Sonographic detection of an isolated cuboid bone fracture not visualized on plain radiographs

We report the case of an isolated cuboid bone fracture in a child that was missed on radiography but was diagnosed on sonography. Plain radiographs of the patient's right foot showed no fracture, whereas sonograms demonstrated a fracture of the cuboid bone that appeared as a steplike discontinuity in the cortical bone. The diagnosis was confirmed on MRI. The fracture was treated with cast immobilization and no weight bearing for 4 weeks. In 8 weeks, the patient had no symptoms and good motor and sensory function of her right foot. Other imaging modalities are usually advocated for diagnosing fractures that are missed by radiography. Over the last decade, sonography has been increasingly used for diagnosing occult fractures. Although its use in such cases is not yet fully established, we believe that in the future, the sonographic detection of an injury that corresponds to the site of the reported pain will be adequate for initiating treatment of many types of fractures.