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Cuboid Fracture

synonyms: nutcracker fracture

Cuboid Fracture ICD-9

Cuboid Fracture Etiology / Epidemiology / Natural History

  • Fractures occur with the forefoot everted on hindfoot pinching cuboid between anterior calcaneus and bases of 4th and 5th metatarsals.
  • Untreated displaced / compression fractures can lead to relative shortening of the lateral column, planus and abduction deformities of the midfoot and chronic pain.

Cuboid Fracture Anatomy

  • Tranvsere Tarsal joint (Chopart's Joint) = Cuboid articulations with the calcaneous proximally and the talus and navicular medially.

Cuboid Fracture Clinical Evaluation

  • foot pain, unable to bear weight
  • tenderness and swelling over lateral midfoot

Cuboid Fracture Xray / Diagnositc Tests

  • Xray: A/P, Oblique, Lateral foot views. A/P, lateral foot often appear normal. Best seen on oblique view.
  • CT: may be useful for fractures poorly seen on plain films.

Cuboid Fracture Classification / Treatment

  • Avulsions: common due to numerus capsular and ligamentous attachments to the cuboid.
    -Treatment: 5-7 days NWB, elevation followed by progressive weight bearing and functional rehab.
  • Displaced / Compression fractrues =open reduction and internal fixation and possible bone grafting is necessary to prevent the development of late painful arthritis (Sangeorxan BJ, JBJS 1990;72Br:376).

Cuboid Fracture Associated Injuries / Differential Diagnosis

Cuboid Fracture Complications

  • Stiffness
  • Nonuion
  • Osteonecrosis
  • Deformity
  • Postraumatic Arthritis

Cuboid Fracture Follow-up Care

  • NWB for 3 months
  • Semirigid custom-molded arthosis

Cuboid Fracture Review References

  1. Hunter JC, Sangeorzan BJ:  A nutcracker fracture:  Cuboid fracture with an associated avulsion fracture of the tarsal navicular.  Am J Roentgenol 1996;166:888.
  2. Sangeorzan BJ, Swiontkowski MF:  Displaced fractures of the cuboid.  J Bone Joint Surg 1990;72B:376-378.
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