Avulsion fracture of the base of the fifth metatarsal is the most common isolated injury of the foot resulting from inversion or adduction force. We discuss the mechanism, relevant anatomy, diagnosis, and principles of treatment of the nutcracker cuboid fracture. Bone stress injuries of the talus in military recruits. An avulsion fracture is also sometimes called a "ballerina fracture" or "dancer's fracture" because of the pointe position that ballet dancers assume when they are up on their toes. Left cuboid (foot bone) fracture ICD-10-CM S92.212A is grouped within Diagnostic Related Group (s) (MS-DRG v40.0): 562 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with mcc 563 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc 963 Other multiple significant trauma with mcc Comminuted fractures will more likely need an operative procedure [14]. (OBQ06.266) This is said to be because of a relatively protected position in the midfoot [3]. cuboid. Isolated stress fractures of the cuboid are rare, with a review of literature showing less than a 1% incidence. 78, no. Surgical management is indicated for nonunions, significantly displaced fractures, and for elite athletes. 423425, 2016. low-impact maneuvers tailored to improve balance. Copyright 2018 Alan Lucerna et al. official website and that any information you provide is encrypted The patient was to follow up on an outpatient basis with orthopedic surgery. Ital J Anat Embryol. {"url":"/signup-modal-props.json?lang=us\u0026email="}, ElBeialy M, Avulsion fracture of the dorsal cuboid bone. Due to this anatomy, a cuboid fracture is considered rare. Patient Data Age: 45 years Gender: Male x_ray Frontal Oblique X-ray Frontal Other cuboid fractures are stress fracture, body fracture, or fracture-dislocation of the cuboid. Cuboid fractures due to the particular bone anatomy and its protected location in the midfoot are rare, and they are usually associated with complex injuries of the foot. Eur J Radiol. Published by Diane; Thursday, August 18, 2022 . Midtarsal fusion has been described. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. Bookshelf Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. H. Jahn and K. G. Freund, Isolated fractures of the cuboid bone: two case reports with review of the literature, The Journal of Foot Surgery, vol. 60, no. G. Yu, T. Yu, Y. Yang, B. Li, F. Yuan, and J. Zhou, Nutcracker fracture of the cuboid: management and results, Acta Orthopaedica Belgica, vol. Team Orthobullets (D) Clinical examination to diagnose these fractures should be detailed and the differential diagnosis, especially in the case of vague symptoms, should include the exclusion of . In an avulsion fracture, your bone moves one way and your tendon or ligament moves in the opposite direction with a broken chunk of bone in tow. (OBQ06.159) The anatomy of the cuboid is complex, with six articular surfaces involvement in all of the intrinsic movements of the midfoot and hindfoot [1]. Particularly in high-energy trauma (eg, motor vehicle collision), cuboid fractures may occur in association with several additional tarsal fractures, and complex articular dislocations [ 3 ]. usually full ROM of ankle and subtalar joint, may be difficult to see and are often missed, more sensitive to identify fracture than radiographs, will show signal intensity on T2 image due to inflammation, any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success, failure of cast immobilization and non weight bearing, minimally displaced Type I and II navicular body fractures, avulsion fractures that failed to improve with nonoperative modalities, tuberosity fractures that went on to symptomatic nonunion, avulsion fractures involving > 25% of articular surface, tuberosity fractures with > 5mm diastasis or large intra-articular fragment, displaced or intra-articular Type I and II navicular body fractures, used for Type I and II navicular body fractures, ORIF followed by external fixation vs. primary fusion, fusion of talonavicular and naviculocuneiform joints in navicular avascular necrosis, Posterior Tibial Tendon Insufficiency (PTTI). The authors likened this compression to a nutcracker effect and noted that this mechanism can result in a nutcracker cuboid fracture [3, 68]. 98-B, no. This condition should be a consideration in a patient with continual lateral foot or ankle pain, especially if the patient has persistent lateral foot pain, is athletically inclined, and has a history of repetitive use such as running, triathlon, and jumping activities such as ballet. 