Cuboid Fractures in Preschool Children

Abstract

The purpose of this study is to describe the clinical and radiographic presentation of cuboid fractures in children and to produce a guide for appropriate evaluation and treatment.Twenty-eight consecutive patients with cuboid fracture treated at the same institution between 1998 and 2004 were retrospectively analyzed. The mean age at presentation was 38.7 months (range, 14-74 months). All patients presented with an avoidance gait pattern, refusing to bear weight on the lateral side of the foot. There was no history of trauma in 8 patients, and the others had minor trauma such as a fall down a few steps on their feet or ankle sprain. Plain radiographs were the method of diagnosis in all but one of the patients. The feet of 21 patients were immobilized at initial presentation. The other 7 patients were observed clinically until symptoms resolved. All fractures healed completely with no complications, and patients were symptom free in 4.9 weeks (range, 2-13 weeks). Twenty-one patients, immobilized immediately after the first presentation, were symptom free in 4 weeks (range, 2-7 weeks). The remaining 7 patients, who were observed and followed up clinically with no immobilization, were symptom free in 7.9 weeks (range, 5-13 weeks). Six patients had associated ipsilateral fractures, and 8 patients had an associated genetic or systemic abnormality. An awareness of cuboid fractures in children can lead to an early diagnosis, treatment, and recovery without the use of a bone scan, and a focus on the possibility of an underlying genetic or medical disorder must be initiated.

Update on diagnosis and management of cuboid fractures

“…The early detection of these fractures requires a high degree of suspicion[26]. Regarding children, local swelling and antalgic limp with refusal to bear weight on the lateral side of the foot may accompany a fracture of the cuboid[11,27]. Cuboid fractures may be associated with lateral foot pain especially with push off when walking[28].…”

Cuboid Injuries

“…Cuboid fractures in children, especially of preschool age, are rare and probably unreported. 14 15 Englaro et al . in their study reported scintigraphic findings in the cuboid in nine out of the 56 children complaining of the midfoot pain of unknown etiology.…”

Cuboid nutcracker fracture in a 9-year-old child

“…The cuboid bone plays an important role in maintaining the length and mobility of the lateral column of the foot 1 2. It is articulated with the calcaneus, the lateral cuneiform and the base of the fourth and fifth metatarsals, and contributes to the stability of the Chopart and Lisfranc joints 1 2…”

“…Cuboid nutcracker fractures have been described in children, although this injury is rare and often goes undiagnosed 1. The trauma mechanism is forced abduction of the forefoot against the fixed rearfoot, compressing the cuboid bone between the bases of the fourth and fifth metatarsals and the calcaneus 1 3–5. Associated injuries may be seen, generally affecting the midfoot, such as Lisfranc fracture/dislocation 4–7…”