The cuboid bone is located in the area of ​​the outer part of the foot, but despite this, its isolated fractures are quite rare.

Among foot bone fractures, cuboid bone fractures account for about 2.5%, and among skeletal bone fractures - 0.14%.

Anatomy

The cuboid bone (tal. os cuboideum) refers to the bones of the tarsus of the foot.

Its articular surfaces (formed by cartilage) articulate with the fourth and fifth metatarsals and the calcaneus.

The cuboid bone is located at the outer edge of the foot between the metatarsal bones.

Causes and mechanisms

Fractures of the cuboid bone occur as a result of direct trauma, such as a blow and a heavy object falling on the foot.

Symptoms

Symptoms common to fractures come to the fore: pain, dysfunction, pain intensifies with passive movements, swelling, hemorrhage.

But upon careful examination, symptoms are revealed that characterize the unconditional presence of a fracture of the cuboid bone: acute pain on palpation corresponds to the location of the cuboid bone, the presence of deformation of its contours, stepwise protrusions when fragments are displaced, exacerbation of pain when axial pressure is applied to the IV-V metatarsal bones, when trying to abduct or adduct the forefoot during rotational movements.

In cases where a fracture of the cuboid bone occurs simultaneously with a fracture with subluxation of the bones, a deformity occurs, which depends on the degree of displacement of the fragments with flattening of the arch with deviation of the forefoot outward or inward.

During palpation, pain aggravates when touching all the bones of the area, with axial pressure on all the toes.

Fractures with displacement, subluxation or dislocation of fragments disrupt the contours of the bones along the dorsal surface with the presence of a stepped deformity.

Diagnostics

The final diagnosis is made after an x-ray examination.

But at the same time should be remembered that there are additional bones: the fibular epiphysis of the tuberosity of the V metatarsal bone (described by V. Gruber in 1885) - located in the angle between the cuboid and V metatarsal bones, closer to its posterior surface.

Os regoneum - appears under the tuberosity of the cuboid bone, at the junction of the cuboid and calcaneal bones and can consist of two parts - os cuboideum secundarium in the form of a process of the cuboid bone, which goes towards the scaphoid bone os cuboideum secundarium - a bone that is located between the heel, cuboid and scaphoid bones.

On radiographs, all additional bones have clear surfaces and edges, whereas in fractures, the fracture planes are uneven and jagged. In addition, they are painful on palpation and there is no hemorrhage.

First aid

First aid for a fracture of the cuboid bone corresponds to the actions provided to the victim for fractures of other bones of the tarsus and metatarsus.

It is necessary to fix the ankle and knee joints to prevent displacement of the fragments. For this, you can use any available means (boards, sticks, iron rods, towels, scarves, any other fabrics).

As a last resort, you can bandage the injured leg to the healthy one.

Treatment

Typically, fractures of the cuboid bone are not accompanied by serious displacement of the fragments, as is the case with fractures of the sphenoid bones.

Therefore, treatment comes down to immobilization with a “boot”-type plaster cast, with a metal instep support built into the plantar part.

A plaster cast is applied from the fingertips to the middle third of the shin for a period of 6 weeks. It is important to correctly model the arch of the foot.

Rehabilitation

In the first week after the injury, walking is prohibited, then dosed loads on the injured leg are allowed.

After the immobilization is removed, the patient is prescribed physiotherapeutic treatment, mechanotherapy to develop the ankle joint, and physical therapy. Working ability returns after about 8-10 weeks.

4147 0

A foot fracture is one of the most common types of fracture.

The huge number of bones in the foot, the enormous loads that these bones must withstand every day, and the lack of minimal knowledge about the prevention of foot fractures make this complex anatomical formation especially vulnerable.

Anatomical excursion

The foot is the lower part of the lower limb, which has an arched structure and is designed to absorb impacts that occur when walking, jumping and falling.

The feet perform two main functions:

• Firstly, maintain body weight;
• secondly, provide movement of the body in space.

