Cuboid Fracture Research Articles

Injury Characteristics of Low-Energy Lisfranc Injuries Compared With High-Energy Injuries.

Lisfranc injuries result from high- and low-energy mechanisms though the literature has been more focused on high-energy mechanisms. A comparison of high-energy (HE) and low-energy (LE) injury patterns is lacking. The objective of this study was to report injury patterns in LE Lisfranc joint injuries and compare them to HE injury patterns. Operative Lisfranc injuries were identified over a 5-year period. Patient demographics, mechanism of injury, injury pattern, associated injuries, missed diagnoses, clinical course, and imaging studies were reviewed and compared. HE mechanism was defined as motor vehicle crash, motorcycle crash, direct crush, and fall from greater than 4 feet and LE mechanism as athletic activity, ground level twisting, or fall from less than 4 feet. Thirty-two HE and 48 LE cases were identified with 19.3 months of average follow-up. There were no differences in demographics or missed diagnosis frequency (21% HE vs 18% LE). Time to seek care was not significantly different. HE injuries were more likely to have concomitant nonfoot fractures (37% vs 6%), concomitant foot fractures (78% vs 4%), cuboid fractures (31% vs 6%), metatarsal base fractures (84% vs 29%), displaced intra-articular fractures (59% vs 4%), and involvement of all 5 rays (23% vs 6%). LE injuries were more commonly ligamentous (68% vs 16%), with fewer rays involved (2.7 vs 4.1). LE mechanisms were a more common cause of Lisfranc joint injury in this cohort. These mechanisms generally resulted in an isolated, primarily ligamentous injury sparing the lateral column. Both types had high rates of missed injury that could result in delayed treatment. Differences in injury patterns could help direct future research to optimize treatment algorithms. Level III, comparative series.

DESIGN AND BIOMECHANICAL STUDY OF TRANSARTICULAR CUBOID BONE PLATE

To design a new type of transarticular cuboid bone plate by measuring and collecting the anatomic data of the articular surface around cuboid, and to carry out comparative biomechanical study. The angle α (between the fifth metatarsocuboid joint and the fifth metatarsal bone) and the angle β (between the fifth metatarsocuboid joint and the calcaneocuboid joint) were measured in 100 adults on medial oblique X-ray film and 30 adult foot specimens. Based on literature data, the transarticular cuboid bone plate was designed with an angle α of 70° and an angle β of 30°. Six adult cadaver feet were chosen and were transected approximately 15 cm proximal to the ankle. Five strain gauges were placed at the calcaneus, cuboid, and the fourth and fifth metatarsal bones. The vertical pressure was loaded on the foot at 0-600 N, the strain value was measured. Then the cuboid fracture model was established and 600 N load was given on foot to measure the strain value and compare with the strain value before fracture. The specimens were randomly divided into groups A and B (n=3). Fracture was fixed with transarticular cuboid bone plate and 9 screws in group A and with double plate and 8 screws in group B, then the 600 N load was given to measure the strain value and vertical displacement of the fracture fragments. After loads of 0-600 N on the foot, the strain value of the 5 points showed an increased trend. No significant difference was found in the strain value between pre- and post-fracture at a, d, and e points P>0.05), but it was significantly larger at post-fracture than pre-fracture at b and c points (P<0.05). After fracture fixation, no significant difference was shown in the strain value at 5 points between groups A and B when loads of 0-600 N was given P>0.05). The experimental data showed that the strain value change mainly focused on the fracture site under the same load, so the strain value after fracture fixation was similar to that before fracture at b and c points P>0.05). The vertical displacement values of medial and lateral fracture fragments in group A[(0.804±0.011) mm and (0.672±0.036) mm] were significantly less than those in group B[(1.126±0.083) mm and (1.007±1.103) mm] (t=-6.711, P=0.003; t=-5.307, P=0.006). Through biomechanical study, a new type of transarticular cuboid bone plate has better fixation effect.

