocations, its mechanism, management and outcomes.

The painful lateral column of the foot: from back to front.

The purpose of this article is to focus attention on the abnormalities which the radiologist may encounter in patients presenting with lateral ankle or foot pain outside of the context of acute trauma. These include anterolateral impingement, subfibular impingement, subtalar instability and tarsal sinus syndrome, tarsal coalition, sural neuromas, peroneal tendon abnormalities, calcaneocuboid instability and occult cuboid fractures, and painful accessory ossicles. The expected and unexpected findings on radiographs, CT, US, and MRI are discussed.

Fractures of the Cuboid Bone: A Critical Analysis Review.

Cuboid fractures rarely occur in isolation, and a high index of suspicion for the presence of Chopart, Lisfranc, or complex midfoot injuries should be raised. The cuboid is the cornerstone of the lateral column and acts as a bridge between the lateral column and the transverse plantar arch. Its most important role is maintenance of lateral column length and associated motion in the midtarsal and tarsometatarsal joints. To date, a classification system that is validated for clinical practice (i.e., guidance for management and prediction of outcome and prognosis) is lacking. The principles of operative treatment are restoration of articular congruity, lateral column length, and stability of the Chopart and Lisfranc joints. Nonoperative management is reserved for nondisplaced articular fractures (<1 mm) or avulsion fractures that are caused by low-energy trauma.

An Unusual Midfoot Fracture-Dislocation: Total Dorsal Dislocation of Midfoot at the Cunei-Navicular Joint Associated with Cuboid Fracture: A Case Report

An Unusual Midfoot Fracture-Dislocation: Total Dorsal Dislocation of Midfoot at the Cunei-Navicular Joint Associated with Cuboid Fracture: A Case Report

“Nutcracker” Cuboid Fracture in a Collegiate Football Player

“Nutcracker” Cuboid Fracture in a Collegiate Football Player

A Typical Metatarsal Fracture in a Patient on Long-Term Bisphosphonate Therapy

Bisphosphonates, more particularly alendronate, are a popular category of drugs in the treatment of postmenopausal and corticosteroid-induced osteoporosis. The present study contends that the long-term consumption of bisphosphonates causes not only subtrochanteric and femoral shaft fractures but also pathological fractures at other musculoskeletal sites. This report presents a rare case of alendronate-induced pathological metatarsal fracture in a 59-year-old female with a history of cuboid fracture following a twisting with abnormal Bone Mineral Density (BMD) (T score: −3.5; lumbar spine and −2.6; proximal femur).

Distractor-assisted reduction for Lisfranc injury complicated with compressive fracture of lateral foot column

Objective To evaluate distractor-assisted reduction for Lisfranc injury complicated with compressive fracture of lateral foot column. Methods A retrospective study was conducted of the 18 patients who had been treated surgically at Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital between May 2014 and March 2017 for Lisfranc injury complicated with compressive fracture of lateral foot column. They were 10 males and 8 females, with an average age of 38.4 years (from 25 to 65 years). The injury involved the right foot in 11 cases and the left foot in 7. Their concomitant injuries were 12 compressive cuboid fractures and 6 compressive fractures of the calcaneal anterior process. According to the Chiodo-Myerson classification, there were 13 cases of three-column injury, 3 ones of middle-lateral column injury and 2 ones of medial-lateral column injury. All the injuries were closed. After the condition of foot soft tissues permitted, open reduction assisted by a distractor and internal fixation with a mini locking plate was performed. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores and visual analogue scale (VAS) at the final follow-ups and complications during follow-up. Results The 18 patients were followed up for one to 4 years (average, 2 years). Their AOFAS hindfoot-ankle scores ranged from 55 to 96 points (average, 80.4 points); their VAS ranged from 0 to 6 points (average, 1.5 points). Radiographic evidence of degeneration was noted in 10 patients. Of them, 2 reported persistent pain which was cured by arthrodesis after conservative therapy failed and one presented with symptoms of injury to sural and cutaneous nerves which disappeared after oral administration of neurotrophic drugs for half a year. No such complication as skin necrosis, infection or implant failure occurred in other patients. Conclusion Open distractor-assisted reduction and internal fixation of lateral foot column with a mini locking plate, combined with bone graft if necessary, is an effective treatment for Lisfranc injury complicated with compressive fracture of lateral foot column, because it can effectively restore the alignment of lateral column and result in satisfactory therapeutic effects. Key words: Cuboid bone; Calcaneus; Foot joints; Fractures, bone; Fracture fixation, internal

