This Bone Doesn't Usually Work Alone - Page #4
 

Working Diagnosis:
Left Mid-foot sprain

Treatment:
Walking boot with goal of pain-free ambulation.
2 week follow-up

Outcome:
Return to clinic, still painful in walking boot. MRI ordered, obtained 4 weeks after injury. Photo 2: MRI showed occult oblique non-displaced fracture of cuboid. Patient at time of MRI was pain-free in walking boot, swelling resolved, still with trace tenderness at cuboid. Continued walking boot with transition to physical therapy and activities out of boot. Patient returned in one month, 8 weeks after injury. Had successfully transitioned to non-painful weight-bearing out of walking boot. Photo 3: Follow up x-ray 8 weeks after injury showed healing oblique non-displaced cuboid fracture. Photo 4: X-ray one month later, 12 weeks after injury, showed complete fracture healing. Patient continued to be pain free.

Author's Comments:
Cuboid bone is essential for lateral column stability of the foot. Isolated cuboid fractures are rare. Only 1 case series of 10 patients documented in the literature. Cuboid fractures are often misdiagnosed at lateral ankle sprains. Medial oblique x-rays are the best way to visualize the cuboid bone. Fracture of the cuboid can often be occult on initial x-ray study. MRI or CT should be performed if clinically suspicious. Cuboid fractures must be considered in plantar flexion and eversion injuries.

References:
1. Miller T., et al. Isolated injury of the cuboid bone. Emergency Radiology. 2002;9(5):272.
2. Hunter J. A nutcracker fracture: cuboid fracture with an associated avulsion fracture of the tarsal navicular. Am J Roentgenol. 1996:166(4):888.

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NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.
 

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