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. Hermel and gershoncohen described the compression fracture of the cuboid bone caused by indirect compression and used the term nutcracker fracture. The cuboid is the anatomical name given to one of the bones in the mid foot. Her right foot was forced into excessive plantar flexion.
The fracture was consistent with a nutcracker cuboid fracture. In most cases, it is asymptomatic but may be the cause of acute and chronic foot pain as in cases of stress fracture or diastasis. Segmental fractures call for the complete immobilization of the location of the fracture and a longer recovery time. Since then nine other cases of this type of fracture have. Preschool children with a cuboid compression fracture may limp and refrain from bearing weight on the affected foot, especially on the lateral side of the foot. Radiograph revealed the shortening of the lateral column with old cuboid fracture. Patients presenting with such a cuboid fracture of this nature should be suspected of having an associated lisfranc injury.
In this injury, the cuboid bone is compressed between the bases of the fourth and the fifth metatarsals and the calcaneus. Cuboid fractures have the potential to cause considerable deformity involving the foot arch, lateral column, and the function of the forefoot. Learn the internal fixation of nutcracker fracture of the cuboid. The cuboid is a square bone on the outside of the foot. Stryker variax 2 foot system surgical technique with step by step instructions on orthoracle. The cuboid is the only part of the midfoot that supports the. 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 retrospective search for patients with the diagnosis of a cuboid stress fracture was performed for a 19year period. Nutcracker cuboid fractures are never isolated injuries. It is even more uncommon for a cuboid fracture to occur in isolation, without other associated injuries to the foot. The primary called me around lunchtime that day and said the mri showed a cuboid bone fracture in the left foot and explained that this bone was right where i was indicating alot of pain.
The patient was to follow up on an outpatient basis with orthopedic surgery. 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. 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. A total of 10 patients nine women and one man with isolated stress fracture of the cuboid were identified during the study period. Im ed smith, a sacramento cuboid bone fracture lawyer. Nutcracker cuboid fractures are never isolated injuries the journal of foot and ankle surgery asiapacific, januaryjune 2014. Lateral column shortening complex fracturessignificant shortening consider bridge plate or external fixator. Not so sweet nutcracker fracture direct orthopedic care.
Fractures to the cuboid are a less common injury that presents to the office. Older children may complain of foot pain at the site of the cuboid bone. 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. A case report of isolated cuboid nutcracker fracture. Magnetic resonance imaging of stress injury of the cuneiform bones in patients with plantar fasciitis. It is an important stabilizing structure of the foot, the articulation of the cuboid with the metatarsal bones contribute to almost all plantar and dorsal movements of the lateral aspect of the foot, fractures of this lateral tarsal bone can have complex consequences to everyday foot function 2,3. The term nutcracker fracture denotes a comminuted fracture of the cuboid which can lead to significant. His left foot was crushed and developed dorsolateral swelling and pain. It is more common to find cuboid fractures from a crush injury, in association with other foot fractures and injuries 1, 3, 4. This is the first report of a case of isolated nutcracker fracture of the cuboid with a stable. 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 would do to a nut. Hermel and gershoncohen described a mechanism that can result in an isolated cuboid fracture, in which forced abduction of the forefoot, generally in.
Metatarsal base fractures, particularly of the second, are not uncommon with an abduction mechanism. A cuboid stress fracture is a condition characterized by an incomplete crack in the cuboid bone. Nutcracker fracture of the cuboid radiology reference. He went to a local hospital and the radiograph showed fractures of the cuboid, navicular. The cuboid bone is cubeshaped and connects the foot and the ankle and provides stability to the foot.
Fracture of the tarsal cuboid bone is commonly referred to as the nutcracker fracture, owing to its mechanism of injury. He presented with a localized pain around his left foot. Update on diagnosis and management of cuboid fractures. The methods used to radiographically evaluate the compression fracture of the cuboid and its associated injuries are presented. Os perineum is an accessory bone located within the peroneus longus tendon adjacent to the lateral plantar aspect of the cuboid, which can cause foot 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. Nutcracker fractures of the cuboid compressed are rare and often missed at an initial visit. As their horse falls on them and their foot remains caught in the stirrup, the foot is forced away from the center of the bone, as. Nutcracker fracture in a ballet dancer performing in the. The nutcracker fracture of the cuboid by indirect violence. This called a nutcracker fracture and it is usually the result of an athletic injury, vehicular accident or a misstep from a height.