These functions determine the structural features of the feet: 26 bones in each foot (a quarter of all bones in the human body are located in the feet), joints connecting these bones, a large number of powerful ligaments, muscles, blood vessels and nerves.

The joints are inactive, and the ligaments are elastic and high-strength, so they occur much less frequently than a fracture.

Since we're talking about fractures, let's pay special attention to the bone skeleton of the foot, which consists of the following bones:

1. Heel. This is the largest bone of the foot. It has the shape of a complex three-dimensional rectangle with depressions and protrusions to which muscles are attached and through which nerves, vessels and tendons pass.
2. Astragalus (supracalcaneal). It is in second place in size, unique in its high percentage of articular surface and in that it does not contain a single bone or tendon attachment. It consists of a head, a body and a neck connecting them, which is the least resistant to fractures.
3. Cuboid. It is located in front of the heel bone, closer to the outside of the foot. Forms the arch of the foot and forms a groove, thanks to which the peroneus longus tendon can fully work.
4. Scaphoid. Forms joints with the talus and three sphenoid bones. Rarely, the development of this bone is disrupted and the 27th bone of the foot, an accessory navicular bone connected to the main cartilage, may be observed. When an unskilled reading of an x-ray is performed, an accessory bone is often mistaken for a fracture.
5. Wedge-shaped. Attached to other bones on all sides.
6. Metatarsals. Short tubular bones serve for shock absorption.
7. Phalanges of fingers. They are similar to the phalanges of the fingers in number and location (two flanks for the thumbs and three for each other finger), but shorter and thicker.
8. Sesamoids. Two very small (less than a pea) but extremely significant round bones are located inside the tendons and are responsible for the flexion of the first toe, which bears the maximum load.

Every tenth fracture and every third closed fracture occurs in the foot (for military personnel this figure is slightly higher and amounts to 13.8% in peacetime).

The most common foot fractures are:

• ram bones - less than 1%, of which about 30% of cases lead to disability;
• calcaneal- 4%, of which 83% - as a result of a jump on straight legs from a great height;
• cuboid — 2,5%;
• scaphoid — 2,3%;
• metatarsal- the most common type of foot bone injury.

Moreover, for athletes a fracture of the fifth metatarsal bone is typical under excessive loads, and for people experiencing unusual excessive loads, often in uncomfortable shoes, a fracture of the second, sometimes 3 or 4 and rarely 1 or 5.

The average duration of disability for a toe injury is 19 days. This is not typical for children; incomplete fractures (cracks) occur.

At a young age, split fractures are common, after 50 years - depressed.

Causes of injury

A fracture of the foot bones can occur for several reasons:

• heavy objects falling on the foot;
• jump (fall) from a great height and land on your feet;
• when kicked;
• when hit on the leg;
• with subluxation of the foot due to walking on uneven surfaces.

Features of fractures of different bones

There are different types of fractures depending on the bone that was injured.

Calcaneal fracture

The main cause of occurrence is landing on the heels when jumping from a significant height, the second most common reason is a strong blow during an accident. Upon impact, the weight of the body is transferred to the talus, it crashes into the heel and splits it into pieces.

Fractures are usually unilateral and usually complex.

A special feature is the stress fracture of the calcaneus, the main cause of which is chronic overload of the bone, which has anatomical defects.

It should be noted that the mere fact of the presence of an anatomical defect does not lead to a fracture; constant and fairly serious loads are required for its occurrence, therefore, most often such a fracture is observed in army recruits and amateur athletes who neglect a medical examination before prescribing high loads.

Trauma to the talus

A relatively rare fracture that occurs as a result of a fall from a great height, an accident, or impacts and is often combined with injuries to the lumbar spine and other fractures (of the bones of the foot, the heel usually suffers along with the talus).

The injury is considered severe and leads to disability in a third of cases. This state of affairs is associated with a lack of blood circulation caused by injury.

