Initial Treatment for Nondisplaced Lateral Cuboid Fracture
Nondisplaced lateral cuboid fractures should be managed nonoperatively with immobilization and protected weight-bearing, as nonoperative management is specifically reserved for nondisplaced articular fractures (<1 mm displacement) or avulsion fractures from low-energy trauma. 1
Immobilization Protocol
- Apply a rigid immobilization device (cast or posterior splint) to stabilize the fracture and provide pain relief, similar to the approach used for other nondisplaced fractures 2
- The immobilization should maintain the foot in a neutral position to preserve lateral column length, which is the cuboid's most critical biomechanical role 1
- Duration of immobilization should be 3-4 weeks until clinical healing is evident, following the general principles for nondisplaced fractures 3
- Consider extending immobilization to 5-7 weeks for complete healing based on clinical and radiographic assessment 4
Pain Management
- Initiate regular scheduled simple analgesics (paracetamol/acetaminophen) immediately, as fractures are particularly painful with movement 3
- Use opioids cautiously and sparingly, especially in patients with renal dysfunction 3
- Non-steroidal anti-inflammatory drugs should be used judiciously given contraindications in many patients 3
Weight-Bearing Status
- Protected weight-bearing or non-weight-bearing is recommended initially to prevent displacement and maintain lateral column integrity 1
- Transition to progressive weight-bearing after 3-4 weeks based on clinical healing and pain tolerance 3
Critical Monitoring Considerations
- Maintain high index of suspicion for associated injuries, as cuboid fractures rarely occur in isolation and may be associated with Chopart, Lisfranc, or complex midfoot injuries 1
- Regular radiographic follow-up is essential to monitor fracture healing and detect any late displacement 5
- Patients should return immediately if symptoms worsen or fail to improve as expected 3
Common Pitfalls to Avoid
- Do not miss associated midfoot injuries - the cuboid acts as the cornerstone of the lateral column and bridge between the lateral column and transverse plantar arch, so failure to identify concomitant injuries can lead to flatfoot deformity 1, 6
- Avoid premature weight-bearing before adequate healing, as this can compromise lateral column length and stability of the Chopart and Lisfranc joints 1
- Do not use removable splints for initial management - rigid immobilization is preferred for fracture stability 2