A cuboid fracture can be isolated, but often is combined with other midfoot fractures. It results from forced plantar flexion and abduction, crushing the cuboid between the calcaneus and fourth and fifth metatarsals. Hermel et al first reported five cases of the nutcracker fracture of the cuboid in 1953 3, which is still the largest series in the literature. Traumatic cuboid fracture treatment if only a crack is visible on xrays, immobilizing the foot with a cast is likely to heal the fracture. We discuss the mechanism, relevant anatomy, diagnosis, and principles of treatment of the.
Associated nutcracker cuboid fractures can occur due to compression by the fourth and fifth metatarsal bases. What treatment is usual for cuboid avulsion fracture when. Nutcracker cuboid fractures are never isolated injuries the journal of foot and ankle surgery asiapacific, januaryjune 2014. The nutcracker fracture of the cuboid by indirect violence. A cuboid fracture can be sometimes be misdiagnosed as an ankle sprain. Nutcracker fracture of the cuboid is a type of compression fracture that happens when severe abduction of the forefoot causes the cuboid to be caught between the base of the fourth and fifth metatarsals and the anterior surface of the calcaneus 3. Sudden severe pain was felt in the tarsal region, and the patient could not step on the injured foot. These cookies, which also could include third party cookies, are used to improve the website and provide more personalized services to you.
Cuboid fractures are frequently associated with other fractures, dislocations, or ligament injuries and may result in considerable longterm disability. The treatment of these injuries depends on the particular fracture. Cuboid fracture definition of cuboid fracture by medical. Pdf nutcracker cuboid fractures are never isolated injuries. Avulsion fractures are generally due to forced inversion and plantar flexion of the foot and are associated with ligament tears. The cuboid bone articulates with the calcaneus, the lateral cuneiform, the navicular, and the fourth and fifth metatarsals. Here, we report a unique case of a nutcracker fracture in which an avulsion fracture of the navicular is seen in conjunction with a fracture of the anterior aspect of the calcaneus, with sparing of the cuboid. What is the recovery time fractures of the cuboid bone. On exam, the location of maximal tenderness is indicated by the white arrow in figure a. Cuboid nutcracker fracture due to horseback riding in children. Its important to treat this type of cuboid fracture correctly because there is a risk that incorrect treatment could lead to permanent disability. Case report a case report of isolated cuboid nutcracker. Within a few minutes she was seen by an orthopedic surgeon.
Nutcracker fractures of the cuboid compressed are rare and often missed at an initial visit. The term nutcracker fracture denotes a comminuted fracture of the cuboid which can lead to significant lateral column shortening and pain if treated improperly. Left untreated, these fractures can lead to severe alterations in foot mechanics and function, such as to severe pain. A cuboid fracture puts your ability to stand at risk, and your ability to walk or run very likely out of the picture you want to avoid any break or fracture of any bone in the foot, including the cuboid bone. Because the injury is so rare, no consistent operative procedure has been established for cuboid bone surgery.
Joint preserving surgery hard to make the multiple fractures and a fusion heal. Not so sweet nutcracker fracture direct orthopedic care. Classification of lisfranc injuries lisfranc classifications are not useful in. We report a 21yearold patient presented with a 9 months old cuboid fracture. Nutcracker fracture definition of nutcracker fracture by. Stryker variax 2 foot system surgical technique with step by step instructions on orthoracle. Particularly in highenergy trauma eg, motor vehicle collision, cuboid fractures may occur in association with several additional tarsal fractures, and complex articular dislocations 3. In addition, we suggest our new treatment plan of this fracture. Ct protocol should be thin cuts with large overlap. This is the first report of a case of isolated nutcracker fracture of the cuboid with a stable. Cuboid nutcracker fracture due to horseback riding in. Fractures of the cuboid are best approached through a. Subsequently, the fracture pattern unique to each subcategory is given a number. Nutcracker fracture in a ballet dancer performing in the.