The patterns of injury and management of cuboid fractures: a retrospective case series.

Although infrequent, a fracture of the cuboid can lead to significant disruption of the integrity of the midfoot and its function. The purpose of this study was to classify the pattern of fractures of the cuboid, relate them to the mechanism of injury and suggest methods of managing them. We performed a retrospective review of patients with radiologically reported cuboid fractures. Fractures were grouped according to commonly occurring patterns of injury. A total of 192 fractures in 188 patients were included. They were classified into five patterns of injury. Type 1 fractures (93 fractures, 48.4%) are simple avulsion injuries involving the capsule of the calcaneo-cuboid joint. Type 2 fractures (25 fractures, 13%) are isolated extra-articular injuries involving the body of the cuboid. Type 3 injuries (13 factures, 6.8%) are intra-articular fractures solely within the body of the cuboid. Type 4 fractures (35 fractures, 18.2%) are associated with disruption of the midfoot and tarsometatarsal injuries. Type 5 fractures (26 fractures, 13.5%) occur in conjunction with disruption of the mid-tarsal joint and either crushing of the lateral column alone or of both medial and lateral columns. Fractures with significant articular disruption or with loss of length of the lateral column underwent fixation. This involved either internal fixation to restore the anatomy of the cuboid and/or restoration of the length of the columns with bridging constructs using internal or external fixation. A classification system for fractures of the cuboid is proposed in relation to the mechanism of injury. The treatment of these fractures is described. Cite this article: Bone Joint J 2016;98-B:1003-8.

Management of cuboid fracture: Results on 27 cases

Fractures of the tarsal navicular are relatively uncommon, and generally are a result of acute trauma or chronic overload in the form of stress fractures. Their importance arise from being somewhat difficult to detect, and if missed can result in significant morbidity with midfoot arthrosis, especially since its complex anatomy and blood supply make the navicular susceptible to osteonecrosis. It is recommended to have a high index of suspicion along with the use of advanced imaging techniques to ensure fractures are not missed. The aetiology and current management concepts of tarsal navicular fractures are reviewed in order to guide optimal treatment for patients. Salvage options for delayed diagnosis and ongoing pain and functional limitation include arthrodesis of the midfoot which will also be discussed.

Epidemiological characteristics of adult cuboid fracture in The Third Affiliated Hospital to Hebei Medical University from 2003 through 2012

Objective To investigate the epidemiological characteristics and trends of adult cuboid fractures in our hospital from 2003 through 2012. Methods The clinical data were retrospectively analyzed of all the adult patients with cuboid fracture who were treated between January 2003 and December 2012 at our institute. The patients' age, gender, fracture site and AO classification were documented. The data between January 2003 and December 2007 were assigned into group A while those between January 2008 and December 2012 into group B. The epidemiological characteristics concerning age, gender and fracture type were compared between the 2 groups. Results During the 10 years, 259 cuboid fractures were treated, involving 181 males and 78 females, with a male to female ratio of 2.32:1. They accounted for 4.45% of the contemporary adult tarsal fractures, 1.86% of the contemporary adult foot fractures, and 0.24% of the contemporary adult systemic fractures. Their peak ages ranged from 21 to 30 years (23.55%). The most frequent fracture type was 84-A (69.50%). In group A, there were 87 cases, with a male to female ratio of 2.00: 1 and a median age of 35.0 years. In group B, there were 172 cases, with a male/ female ratio of 2.51:1 and a median age of 42.0 years. There was a significant difference in the mean age between the 2 groups (P<0.05). Compared with group A, group B had significantly higher proportions of cuboid fracture in the contemporary tarsal, foot and systemic fractures, a significantly smaller age group of 16 to 20 years, and a significantly higher proportion of type 84-B (P<0.05). Conclusions During the 10 years in our hospital, the peak age of adult cuboid fracture ranged from 21 to 30 years. The most common fracture type was 84-A. compared with the first 5 years, the second 5 years witnessed a decreased proportion of patients of 16 to 20 years old, increased proportion of type 84-B, increased median age, and increased proportions of cuboid fracture in the contemporary tarsal, foot and systemic fractures. Key words: Tarsal bones; Cuboid bones; Fractures, bone; Epidemiology; Adult