2, pp. Professionalism & Rotation Evaluations Accurate ACGME levels AND summative faculty feedback the residents want. Smith et al. Copyright 2022 Lineage Medical, Inc. All rights reserved. Treatment can be nonoperative or operative depending on fracture displacement, ankle stability, presence of syndesmotic injury, and patient activity demands. Fractures of the cuboid can present with varying swelling and deformity of the lateral midfoot. An X-ray of the left foot showed a commuted fracture of the cuboid bone with mildly displaced fragments, as well as moderate soft tissue edema (red arrows). Cuboid syndrome is an easily misdiagnosed source of lateral midfoot pain, and is believed to arise from a subtle disruption of the arthrokinematics or structural congruity of the calcaneocuboid(CC) joint, which in turn irritates the joint capsule, ligaments, and fibularis (peroneus) longus tendon. 72-B, no. . 2022 Aug 8. Disclaimer, National Library of Medicine Cuboid fractures are frequently associated with other fractures, dislocations, or ligament injuries and may result in considerable long-term disability. This type of fracture often occurs during a high-energy event, such as a car collision or a fall from a significant height. Biomechanics. The cuboid constitutes part of the lateral longitudinal arch of the foot [4]. We discuss the mechanism, relevant anatomy, diagnosis, and principles of treatment of the nutcracker cuboid fracture. mechanism is plantarflexion or eversion/inversion, can involve talonavicular or naviculocuneiform ligaments, mechanism is eversion with simultaneous contraction of PTT, may represent an acute widening/diastasis of an accessory navicular, mechanism of injury is usually due to chronic overuse, often seen in athletes running on hard surfaces, most common complications include delayed union and non-union, Spontaneous navicular AVN (Mueller-Weiss syndrome), Spontaenous navicular AVN is a rare disease that and can be seen in middle aged adults with chronic midfoot pain, navicular bone and its articulations play an important role in inversion and eversion biomechanics and motion, Sangeorzan Classification of Navicular Body Fractures, (based on plane of fracture and degree of comminution). In: StatPearls [Internet]. Initial radiographs were reported as unremarkable and MRI was requested. Plantar flexion of the foot may be involved at the time of injury (Gaines). tuberosity fractures with > 5mm diastasis or large intra-articular fragment. Navicular Fractures. 84A fractures are the most common cuboid fracture. 512515, 1989. Avulsion fractures of the cuboid mostly occur at the insertion of the plantar calcaneocuboid ligament. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. On examination: mild swelling, hotness, and tenderness over the lateral malleolus and base of the dorsal side of the right foot. -. . Diagnosis can be made with plain radiographs and CT studies are helpful for fracture characterization and surgical planning. There can be compensatory eversion of the hindfoot [2]. navicular bone and its articulations play an important role in inversion and eversion biomechanics and motion. This most often happens when you suddenly change direction. Swelling and ecchymosis over the cuboid should raise suspicion of this injury and when other midfoot injuries are present , the cuboid articulations should be carefully inspected for subtle injury. The major concerns with outcome include pain, loss of the lateral structural integrity of the foot, and decreased range of motion of the lateral tarsometatarsal joints [5]. 336339, 1991. 6, pp. ADVERTISEMENT: Supporters see fewer/no ads. It is more common to find cuboid fractures from a crush injury, in association with other foot fractures and injuries [1, 3, 4]. Diagnosis can be made with plain radiographs of the foot. It is the only bony structural support for the lateral column of the midfoot [5]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. All rights reserved. Cuboid Fracture Orthobullets - 9 images - daily dose cuboid fracture, osteochondral lesions of the talus and occult fractures of the foot and, Menu Home ; Login & Register ; Contact ; Home; Cuboid Fracture Orthobullets; Cuboid Fracture Orthobullets. Little high-quality evidence can be found on the best treatment for navicular-cuboid fractures. A talus fracture can cause significant loss of function in your ankle. talus. Nondisplaced fractures may be treated with a short leg cast and non-weight-bearing status. (OBQ15.114) Body fractures of the cuboid are usually intra-articular and crescentic-shaped and due to . 