The term nutcracker fracture denotes a comminuted fracture of the cuboid which can lead to significant. Case report a case report of isolated cuboid nutcracker fracture takaakiohmori, 1,2 shinichikatsuo, 1 chiakisunayama, 1 katsunorimizuno, 1 tomohiroojima, 1 kotaroyamakado, 1 tomonariando, 1 shinwatanabe, 1 seigakuhayashi, 1 andhiroyukitsuchiya 2 department of orthopedic surgery, fukui general hospital, egami, fukui, fukui, japan. Old nutcracker fracture of cuboid pubmed central pmc. Compressed fracture of the cuboid was named nutcracker fracture by hermel and gershoncohen.
Radiograph revealed the shortening of the lateral column with old cuboid fracture. Learn the internal fixation of nutcracker fracture of the cuboid. Old nutcracker fracture of cuboid ebsco information services. Feb 25, 2018 next, the articulations at the calcaneal cuboid and cuboid metatarsal joints were directly visualized fig.
There were several reports about fresh fracture of cuboid,,, but very few it results from forced plantar flexion and abduction, crushing the cuboid between the calcaneus and fourth and fifth metatarsals. A nutcracker fracture of the cuboid refers to a cuboid bone fracture with associated navicular avulsion fracture due to compression between the bases of 4th and. A nutcracker fracture of the cuboid refers to a cuboid bone fracture with associated. He also said non weight bearing for two weeks with crutches and referred me to my regular physician. The ota classification system may be used for research purposes. Nutcracker fracture of the cuboid radiology reference. A fracture that occurs with the forefoot everted on hindfoot pinching cuboid between anterior calcaneus and bases of 4th and 5th metatarsals diffdx navicular fracture, navicular stress fracture, lisfranc fracture, talar head fracture. Nutcracker fracture of the cuboid is a rare injury usually caused by forced abduction of the forefoot on a fixed hindfoot. Cuboid fractures also occur after a fall from height as a result of an axial load. Most cuboid bone fractures are stress fractures that are caused by ordinary daily wear and tear, especially with athletes or dancers. A cuboid fracture puts your ability to stand at risk, and your ability to walk or run very likely out of the picture. Old nutcracker fracture of cuboid yu g, yu t, yang y, yuan f.
In addition, the surgical treatment to correct the nutcracker fracture of the cuboid in our patients is presented. The authors present an isolated cuboid fracture in a collegiate football player following a supination, hyperplantarflexion injury of the foot with recommendations for. An associated avulsion fracture of the tuberosity of the navicular was also present. Nutcracker fracture in a ballet dancer performing in the nutcracker. We discuss the mechanism, relevant anatomy, diagnosis, and principles of treatment of the nutcracker cuboid fracture. She sustained an isolated fracture of her left cuboid, consistent with a nutcracker cuboid fracture. A case report of isolated cuboid nutcracker fracture. Fracture of the tarsal cuboid bone is commonly referred to as the nutcracker fracture, owing to its mechanism of injury. This is a case presentation involving a complex foot injury noted to have first through third metatarsal fractures and a navicular fracture on plain radiographs and an associated cuboid and first metatarsal base fracture seen only on ct scan. It is more common to find cuboid fractures from a crush injury, in association with other foot fractures and injuries 1, 3, 4. Nutcracker fracture of the cuboid is a type of compression fracture that happens when severe abduction of the forefoot causes the cuboid to be caught between the base of the fourth and fifth metatarsals and the anterior surface of the calcaneus.
The usual treatment for this fracture is internal fixation and a bone graft, if the healthcare provider feels it is necessary. To our knowledge, this is the first reported case of this type of nutcracker fracture in the literature. Nutcracker fractures of the cuboid are rare and often missed at an initial visit. Patients suffering a cuboid bone fracture due to traumatic injuries will likely need immediate cuboid bone fracture treatment. Old nutcracker fracture of cuboid yu g, yu t, yang y, yuan. Direct blows or highenergy crush injuries usually cause cuboid fractures.
