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Cuboid nutcracker fracture in children: Management and results
Thomas Ruffing1, Tilmann Rückauer2, Frederic Bludau3
1Westpfalz-Klinikum Kaiserslautern, Department of Trauma and Orthopaedics, Medical Faculty Mannheim, University of Heidelberg and University of Mainz, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Germany.
Insights
Pediatric cuboid fractures are rare but present diverse morphologies. Extra-articular Fenton type 2 fractures are most common, with outcomes varying based on intra-articular involvement or midfoot disruption.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Cuboid bone compression fractures are exceptionally rare in pediatric and adolescent populations.
- Existing literature primarily consists of isolated case reports, limiting comprehensive understanding of this injury.
Purpose of the Study:
- To elucidate the fracture patterns, treatment strategies, and long-term outcomes of cuboid bone fractures in children and adolescents.
- To enhance decision-making pathways for managing this rare pediatric injury through literature review and case series analysis.
Main Methods:
- A retrospective two-center study analyzed patients under 18 with cuboid fractures between 2001 and 2016.
- Data collected included age, gender, injury mechanism, fracture morphology (Fenton classification), displacement, associated injuries, and treatment.
- Long-term follow-up assessed outcomes using the AOFAS Midfoot Scale.
Main Results:
- The cohort included 16 patients (7 boys, 9 girls) with a mean age of 10 years.
- Fenton type 2 fractures constituted 69% of cases; type 3 and 5b were also observed. All children under 10 had type 2 fractures.
- Mean AOFAS scores were 100 for extra-articular type 2, 95 for type 3, and 66 for type 5b, indicating poorer outcomes with intra-articular or mid-tarsal disruption.
Conclusions:
- Pediatric cuboid fractures exhibit varied morphologies and treatment approaches.
- Extra-articular Fenton type 2 fractures are predominant in children, but potential lateral column length loss should be monitored.
- Intra-articular fractures or associated midfoot lesions correlate with lower functional outcome scores.
Introduction:
Compression fractures of the cuboid bone in children and adolescents are rare. Fracture morphology, associated lesions, treatment options and long-term outcomes of this very rare injury are published in a few case reports. This study with review of the literature aims to support the understanding of fracture pattern and optimize pathways of decision making.
Material And Methods:
A retrospective two-center study was performed in a patient cohort treated between 2001 and 2016. All patients aged less than 18 years who sustained a cuboid fracture were included. Age, gender, mechanism of injury, fracture morphology, amount of displacement, associated injuries, and therapy were analyzed. In the follow-up (FU), the AOFAS Midfoot Scale was investigated.
Results:
Fractures of the cuboid bone were diagnosed in 7 boys and 9 girls. The mean age of the patients was 10 years (range: 2.2-16.1 years). According to the classification of Fenton we detected 11 (69%) type 2, 2 (12%) type 3 and 3 (19%) type 5b fractures. Other fracture types according to Fenton were not observed. All children under 10 years sustained a type 2 fracture. Open reduction and internal fixation was performed in 5 (31%) patients. Bone grafting was not necessary. FU was performed in 14/16 patients on average after 9 years (mean; range: 1.4-16.2 years). The mean AOFAS Midfoot Scale at FU for extra-articular type 2 fractures was 100 points, whereas in intra-articular fractures (Type 3) and fractures associated with mid-tarsal disruption (type 5b) worse results were found (95 and 66 points, accordingly).
Conclusion:
This rare injury shows inhomogenous morphologies and offers different treatment approaches. Extra-articular Fenton type 2 lesions are the most common type of cuboid fracture in children (69%). A potential loss of length of the lateral column must be considered. In contrast to adults, type 1, 4, and 5a fractures were not found in our cohort of children and adolescents. Lower scores of the AOFAS Midfoot Scale were found with either intra-articular involvement or associated midfoot lesions.
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