Stress fracture of tarsal cuboid bone in early childhood.

PURPOSE: We present the clinical characteristics, radiographic, and bone scintigraphy finding of the cuboid fracture in early childhood.

METHODS: From 2008 to 2012, we identified 25 patients (13 boys and 12 girls) with cuboid fracture who were seen in our institution. Medical records and radiographs as well as bone scintigraphy of 25 patients were reviewed. Nutcracker test was performed as a provocation test.

RESULTS: The mean age of the patients was 24.7 months (range 15-38 months). The average duration of symptom before visit was 7 days (range 2-14 days). Most of the parents/caregivers (76 %) did not recall a traumatic episode. Patterns of limping were variable. Nutcracker test was positive in 11 patients. In 10 of 25 patients, initial plain radiographs of the foot showed no abnormal finding. The average duration of symptom of these patients was 4.5 days (range 2-7 days). In 15 patients, the radiograph of the foot showed sclerosis along the base of the cuboid. Bone scintigraphy of the patients with normal radiograph showed hot spot in cuboid. Eleven patients visited our institution to seek for second opinion as their child has persistent limping gait.

CONCLUSIONS: It is not always possible to make an early diagnosis of this fracture since the initial radiographic finding and physical examination are often negative. Considering the consequences of a missed fracture and avoiding unnecessary treatment, bone scan might be useful in the early diagnosis of the stress fracture of the cuboid in young children.

LEVEL OF EVIDENCE: Diagnostic study, Level IV.