The Common Vein Copyright 2011
Definition
Fractures of the are usually caused by indirect is most common mechanism for cuboid fractures. Indirect trauma results from torsional stress, forefoot abduction or extreme plantar flexion. Direct is trauma to the dorsolateral foot.
“Nutcracker injury” is the term for a when a torsional or forefoot abuction stress causes an impaction of the cuboid between the calcaneus and lateral metatarsals.
Cuboid stress fractures are most common in athletes.
The fracture may be complicated in the acute phase by neurovascular injury, or in the subacute or chronic phases by nonunion, malunion, infection, osteonecrosis, or osteoarthritis.
The diagnosis of this injury is usually made by a combination of physical examination and x-ray imaging.
Imaging includes the use of plain x-rays, and if indicated CT-scan, or MRI.
Isolated fractures of the cuboid can be treated when immobilization and non-weightbearing for 4 to 6 weeks.
Surgery is indicated if there is 2mm or more of joint disruption. Severely comminuted cuboid fractures may require an arthrosesis of the calcaneocuboid joint.
Stress fractures are treated non-operatively initially but can require surgical fixation if they persist.
References
Davis MF, Davis PF, Ross DS. Expert Guide to Sports Medicine. ACP Series, 2005.
Elstrom J, Virkus W, Pankovich (eds), Handbook of Fractures (3rd edition), McGraw Hill, New York, NY, 2006.
Koval K, Zuckerman J (eds), Handbook of Fractures (3rd edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.
Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Wheeless’s Textbook of Orthopaedics: Cuboid Fracture (http://www.wheelessonline.com/ortho/cuboid_frx)