30, no. W. R. Smith, P. F. Stahel, T. Suzuki, and P. Gabrielle, Current Diagnosis & Treatment in Orthopedics, Musculoskeletal Trauma Surgery, chapter 2, McGraw-Hill, New York, NY, USA, 5th edition, 2014. sharing sensitive information, make sure youre on a federal Female athlete triad and stress fractures. According to Smith et al., who performed a large retrospective study of cuboid fractures, there is no current widely accepted classification for cuboid fractures and there are no long-term outcome studies [3]. Tarsal Navicular Fractures are rare fractures of the midfoot that may occur due to trauma or due to repetitive microstress. Ohmori et al. FOIA A cuboid fracture is considered rare. decreased ankle plantarflexion strength with avulsion fractures. S. Carsen, B. J. Quinn, E. Beck, H. Southwick, and L. J. Micheli, "Nutcracker Fracture" in a Ballet Dancer Performing in The Nutcracker, Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science, vol. B. Sangeorzan and M. Swiontkowski, Displaced fractures of the cuboid, The Journal of Bone & Joint Surgery (British Volume), vol. The mechanisms of injuries include overuse and neuropathic conditions, although most cases are related to trauma. What is the internervous plane for a posterior approach to the glenohumeral joint? The cuboid bone is within the area of the mid-foot. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Type 3 injuries (13 factures, 6.8%) are intra-articular fractures solely within the body of the cuboid. In patients with scapular fractures, what other fracture is MOST commonly observed? Clinical exam did not show evidence of other foot or leg injuries. Others may be along the lateral border of the cuboid due to cuboid adduction on the calcaneus, posing tension on the lateral calcaneocuboid ligament. Epidemiology Incidence rare <1% of all fractures 3-5% of shoulder girdle fractures Demographics age commonly between 25-50 males > females Location scapular body/spine = 45-50% A cuboid fracture is considered rare. avulsion fractures involving > 25% of articular surface tuberosity fractures with > 5mm diastasis or large intra-articular fragment displaced or intra-articular Type I and II navicular body fractures technique medial approach used for Type I and II navicular body fractures ORIF followed by external fixation vs. primary fusion indications This is an isolated shoulder injury, and he has no neurologic deficits on physical exam. government site. External fixation may have a role in some cases [8]. 2001 Apr-Jun;106(2):85-98. Others may be along the lateral border of the cuboid due to cuboid adduction on the calcaneus, posing tension on the lateral calcaneocuboid ligament. Loss of length of the lateral column due to a cuboid fracture can result in abduction of the forefoot with a planus deformity. In: StatPearls [Internet]. The foot is anatomically subdivided into the hindfoot, midfoot, and forefoot. The .gov means its official. This does not need surgery Type 3 Cuboid Fracture note that the indications and the best method of surgical treatment have not been established due the rarity of the fracture and the paucity of literature [5]. A 30 year-old male is involved in a motor vehicle collision and sustains a scapular fracture. The rest of her exam was unremarkable. Avulsion fractures are the most common of the tarsal fractures representing about 70% of the cuboid fractures. note that when a nutcracker cuboid fracture is associated with lateral column shortening, lengthening of the lateral column, open reduction internal fixation (ORIF), and bone grafting may be needed [3]. In trauma patients with multiple injuries, patients with scapula fractures have been shown to have an association with which of the following, as compared to patients without scapula fractures? neurologic. Imaging includes X-rays of the foot. A patient sustains a displaced scapular neck fracture. The fracture occurs via two main mechanisms: chronic overuse injuries causing a stress fracture (often in athletes) acute high-energy trauma where the head of the talus impacts the concavity of the navicular bone Classification The Sangeorzan classification is used to assess the severity of isolated navicular fractures and to determine management: (OBQ08.134) The importance of increasing awareness amongst radiologists. The cuboid bone is on the most lateral aspect of the mid-foot, articulating with the calcaneus proximally and the base of the fourth and fifth metatarsals distally. When. The treatments described in the literature include such options as immobilization with casting, external fixation, and open reduction internal fixation with or without bone grafting. Check for errors and try again. Fracture cuboid is uncommon (about 5 to 10 percent of the tarsal fractures) and is frequently associated with lateral column fracture or tarsometatarsal joint fracture-dislocation. It is one of the most common fractures of the foot and has unique . vascular. 