Advertisement

Pediatric Radiology

, Volume 48, Issue 5, pp 680–685 | Cite as

MR imaging features of cuboid fractures in children

  • M. Cody O’Dell
  • Nancy A. Chauvin
  • Diego Jaramillo
  • David M. Biko
Original Article

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.

Keywords

Children Cuboid Foot Fracture Injury Magnetic resonance imaging Radiography 

Notes

Acknowledgments

This abstract was presented at the Society for Pediatric Radiology 2017 meeting in Vancouver, British Columbia, Canada.

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Pierre-Jerome C, Reyes EJ, Moncayo V et al (2012) MRI of the cuboid bone: analysis of changes in diabetic versus non-diabetic patients and their clinical significance. Eur J Radiol 81:2771–2775CrossRefPubMedGoogle Scholar
  2. 2.
    Senaran H, Mason D, De Pellegrin M (2006) Cuboid fractures in preschool children. J Pediatr Orthop 26:741–744CrossRefPubMedGoogle Scholar
  3. 3.
    Sadineni RT, Pasumarthy A, Bellapa NC, Velicheti S (2015) Imaging patterns in MRI in recent bone injuries following negative or inconclusive plain radiographs. J Clin Diagn Res 9:TC10–TC13PubMedPubMedCentralGoogle Scholar
  4. 4.
    Englaro EE, Gelfand MJ, Paltiel HJ (1992) Bone scintigraphy in preschool children with lower extremity pain of unknown origin. J Nucl Med 33:351–354PubMedGoogle Scholar
  5. 5.
    Yu SM, Dardani M, Yu JS (2013) MRI of isolated cuboid stress fractures in adults. AJR Am J Roentgenol 201:1325–1330CrossRefPubMedGoogle Scholar
  6. 6.
    Joo SY, Jeong C (2015) Stress fracture of tarsal cuboid bone in early childhood. Eur J Orthop Surg Traumatol 25:595–599CrossRefPubMedGoogle Scholar
  7. 7.
    Miller TT, Pavlov H, Gupta M et al (2002) Isolated injury of the cuboid bone. Emerg Radiol 9:272–277PubMedGoogle Scholar
  8. 8.
    Kolker D, Marti CB, Gautier E (2002) Pericuboid fracture-dislocation with cuboid subluxation. Foot Ankle Int 23:163–167CrossRefPubMedGoogle Scholar
  9. 9.
    Borrelli J Jr, De S, VanPelt M (2012) Fracture of the cuboid. J Am Acad Orthop Surg 20:472–477CrossRefPubMedGoogle Scholar
  10. 10.
    Dodson NB, Dodson EE, Shromoff PJ (2008) Imaging strategies for diagnosing calcaneal and cuboid stress fractures. Clin Podiatr Med Surg 25:183–201 viCrossRefPubMedGoogle Scholar
  11. 11.
    Yu JS, Solmen J (2001) Stress fractures associated with plantar fascia disruption: two case reports involving the cuboid. J Comput Assist Tomogr 25:971–974CrossRefPubMedGoogle Scholar
  12. 12.
    Mayr J, Peicha G, Grechenig W et al (2006) Fractures and dislocations of the foot in children. Clin Podiatr Med Surg 23:167–189 ixCrossRefPubMedGoogle Scholar
  13. 13.
    Hermel MB, Gershon-Cohen J (1953) The nutcracker fracture of the cuboid by indirect violence. Radiology 60:850–854CrossRefPubMedGoogle Scholar
  14. 14.
    Bahel A, Yu JS (2010) Lateral plantar pain: diagnostic considerations. Emerg Radiol 17:291–298CrossRefPubMedGoogle Scholar
  15. 15.
    Ceroni D, De Rosa V, De Coulon G, Kaelin A (2007) Cuboid nutcracker fracture due to horseback riding in children: case series and review of the literature. J Pediatr Orthop 27:557–561CrossRefPubMedGoogle Scholar
  16. 16.
    Franco M, Albano L, Kacso I et al (2005) An uncommon cause of foot pain: the cuboid insufficiency stress fracture. Joint Bone Spine 72:76–78CrossRefPubMedGoogle Scholar
  17. 17.
    Hunter JC, Sangeorzan BJ (1996) A nutcracker fracture: cuboid fracture with an associated avulsion fracture of the tarsal navicular. AJR Am J Roentgenol 166:888CrossRefPubMedGoogle Scholar
  18. 18.
    Williams DP, Hanoun A, Hakimi M et al (2009) Talonavicular dislocation with associated cuboid fracture following low-energy trauma. Foot Ankle Surg 15:155–157CrossRefPubMedGoogle Scholar
  19. 19.
    Holbein O, Bauer G, Kinzl L (1998) Fracture of the cuboid in children: case report and review of the literature. J Pediatr Orthop 18:466–468PubMedGoogle Scholar
  20. 20.
    Hsu JC, Chang JH, Wang SJ, Wu SS (2004) The nutcracker fracture of the cuboid in children: a case report. Foot Ankle Int 25:423–425CrossRefPubMedGoogle Scholar
  21. 21.
    Nicastro JF, Haupt HA (1984) Probable stress fracture of the cuboid in an infant. A case report. J Bone Joint Surg Am 66:1106–1108CrossRefPubMedGoogle Scholar
  22. 22.
    Stalder H, Zanetti M (2000) Stress fracture of the cuboid in an 8-year-old boy: a characteristic magnetic resonance imaging diagnosis. Arch Orthop Trauma Surg 120:233–235CrossRefPubMedGoogle Scholar
  23. 23.
    Blumberg K, Patterson RJ (1991) The toddler's cuboid fracture. Radiology 179:93–94CrossRefPubMedGoogle Scholar
  24. 24.
    Simonian PT, Vahey JW, Rosenbaum DM et al (1995) Fracture of the cuboid in children. A source of leg symptoms. J Bone Joint Surg (Br) 77:104–106CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • M. Cody O’Dell
    • 1
  • Nancy A. Chauvin
    • 2
  • Diego Jaramillo
    • 3
  • David M. Biko
    • 2
  1. 1.Department of Radiology and Imaging ScienceEmory University HospitalAtlantaUSA
  2. 2.Department of RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Department of RadiologyNicklaus Children’s HospitalMiamiUSA

Personalised recommendations