SLR - July 2020 - Gireesh Reddy

Fractures of the Cuboid Bone: A Critical Analysis Review

Reference: Engelmann, Esmee W.m., et al. “Fractures of the Cuboid Bone: A Critical Analysis Review.” JBJS Reviews, vol. 8, no. 4, Apr. 2020, doi:10.2106/jbjs.rvw.19.00173.

Scientific Literature Review

Reviewed By: Gireesh Reddy, DPM 
Residency Program: Detroit Medical Center – Detroit, Michigan 

Podiatric Relevance: Cuboid fractures are uncommon in relation to other foot injuries. The incidence of a cuboid fracture is extremely low and is thought to mostly occur in conjunction with another midfoot injury. Cuboid fractures are also underdiagnosed. It is important in the podiatric surgical field to gain an understanding of this type of injury because when misdiagnosed, cuboid fractures can cause disruption to the lateral column and the transverse arch, which ultimately affects the biomechanics of the foot. This article was intended to discuss the presentation of cuboid fractures, effects on biomechanics and treatment options via a review of available literature. 

Methods: The articles for this review were gathered by searching multiple databases focusing on functional outcomes of cuboid fractures from 2002. Per authors of this article there are only a few case series regarding this presentation and that a study with a large sample size of cuboid fractures was not located. The intent of this analysis is to develop an organized structure in diagnosing and managing cuboid fractures. 

Results: The authors found that the functional outcomes of cuboid fractures included chronic pain, stiffness, instability, shortening of the lateral column, collapse of medial arch, and pronation. It was also noted that cuboid fractures typically occur in conjunction with other midfoot injuries. It is important that patients with suspected midfoot injury undergo advanced imaging for confirmation.  In regards to treatment options, they found that open reduction internal fixation was typically performed as a primary procedure, followed by secondary arthrodesis if symptoms of posttraumatic arthritis were present. Arthrodesis of the fourth and fifth tarsometatarsal joints is not recommended as it causes stiffness in the lateral column. Lengthening of the lateral column is presented as an optional procedure if the cuboid injury caused lateral column shortening. 

Conclusions: Cuboid fractures, although rare, are often under diagnosed. Untreated cuboid fractures can cause shortening of the lateral column, which in turn results in a flat foot deformity. Treatment of cuboid fractures may be surgical or conservative depending on the fracture type, however it is vital to ensure proper treatment to avoid biomechanical deformity. In conclusion, the cuboid is an essential tarsal bone as it engages in both the lateral column and the transverse arch. As podiatric surgeons, it is essential that we understand how to diagnose and treat this injury because although it is uncommon, it can greatly affect the patient’s lifestyle if left untreated.

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