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I don't think there is ever a gold standard for anything. Just my opinion as each case has to be treated individually.
For those cuboid fractures which I have treated I generally immobilize them if the alignement is good. Partial weightbearing to tolerance is allowed.
If asymptomatic then no further treatment is advised. You have to consider the possibility of a C-C fusion somewhere later down the road if the joint is symptomatic, although surgical intervention is suggested immediately if the alignment is poor or the fracture is severely comminuted.
The purpose of this study is to describe the clinical and radiographic presentation of cuboid fractures in children and to produce a guide for appropriate evaluation and treatment.Twenty-eight consecutive patients with cuboid fracture treated at the same institution between 1998 and 2004 were retrospectively analyzed.The mean age at presentation was 38.7 months (range, 14-74 months). All patients presented with an avoidance gait pattern, refusing to bear weight on the lateral side of the foot. There was no history of trauma in 8 patients, and the others had minor trauma such as a fall down a few steps on their feet or ankle sprain. Plain radiographs were the method of diagnosis in all but one of the patients. The feet of 21 patients were immobilized at initial presentation. The other 7 patients were observed clinically until symptoms resolved. All fractures healed completely with no complications, and patients were symptom free in 4.9 weeks (range, 2-13 weeks). Twenty-one patients, immobilized immediately after the first presentation, were symptom free in 4 weeks (range, 2-7 weeks). The remaining 7 patients, who were observed and followed up clinically with no immobilization, were symptom free in 7.9 weeks (range, 5-13 weeks). Six patients had associated ipsilateral fractures, and 8 patients had an associated genetic or systemic abnormality.An awareness of cuboid fractures in children can lead to an early diagnosis, treatment, and recovery without the use of a bone scan, and a focus on the possibility of an underlying genetic or medical disorder must be initiated.
This looks like a good paper
Journal of the American Podiatric Medical Association Volume 91 Number 2 85-88 2001
Isolated Cuboid Fracture A Rare Occurrence
S. Rick Miller, DPM* and Charleen Handzel, DPM
I didn't get round to renewing my JAPMA subscription this year, I must do that.
In the mean time if anyone who would like to email the article
my adress is david.smithpodiatrist@tesco.net.
I had a sudden inversion/eversion, along with a cuboid avulsion ( fracture ) 10/8/02, was casted within two hours at ER, followed up by orthopedic PA who had casted with a weight bearing cast/crutches. Followed up w/therapy, during the interum taking Dilantin for seizure disorder, which in turn made pain erratic due to half life of meds losing potentcy. As a result of being in a weight bearing cast and taking nuero med I had probably been too active, complicating healing process. Was scheduled for triple arthrodesis, but after the first procedure decided against it, I could not tolerate anymore post-op pain. Was fitted for Richie Brace, at first it was good , however the heel is made of a softer material which in turn wears out, causing supination of the foot, which in turn causes compression of the sural nerve along with a streching of ligament going to the first metatarsel. I have been dealing with pain for five and one half years. I then decided to take it upon myself and read in regards to the bio-mechanics of the foot. As a result of measuring the wearing of the rubber heel of the Richie Brace with a carpenters modular ruler I had cut the back side jacket of a note book into small pieces the size of the heel on the brace to compensate for the worn supinated ( outside ) side of the heel. I then taped the four " slices " to the bottom of the heel. It stopped the peroneus brevis tendons from compressing onto the sural nerve by lifting the heel thus lessening the tension being caused by a dropped suppinated heal pulling of the ligament going to the first metatarsel. NO MORE PAIN. C C fusion should have been done as opposed to the inside of the foot.
Cuboid Fracture
Linear Mode