Even if the vessels are not ruptured, due to their compression, the supply of nutrients to the bone is disrupted, and the fracture takes a very long time to heal.

Cuboid fracture

The main cause of a fracture is a heavy object falling on the leg; a fracture due to an impact is also possible.

As is clear from the mechanism of occurrence, it is usually one-sided.

Scaphoid fracture

It is formed as a result of a heavy object falling on the back of the foot at a time when the bone is under tension. A fracture with displacement and in combination with fractures of other bones of the foot is typical.

Recently, stress fractures of the scaphoid bone have been observed, which was previously very rare - this is primarily due to the increase in the number of non-professional athletes who train without medical and coaching support.

Damage to the sphenoid bone

The consequence of a heavy object falling on the dorsum of the foot and crushing the wedge-shaped bones between the metatarsals and naviculars.

This mechanism of occurrence leads to the fact that fractures are usually multiple, often combined with dislocations of the metatarsal bones.

Metatarsal fractures

The most commonly diagnosed are divided into traumatic (arising as a result of a direct blow or twisting

feet) and fatigue (occur due to foot deformation, prolonged repeated loads, improperly selected shoes, osteoporosis, pathological bone structure).

A stress fracture is often incomplete (it does not go beyond a crack in the bone).

Trauma to the phalanges of the fingers

A fairly common fracture, usually caused by direct trauma.

The phalanges of the fingers lack protection from external influences, especially the distal phalanges of the first and second fingers, which protrude noticeably forward compared to the rest.

Almost the entire spectrum of fractures can be observed: transverse, oblique, T-shaped, and comminuted fractures are found. Displacement, if observed, is usually on the proximal phalanx of the thumb.

In addition to displacement, it is complicated by the penetration of infection through the damaged nail bed, and therefore requires sanitary treatment of the fracture site, even if the fracture at first glance seems closed.

Sesamoid fracture

A relatively rare type of fracture. The bones are small, located at the end of the metatarsal bone of the big toe, and are usually broken due to sports activities associated with heavy load on the heel (basketball, tennis, long walking).

Sometimes it is easier to remove the sesamoids than to treat the fracture.

Symptoms depending on location

Symptoms of foot fractures, regardless of type:

• pain,
• edema,
• inability to walk,
• bruising in the area of ​​injury,
• change in the shape of the foot due to a displaced fracture.

Not all symptoms may be present, and the severity of the symptoms depends on the specific injury.

Specific signs:

In the photo, a characteristic symptom of a foot fracture is swelling and cyanosis.

• with an talus fracture: displacement of the talus (noticeable on palpation), pain when trying to move the thumb, sharp pain in the ankle when moving, the foot is in a flexed position;
• for cuboid and navicular fractures: acute pain in the location of the corresponding bone, when trying to abduct or adduct the forefoot, swelling on the entire anterior surface of the ankle joint.

Diagnostic methods

Diagnosis usually comes down to an X-ray examination, which is carried out in one or two projections, depending on the location of the suspected fracture.

If a talus fracture is suspected, X-ray examination is uninformative; computed tomography is the optimal diagnostic method.

First aid

The only type of first aid for suspected foot fractures is ensuring foot immobility. This is carried out in mild cases by prohibiting movement, in other cases by applying a splint.

The victim should then be taken to the clinic. If swelling occurs, cold can be applied.

Therapeutic measures

Treatment is prescribed depending on several factors:

• type of broken bone;
• closed or open fracture;
• complete or incomplete (crack).

Treatment consists of applying a plaster splint, plaster cast, bandage or fixator, surgical or conservative treatment, including physical therapy and special massage.

Surgical treatment is carried out in exceptional cases - for example, for displaced fractures of the sphenoid bones (in this case, surgery with transarticular fixation with a metal Kirschner wire is indicated) or for fractures of the sesamoid bones.