19, no. Thank you. Clin Pract. A cuboid fracture is considered rare. Avulsion fractures of the cuboid mostly occur at the insertion of the plantar calcaneocuboid ligament. [1]Cuboid syndrome has been documented in the podiatric, orthopaedic, osteopathic, and . reported a new treatment plan for an isolated nutcracker injuryarthroscopic elevation of depressed bone fragments and the use of a bone biopsy needle to fill in the large defect with artificial bone [13]. Surgical management is indicated for intra-articular fractures, displaced scapular body/neck fractures, open fractures, and those associated with glenohumeral instability. Treatment is generally nonoperative with cast immobilization and non weight-bearing for the majority of fractures. Yu et al. The cuboid bone is on the most lateral aspect of the mid-foot, articulating with the calcaneus proximally and the base of the fourth and fifth metatarsals distally. This site needs JavaScript to work properly. The patient will most often be unwilling to walk and put weight on the lateral aspect of the foot. calcaneus. Undisplaced metatarsal fractures and the nutcracker cuboid fractures are often apparent when radiographs are repeated two weeks after an injury. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Would you like email updates of new search results? 2022 Aug 1. J. Koch, Rahimi Nutcracker fractures of the cuboid, The Journal of Foot Surgery, vol. An X-ray of the left foot showed a commuted fracture of the cuboid bone with mildly displaced fragments, as well as moderate soft tissue edema (Figure 1). Physical therapy will not only help you heal but it can also help prevent further injury. Isolated stress fractures of the cuboid are rare . Others may be along the lateral border of the cuboid due to cuboid adduction on the calcaneus, posing tension on the lateral calcaneocuboid ligament. Isolated cuboid fracture is a rare fracture. 557561, 2007. MeSH A left clavicular fracture was found on exam and on the imaging studies. HHS Vulnerability Disclosure, Help Comminuted fractures will more likely need an operative procedure like open reduction internal fixation (ORIF) and bone grafting as well as placement of external fixators. -, Saxena A, Fullem B, Hannaford D. Results of treatment of 22 navicular stress fractures and a new proposed radiographic classification system. Trauma since 1 year. 2006 Jul;39(1):199-204. An orthopedic consult was obtained in the emergency department. 2000 Mar-Apr;39(2):96-103. Ankle fractures are very common injuries to the ankle which generally occur due to a twisting mechanism. Nutcracker cuboid fractures have been described in ballet dancers, likely due to repetitive axial loading of the foot [9]. Type 2 fractures (25 fractures, 13%) are isolated extra-articular injuries involving the body of the cuboid. Copyright 2022, StatPearls Publishing LLC. Curr Sports Med Rep. 2014 Nov-Dec;13(6):370-6. doi: 10.1249/JSR.0000000000000099. oblique fractures that extend distal to coronoid excision and triceps advancement indications elderly patients with osteoporotic bone fracture must involve <50% of joint surface nonunions outcomes salvage procedure that leads to decreased extension strength may result in instability if ligamentous injury is not diagnosed before operation Techniques Transverse fracture of dorsal fragment that involves < 50% of bone. 2018 Jul 10;8(3):1093. The plantar surface of the cuboid has attachments for the short and long plantar ligaments [2]. Treatment is usually nonoperative with a sling. CT scan of the scapula shows the glenoid to be translated medially 3mm, and anglulated 20 degrees from its anatomic axis. Epidemiology Incidence 850854, 1953. An official website of the United States government. The modified Judet approach to the posterior scapula exploits the internervous interval between what two muscles? She sustained an isolated fracture of her left cuboid, consistent with a nutcracker cuboid fracture. Not all ankle injuries are ankle sprains - Case of an isolated cuboid stress fracture. 216219, 2012. 2007 Apr;62(1):16-26. Extra-articular (25%) . Tarsal Navicular Fractures are rare fractures of the midfoot that may occur due to trauma or due to repetitive microstress. 2006 Oct;37(4):575-83. R. B. Abu-Laban and N. G. Rose, Ankle and Foot, in Rosens Emergency Medicine: Concepts and Clinical Practice, J. Scapula Fractures are uncommon fractures to the shoulder girdle caused by high energy trauma and associated with pulmonary injury, head injury, and increased injury severity scores. Before . The authors declare that they have no conflicts of interest. As noted by Fenton et al., there are no long term reports of outcomes following fractures of the cuboid [2]. 