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

Working Diagnosis:
Left Mid-foot sprain

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

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.

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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