Recovery after injury

Recovery after injury is achieved through special massage and exercise therapy, reducing the load on the affected limb, using arch supports, and refusing to wear heels for a long period.

With fractures of the sphenoid bones, prolonged pain may occur.

Complications

Complications are rare, with the exception of extremely rare fractures of the talus.

Foot fractures are not life-threatening. However, the quality of later life largely depends on whether the injured person received treatment.

That is why it is important, if symptoms of injury occur, not to self-medicate, but to seek qualified medical help.

In addition, I would like to draw the attention of non-professional athletes and physical educators to the fact that thoughtlessly increasing loads and using inappropriate shoes during exercise is a direct way to close the opportunity to engage in physical education forever.

Even a high-quality recovery from a foot injury will never allow you to return to super-intense training. Prevention is always easier than cure.

21384 0

Most midfoot fractures are intra-articular. With these fractures, the anatomical relationships in the Lisfranc and Chopart joints are often disrupted, which subsequently leads to such serious disorders as limited pronation, supination, adduction and abduction of the foot, long-term lameness, pain, loss of ability to work, and sometimes disability.

Clinical signs of fractures of the navicular, sphenoid and cuboid bones are a sharp swelling in the middle part of the foot, spreading to the anterior surface of the ankle joint, severe deformation of this part immediately after the injury, pain at the fracture site during palpation and pushing the finger along the axis, and the inability to load the injured limb. The final diagnosis is made using X-ray data.

Fractures of the scaphoid are isolated and can be combined with fractures of other bones of the foot. Isolated fractures are rare. According to the literature, scaphoid fractures account for 2.2-2.5% of all foot bone fractures. As you know, the inner part of the foot bears almost the entire weight of the body. The injury causes the space between the sphenoid bones and the head of the talus to narrow, causing the scaphoid to be crushed or splintered and pushed out of its seat.

In this case, the strength of the longitudinal arch of the foot is impaired, which must be taken into account when treating this injury. According to our data, fractures of the scaphoid were observed in 14 patients, of which isolated - in 6, in combination with other bones of the foot - in 8. As a result of direct trauma, the fracture occurred in 10 patients, indirect - in 4. In 3 patients, compression fractures of the scaphoid bones were combined with a dislocation in the Chopart joint. Such a fracture-dislocation occurs when the foot is forcibly abducted or adducted, when a weight falls on the midfoot, or when a wheel of a moving vehicle collides. In most cases, scaphoid fractures were the result of a weight falling on the foot with increased plantar flexion.

These fractures are accompanied by displacement of the fragments, the degree of which depends on the magnitude and direction of the traumatic force and the presence or absence of rupture of the ligaments surrounding the scaphoid bone.

Rice. 4.8. Types of scaphoid fractures.
a - compression fracture; b - separation of the horizontal plate; c — fracture in the sagittal direction; d - additional external tibial bone at the inner edge of the scaphoid bone; e — separation of a fragment of the tuberosity of the scaphoid bone in the area of ​​attachment of the tibial muscle.

As a rule, the displacement occurs on the dorsal side, since the ligaments located on the dorsal surface between the talus, sphenoid and cuboid bones are less strong than on the plantar side. A tear of the horizontal plate of the scaphoid can subsequently cause long-term pain when walking (Fig. 4.8).

Sometimes there is a displacement of fragments to the inner edge of the foot. Typically, such a fragment is a fragment of the tuberosity of the scaphoid bone, formed after a blow or as a result of separation of the tibial muscle at the site of its attachment to the scaphoid bone. These fractures are uncommon and are usually mistaken for the accessory lateral tibia. Therefore, when planning to formulate a diagnosis, you need to take into account that, unlike the additional bone, which has smooth contours, the fragment has jagged contours. In doubtful cases, radiographs of both feet should be compared.

Avulsion of the scaphoid tuberosity is more common than many authors assume. A fresh fracture, as a rule, is mistaken for a bruise and the correct diagnosis is established already at the stage of a formed pseudarthrosis, when pain appears when walking, especially at the moment of rolling the foot. The fracture line in the tuberosity area is often transverse.

