A Case Report of Isolated Cuboid Nutcracker Fracture

Abstract

Isolated cuboid fractures are very rare, since they typically occur in combination with midfoot fractures or dislocations. A 61-year-old man presented at our hospital with pain and swelling on the outside of his right foot. The lateral column of his right foot was shortened by approximately 6.5 mm on X-ray. CT showed displacement of the joint surface between the cuboid and the fourth metatarsal, with a 3.5 mm depression. An MRI revealed no other injuries. Based on these findings, we diagnosed the patient with an isolated nutcracker fracture of the cuboid. Using a 1.9 mm arthroscope, we examined the Lisfranc joint. Then the depressed fragments were elevated until the regular joint line was restored. A bone biopsy needle was then used to fill in the large defect with artificial bone. In this case, we did not plate the fracture. Six months after surgery, patient could walk without pain. We report a very rare case of isolated nutcracker fracture of the cuboid. In addition, we suggest our new treatment plan of this fracture.

Cuboid Injuries

“…The majority of the evidence reporting on the functional outcomes following cuboid fracture fixation comes from case reports [ Table 1 ]. 1 9 19 20 23 24 25 26 27 28 29 The outcomes presented by these studies are favorable. In two small case series involving four patients each, the authors reported no complications and good function postoperatively.…”

Nutcracker Cuboid Fracture: A Case Report and Review

“…“Due to the limited number of reported cases of nutcracker fractures, the best method of treatment has not been determined” [ 12 ]. Ohmori et al reported a “new treatment plan” for an isolated nutcracker injury—arthroscopic elevation of depressed bone fragments and the use of a bone biopsy needle to fill in the large defect with artificial bone [ 13 ]. Nondisplaced fractures may be treated with a short leg cast and non-weight-bearing status [ 14 ].…”

“Nutcracker” Cuboid Fracture in a Collegiate Football Player

“…Cuboid fractures are uncommon in sports, with isolated cuboid fractures being rare 1,8 because they typically occur in combination with other fractures or dislocations about the foot and ankle. Anatomy and function as it relates to the foot biomechanics is important because, once disrupted, they are the main factors that underlie the concern for potential complications.…”

“…Isolated cuboid fractures are rare because cuboid fractures typically occur in combination with other midfoot fractures or dislocations. 1 A 5-year study demonstrated an annual incidence of midfoot fractures as 3.6 in 100,000 per year in the United Kingdom, of which the cuboid accounted for 50% of all midfoot fractures. 2 The cuboid bone has six surfaces, four of which articulate with surrounding bony structures (Figure 1).…”