CLASSIFICATION OF ADULT CUBOID FRACTURE AND EFFECTIVENESS ANALYSIS

To study the classification criteria of adult cuboid fracture and its guidance feasibility and effect of treatment. A retrospective analysis was made on the clinical data of 415 adult patients (416 feet) with cuboid fractures who had complete CT data treated between May 2009 and April 2014. There were 337 males and 78 females, aged 19 to 64 years (mean, 38.8 years). The left foot, right foot, and bilateral feet were involved in 220 cases, 194 cases, and 1 case respectively. The causes of injury were sprain in 106 cases, traffic accident in 65 cases, falling from height in 129 cases, and heavy crushing in 115 cases. The interval of injury and hospitalization was 2 hours to 3 days (mean, 8.5 hours). Based on CT findings, the classification criteria of cuboid fracture was proposed and methods of treatment was statistically analyzed. The external fixation surgery was performed in patients of type I (285 feet), type IIa (18 feet), and type III (5 feet); open reduction and internal fixation were performed in patients of type IIb (41 feet) and type III (67 feet), and bone grafting was used to repair defects in 58 feet (type III). All patients were followed up 1 year to 5 years and 11 months (mean, 2 years and 3 months). Primary healing of incision was obtained. In patients with type I fracture, fracture healed in 165 feet at 4-6 weeks (mean, 5.5 weeks), fracture did not heal in the other 120 feet; the American Orthopaedic Foot and Ankle Society (AOFAS) score was 95-100(mean, 96.7) at last follow-up. In patients with type II fracture, fracture healed in all feet at 6-8 weeks (mean, 6.5 weeks); the AOFAS score was 92-100(mean, 95.5) at last follow-up. In patients with type III fracture, malunion was observed at 6-8 weeks in 5 feet undergoing external fixation, and in 9 feet undergoing open reduction and internal fixation with foot lateral column shortening, forefoot abduction deformity, osteoarthritis, lateral foot pain; fracture healed at 8-12 weeks in 58 feet undergoing open reduction and internal fixation, without osteoarthritis, cuboid bone shortening, and pain at cuboid bone; and AOFAS score was 75-97(mean,93.5) at last follow-up. The classification criteria of cuboid fracture proposed based on CT examination is feasible and has guiding significance to the choice of treatment method.

A Case Report of Isolated Cuboid Nutcracker Fracture.

Isolated cuboid fractures are very rare, since they typically occur in combination with midfoot fractures or dislocations. A 61-year-old man presented at our hospital with pain and swelling on the outside of his right foot. The lateral column of his right foot was shortened by approximately 6.5 mm on X-ray. CT showed displacement of the joint surface between the cuboid and the fourth metatarsal, with a 3.5 mm depression. An MRI revealed no other injuries. Based on these findings, we diagnosed the patient with an isolated nutcracker fracture of the cuboid. Using a 1.9 mm arthroscope, we examined the Lisfranc joint. Then the depressed fragments were elevated until the regular joint line was restored. A bone biopsy needle was then used to fill in the large defect with artificial bone. In this case, we did not plate the fracture. Six months after surgery, patient could walk without pain. We report a very rare case of isolated nutcracker fracture of the cuboid. In addition, we suggest our new treatment plan of this fracture.

Open Calcaneus Fractures and Associated Injuries

Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of requiring subsequent amputation. The management of these injuries should include intravenous antibiotics, tetanus prophylaxis, and urgent debridement and irrigation.

