Cuboid fractures can be difficult to identify in children. The presence of a cuboid fracture is rare in children and adolescents, however they can occur. The cuboid bone is one of the bones on the outside of the midfoot. It is a non-weight bearing bone.
What Causes Pediatric Cuboid Fractures?
Cuboid fractures can occur in children from sports-related injuries and falls. Compression fractures of the cuboid are called a “nutcracker cuboid fracture”.
Cuboid fractures can also occur in toddlers when they are first learning how to walk. If they place excessive pressure on the lateral column (outside portion of the foot) they can develop a stress fracture of the cuboid bone.
Symptoms of Pediatric Cuboid Fractures
Symptoms of fractured cuboid bones in children include pain in the lateral midfoot, swelling, bruising, and limping (with recent history of injury). Many young children may not know how to identify their pain, but limping may be the first obvious sign of a broken bone.
Diagnosis of Pediatric Cuboid Fractures
If you suspect that your child has a cuboid nutcracker fracture, it’s best to see your local foot doctor for evaluation.
X-Ray
Your doctor will obtain x-rays to view the foot. An acute cuboid bone fracture will show a fracture line on x-ray. However, cuboid stress fractures may not be immediately visible on an x-ray. Stress fractures are often visible on x-ray 3-4 weeks after the initial onset of pain.
MRI
In some cases, your doctor may choose to order a Magnetic resonance imaging scan (MRI). An MRI will provide detailed images of the bone as well as surrounding soft tissue structures. It can be helpful in identifying a stress fracture that is not present on x-ray.
Bone Scan
Your doctor may order a bone scan to check for the presence of a fracture. A cuboid stress fracture on a bone scan would typically appear as a focal area of increased uptake in the area of the fracture.
Treatment for Pediatric Cuboid Fractures
Treatment of a pediatric stress fracture will depend on whether the fracture is displaced (fracture fragments are shifted) or non-displaced (fracture fragments are aligned).
For non-displaced fractures, doctors will recommend children stay non-weight-bearing in a cast for 4 weeks. This will allow the fracture site to heal. After that, children can transition back into athletic shoes.
If the fracture is displaced, doctors may recommend surgery to fix the fracture. The surgeon will repair the cuboid fracture under anesthesia using fixation such as plates and screws. A child will need to remain off of their foot for 4-6 weeks in a cast boot followed by gradual transition to athletic shoes.
Physical Therapy
Physical therapy will need to be performed three times a week for one month to help improve strength, balance, range of motion in the foot, and to help decrease pain. Physical therapy can help children/adolescents get back to their activities sooner.
Healing Time
Full recovery from a pediatric cuboid fracture can take 4 to 6 weeks in total. Children heal fairly quickly.
Once the fracture is healed, most children can resume normal activities including sports.
Cuboid fractures, although uncommon, can often be missed. It’s important to diagnose them very early to ensure the best possible outcomes.
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References
- Senaran H, Mason D, De Pellegrin M. Cuboid fractures in preschool children. J Pediatr Orthop. 2006 Nov-Dec;26(6):741-4.https://pubmed.ncbi.nlm.nih.gov/17065937/
- Simonian PT, Vahey JW, Rosenbaum DM, Mosca VS, Staheli LT. Fracture of the cuboid in children. A source of leg symptoms. J Bone Joint Surg Br. 1995 Jan;77(1):104-6.https://pubmed.ncbi.nlm.nih.gov/7822362/
- Blumberg K, Patterson RJ. The toddler’s cuboid fracture. Radiology. 1991 Apr;179(1):93-4.https://pubmed.ncbi.nlm.nih.gov/2006311/
- Ruffing T, Rückauer T, Bludau F, Hofmann A, Muhm M, Suda AJ. Cuboid nutcracker fracture in children: Management and results. Injury. 2019 Feb;50(2):607-612.https://pubmed.ncbi.nlm.nih.gov/30580927/
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