The patient was to follow up on an outpatient basis with orthopedic surgery. The patient remained symptomfree and no radiographic evidence of recurrence was observed 1 year postsurgery. Old nutcracker fracture of the cuboid with shortening of the lateral column change. Since then nine other cases of this type of fracture. Cuboid and nutcracker fractures musculoskeletal key. If your symptoms persist for more than three months, you should make another appointment to see your doctor. He presented with a localized pain around his left foot. Six months a er surgery, patient could walk without pain.
You want to avoid any break or fracture of any bone in the foot, including the cuboid bone. An xray of the left foot showed a commuted fracture of the cuboid bone with mildly displaced fragments, as well as moderate soft tissue edema red arrows. Traumatic fractures of the cuboid bone can be difficult to fix if the shape of the bone is destroyed. Our elearning platform contains high resolution images and a certified cme of the internal fixation of nutcracker fracture of the cuboid. Case report a case report of isolated cuboid nutcracker fracture. Cuboid fracture the causes, symptoms, and treatment options. Xray examination of the right foot disclosed a severely comminuted fracture of the cuboid with widening and disruption of the calcaneocuboid joint fig. The doctor showed me the xray and explained what an avulsion was. Symptoms of a cuboid fracture include bruising, tenderness, swelling, lateral foot pain, instability, and difficulty with weight bearing. A nutcracker fracture results when the cuboid is compressed between the calcaneous and the fourth and fifth metatarsels. If its a more complex traumatic cuboid fracture, surgery is probably required.
We report a case of this fracture in a 58yearold man who was treated on the principle of ligamentotaxis and the position being held with kirchner wires for a period of 5 weeks. Cuboid fracture simple patterns can be treated with direct reduction and. What treatment is usual for cuboid avulsion fracture when the avulsion is seperated from the bone. The cuboid is the anatomical name given to one of the bones in the mid foot. In the case of continued pain without abnormality on xrays, a bone scan or mri might be useful in uncovering a stress fracture. Ct clearly demonstrated a minimally displaced, comminuted cuboid fracture with articular extension into both the calcaneocuboid joint posteriorly and the cuboid metatarsal joints anteriorly, with little. Introduction e cuboid is one of the most critical tarsal bones and con. Cuboid syndrome is an injury related to a dislocation of the cuboid bone in the middle of the foot.
A cuboid stress fracture is a condition characterized by an incomplete crack in the cuboid bone. The authors present an isolated cuboid fracture in a collegiate football player following a supination, hyperplantarflexion injury of the foot with recommendations for successful evaluation and. Compression fracture of the cuboid by indirect violence is not mentioned in many textbooks 3, 5, 6, 9, 10, 11 and is seldom referred to in the voluminous literature. A direct trauma is another possible cause of a nutcracker fracture. Articular impaction was addressed with mobilization of the lateral cuboid cortical surface and elevation of the depressed articular segments to produce a congruent articular surface fig.
It is even more uncommon for a cuboid fracture to occur in isolation, without other. Complex fractures significant shortening consider bridge plate or external fixator. Injuries of the cuboid are uncommon and often missed. Nutcracker cuboid fracture in a collegiate football player. Ct with sagittal and coronal reconstructions is useful in obtaining a threedimensional understanding of the injury. Although it is uncommon, sometimes a nutcracker fracture of the cuboid is seen in horseback riding children whose foot has become stuck in the stirrup. Nutcracker cuboid fractures are never isolated injuries. What is the recovery time fractures of the cuboid bone answers. Apr 14, 2020 fractures may either be an avulsion fracture, where an attached tendon or ligament pulls away a part of the bone, or a body fracture.