Displaced Isolated Cuboid Fractures

Isolated fractures of the cuboid without involvement of other parts of the midfoot are relatively unusual [2] but can be treated well with simple tactics. Often CT scan and 3D CT reconstruction can help elucidate exactly where the area of the injury is. Other injuries across the whole midfoot must also be ruled out. If a cuboid does present as an isolated injury, proven by CT, then a direct approach to deal with the fracture seems to be the best (Figure 2). Figure 2: CT of isolated cuboid fracture.

Stress fracture of tarsal cuboid bone in early childhood.

We present the clinical characteristics, radiographic, and bone scintigraphy finding of the cuboid fracture in early childhood. From 2008 to 2012, we identified 25 patients (13 boys and 12 girls) with cuboid fracture who were seen in our institution. Medical records and radiographs as well as bone scintigraphy of 25 patients were reviewed. Nutcracker test was performed as a provocation test. The mean age of the patients was 24.7months (range 15-38months). The average duration of symptom before visit was 7days (range 2-14days). Most of the parents/caregivers (76%) did not recall a traumatic episode. Patterns of limping were variable. Nutcracker test was positive in 11 patients. In 10 of 25 patients, initial plain radiographs of the foot showed no abnormal finding. The average duration of symptom of these patients was 4.5days (range 2-7days). In 15 patients, the radiograph of the foot showed sclerosis along the base of the cuboid. Bone scintigraphy of the patients with normal radiograph showed hot spot in cuboid. Eleven patients visited our institution to seek for second opinion as their child has persistent limping gait. It is not always possible to make an early diagnosis of this fracture since the initial radiographic finding and physical examination are often negative. Considering the consequences of a missed fracture and avoiding unnecessary treatment, bone scan might be useful in the early diagnosis of the stress fracture of the cuboid in young children. Diagnostic study, Level IV.

Missed peritalar injuries: an analysis of factors in cases of known delayed diagnosis and methods for improving identification.

Because of the complex anatomy of the foot, rarity of fractures of the foot, and subtle radiographic cues, foot injuries are commonly overlooked and mis/undiagnosed. This study seeks to investigate a patient population whose peritalar injuries, including fractures and dislocations, were missed on initial examination, in order to analyze factors of known, missed injuries and provide insight into methods for reducing the incidence of missed diagnoses. Surgical cases between January 1999 and May 2011 were queried and retrospectively reviewed to identify missed peritalar injuries. Of 1682 surgical cases reviewed, 27 patients with missed peritalar injury(ies), which were subsequently confirmed by imaging studies, were identified. Using the Orthopaedic Trauma Association classification, fracture and dislocation subtypes were classified. A medical record review was performed to assess demographic and surgical data elements. In this study population, 7 types of peritalar injuries (talus, calcaneal, navicular, and cuboid fractures as well as subtalar, calcaneocuboid, and talonavicular joint dislocations) were diagnosed in 27 patients. All patients required surgical intervention. Talus fractures were the most commonly missed injury. In patients with multiple peritalar injuries, there was a strong correlation between talus and navicular fractures (r = -0.60; P < .01) as well as a moderate correlation between talus fractures and calcaneocuboid dislocations (r = -0.46; P = .02). The presence of a calcaneal fracture significantly decreased the time to definitive diagnosis (P = .01). Male patients' diagnoses were delayed an average of 324 days and females 105 days (P = .04). A moderate correlation was found between patient age at injury and time to diagnosis (r = -0.47; P = .04), with a decreased time to diagnosis as patient age increased. Significant factors were identified in this patient population, including patient sex and age, which may contribute to missed or delayed diagnosis in the clinical setting. Prompt and accurate diagnosis of peritalar injuries may improve long-term outcomes. Care Management, Level V.

Nutcracker Cuboid Fractures are never Isolated Injuries

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.

