The cuboid has six bony surfaces, of which five are articular. Thus, a simple fracture will nearly always be intraarticular.
There is swelling, bruising, and point tenderness at the dorsolateral aspect of the foot.
The patient will most often be unwilling to walk and put weight on the lateral aspect of the foot.
In the multi-injured patient, foot fractures are often overlooked and are picked up on the secondary survey. In the unconscious patient, one must rely on a careful physical examination. Swelling, crepitus, or a deformity are suggested signs of underlying injury and should be followed up with appropriate x-rays.
This injury is frequently part of a Lisfranc or Chopart injury, in which case there may also be bruising at the plantar aspect and medial pain. When avulsion fracture is identified, a high suspicion index is needed to exclude Lisfranc and Chopart injuries.
CT with sagittal and coronal reformation helps obtain a three-dimensional understanding of the injury. The CT protocol should call for thin cuts with significant overlap. The fragments are small and easily missed on thicker cuts.
This CT scan shows an 83C(b) fracture with dorsal fragment dislocation.
Mechanism of injury
These fractures are usually caused by multiple mechanisms including motorwheicle crashes and falls.