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[CLASSIFICATION OF ADULT CUBOID FRACTURE AND EFFECTIVENESS ANALYSIS]
Xiaojian Du1, Jiafu Qu1, Jing Wang1
1Department of Foot and Ankle Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China.
Insights
A new classification system for adult cuboid fractures, based on CT scans, effectively guides treatment decisions. This approach improves fracture healing and patient outcomes, demonstrating its clinical feasibility.
Area of Science:
- Orthopedic Surgery
- Radiology
- Trauma Care
Background:
- Cuboid fractures are complex injuries requiring precise classification for effective treatment.
- Current classification systems may not fully capture the nuances of cuboid fractures.
- Accurate diagnosis and treatment are crucial for optimal patient outcomes and function.
Purpose of the Study:
- To develop and validate a new classification system for adult cuboid fractures.
- To assess the feasibility and effectiveness of this classification in guiding treatment strategies.
- To correlate fracture classification with treatment outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) score.
Main Methods:
- Retrospective analysis of 415 adult patients (416 feet) with cuboid fractures.
- Utilized computed tomography (CT) data for fracture classification.
- Categorized fractures into Type I, II (IIa, IIb), and III based on CT findings.
- Analyzed treatment methods including external fixation, open reduction and internal fixation, and bone grafting.
- Followed patients for 1 to 5 years, assessing healing and AOFAS scores.
Main Results:
- The proposed CT-based classification system was applied to all patients.
- Type I fractures (n=285) treated with external fixation showed a mean AOFAS score of 96.7.
- Type II fractures (n=59) showed good healing and a mean AOFAS score of 95.5.
- Type III fractures (n=72) had varied outcomes depending on treatment, with some experiencing malunion but overall achieving a mean AOFAS score of 93.5.
Conclusions:
- The CT-based classification criteria for adult cuboid fractures are feasible.
- This classification system provides significant guidance for selecting appropriate treatment methods.
- The proposed system aids in achieving better functional outcomes for patients with cuboid fractures.
Objective:
To study the classification criteria of adult cuboid fracture and its guidance feasibility and effect of treatment.
Methods:
A retrospective analysis was made on the clinical data of 415 adult patients (416 feet) with cuboid fractures who had complete CT data treated between May 2009 and April 2014. There were 337 males and 78 females, aged 19 to 64 years (mean, 38.8 years). The left foot, right foot, and bilateral feet were involved in 220 cases, 194 cases, and 1 case respectively. The causes of injury were sprain in 106 cases, traffic accident in 65 cases, falling from height in 129 cases, and heavy crushing in 115 cases. The interval of injury and hospitalization was 2 hours to 3 days (mean, 8.5 hours). Based on CT findings, the classification criteria of cuboid fracture was proposed and methods of treatment was statistically analyzed. The external fixation surgery was performed in patients of type I (285 feet), type IIa (18 feet), and type III (5 feet); open reduction and internal fixation were performed in patients of type IIb (41 feet) and type III (67 feet), and bone grafting was used to repair defects in 58 feet (type III).
Results:
All patients were followed up 1 year to 5 years and 11 months (mean, 2 years and 3 months). Primary healing of incision was obtained. In patients with type I fracture, fracture healed in 165 feet at 4-6 weeks (mean, 5.5 weeks), fracture did not heal in the other 120 feet; the American Orthopaedic Foot and Ankle Society (AOFAS) score was 95-100(mean, 96.7) at last follow-up. In patients with type II fracture, fracture healed in all feet at 6-8 weeks (mean, 6.5 weeks); the AOFAS score was 92-100(mean, 95.5) at last follow-up. In patients with type III fracture, malunion was observed at 6-8 weeks in 5 feet undergoing external fixation, and in 9 feet undergoing open reduction and internal fixation with foot lateral column shortening, forefoot abduction deformity, osteoarthritis, lateral foot pain; fracture healed at 8-12 weeks in 58 feet undergoing open reduction and internal fixation, without osteoarthritis, cuboid bone shortening, and pain at cuboid bone; and AOFAS score was 75-97(mean,93.5) at last follow-up.
Conclusions:
The classification criteria of cuboid fracture proposed based on CT examination is feasible and has guiding significance to the choice of treatment method.
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