There are no clear criteria for surgery for a nutcracker fracture. Finally, the articular capsule was resutured. We used about 2.0 g in the fracture site ( Figure 6). We used granular type OSferion® produced by OLYMPUS in Japan. A bone biopsy needle was then used to fill in the large defect with artificial bone ( Figure 5). A hole was created at the fracture site, and the depressed fragments were elevated using surgical instruments, until the regular joint line was restored. The articular capsule was opened widely, and the fracture site was identified using fluoroscopic guidance. Articular surface of metatarsal was kept with a little fibrillation. Using a 1.9 mm arthroscope, we examined the Lisfranc joint ( Figure 3) and noted that the cuboid articular surface between the cuboid and the fourth metatarsal was crushed ( Figure 4). Next, we identified the Lisfranc joint using fluoroscopic guidance and made an incision in the joint capsule. This is the first report of a case of isolated nutcracker fracture of the cuboid with a stable postoperative course.ĭepression of the cuboid articular surface between the cuboid and the fourth metatarsal (3.5 mm).Ī lateral incision was made along the axis from the tip of the fibula to the tip of the fifth metatarsal. Nutcracker fracture of the cuboid is a type of compression fracture that happens when severe abduction of the forefoot causes the cuboid to be caught between the base of the fourth and fifth metatarsals and the anterior surface of the calcaneus. Isolated cuboid fractures are very rare, since they typically occur in combination with midfoot fractures (e.g., cuneiform or navicular) or dislocations (e.g., the Lisfranc joint). Midfoot fractures are rare, with an annual incidence of 3.6/100000 in Edinburgh, and 50% of all midfoot fractures are cuboid fractures. The cuboid is the only bony structure supporting the lateral column of the midfoot, and it is required to maintain polyarticular alignment of the tarsal bones (the calcaneus, the lateral cuneiform, and the fourth and fifth metatarsals). The cuboid is one of the most critical tarsal bones and constitutes a core element of both the longitudinal and transverse arch of the foot. In addition, we suggest our new treatment plan of this fracture. We report a very rare case of isolated nutcracker fracture of the cuboid. Six months after surgery, patient could walk without pain. In this case, we did not plate the fracture. A bone biopsy needle was then used to fill in the large defect with artificial bone. Then the depressed fragments were elevated until the regular joint line was restored. Using a 1.9 mm arthroscope, we examined the Lisfranc joint. Based on these findings, we diagnosed the patient with an isolated nutcracker fracture of the cuboid. CT showed displacement of the joint surface between the cuboid and the fourth metatarsal, with a 3.5 mm depression. The lateral column of his right foot was shortened by approximately 6.5 mm on X-ray. A 61-year-old man presented at our hospital with pain and swelling on the outside of his right foot. Isolated cuboid fractures are very rare, since they typically occur in combination with midfoot fractures or dislocations.
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