7, pp. In: StatPearls [Internet]. -, Sormaala MJ, Niva MH, Kiuru MJ, Mattila VM, Pihlajamki HK. After your examination you conclude this to be an isolated injury and there is no neuromuscular compromise of the limb. Bone. J. Hsu, J. Chang, S. Wang, and S. Wu, The Nutcracker Fracture of the Cuboid in Children: A Case Report, Foot & Ankle International, vol. CONCLUSION. Your talus is the main connection between your foot and your leg. D. Ceroni, V. De Rosa, G. De Coulon, and A. Kaelin, Cuboid nutcracker fracture due to horseback riding in children: case series and review of the literature, Journal of Pediatric Orthopaedics, vol. A talus fracture is a broken bone in your ankle. Treatment is generally nonoperative with cast immobilization and non weight-bearing for the majority of fractures. avulsion fractures involving > 25% of articular surface. Three types of navicular fractures generally occur: Avulsion fractures, high-energy fractures with other associated injuries, and stress fractures. Avulsion fractures of the cuboid mostly occur at the insertion of the plantar calcaneocuboid ligament. Treatment usually requires surgery, and the recovery process can take months. Further imaging of the injury is shown in Figures C and D. What is the most appropriate management of this injury? A competency based surgical skill training & evaluations system that is mobile, user-friendly, and improved technical training. Talus fractures usually occur due to high-impact injuries such as car accidents. Due to the limited number of reported cases of nutcracker fractures, the best method of treatment has not been determined [12]. Classification. The cuneiforms are located on the medial side of the midfoot. connects the dorsal aspect of the anterior process to the cuboid and navicular. A posterior fiberglass splint was recommended as well as non-weight bearing on the affected foot. Unable to process the form. Talus Fractures. 8600 Rockville Pike Oblique fracture, usually from dorsal-lateral to plantar-medial. Surgical management is indicated for intra-articular fractures, displaced scapular body/neck fractures, open fractures, and those associated with glenohumeral instability. Diagnosed with tendinopathy and pain since then. A fracture is a break or crack in a bone that often results from an injury. -, Berger FH, de Jonge MC, Maas M. Stress fractures in the lower extremity. Which of the following correctly identifies the internervous plane utilized for the Modified Judet approach to the scapula? There are no long-term reports of outcomes following fractures of the cuboid. Appropriately managed, these stress fractures are among the quickest to heal, as the cuboid has a generous vascular supply. 6, pp. Treasure Island (FL): StatPearls Publishing; 2022 Jan. An avulsion fracture can happen to any bone that's connected to a tendon or ligament. The foot is comprised of 26 bones and 33 joints. Careers. 27, no. It is likely that the patient described had just such a force (axial load with abduction) from the motor vehicle accident. Cuboid fractures are considered rare, even more so without other associated injuries to the foot. There are 5 main classifications of cuboid fractures that we have outlined below: Type 1 Cuboid Fracture An avulsion fracture is where a tendon or ligament pulls off a fragment of bone. Body fractures of the cuboid are usually intra-articular and crescentic-shaped and due to . With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. All three (medial, middle and lateral) articulate with the navicular proximally. A 35-year-old male is involved in a motor vehicle accident and suffers the fracture shown in Figure A. Isolated fractures of the cuboid, as in the case presented, are rare. A 20-year-old female restrained driver presented to the emergency department (ED) after motor vehicle accident. note that little has been published on the frequency, diagnosis or treatment of the nutcracker fracture in the pediatric population. Nutcracker cuboid injuries in children can be difficult to diagnose [11]. 28, no. Immobilization in sling x 2 weeks then PT, Immobilization in sling x 8 weeks then PT. Koch makes a similar point. 10031008, 2016. Bethesda, MD 20894, Web Policies 25, no. (OBQ07.122) A. Marx, R. S. Hockberger, and R. M. Walls, Eds., Philadelphia, Pa, USA, Elsevier Health Sciences, 2014. We report the case of a 20-year-old female restrained driver who presented to the emergency department (ED) after a motor vehicle accident. A talus fracture is a break in one of the bones that forms the ankle. P. Fenton, S. Al-Nammari, C. Blundell, and M. Davies, The patterns of injury and management of cuboid fractures: a retrospective case series, The bone & joint journal, vol. Clinical presentation There is swelling, bruising, and point tenderness at the dorsolateral aspect of the foot. Diagnostic considerations of lateral column foot pain in athletes. J Foot Ankle Surg. What is the most appropriate initial treatment for this injury? 