Fracture of the talar neck associated with a compression fracture of the calcaneocuboid joint in a 5-year-old child: a case report

The objectives of this present case study are to report a rare combination of a displaced talar neck fracture with a compression fracture of the calcaneocuboid joint in a 5-year-old child and to describe its radiological features, surgical treatment and clinical outcome. A 5-year-old male boy was injured in a car accident in which his left foot underwent one of the tires. On arrival at the hospital, a displaced talar neck fracture associated both with a cuboid fracture and compression of the articular surface of the cuboid at the calcaneocuboid join was identified. Fractures were fixed surgically. Leg was protected with a below-knee plaster split immobilization and non-weight-bearing for 5weeks. After that period, the patient initiated a rehabilitation protocol with active and passive motion exercises. Fractures and fracture dislocations at the mid-tarsal joint have an important impact on the global foot function because malunion can result in post-traumatic arthritis and three-dimensional deformities of the foot. If a cuboid compression fracture is not reduced properly, it can result in the shortening of the lateral column with the development of an abduction, pronation and flat foot deformity. A talar neck fracture, if unreduced, can result in medial column displacement and rotational dislocation of the talar head, leading to a subluxation in the talonavicular joint with severe restriction of foot function. With early surgical treatment and open reduction and internal fixation, our patient recovered from the accident without having symptoms of pain, avascular necrosis, postoperative foot deformities or neurovascular deficits. The combination of a displaced talar neck fracture with a compression fracture of the calcaneocuboid joint in children usually requires correct diagnoses and early treatment with anatomic reduction and internal fixation to prevent severe post-traumatic deformities. V.

Old nutcracker fracture of cuboid

Nutcracker fractures of the cuboid (compressed) are rare and often missed at an initial visit. We report a 21-year-old patient presented with a 9 months old cuboid fracture. He presented with a localized pain around his left foot. Radiograph revealed the shortening of the lateral column with old cuboid fracture. The lateral column of foot was reconstructed. The patient remained symptom-free and no radiographic evidence of recurrence was observed 1 year postsurgery.

Nonunion of an Isolated Cuboid Fracture

Nonunion of an isolated undisplaced cuboid fracture is unusual. We report a case of symptomatic nonunion of an isolated cuboid fracture after nonoperative treatment. Fracture union was achieved with surgery, and the patient returned to full activities.

Complete Medial Dislocation of the Tarsal Navicular without Fracture: Report of a Rare Injury

Complete dislocation of the tarsal navicular, without fracture of the navicular, is an uncommon injury. A review of the published data revealed only 15 previous reported cases. The rarity of this injury can be attributed to the rigid bony and ligamentous support surrounding the navicular, which usually undergoes fracture and dislocation rather than pure dislocation of the navicular. The mechanism and appropriate treatment of this injury remains unclear. In the present report, we describe the case of a 29-year-old male who sustained complete dislocation of the tarsal navicular, without fracture of the navicular, along with fractures of the cuboid and calcaneus, when he was involved in a motor vehicle collision. The proposed mechanism of injury in this case was that of a pronation-abduction force applied to the midfoot, resulting in a transient midtarsal dislocation and disruption of the ligamentous support of the navicular, with medial dislocation of the navicular when the midtarsal dislocation was reduced. The anterolateral calcaneus and cuboid fractures were likely from an avulsion injury through the bifurcate ligament. The patient was treated successfully with closed reduction and Kirschner wire fixation of the navicular combined with application of a spanning external fixator. The pins and external fixator were removed at 7 weeks postoperatively, and the navicular was stable at that time. The patient was lost to follow-up shortly thereafter.

Fracture of the Cuboid

Cuboid fracture accounts for a minority of all foot fractures in adults and often is indicative of a multiply injured foot. Understanding the normal anatomy and function of the cuboid and its relation to foot biomechanics is necessary for appropriate management. Clinical evaluation includes history, physical examination, and thorough assessment of the skin and soft tissues. Plain radiographs and CT are helpful in preoperative planning. Cuboid fractures may be managed either nonsurgically (splinting or casting) or surgically (closed reduction and external fixation or open reduction and internal fixation). Careful handling of the soft tissues is important, as is restoration of articular congruity, lateral column length, and a stable midfoot. Postoperative care consists of prolonged immobilization followed by 3 months of progressive weight bearing. Published reports of long-term outcomes and functional postoperative assessments are lacking.

