Joo Sun Young, Jeong Changhoon
Department of Orthopedic Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea.
Eur J Orthop Surg Traumatol. 2015 Apr;25(3):595-9. doi: 10.1007/s00590-014-1543-8. Epub 2014 Sep 24.
We present the clinical characteristics, radiographic, and bone scintigraphy finding of the cuboid fracture in early childhood.
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.
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.
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.
Diagnostic study, Level IV.
我们展示幼儿骰骨骨折的临床特征、影像学及骨闪烁显像表现。
2008年至2012年，我们确定了在本机构就诊的25例骰骨骨折患者（13例男孩和12例女孩）。回顾了25例患者的病历、X线片及骨闪烁显像。进行胡桃夹试验作为激发试验。
患者的平均年龄为24.7个月（范围15 - 38个月）。就诊前症状的平均持续时间为7天（范围2 - 14天）。大多数家长/照顾者（76%）未回忆起有外伤史。跛行模式各异。11例患者胡桃夹试验呈阳性。25例患者中有10例足部初次X线平片未见异常。这些患者症状的平均持续时间为4.5天（范围2 - 7天）。15例患者足部X线片显示骰骨底部骨质硬化。X线片正常的患者骨闪烁显像显示骰骨有热点。11例患者因其孩子持续跛行步态来本机构寻求二次诊断。
由于最初的影像学表现和体格检查常为阴性，早期诊断这种骨折并非总是可行的。考虑到漏诊骨折的后果并避免不必要的治疗，骨扫描可能有助于幼儿骰骨应力性骨折的早期诊断。
诊断性研究，IV级。