There are fractures of the scaphoid with a longitudinal fracture line; the bone is then divided into two closely adjoining fragments - internal and external. The scaphoid fracture line, running from anterior to posterior, is a continuation of the line between the medial and intermediate cuneiform bones. Sometimes the medial fragment is displaced along with the medial cuneiform and first metatarsal bones along the line of the Lisfranc joint posteriorly and inwardly. We observed such displacement in divergent fracture-dislocations in the Lisfranc joint. With fractures of the scaphoid in the sagittal direction, damage to the head or neck of the talus or fractures of the sphenoid bones are often observed, which may be combined with a separation of the inner end of the cuboid or the anterior end of the calcaneus.

With compression fractures of the navicular bone with dislocation of the foot in the Chopart joint, displacement of the fore and middle sections of the foot is possible towards the rear, towards the sole, inwards and very rarely outwards.

Clinical picture

With an isolated fracture of the navicular bone, loading the foot is impossible due to pain, the position of the foot is forced - the patient tries to keep it in a supination position and avoid pronation. When fragments are displaced, they can be felt under the skin. The clinical picture of a fracture-dislocation in the Chopart joint is characterized by a sharp deformation of the midfoot and ankle joint, severe pain when palpating the fracture area, and the inability to put weight on the damaged foot. Foot deformation occurs in the first hours after injury. Sometimes a dislocation in the Chopart joint is accompanied by paralysis of the medial and lateral plantar nerves with numbness of the plantar surface of the fingers and paralysis of the lumbrical muscles. The fingers acquire a claw-like deformity (similar to a “clawed paw” in case of paralysis of the fingers).

X-ray diagnostics

The scaphoid bone is examined in direct (plantar) and lateral (axial) projections. A compression fracture is characterized by a wedge-shaped deformation of the scaphoid with the tip of the wedge facing the plantar side, as well as compaction of the shadow of the bone due to compression of the bone beams. All these signs stand out in relief on photographs in a lateral projection.

Treatment

If a fracture of the navicular bone is not accompanied by displacement of the fragments, a boot-type plaster cast should be applied in moderate plantar flexion of the foot, with a special metal arch support placed in the plantar part to prevent flattening of the arches of the feet. The duration of immobilization is up to 8 weeks. Dosed loads on the foot are allowed after 3-4 weeks. Periodic X-ray monitoring is required during treatment.

If fragments are displaced, you should try to compare them manually under anesthesia or intraosseous anesthesia with the patient lying on the table with the leg bent at the knee joint to a right angle. The reposition technique is as follows. One assistant holds the heel, the other pulls the toes forward, bends the foot and makes an eversion.

The space between the sphenoid bones and the head of the talus increases, and at this moment you need to press your thumb on the protruding fragment of the scaphoid bone; in most cases, the fragment is reduced. After a control x-ray, a boot-type plaster cast is applied.

In case of avulsion of the navicular tuberosity, it is necessary to place the foot in the most supinated position in order to bring the tuberosity together with the tendon closer to its place. In a plaster cast applied in this position, the load is not allowed for 2 weeks; the plaster cast is removed after 6-8 weeks. After this, the pain may persist for a long time - for several months, until the fragments are completely fused, and only after that there is a complete restoration of the function of the limb. If the torn tuberosity of the scaphoid bone, together with the ligament, grows back into place, a violation of statics will not occur.

In more difficult cases of fracture-dislocation of the scaphoid with large displacement of fragments, we perform reduction using a device of our own design.

Reduction method: one wire is passed through the heel bone, the other through the heads of the metatarsal bones; after stretching the bed of the scaphoid, pressing on the displaced fragment, it is easily set.

Compression fractures of the scaphoid with dislocation of the foot at the Chopart joint, which are difficult to treat conservatively, require open reduction.