A Rare Midfoot Injury Pattern: Navicular—Cuneiform and Calcaneal—Cuboid Fracture—Dislocation

A rare midfoot injury pattern of navicular—cuneiform and calcaneal—cuboid fracture—dislocation is presented with two typical cases and a systematic review of the literature. This injury usually occurs as a result of high-energy crushing trauma and most often causes plantarly directed dislocation of the midfoot. Initial diagnosis includes a thorough physical examination and adequate radiological imaging, comprising anteroposterior, oblique and lateral X-radiography and computed tomography with three-dimensional reconstruction. Care should be taken to determine any injury to adjacent midfoot joints, in particular the Lisfranc joint. Intrasurgical protection of soft tissue is essential. Open reduction using two parallel incisions with minifragment plate fixation is recommended in more comminuted injuries. The navicular—cuneiform and calcaneal—cuboid joints play important roles in maintaining the arch of the foot and in weight-bearing during locomotion. Without proper therapy in the immediate post-traumatic phase, the long-term results are generally unsatisfactory.

MRI of the cuboid bone: Analysis of changes in diabetic versus non-diabetic patients and their clinical significance

Objectives(1) To investigate the association between diabetes and marrow changes in the cuboid; and (2) to evaluate the influence of age, gender, body mass index (BMI) and use of insulin in the occurrence of marrow changes in the cuboid. Research design and methodsMR and X-ray foot examinations of 237 patients [94 males, 143 females; mean age, 47.1 years (range 16–93 years)], five of whom underwent bilateral examinations, were reviewed. MR and radiographic studies were analyzed for the presence of marrow edema and fractures in the cuboid. Findings were correlated with demographic data (age, gender) and clinical information (BMI and use of insulin). ResultsTwo hundred and forty two feet – 69 diabetic and 173 non-diabetic – were retrospectively evaluated. There was a higher prevalence of marrow edema and fractures in the diabetic cuboid (n=31, 45%) compared to non-diabetic cuboid (n=25, 14%, p=0.02). A fracture line was seen in fourteen (20%) diabetic cuboid bones compared to 4 (2%) in non-diabetic cuboid bones (p<0.0001). Eleven (79%) cases of cuboid fractures in the diabetic population were radiographically occult. Multivariate data analysis revealed an adjusted odds ratio of 4.416 (95% CI; 2.307, 8.454) for the relationship between marrow changes (edema and fractures) in the cuboid and diabetes. For each year of age, the odds of changes in the cuboid increased by 2.2% (95% CI; 1.001, 1.044). ConclusionDespite not bearing weight, the cuboid bone is more vulnerable to marrow edema and fractures in diabetic patients compared to non-diabetic patients. Age seems to be an influential factor.

Surgical treatment of the cuboid fractures

Objective To explore the operative methods of open reduction and fixation for the cuboid fractures. Methods The study involved 12 patients with cuboid fractures treated from October 2006 to October 2008. There were seven males and five females, at average age of 38.5 years (range 18-70 years). All patients had closed fractures, including 10 with compression fracture and two with sagittal fractures. The surgical treatments included open reduction, internal fixation by plate, screw or K-wire.Results Ten patients were followed up for 15 months on average ( range 12-24 months), which showed one stage wound healing, with mean time of bone union for 10 weeks ( range 8-15 weeks). No infection was found in any patient. The weight load walk began at 12 weeks ( range 8-18 weeks), with no obvious pain. According to American orthopaedic foot and ankle society (AOFAS) midfoot scale, the mean score was 88.6 (range 73-100). Conclusion Anatomic reduction and stable internal fixation of the cuboid fractures is the key point for recovery of foot form, stabilization and function of the feet. Key words: Tarsal bones; Fracture fixation, internal; Follow-up studies