Open reduction combined with a variable angle foot plate for treatment of acute Lisfranc frac-ture-dislocation

Objective To analyze the clinical outcomes of a standard protocol of open reduction and internal fixation using a variable angle foot plate for a consecutive series of patients with acute Lisfranc joint injury. Methods This study retrospectively evaluated the clinical outcomes of 11 Chinese patients (13 feet) with acute Lisfranc joint injury who had been treated by open reduction and internal fixation with a variable angle foot plate from December 2016 to June 2017 at Department of Orthopaedics, West China Hospital.They were 8 men (10 feet) and 3 women (3 feet), aged from 19 to 57 years (average, 36.4 years).Of them, 10 were complicated with fracture of metatarsus, 6 with cuneiform fracture and/or dislocation, 4 with cuboid fracture, and one with cuboid fracture.According to the Myerson classification for Lisfranc frac-ture-dislocations, one case (one foot) belonged to type A, 2 (2 feet) to type B1, 5 (6 feet) to type B2, 2 (3 feet) to type C1 and one (one foot) to type C2.The outcomes were evaluated using the visual analogue scale (VAS) and the midfoot scores of American Orthopedic Foot and Ankle Society (AOFAS). Results This cohort was followed up for 18 to 24 months (average, 22 months).Their VAS scores were decreased signif-icantly from preoperative 7.3±1.2 (from 6 to 9) to postoperative 1.2±0.2 (from 0 to 2) (P<0.05); their AOFAS midfoot scores were increased significantly from preoperative 0 to postoperative 84.6±4.6 (P< 0.05).Anatomic reduction was obtained in all the patients and all the fractures united successfully without any delayed union or nonunion.Superficial necrosis of the wound edge occurred in 2 cases without deep in-fection; skin anesthesia occurred in 2 and skin hypesthesia in 4, indicating a lesion of the superficial peroneal nerve. Conclusion Fixation of acute Lisfranc joint injury with a variable angle foot plate can lead to rigid stability, precise reduction and satisfactory short-term clinical outcomes. Key words: Foot; Wounds and injuries; Bone plate; Lisfranc

Update on diagnosis and management of cuboid fractures.

Cuboid fractures due to the particular bone anatomy and its protected location in the midfoot are rare, and they are usually associated with complex injuries of the foot. Clinical examination to diagnose these fractures should be detailed and the differential diagnosis, especially in the case of vague symptoms, should include the exclusion of all lateral foot pain causes. Conventional radiographs do not always reveal occult fractures, which can be under diagnosed especially in children. In this case, further investigation including magnetic resonance imaging or scintigraphy may be required. The treatment of these injuries depends on the particular fracture characteristics. Non-displaced isolated fractures of the cuboid bone can be effectively treated conservatively by immobilization and by avoiding weight bearing on the injured leg. In the case of shortening of the lateral column > 3 mm or articular displacement > 1 mm, surgical management of the fracture is mandatory in order to avoid negative biomechanical and functional consequences for the foot and adverse effects such as arthritis and stiffness as well as painful gait. In this review, an update on diagnosis and management of cuboid fractures is presented.

Cuboid nutcracker fracture in children: Management and results

IntroductionCompression fractures of the cuboid bone in children and adolescents are rare. Fracture morphology, associated lesions, treatment options and long-term outcomes of this very rare injury are published in a few case reports. This study with review of the literature aims to support the understanding of fracture pattern and optimize pathways of decision making. Material and MethodsA retrospective two-center study was performed in a patient cohort treated between 2001 and 2016. All patients aged less than 18 years who sustained a cuboid fracture were included. Age, gender, mechanism of injury, fracture morphology, amount of displacement, associated injuries, and therapy were analyzed. In the follow-up (FU), the AOFAS Midfoot Scale was investigated. ResultsFractures of the cuboid bone were diagnosed in 7 boys and 9 girls. The mean age of the patients was 10 years (range: 2.2–16.1 years). According to the classification of Fenton we detected 11 (69%) type 2, 2 (12%) type 3 and 3 (19%) type 5b fractures. Other fracture types according to Fenton were not observed. All children under 10 years sustained a type 2 fracture. Open reduction and internal fixation was performed in 5 (31%) patients. Bone grafting was not necessary. FU was performed in 14/16 patients on average after 9 years (mean; range: 1.4–16.2 years). The mean AOFAS Midfoot Scale at FU for extra-articular type 2 fractures was 100 points, whereas in intra-articular fractures (Type 3) and fractures associated with mid-tarsal disruption (type 5b) worse results were found (95 and 66 points, accordingly). ConclusionThis rare injury shows inhomogenous morphologies and offers different treatment approaches. Extra-articular Fenton type 2 lesions are the most common type of cuboid fracture in children (69%). A potential loss of length of the lateral column must be considered. In contrast to adults, type 1, 4, and 5a fractures were not found in our cohort of children and adolescents. Lower scores of the AOFAS Midfoot Scale were found with either intra-articular involvement or associated midfoot lesions.