In case of comminuted fractures of the scaphoid with significant displacement of fragments that are not amenable to conservative treatment, arthrodesis should be resorted to in two directions - between the scaphoid and the head of the talus and between the scaphoid and the posterior surfaces of the three sphenoid bones. However, this intervention can lead to shortening of the inner edge or part of the foot and to lowering of the inner arch - flat feet. Some authors suggest resecting part of the scaphoid to restore balance.

In our opinion, it is more appropriate to use a bone graft after refreshing the articular surfaces of the bones surrounding the scaphoid. In the absence of allobone, a bone graft from the tibia can be used. A bone groove is made in the head of the talus and medial sphenoid bones, where a bone graft is inserted or the defect is tightly filled with spongy substance taken from the wing of the ilium.

The scaphoid bone should not be removed even if it is significantly damaged, since with prolonged plaster immobilization it is possible to achieve fusion. Removal of the navicular bone may subsequently affect the statics of the foot due to a sharp flattening of the sole and valgus curvature of the forefoot. The scaphoid bone can be removed only if it is very severely damaged, but at the same time arthrodesis along the line of the Chopart joint and bone grafting should be performed using the method described above.

After the operation, a blind plaster cast is applied to the knee joint with a metal arch support for 3 months. Loading the affected limb in such a bandage begins after 5-6 weeks. After removing the plaster cast, physical therapy, massage, swimming in the pool or baths are prescribed. In the future, patients must wear orthopedic shoes for at least 6-8 months or insoles for a year or more.

Fractures of the sphenoid bones. Due to the fact that all sphenoid bones, except the medial one, articulate with other bones of the foot on all sides, isolated fractures are extremely rare. Such a fracture is often combined with dislocations of the metatarsal bones in the Lisfranc joint. This is explained by the fact that the anterior articular surfaces of the sphenoid bones articulate with the posterior articular surfaces of the I, II and III metatarsals, and the line between these bones is the inner part of the Lisfranc joint (Fig. 4.9).

Of the three wedge-shaped bones, the medial one is most often damaged, located at the inner edge of the foot and less protected from external influences. However, fractures of all sphenoid bones are possible at the same time.

Fractures of the sphenoid bones are intra-articular and belong to the category of severe foot injuries. In most cases, they are caused by compression or crushing of the wedge-shaped bones between the metatarsals and scaphoid.

Basically, these fractures are the result of direct trauma - falling heavy objects on the dorsum of the foot. The prognosis for these fractures is favorable, but sometimes long-term pain remains. Elderly people may develop static arthrosis in the joints of the foot.

Rice. 4.9. Scheme of a fracture of the medial sphenoid bone with dislocation of the I, II, III metatarsal bones in the Lisfranc joint.

We observed 13 patients with fractures of the sphenoid bones: in 3 - isolated, in the rest - multiple in combination with fractures of other bones of the foot. In 10 patients, the fracture was the result of direct trauma, in 3 – indirect.

Clinical picture

There is a sharp swelling of the dorsum of the foot, spreading to the anterior surface of the ankle joint and the area of ​​the base of the I, II and III metatarsal bones, subcutaneous hemorrhage (hematoma) and sharp pain on palpation. In the area where the traumatic force is applied, indentation of the soft tissues is determined. There is pathological mobility of the entire forefoot.

Damage to the arch of the foot due to fractures of the wedge-shaped bones occurs when a large crushing force is applied, which could displace the broken bones towards the sole and cause traumatic flat feet. However, more often, fractures of the sphenoid bones occur without significant displacement of the fragments.

X-ray diagnostics

The X-ray examination technique and the method for recognizing fractures of the sphenoid bones are the same as for fractures of the scaphoid bone; the only difference is that the overlap of the intermediate and lateral cuneiforms and the metatarsal bones that articulate with them often simulates a fracture line. A slight change in the direction of the X-ray beams makes it possible to avoid overlapping contours.