I was diagnosed today with a cuboid avulsion fracture of the left foot. The methods used to radiographically evaluate the compression fracture of the cuboid and its associated injuries are presented. She has pain throughout the day that worsens with prolonged weightbearing. Update on diagnosis and management of cuboid fractures. In comminuted crush nutcracker type fractures there may also be deformity with shortening of the lateral column. The fracture was consistent with a nutcracker cuboid fracture.
The injury usually occurs secondary to the traumatic abduction of the forefoot. Lateral column shortening complex fracturessignificant shortening consider bridge plate or external fixator. Cuboid fracture abduction force compressive failure nutcracker fracture indications for orif articular displacement 2mm. It is the key bone in the rigid lateral column of the foot. We report a very rare case of isolated nutcracker fracture of the cuboid. Mar 25, 2020 a cuboid bone fracture is sometimes referred to as a nutcracker fracture because the cuboid is often broken between the fourth and fifth metatarsals in a way that is reminiscent of a nut being cracked between the prongs in a nutcracker. These fractures were treated conservatively by immobilization in a plaster cast. Cuboid fractures are rare injuries and have an annual incidence of approximately 1. A particular type of isolated cuboid fracture was presented in the literature by hermel and gershoncohen in 1953 who coined the term nutcracker fracture in order to describe a cuboid fracture that is caused by compression between the calcaneus proximally and the bases of the fourth and fifth metatarsals distally. Others might be caused by trauma from a car, motorcycle or bicycle accident when trauma forces a foot to buckle and crush like a nutcracker. The nutcracker fracture of the cuboid by indirect violence radiology. The cuboid bone is an important stabiliser of the lateral column of the foot 1,and is involved in all intrinsic movements of midfoot and hind foot 2.
Cuboid fractures are rare injuries, and treatment methods are ill defined. The published literature discusses these injures with implications of such fractures being isolated injuries. Fracture of base of the 2nd metatarsal and compression fracture of the cuboid. A nutcracker fracture of the cuboid refers to a cuboid bone fracture with associated navicular avulsion fracture due to compression between the bases of 4 th and 5 th metatarsals and calcaneus bone. It is even more uncommon for a cuboid fracture to occur in isolation, without other associated injuries to the foot 2. Aug 30, 2019 cuboid fractures are rare injuries and have an annual incidence of approximately 1. Cuboid syndrome often results from injury or overuse and is more common in athletes and dancers.
It is located at the outer aspect of the mid foot just in front of the ankle figure 1. It is even more uncommon for a cuboid fracture to occur in isolation, without other associated injuries to the foot. Cuboid fractures are rare injuries, and treatment methods are illdefined. Patients presenting with such a cuboid fracture of this nature should be suspected of having an associated lisfranc injury. Isolated fractures of the cuboid, as in the case presented, are rare. Internal fixation of nutcracker fracture of the cuboid. This will start with an xray evaluation of the fracture site to determine whether or not there is displacement in the fracture. This classifies cuboid fractures as 76 with a extraarticular, b involving either the calcaneocuboid joint or metatarsocuboid joint, c involving both major joint surfaces. The cuboid bone is the keystone of the lateral longitudinal arch of the foot. Subscribe to get full access to this operation and the extensive foot surgery atlas.
If you think that you might have a fracture in the cuboid, you know theres a problem. Academy of orthopedic surgeons classification periprosthetic hip fracture. Six months after surgery, patient could walk without pain. Nutcracker fracture of the cuboid radiology reference article. Nutcracker fracture indications for orif articular displacement. Plates, screws, external fixators and bone grafts can all be used to repair the bone. Metatarsal base fractures, particularly of the second, are not uncommon with an abduction mechanism. Nutcracker fracture of the cuboid associated with metatarsal dislocation and its treatment. Jul 01, 2015 fracture of the tarsal cuboid bone is commonly referred to as the nutcracker fracture, owing to its mechanism of injury. Surgery is done to restore the bone to its regular shape and return the side of the foot to its regular length.
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