Surgical Fixation of Type 2 Navicular Fractures

Category: Trauma Introduction/Purpose: The navicular plays a vital role in maintenance of the medial column of the foot and provides a pivotal function in hind foot biomechanics. Type 2 fractures demonstrate a primary fracture line from dorsolateral to plantar medial where the major fracture fragment is displaced medially. They are typically the result of high energy and are associated with poor outcome. This study reports on the demographics of a series of Type 2 navicular fractures, the operative technique employed and the subsequent outcome. Methods: Six patients with a Type 2 navicular fracture were identified from the theatre records. The study period was June 2014 to February 2016. All patients sustained their injuries in either high speed MVAs or motocross accidents. All patients had surgery performed after the soft tissue envelope had settled (mean 7 days after injury). The key component to the surgical procedure was the reduction of the constant large medial fragment. This allowed simple access to the navicular for fracture reduction. The construct was supported with a bridge plate. The bridge plate was removed approximately 9 months post surgery. Final radiological follow up was at 12 months post surgery. Clinical follow up included the AOFAS midfoot score by phone questionnaire at a mean of 15 months’ post injury. Results: The study comprised 5 males and one female with a mean age of 22 years. In 5 patients the navicular fracture was an isolated injury, in one there was an associated cuboid fracture. None of the patients experienced any significant complications. All patients returned to work, one as a roofer and two to motocross. AOFAS midfoot scores were obtained from all patients via a telephone conversation at a mean of 15 months’ post injury. The mean score was 70 (range 65 - 80). Radiographs at a mean of 12 months showed no loss of position and maintained alignment. Conclusion: Acute fractures of the navicular are uncommon and they typically result in significant long-term morbidity. Our series demonstrate a technique which is reproducible in both maintaining the length of the medial column but also providing good access to the navicular for fracture reduction. It also results in good clinical outcomes in the short term. All our patients returned to their previous occupations with minimal symptoms.

Cuboid Injuries.

Cuboid fractures are rare injuries. A number of different treatment methods have been proposed including plaster immobilization, open reduction, and internal fixation or external fixation. Bone grafting is commonly used to restore bony length. The majority of the current literature suggests that the loss of length of the lateral column and articular congruency are the two criteria opting for the surgical management of these fractures. Nevertheless, the exact indications and ideal management of these fractures are not established mainly due to the rarity of these injuries and the paucity of literature.

MR imaging features of cuboid fractures in children.

Cuboid fractures are rare, usually occult on initial radiographs and are often underdiagnosed. MRI is more sensitive than radiographs for detecting acute, non-displaced cuboid fractures in adults, but only case reports have described these findings in children. To summarize the MR and clinical features of cuboid fractures and compare MR findings with initial and follow-up radiographs in a cohort of children. A retrospective search for patients <18years of age with cuboid fractures was performed during a 10-year period at a large tertiary children's hospital. Subjects with cuboid fractures reported on MRI and available clinical history were included. MR images were evaluated for fracture location, fracture morphology, percentage of marrow edema in the cuboid, subchondral disruption, and associated tendon or ligamentous injury. Initial and short-term follow-up radiographs were also reviewed when available. Nineteen children ages 18months to 17years (mean: 9.0years, standard deviation: 4.1years, 63% boys) were diagnosed with cuboid fractures by MRI. Most cases of cuboid fractures are related to acute trauma (63%) but can be seen as stress fractures (16%). Most fractures (17/19, 89%) were linear in configuration. Fractures were most commonly adjacent to the tarsometatarsal joint (10/19, 52%). The degree of marrow edema was variable. Ligamentous injury was seen in two patients and tendon pathology was seen in one, all adolescents. Initial radiographs (n=10) were negative in 9 cases (90%). All available follow-up radiographs (n=12, obtained 19-42days after MRI) demonstrated sclerosis in the region of the fracture. MR-depicted cuboid fractures in children typically occur in isolation. The fractures were most commonly adjacent to the tarsometatarsal joint and linear in morphology. Initial radiographs were usually normal and follow-up radiographs depicted sclerosis at the site of fracture in all available cases.