Treatment

Fractures of the sphenoid bones most often occur without significant displacement of the fragments, so treatment is reduced to the application of a circular plaster cast like a boot with a metal instep support built into the plantar part to prevent the development of post-traumatic flatfoot. Walking is prohibited for 7-10 days, then dosed loads are allowed on the injured limb. The plaster cast is removed after 5-7 weeks, after which physical therapy, massage, and baths are performed. It is recommended to wear shoes with orthopedic cork insoles for a year. Working capacity is restored after 8-10 weeks.

Fractures of the sphenoid bones with displacement of fragments, when conservative measures do not have an effect, are treated surgically with transarticular fixation of fragments with a metal Kirschner wire.

In general, the prognosis for fractures of the sphenoid bones is favorable, except for pain, which is often long-lasting. Fractures of the cuboid bone. The cuboid bone is the key to the outer arch of the foot and breaks very rarely, although it is located in the area of ​​​​the outer part of the foot. Almost always, its fracture is the result of a direct injury, but can be caused by a weight falling on the foot in a position of sharp flexion. In rare cases, when the cuboid bone is compressed between the heel bone and the bases of the IV and V metatarsal bones, it splits into several fragments. The fracture line most often occurs in a sagittal or slightly oblique direction. The external fragment has a protrusion, which is limited anteriorly by a groove for the peroneus longus muscle.

Comminuted fractures of the cuboid bone are often combined with fractures of other bones of the foot, in particular the base of the metatarsal bones, the lateral cuneiform and navicular bones. Isolated fractures of the cuboid bone are extremely rare. When a cuboid bone is fractured, one should not forget about the existence of additional bones, which can be mistaken for a fragment of the cuboid bone. Severance of a piece of bone tissue from the cuboid bone occurs quite often with severe trauma in the midfoot area.

We observed 8 patients with cuboid bone fractures. In 6 of them there was an isolated fracture and in 2 it was combined with fractures of the bases of the IV and V metatarsal bones. In 5 patients the fracture was the result of direct trauma and in 3 patients it was due to indirect trauma.

Clinical picture

With a fracture of the cuboid bone, sharp local pain and hemorrhage are observed, involving the entire outer part of the foot. Often a fragment is felt between the base of the fifth metatarsal bone and the cuboid bone; in this case, the latter moves up, forward or down. The fragment is usually mobile. When the bone is severely damaged, the outer edge of the foot is usually elevated. Passive movements in the Chopart joint are severely limited and painful, and complete blockade of the joint is possible. In most cases, there is no significant displacement of fragments. Fracture lines can be very different (Fig. 4.10). The nature of the fractures is most often comminuted.

X-ray diagnostics

X-ray examination of the cuboid bone is carried out in direct and lateral projections. The most informative picture is in direct projection.

Rice. 4.10. The most common fractures of the cuboid bone.

Treatment

Like fractures of the sphenoid bones, fractures of the cuboid bone are usually not accompanied by large displacement of the fragments, so treatment mainly comes down to immobilizing the foot with a plaster cast like a boot with a metal arch support cast into the plantar part.

Dosed loads on the injured limb are allowed no earlier than after 5-7 days. After removing the plaster cast (after 4-6 weeks), physical therapy, massage, swimming in the pool or baths are prescribed. Working capacity is restored after 6-8 weeks. The patient must wear orthopedic shoes with a cork insole for a year.

With comminuted fractures, the patient often suffers from pain for several months, especially when walking for a long time. In such cases, it is necessary to promptly remove small fragments. When a comminuted fracture of the cuboid bone is combined with fractures of other bones of the foot, preference is given to surgical treatment.

Foot surgery
D.I.Cherkes-Zade, Yu.F.Kamenev

An insufficiently successful fall from a height can lead to serious injuries, including fractures of bones localized in the foot. Just such bones include the cuboid bone, which is localized in the area of ​​the outer part of the foot. Most often, its fracture occurs in combination with a violation of the integrity of other bones in this area. But sometimes it can be damaged on its own, for example, if something falls on your leg. So, let's clarify what to do if a fracture of the cuboid bone of the foot occurs, what should be the treatment of the bone in such a situation.

