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Bradshaw CDL. Navicular and Cuboid Fractures. Clin Podiatr Med Surg 2024; 41:425-435. [PMID: 38789162 DOI: 10.1016/j.cpm.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Navicular and cuboid fractures can be complex and difficult to treat. Depending on the mechanism of injury, diagnosis of such fractures is not always possible with conventional radiographs due to the irregularity and overlap of the midfoot bones. Advanced imaging is indicated if a fracture is of high suspicion or to further characterize a displaced fracture. Cuboid and navicular fractures can occur in isolation but are often associated with other midfoot injuries due to their anatomic relationships. Typically, nondisplaced fractures can be treated conservatively, whereas displaced fractures require surgical intervention to prevent future complications.
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Affiliation(s)
- Crystal-Dawn L Bradshaw
- Foot and Ankle Services, WVU Medicine Wheeling Hospital, 10 Medical Park Road Suite 203, Wheeling, WV 26003, USA.
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Baltas C, Mylonas T, Lamprou D, Koskiniotis AE, Arnaoutoglou C. Dorsal Dislocation of Intermediate Cuneiform With Multiple Cuneiform and Cuboid Fractures Combined With Lisfranc Injury: A Case Report. Cureus 2023; 15:e50689. [PMID: 38229780 PMCID: PMC10791154 DOI: 10.7759/cureus.50689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/18/2024] Open
Abstract
Multiple cuneiform fractures combined with isolated intermediate cuneiform dorsal dislocation and cuboid fracture, with disruption of the Lisfranc ligament, are rare injuries. In this study, we present a polytrauma patient who sustained these injuries, his treatment course, and the follow-up period. The patient was operated on the day of the injury and six months after that the results are very satisfactory.
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Affiliation(s)
- Christos Baltas
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Theodoros Mylonas
- Department of Orthopaedics and Traumatology, General University Hospital Of Larissa, Larissa, GRC
| | - Dimitrios Lamprou
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Alexandros E Koskiniotis
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Christina Arnaoutoglou
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
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Pediatric Sports Trauma. Clin Podiatr Med Surg 2023; 40:55-73. [PMID: 36368848 DOI: 10.1016/j.cpm.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pediatric foot and ankle fractures are common in athletic participation. Treatment of pediatric sports trauma must take into account the unique challenges this population presents, and aim to minimize long-term complications. Given the excellent remodeling potential of pediatric bone, conservative treatment can often be used. However, a thorough understanding of physeal anatomy, fracture patterns, and biomechanics is needed to guide treatment choice and determine when surgical intervention is warranted.
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Perloff E, Posner AD, Haddad S, Arain A, Bagchi K. Surgical Management of a Pediatric Cuboid Nutcracker Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00037. [PMID: 34293796 DOI: 10.2106/jbjs.cc.21.00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Cuboid impaction fractures (nutcracker fractures) result from high-energy trauma and are exceedingly rare in children. We present a case of an 8-year-old boy who sustained a comminuted cuboid nutcracker fracture after a fall from height. The patient underwent open reduction and internal fixation with a locking plate. At 1 year postoperatively, lateral column length and articular congruency were maintained, and the patient return to full function and activity. CONCLUSION Cuboid nutcracker fractures in children are rare and can be successfully treated with open reduction and internal fixation with locking plates, with excellent radiographic and functional outcomes.
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Affiliation(s)
- Eric Perloff
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York
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Mabry LM, Patti TN, Ross MD, Bleakley CM, Gisselman AS. Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies. J Am Podiatr Med Assoc 2021; 111:470036. [PMID: 34478529 DOI: 10.7547/20-047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach. METHODS Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed. RESULTS Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient. CONCLUSIONS Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months.
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Reyes AM, Yellin J, von Keudell A. Closed Reduction Percutaneous Pinning Management of a Cuboid Fracture-Dislocation in a 70-Year-Old Man: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00022. [PMID: 33848274 DOI: 10.2106/jbjs.cc.20.00723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 70-year-old man sustained a traumatic injury to his right foot after falling from a 3-foot height. Imaging demonstrated a cuboid fracture with inferomedial dislocation and associated nondisplaced midfoot fractures. Treatment consisted of closed reduction and percutaneous pinning (CRPP) using Kirschner wire fixation. His postoperative recovery was uneventful with full return to activities. CONCLUSION Cuboid fracture-dislocations are exceedingly rare, and subsequently, there is a paucity of treatment recommendations in the literature. To the best of our knowledge, this is the first reported successful closed reduction with percutaneous pinning for a cuboid fracture with associated dislocation. CRPP is a potential treatment option for this injury.