The stress fracture generally occurs as the result of a gradual build up in tension and microtrauma from the connecting lower leg and foot muscles. It takes a significant amount of compres sive kinetic. They can be difficult to manage and convey a high risk of longterm pain in the foot. Old nutcracker fracture of cuboid ebsco information services. The term nutcracker fracture denotes a comminuted fracture of the cuboid which can lead to significant lateral column shortening and pain if treated improperly.
Traumatic fractures tend to occur when your foot buckles and crushes the cuboid. Navicular avulsion fracture wide arrows and depressed intraarticular fracture of the calcaneus at the calcaneocuboid joint narrow arrows are noted. 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. 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. The purpose of this study was to evaluate the mri appearance of this condition. A nutcracker fracture results when the cuboid is compressed between the calcaneous and the fourth and fifth metatarsels. What is the recovery time fractures of the cuboid bone. 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. Nutcracker fractures of the cuboid are rare and often missed at an initial visit. Cuboid fractures are rare injuries, and treatment methods are illdefined. Although nutcracker fractures of the foot are rare, they can lead to. The published literature discusses these injures with implications of such fractures being isolated injuries. Cuboid stress fractures are most common in the young people who participate in athletic sports like running or dancing. A 48yearold housewife caught the toe of her right shoe on the edge of a stair step.
Mid foot injuries are rare but potentially debilitating in professional dancers. We can evaluate your injuries regarding your accident claim and provide expert analysis of your case. Isolated fractures of the cuboid, as in the case presented, are rare. She sustained an isolated fracture of her left cuboid, consistent with a nutcracker cuboid fracture. A history of significant athletic activities was present in seven individuals, and three presented with pain without a known history of acute or repetitive trauma. We report a 21yearold patient presented with a 9 months old cuboid fracture. The nutcracker fracture journal of emergency medicine. Tenderness over the cuboid bone can be elicited or a nutcracker maneuver may be performed. If you or a loved one has sustained a cuboid bone fracture in an accident, call me for free, friendly advice.
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. In addition, the surgical treatment to correct the nutcracker fracture of the cuboid in our patients is presented. Nutcracker cuboid fracture in a collegiate football player. The cuboid nutcracker fracture isnt a common fracture but it is serious because of how the bone is broken.
Its been found in girls who fall while horseback riding. The nutcracker fracture of the cuboid by indirect violence radiology. Axial ct of the right foot a, b with sagittal c and 3d d reformations. Old nutcracker fracture of cuboid pubmed central pmc. Our elearning platform contains high resolution images and a certified cme of the internal fixation of nutcracker fracture of the cuboid. Cuboid syndrome happens when the joint and ligaments near the cuboid bone in your foot become injured or torn. The injury usually occurs secondary to the traumatic abduction of the forefoot. Patients with a cuboid fracture present with two types. Nutcracker fracture definition of nutcracker fracture by. It is located at the outer aspect of the mid foot just in front of the ankle figure 1. Cuboid fractures, however, are uncom mon, often occurring in association with other injuries to the foot 1. During the last six years, 6 recent cuboid fractures in 6 patients were treated at our hospital by open reduction, allogeneic bone grafting where necessary and internal fixation.
Cuboid and nutcracker fractures musculoskeletal key. 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. All patients underwent an initial threeview radiographic foot series for pain. Nutcracker fracture of the cuboid radiology reference article. A cuboid fracture might also be seen when victims misstep from uneven surfaces, and their ankle buckles. It connects the fourth and fifth metatarsal to the heel bone. Cuboid fractures are rare and usually associated with complex foot. This typically results in a compression fracture of the cuboid between the. The journal of foot and ankle surgery asiapaci c, januaryjune 2014. We discuss the mechanism, relevant anatomy, diagnosis, and principles of treatment of the. Symptoms of a cuboid fracture include bruising, tenderness, swelling, lateral foot pain, instability, and difficulty with weight bearing.
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 figure 1. Associated nutcracker cuboid fractures can occur due to compression by the fourth and fifth metatarsal bases. Cuboid nutcracker fracture due to horseback riding in. Pdf nutcracker cuboid fractures are never isolated injuries. Fractures of the cuboid are uncommon injuries in children, and they should be considered in the differential diagnosis of a limping child with pain in the outer aspect of the foot and inability to bear weight after an injury to the foot. If you think that you might have a fracture in the cuboid, you know theres a problem. Its also known as cuboid subluxation, which means that one of the bones in a. Unusual variant of the nutcracker fracture of the calcaneus and. Cuboid fracture the causes, symptoms, and treatment options.