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never visited CUBOID PLANTAR AVULSION FRACTURE
Contributed by: Radiology Residency Program Faculty & Staff.
Patient: 47 year old female
History: 47 y/o female with foot pain after an MVA.
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Fig. 1: Plain film radiographs demonstrate a minimally displaced plantar avulsion fracture of the navicular which is only visualized on the lateral view.Fractures of the lateral sesamoid and third metatarsal are also noted.

Fig. 2: Plain film radiographs demonstrate a minimally displaced plantar avulsion fracture of the navicular which is only visualized on the lateral view.Fractures of the lateral sesamoid and third metatarsal are also noted.

Fig. 3: Coronal reconstructed images demonstrate a small avulsion fracture of the cuboid at the site of the patient's pain.

Fig. 4: Surface rendering on the 3D workstation demonstrates the small plantar avusion fracture of the cuboid

Fig. 5: Surface rendering on the 3D workstation demonstrates the small plantar avusion fracture of the cuboid

Fig. 6: Surface rendering on the 3D workstation demonstrates the small plantar avusion fracture of the cuboid

Fig. 7: Surface rendering on the 3D workstation demonstrates the small plantar avusion fracture of the cuboid
Findings:

Plain film radiographs demonstrate a minimally displaced plantar avulsion fracture of the cuboid which is only visualized on the lateral view. Fractures of the lateral 1st metatarsal sesamoid and third metatarsal are also noted.

CT images also demonstrate avulsion of the plantar aspect of the cuboid at the insertion point of the plantar calcaneocuboid ligament.

Diagnosis: Plantar avulsion fracture of the cuboid.
Discussion:

Isolated fracture of the cuboid is rare.

Injury to the cuboid may occur with athletic injuries or in high energy trauma, as in our patient.

Patients with Ehlers-Danlos syndrome have increased incidences or cuboid injury

The cuboid articulates with the calcaneus, navicular, lateral cuneiform, and the lateral two metatarsals.

The plantar aspect forms the roof of the peroneal groove. Plantar cuboid fracture can, therefore, be associated with peroneal longus injury. Plantar avulsion fractures are usually seen at the ligamentous attachment of the plantar calcaneocuboid ligament.

"Nutcracker injury" is the most common cause of cuboid fracture with impaction of the cuboid between the calcaneus and the lateral metatarsals due to forefoot abduction or torsional stress.

Stress fractures of the cuboid in athletes does occur, use Tc-99m bone scan to diagnose.

OTA classification of cuboid fractures is the most commonly used.

Osteonecrosis, nonunion, and post-traumatic oseteoarthritis are problems asociated with cuboid fractures

References:

1. Koval, K. Zuckerman, J. Handbook of Fractures. 2nd Edition. Lippincott; Philadelphia, 2002.
2. Theodore T. Miller, Helene Pavlov, Monali Gupta, Elizabeth Schultz, Craig Greben, Isolated injury of the cuboid bone, Emergency Radiology, Volume 9, Issue 5, Nov 2002, Pages 272 - 277.
3. Karasick, D. Schweitzer, M. The Foot. In: Lee Roger's Radiology of Skeletal Trauma. Churchill Livingston: Philadelphia, 2002.

Submitted by Craig Johnson, DO PGY-4 Radiology Resident and Victoria Griffiths, MD Attending Physician Aultman Hospital

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Additional Details:

Case Number: 5341997Last Updated: 07-18-2006
Anatomy: Skeletal System   Pathology: Trauma
Modality: Conventional RadiographExam Date: Access Level: Readable by all users

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