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Affiliation(s)
| | - Joseph Yellin
- Harvard Combined Orthopaedic Residency Program, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arvind von Keudell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Sassine TJ, Terra BB, Giordano V, Ejnisman B. Cuboid nutcracker fracture in a 9-year-old child. BMJ Case Rep 2021; 14:e240441. [PMID: 33541960 PMCID: PMC7868228 DOI: 10.1136/bcr-2020-240441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
A 9-year-old girl presented to the emergency department reporting intense pain and inability to bear weight on her left foot after a classmate tripped over it. Imaging studies confirmed a fracture of the cuboid bone due to compression of the lateral column of the foot (also known as nutcracker fracture). The patient was treated surgically, with direct reduction of the compression fracture and definitive fixation with two Kirschner wires. Cuboid nutcracker fracture is rare in children and adolescents, and potential consequences can occur if it is not correctly diagnosed and adequately managed. Literature on this type of fracture is scarce, along with information on treatment options and results over medium-term and long-term follow-up. We describe this case and review the literature on this particular topic.
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Affiliation(s)
- Tannous Jorge Sassine
- Departamento de Ortopedia, Escola de Medicina Santa Casa de Misericórdia de Vitória, Vitoria, ES, Brazil
| | - Bernardo Barcellos Terra
- Departamento de Ortopedia, Escola de Medicina Santa Casa de Misericórdia de Vitória, Vitoria, ES, Brazil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - Benno Ejnisman
- CETE - Centro de Traumatologia do Esporte, Federal University of Sao Paulo Paulista Medical School, Sao Paulo, SP, Brazil
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Tafur M, Bencardino JT, Roberts CC, Appel M, Bell AM, Gyftopoulos S, Metter DF, Mintz DN, Morrison WB, Small KMS, Subhas N, Weissman BN, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria® Chronic Foot Pain. J Am Coll Radiol 2020; 17:S391-S402. [PMID: 33153552 DOI: 10.1016/j.jacr.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
Chronic foot pain is a frequent clinical complaint, which can significantly impact the quality of live in some individuals. These guidelines define best practices with regards to requisition of imaging studies based on specific clinical scenarios, which have been grouped into different variants. Each variant is accompanied by a brief description of the usefulness, advantages, and limitations of different imaging modalities. The present narrative is the result of an exhaustive assessment of the available literature and a thorough review process by a panel of experts on Musculoskeletal Imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | - Angela M Bell
- Rush University Medical Center, Chicago, Illinois; American College of Physicians
| | | | | | | | | | | | | | | | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Engelmann EWM, Rammelt S, Schepers T. Fractures of the Cuboid Bone: A Critical Analysis Review. JBJS Rev 2020; 8:e0173. [PMID: 32304497 DOI: 10.2106/jbjs.rvw.19.00173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cuboid fractures rarely occur in isolation, and a high index of suspicion for the presence of Chopart, Lisfranc, or complex midfoot injuries should be raised. The cuboid is the cornerstone of the lateral column and acts as a bridge between the lateral column and the transverse plantar arch. Its most important role is maintenance of lateral column length and associated motion in the midtarsal and tarsometatarsal joints. To date, a classification system that is validated for clinical practice (i.e., guidance for management and prediction of outcome and prognosis) is lacking. The principles of operative treatment are restoration of articular congruity, lateral column length, and stability of the Chopart and Lisfranc joints. Nonoperative management is reserved for nondisplaced articular fractures (<1 mm) or avulsion fractures that are caused by low-energy trauma.
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Affiliation(s)
- Esmee W M Engelmann
- Trauma Unit, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Stefan Rammelt
- University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Hennings R, Voigt P, Kahn T, Josten C, Ahrberg AB. Os calcaneus secundarius, a relevant differential diagnosis to fracture or pseudarthrosis of processus anterior of the calcaneus: a CT morphologic description. Surg Radiol Anat 2019; 41:1425-1432. [PMID: 31563970 DOI: 10.1007/s00276-019-02348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE A fracture or a pseudarthrosis of the processus anterior calcanei (PAC) as well as a traumatized Os calcaneus secundarius (OCS) is often overlooked. A clinical or conventional radiological differentiation of these is uncertain. Therefore, a CT scan is recommended. The aim of the study was to identify CT morphological differentiators between OCS and pathologies of PAC. METHODS All CT scans at our trauma center level I from 2010 to 2014, which imaged the entire foot, performed after acute trauma or postoperative control were retrospectively re-examined for OCS, other accessory ossicles (oAOS), fracture or pseudarthrosis of PAC and analyzed for specifiers. RESULTS In 611 CT examinations, 14 (2.3%) accessory ossicles (AOS) at the PAC were detected. 12 (86%) were identified as typical OCS and 2 (14%) as oAOS. 56 (9.2%) pathologies were detected. Of these, 44 (79%) were declared as fractures and 12 (21%) as pseudarthrosis. 7 OCS (58%) and 25 (46%) of the pathologies were not mentioned in the initial CT reports. The main differentiators of OCS to fracture of PAC were the anteromedial localization into a concave notch at the calcaneal facet at PAC and the continuous corticalization. With increasing size, radiological osteoarthritic signs at the OCS were frequent (p ≤ 0.05). CONCLUSIONS The study confirms that AOS or pathologies at the PAC often are not exactly described in CT report. In the context of foot trauma, attention should be paid to this region. Based on the presented differentiation criteria, a precise distinction can be made with the help of a CT.
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Affiliation(s)
- Robert Hennings
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany.
| | - Peter Voigt
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Christoph Josten
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Annette B Ahrberg
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
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