Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2019; 10(2): 71-80
Published online Feb 18, 2019. doi: 10.5312/wjo.v10.i2.71
Update on diagnosis and management of cuboid fractures
Antonios G Angoules, Nikolaos A Angoules, Michalis Georgoudis, Stylianos Kapetanakis
Antonios G Angoules, Michalis Georgoudis, Orthopaedic Department, Athens Medical Center, Athens 15125, Greece
Nikolaos A Angoules, School of Physiotherapy, AMC Metropolitan College, Athens 15125, Greece
Stylianos Kapetanakis, Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki 55535, Greece
Author contributions: All authors equally contributed to this paper, from the conception of the study and the writing of the discussion through the final structure and design of the paper.
Conflict-of-interest statement: Antonios G Angoules, Nikolaos A Angoules, and Michalis Georgoudis declare that they have no conflict of interests. Stylianos Kapetanakis is a reference doctor for joimax® GmbH and receives payments for teaching.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Antonios G Angoules, MD, PhD, Surgeon, Orthopaedic Department, Athens Medical Center, Distomou 5-7, Marousi, Athens 15125, Greece.
Telephone: +30-69-77011617 Fax: +30-21-6198555
Received: October 24, 2018
Peer-review started: October 24, 2018
First decision: November 1, 2018
Revised: December 11, 2018
Accepted: January 5, 2019
Article in press: January 6, 2019
Published online: February 18, 2019

Cuboid fractures due to the particular bone anatomy and its protected location in the midfoot are rare, and they are usually associated with complex injuries of the foot. Clinical examination to diagnose these fractures should be detailed and the differential diagnosis, especially in the case of vague symptoms, should include the exclusion of all lateral foot pain causes. Conventional radiographs do not always reveal occult fractures, which can be under diagnosed especially in children. In this case, further investigation including magnetic resonance imaging or scintigraphy may be required. The treatment of these injuries depends on the particular fracture characteristics. Non-displaced isolated fractures of the cuboid bone can be effectively treated conservatively by immobilization and by avoiding weight bearing on the injured leg. In the case of shortening of the lateral column > 3 mm or articular displacement > 1 mm, surgical management of the fracture is mandatory in order to avoid negative biomechanical and functional consequences for the foot and adverse effects such as arthritis and stiffness as well as painful gait. In this review, an update on diagnosis and management of cuboid fractures is presented.

Keywords: Cuboid, Fracture, Diagnosis, Treatment, Surgery

Core tip: The cuboid bone is an essential anatomic element of the midfoot contributing greatly to foot biomechanics. Cuboid fractures are rare and usually associated with complex foot fractures and dislocations. Such fractures require a high level of attention in order to ensure a timely diagnosis. Besides a detailed physical examination, further radiological assessment will identify the presence and type of fracture. Although simple cuboid fractures are effectively treated conservatively, displaced fractures require surgical treatment in order to avoid future devastating consequences. Because of the lack of adequate scientific evidence, the ideal surgical approach is still not universally accepted.