What is the management of an undisplaced cuboid fracture?

Management of Undisplaced Cuboid Fracture

Undisplaced cuboid fractures should be treated conservatively with rigid immobilization and non-weight bearing for 6 weeks. 1, 2

Diagnostic Considerations

• Cuboid fractures are rare injuries, often difficult to diagnose
• Conventional radiographs may not always reveal occult fractures
• If clinical suspicion is high despite negative radiographs, consider:
  • MRI (nearly 100% sensitivity for occult fractures)
  • CT scan (69-87% sensitivity)
  • Bone scintigraphy for subtle injuries 1, 2

Treatment Algorithm

Conservative Management for Undisplaced Fractures

1. Initial Immobilization:

   • Rigid immobilization with below-knee cast or walking boot 1, 3
   • Non-weight bearing status for first 3-6 weeks 2
   • Appropriate pain management with acetaminophen as primary treatment, limiting opioid use 1

2. Follow-up Protocol:

   • Radiographic assessment at 2,6, and 12 weeks to monitor healing progression 1
   • Transition to protected weight bearing after 6 weeks if healing is adequate 2
   • Progressive return to normal footwear and activities over 3 months 4

Surgical Indications (for displaced fractures)

While the question focuses on undisplaced fractures, it's important to recognize when conservative treatment is not appropriate:

• Displacement of articular surface > 1 mm
• Shortening of lateral column > 3 mm
• Instability of the midfoot 5, 2

Rehabilitation

• Early physical therapy after immobilization period
• Focus on:
  • Ankle and foot range of motion exercises
  • Progressive strengthening
  • Balance training
  • Gradual return to activities 1

Potential Complications

• Post-traumatic arthritis (particularly in cuboid-metatarsal and cuboid-calcaneal joints)
• Lateral column shortening leading to biomechanical dysfunction
• Midfoot stiffness and chronic pain 4, 6

Key Considerations

• The cuboid serves as a critical component of the lateral column of the foot
• Maintaining proper length and alignment is essential for normal foot biomechanics
• Even undisplaced fractures require adequate immobilization to prevent displacement and ensure proper healing 4, 2
• Long-term outcomes for properly managed undisplaced cuboid fractures are generally good 2

Monitoring

• Regular follow-up to assess healing and alignment
• Evaluate for development of post-traumatic arthritis
• Monitor for return of normal gait pattern and function 1, 4

The evidence suggests that conservative management with proper immobilization and protected weight bearing is effective for undisplaced cuboid fractures, with surgical intervention reserved for displaced fractures or those with lateral column shortening.