Clinical and radiological outcomes of a cohort of 9 patients with anatomical fractures of the cuboid treated by locking plate fixation.

Cuboid fractures are very rare. Hence, their treatment has not been standardized. Advances in imaging techniques, particularly three-dimensional computed tomography (3D CT), and the introduction of cuboid-specific plates has improved the care of these injuries. The aim of this study was to determine the radiological and clinical outcomes of anatomical reconstruction of comminuted cuboid fractures with a locking plate. Fixation of comminuted cuboid fractures with a cuboid-specific locking plate leads to stable anatomical reduction and good functional outcomes. This was a retrospective study of 9 consecutive cases of comminuted cuboid fracture treated at a single hospital between January 2009 and December 2015. A 3D CT scan was performed preoperatively with subtraction of the posterior tarsal bone to allow the articular facets to be viewed and analyzed. Fracture fixation was done with a Locking Cuboid Plate (DePuy Synthes™). Associated lesions in the foot were treated during the same procedure. The patients were reviewed by an independent observer who performed a clinical examination, and determined the AOFAS and Maryland Foot Score. The success of the reconstruction was determined by comparing the parameters on weight-bearing X-rays views between the fixed and non-operated cuboid. The mean follow-up was 4.1 years (range 1-6). The Maryland Foot Score was 93.1 [86-100] and the AOFAS was 91.9 [82-100]. The reconstruction was anatomical and long lasting in all 9 cases. There was no foot misalignment in the frontal plane, based on the radiographs (hindfoot axis 5.5° [0-9]). The mean Djian-Annonier angle was 123.9° [108-130]. Cuboid fractures can be treated effectively through appropriate imaging and with a cuboid-specific locking plate as evidenced by very good midterm clinical and radiological outcomes in this study. IV Retrospective study.

Nutcracker Cuboid Fracture: A Case Report and Review

Here we report the case of a 20-year-old female restrained driver who presented to the emergency department (ED) after a motor vehicle accident. She sustained an isolated fracture of her left cuboid, consistent with a nutcracker cuboid fracture. A cuboid fracture is considered rare. It is even more uncommon for a cuboid fracture to occur in isolation, without other associated injuries to the foot. We discuss the mechanism, relevant anatomy, diagnosis, and principles of treatment of the nutcracker cuboid fracture.

Cuboid fracture: Epidemiology and treatment algorithm on 28 patients

Distal hallux gangrene and neuropathic ulceration associated with digit deformity frequently result in osteomyelitis of the distal phalanx. Ideal treatment would involve limited resection to preserve function. We describe our surgical technique and retrospective results for distal Syme hallux amputation with plantar flap closure. An institutional review board-approved review was conducted on cases performed over 8 years. A total of 15 consecutive patients (16 digits) with hallux soft tissue loss who had undergone distal Syme hallux amputation were included. In each case, initial resection removed the distal hallux wound, nail bed, and distal phalanx. The proximal phalanx tip was remodeled, allowing margin biopsy and reduction of prominence. Of the 16 digits, 5 (31.3%) had hammertoe deformity and 1 (6.3%) was excessively long. Positive probe-to-bone status was identified in 8 of the 16 digits (50.0%). All 8 ulcers (100.0%) that probed to bone had histologic or culture results consistent with distal phalanx osteomyelitis. A proximal margin biopsy was taken in 12 of 16 digits (75.0%), and proximal phalanx osteomyelitis was observed in 4 of 12 proximal margin biopsies (33.3%). Two digits (12.5%) failed to heal. Three digits (18.8%) required a more proximal amputation, and the remaining 13 (81.3%) were found to be well-healed and functional at the final follow-up examination. The mean follow-up period was 27.6 (range 8 to 97) months. We have found distal Syme hallux amputation to be an effective treatment when used judiciously for distal hallux gangrene and osteomyelitis associated with neuropathic ulceration. This procedure permits bone biopsy for early diagnosis, confirmation of clean margins, removal of nonviable tissue and the abnormal toenail, and some deformity correction.