Of course, the need to treat a fracture of the cuboid bone arises only after confirmation of the diagnosis, which only a traumatologist can do. To determine the problem, an x-ray examination is necessary.

The patient himself may suspect something is wrong based on a number of symptoms.:

Disturbances in the full functioning of the foot - pain when moving and turning, inability to fully stand on the foot;

Severe painful sensations;

Puffiness and swelling;

Subcutaneous bleeding.

Over time, other symptoms may appear:

Pain in a certain area when palpated;

Leg deformities;

Specific step performances;

Increased pain in response to movement.

Treatment of the cuboid bone of the foot

As soon as an injury occurs, it is necessary to fix the knee and ankle joints. This can be done by applying a splint using any available means, for example, sticks and ropes. Fixation will help prevent the dislocation of fragments (if they have formed) and ensure a faster recovery.

Afterwards, you need to quickly visit a traumatologist to take an x-ray and make an accurate diagnosis. If your doctor confirms that you have a cuboid fracture in your foot, further treatment depends on the type of injury. In the absence of fragments and displacement, treatment of the cuboid bone is quite simple. The patient needs to apply a plaster cast, which is shaped like a boot and provides complete fixation of the entire foot. In this case, a special metal plate is placed in the area of ​​the sole - an instep support. The cast is relatively large, it continues from the tips of the fingers and ends in the area of ​​​​the second third of the lower leg (not reaching the knee). And you will have to wear it for about a month, maybe a little more.

If an X-ray examination shows the presence of a complex fracture - displacement or bone fragments, and also if the fracture is open, the patient is indicated for surgical intervention. Doctors normalize the position of the bone, remove fragments and, if necessary, install fixing metal pins. After this, a plaster cast is applied to the affected limb. In case of a complex fracture, you will need to wear it longer - about two to three months.

When a cuboid bone fracture occurs, the victim is usually advised to take analgesics (painkillers) until the unpleasant symptoms disappear. Sometimes doctors may also prescribe non-steroidal anti-inflammatory drugs. In some cases, it is advisable to use local medications in the form of gels or ointments, which help eliminate swelling and get rid of hematomas.

In the first week, a patient with a fracture of this kind cannot even lean slightly on the injured leg. He needs to use crutches to get around. Over time, a slight load is allowed, but only with the approval of a doctor.

Further recovery

After removing the plaster cast, the patient usually experiences discomfort, pain and other unpleasant sensations in the injured limb. This is quite easy to explain, because during the period of wearing the cast the muscles weakened and became completely incapable of exertion. Therefore, proper rehabilitation is necessary to successfully restore physical activity.

The patient needs to undergo regular kneading massages (self-massages) of the entire foot and lower leg. In this case, with the permission of a doctor, you can use warming agents or massage oils.

It is extremely important to gradually load the leg, and not immediately move on to full-fledged physical activity. First you need to do some simple exercises:

Bend and straighten the leg at the ankle joint;

Perform rotating movements with the ankle joint.

After a few days you need to move on to more complex loads:

Rise carefully on your toes and lower yourself down;

Trying to lift various objects from the floor with your foot;

Roll round objects on the floor with your feet.

The recovery program after a cuboid fracture usually includes physical therapy procedures. Thus, exposure to interference currents, ultraviolet therapy and electrophoresis with various active components have an excellent effect. UHF therapy is sometimes practiced.

Usually, for successful recovery, doctors recommend wearing shoes with special arch supports. They will contribute to proper load distribution. Typically, this recommendation remains valid for one year after the cast is removed, but for complex injuries it is better to use appropriate shoes longer. Sometimes doctors even insist on wearing orthopedic shoes made to individual measurements.