MR Imaging Features of Cuboid Fractures in Children

Overview

Journal Pediatr Radiol

Specialty Pediatrics

Date 2018 Feb 11

PMID 29427027

Citations 1

Authors

M Cody ODell

Nancy A Chauvin

Diego Jaramillo

David M Biko

Affiliations

Soon will be listed here.

Abstract

Background: Cuboid fractures are rare, usually occult on initial radiographs and are often underdiagnosed. MRI is more sensitive than radiographs for detecting acute, non-displaced cuboid fractures in adults, but only case reports have described these findings in children.

Objective: To summarize the MR and clinical features of cuboid fractures and compare MR findings with initial and follow-up radiographs in a cohort of children.

Materials And Methods: A retrospective search for patients <18 years of age with cuboid fractures was performed during a 10-year period at a large tertiary children's hospital. Subjects with cuboid fractures reported on MRI and available clinical history were included. MR images were evaluated for fracture location, fracture morphology, percentage of marrow edema in the cuboid, subchondral disruption, and associated tendon or ligamentous injury. Initial and short-term follow-up radiographs were also reviewed when available.

Results: Nineteen children ages 18 months to 17 years (mean: 9.0 years, standard deviation: 4.1 years, 63% boys) were diagnosed with cuboid fractures by MRI. Most cases of cuboid fractures are related to acute trauma (63%) but can be seen as stress fractures (16%). Most fractures (17/19, 89%) were linear in configuration. Fractures were most commonly adjacent to the tarsometatarsal joint (10/19, 52%). The degree of marrow edema was variable. Ligamentous injury was seen in two patients and tendon pathology was seen in one, all adolescents. Initial radiographs (n=10) were negative in 9 cases (90%). All available follow-up radiographs (n=12, obtained 19-42 days after MRI) demonstrated sclerosis in the region of the fracture.

Conclusion: MR-depicted cuboid fractures in children typically occur in isolation. The fractures were most commonly adjacent to the tarsometatarsal joint and linear in morphology. Initial radiographs were usually normal and follow-up radiographs depicted sclerosis at the site of fracture in all available cases.

Citing Articles

Update on diagnosis and management of cuboid fractures.

Angoules A, Angoules N, Georgoudis M, Kapetanakis S World J Orthop. 2019; 10(2):71-80.

PMID: 30788224 PMC: 6379735. DOI: 10.5312/wjo.v10.i2.71.

References

Kolker D, Marti C, Gautier E . Pericuboid fracture-dislocation with cuboid subluxation. Foot Ankle Int. 2002; 23(2):163-7. DOI: 10.1177/107110070202300215. View

Mayr J, Peicha G, Grechenig W, Hammerl R, Weiglein A, Sorantin E . Fractures and dislocations of the foot in children. Clin Podiatr Med Surg. 2006; 23(1):167-89, ix. DOI: 10.1016/j.cpm.2005.10.011. View

Pierre-Jerome C, Reyes E, Moncayo V, Chen Z, Terk M . MRI of the cuboid bone: analysis of changes in diabetic versus non-diabetic patients and their clinical significance. Eur J Radiol. 2011; 81(10):2771-5. DOI: 10.1016/j.ejrad.2011.10.001. View

Simonian P, Vahey J, ROSENBAUM D, Mosca V, STAHELI L . Fracture of the cuboid in children. A source of leg symptoms. J Bone Joint Surg Br. 1995; 77(1):104-6. View

Miller T, Pavlov H, Gupta M, Schultz E, Greben C . Isolated injury of the cuboid bone. Emerg Radiol. 2004; 9(5):272-7. DOI: 10.1007/s10140-002-0240-9. View

Blumberg K, Patterson R . The toddler's cuboid fracture. Radiology. 1991; 179(1):93-4. DOI: 10.1148/radiology.179.1.2006311. View

Dodson N, Dodson E, Shromoff P . Imaging strategies for diagnosing calcaneal and cuboid stress fractures. Clin Podiatr Med Surg. 2008; 25(2):183-201, vi. DOI: 10.1016/j.cpm.2007.12.001. View

Stalder H, Zanetti M . Stress fracture of the cuboid in an 8-year-old boy: a characteristic magnetic resonance imaging diagnosis. Arch Orthop Trauma Surg. 2000; 120(3-4):233-5. DOI: 10.1007/s004020050054. View

Bahel A, Yu J . Lateral plantar pain: diagnostic considerations. Emerg Radiol. 2010; 17(4):291-8. DOI: 10.1007/s10140-009-0855-1. View

10.

Englaro E, Gelfand M, Paltiel H . Bone scintigraphy in preschool children with lower extremity pain of unknown origin. J Nucl Med. 1992; 33(3):351-4. View

11.

Ceroni D, De Rosa V, De Coulon G, Kaelin A . Cuboid nutcracker fracture due to horseback riding in children: case series and review of the literature. J Pediatr Orthop. 2007; 27(5):557-61. DOI: 10.1097/01.bpb.0000279031.66774.c0. View

12.

Nicastro J, Haupt H . Probable stress fracture of the cuboid in an infant. A case report. J Bone Joint Surg Am. 1984; 66(7):1106-8. View

13.

Yu J, Solmen J . Stress fractures associated with plantar fascia disruption: two case reports involving the cuboid. J Comput Assist Tomogr. 2001; 25(6):971-4. DOI: 10.1097/00004728-200111000-00023. View

14.

Senaran H, Mason D, De Pellegrin M . Cuboid fractures in preschool children. J Pediatr Orthop. 2006; 26(6):741-4. DOI: 10.1097/01.bpo.0000242378.87724.7b. View

15.

Holbein O, Bauer G, Kinzl L . Fracture of the cuboid in children: case report and review of the literature. J Pediatr Orthop. 1998; 18(4):466-8. View

16.

Joo S, Jeong C . Stress fracture of tarsal cuboid bone in early childhood. Eur J Orthop Surg Traumatol. 2014; 25(3):595-9. DOI: 10.1007/s00590-014-1543-8. View

17.

HERMEL M, GERSHON-COHEN J . The nutcracker fracture of the cuboid by indirect violence. Radiology. 1953; 60(6):850-4. DOI: 10.1148/60.6.850. View

18.

Hunter J, Sangeorzan B . A nutcracker fracture: cuboid fracture with an associated avulsion fracture of the tarsal navicular. AJR Am J Roentgenol. 1996; 166(4):888. DOI: 10.2214/ajr.166.4.8610568. View

19.

Williams D, Hanoun A, Hakimi M, Ali S, Khatri M . Talonavicular dislocation with associated cuboid fracture following low-energy trauma. Foot Ankle Surg. 2009; 15(3):155-7. DOI: 10.1016/j.fas.2008.10.001. View

20.

Hsu J, Chang J, Wang S, Wu S . The nutcracker fracture of the cuboid in children: a case report. Foot Ankle Int. 2004; 25(6):423-5. DOI: 10.1177/107110070402500611. View