Abstract
Category:
Trauma
Introduction/Purpose:
The navicular plays a vital role in maintenance of the medial column of the foot and provides a pivotal function in hind foot biomechanics. Type 2 fractures demonstrate a primary fracture line from dorsolateral to plantar medial where the major fracture fragment is displaced medially. They are typically the result of high energy and are associated with poor outcome. This study reports on the demographics of a series of Type 2 navicular fractures, the operative technique employed and the subsequent outcome.
Methods:
Six patients with a Type 2 navicular fracture were identified from the theatre records. The study period was June 2014 to February 2016. All patients sustained their injuries in either high speed MVAs or motocross accidents.
All patients had surgery performed after the soft tissue envelope had settled (mean 7 days after injury). The key component to the surgical procedure was the reduction of the constant large medial fragment. This allowed simple access to the navicular for fracture reduction. The construct was supported with a bridge plate. The bridge plate was removed approximately 9 months post surgery. Final radiological follow up was at 12 months post surgery. Clinical follow up included the AOFAS midfoot score by phone questionnaire at a mean of 15 months’ post injury.
Results:
The study comprised 5 males and one female with a mean age of 22 years. In 5 patients the navicular fracture was an isolated injury, in one there was an associated cuboid fracture. None of the patients experienced any significant complications. All patients returned to work, one as a roofer and two to motocross.
AOFAS midfoot scores were obtained from all patients via a telephone conversation at a mean of 15 months’ post injury. The mean score was 70 (range 65 - 80). Radiographs at a mean of 12 months showed no loss of position and maintained alignment.
Conclusion:
Acute fractures of the navicular are uncommon and they typically result in significant long-term morbidity.
Our series demonstrate a technique which is reproducible in both maintaining the length of the medial column but also providing good access to the navicular for fracture reduction. It also results in good clinical outcomes in the short term. All our patients returned to their previous occupations with minimal symptoms.