124127, 2015. Computerized tomography (CT) imaging may be helpful when the diagnosis is unclear [5]. Because of these important anatomic elements, any disturbance of the articular surfaces of the cuboid can lead to a profound disruption of the movement and biomechanics of the midfoot [2]. Federal government websites often end in .gov or .mil. Children have been described with nutcracker cuboid injuries associated with horseback riding [10]. Lateral foot pain. Unable to load your collection due to an error, Unable to load your delegates due to an error. Each articulates with a single metatarsal (MT) distally - medial : 1 st MT, middle : 2 nd MT; lateral - third MT. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Accessibility Clipboard, Search History, and several other advanced features are temporarily unavailable. This is an open access article distributed under the. In: StatPearls [Internet]. Arm sling for 1-2 weeks followed by graduated advancement of range of motion, Figure-of-Eight sling for 1-2 weeks followed by graduated advancement of range of motion, Open reduction internal fixation of only the scapula utilizing deltopectoral approach, Open reduction internal fixation of only the scapula only utilizing the extensile Judet approach, Open reduction internal fixation of the scapula and clavicle. A Jones fracture is a horizontal or transverse fracture at the base of the fifth metatarsal. 3, pp. An isolated cuboid stress reaction/fracture is typically manageable by a primary care clinician (who is knowledgeable and comfortable with fracture management), podiatry, sports medicine, or orthopedics. It is even more uncommon for a cuboid fracture to occur in isolation, without other associated injuries to the foot. assess for neuologic compromise due to swelling. 4, pp. Physical therapy to treat cuboid syndrome can include: exercises designed to strengthen the foot, stretching activities that focus on the foot and calf muscles and/or. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-51586, Avulsion fracture of the dorsal cuboid bone. 2016, Article ID 3264172, 5 pages, 2016. Diagnosis is made with plain radiographs of the ankle. Foot conditions can be challenging to diagnose and treat due to their complex anatomy. Yu et al. Of note, the tendon of the peroneus longus courses in a groove on the inferior surface of the cuboid bone [4]. It is even more uncommon for a cuboid fracture to occur in isolation, without other associated injuries to the foot [2]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. The diagnosis may be difficult to make and can be missed on the initial evaluation [5]. The site is secure. The lateral cuneiform also articulates laterally with the cuboid in a variable manner. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Body fractures of the cuboid are usually intra-articular and crescentic-shaped and due to rotational motion trauma to the forefoot in a plantar-flexed position. The stabilizing ligaments that hold the calcaneus in place occupy very specific locations, and the Achilles tendon enthesis is in a relatively constant location; therefore, avulsion fractures occur in reproducible locations. She complained of left clavicular and left foot pain. So, full examination of the foot for other fractures is a must. 6, pp. and transmitted securely. Hermel and Gershon-Cohen described a mechanism that can result in an isolated cuboid fracture, in which forced abduction of the forefoot, generally in combination with an axial load, can compress the cuboid between the bases of the 4th and 5th metatarsals and the calcaneus [6]. (OBQ20.36) This area comprises the navicular medially, three cuneiform bones, and the cuboid on the lateral side. The injury usually occurs secondary to the traumatic abduction of the forefoot. Due to the repetitive mechanical forces dissipated in the area, the foot is prone to overuse injuries, especially stress fractures. Routine radiographs must include oblique medial view. 2022 Jul 12. 5, pp. We have found isotope bone scans valuable in . M. W. Chapman, R. M. Szabo, and R. A. Marder, Chapman's Orthopaedic Surgery, chapter 111, LWW, Philadelphia, Pa, USA, 2000. T. Ohmori, S. Katsuo, C. Sunayama et al., A Case Report of Isolated Cuboid Nutcracker Fracture, Case Reports in Orthopedics, vol. The https:// ensures that you are connecting to the M. B. Hermel and J. Gershon-Cohen, The nutcracker fracture of the cuboid by indirect violence, Radiology, vol. You can rate this topic again in 12 months. Hsu et al. A 32-year-old female is transported to your institution's emergency department after being involved in a motor vehicle collision. Here we report the case of a 20-year-old female restrained driver who presented to the emergency department (ED) after a motor vehicle accident. Please enable it to take advantage of the complete set of features! 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