Acta Chir Orthop Traumatol Cech. 2025; 92(1):28-35 | DOI: 10.55095/achot2024/034
The Outcomes of Navicular Fracture SurgeryOriginal papers
- 1 Department of Trauma Surgery, České Budějovice Hospital, a.s., České Budějovice
- 2 Department of Trauma Surgery, Pardubice Hospital, Pardubice
- 3 Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague
- 4 Clinic of Traumatology, Faculty Hospital Olomouc, Olomouc
- 5 Faculty of Medicine and Dentistry, Palacky University Olomouc
- 6 Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague
Purpose of Study: Inadequate treatment of displaced fractures of the navicular bone may result in malalignment, formation of non-union, accelerated development of osteoarthritis or avascular necrosis and thus a fundamental limitation of mobility and gait disturbance. The aim of our study was to evaluate the results in our group of patients undergoing surgery for navicular fractures.
Material and method: Our retrospective monocentric study included all surgically treated navicular fractures in patients over 18 years of age performed in our department between 2009 and 2018. A total of 18 patients met these criteria and were invited for clinical and radiographic follow-up. One patient refused to attend and two were lost to follow-up. The remaining 15 patients underwent clinical assessment, including the use of AOFAS midfoot and VAS scores, and the grade of osteoarthritis was determined using radiographs.
Results: Our final group of patients consisted of six women and nine men. The mean age of the patients at the time of surgery was 43 (21–67) years, with mean follow-up duration of 68 (18–130) months. The most common mechanism of trauma was high-energy injury occurring in nine of cases. According to the Schmid classification, six fractures were Type I and II each whereas three cases were Type III fractures. Concomitant injuries involving the foot and ankle were present in six cases. All fractures healed.
Open reduction and internal fixation (ORIF) was performed in 14 cases. The radiographs showed the presence of osteoarthritis grade 0 or I in nine patients and osteoarthritis grades II and III in six patients. The AOFAS Midfoot scale was excellent and good in eleven cases, satisfactory in two and poor also in two cases. The average AOFAS Midfoot scale was 87.7 points. A procedure-related complication was a case of skin necrosis in a patient eventually undergoing cuneonaviculotalar arthrodesis in another hospital.
Discussion: Consistent with literature data, our group showed a higher incidence of concomitant injuries in the foot region. Use of two approaches was not associated with an increased risk of developing avascular necrosis. We do not recommend the use of Kirschner wires for definitive osteosynthesis although we do use them as part of staged treatment or as an additional type of fixation. Like other authors, we observed higher grades of post-traumatic osteoarthritis in the subgroup of patients with more severe injuries.
Conclusion: Open reduction and stable osteosynthesis of navicular fracture-displacements are associated with good outcomes in most patients. The most serious consequences of these fractures are post-traumatic arthritis and pain. It is critical to search for concomitant injuries. Given the rarity of these fractures, they should be preferably treated in specialised medical centres.
Keywords: fracture, tarsal navicular, foot, hindfoot.
Received: January 8, 2024; Revised: January 8, 2024; Accepted: July 13, 2024; Published: March 13, 2025 Show citation
References
- Astion DJ, Deland JT, Otis JC, Kenneally S. Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg Am. 1997;79:241-246.
Go to original source...
Go to PubMed...
- Atif A, Westrick E. Management of midfoot fractures and dislocations. Curr Rev Musculoskelet Med. 2018;11:529-536.
Go to original source...
Go to PubMed...
- Clements JR, Dijour F, Leong W. Surgical management navicular and cuboid fractures. Clin Podiatr Med Surg. 2018;35:145-159.
Go to original source...
Go to PubMed...
- Coulibaly MO, Jones CB, Sietsema DL, Schildhauer TA. Results and complications of operative and non-operative navicular fracture treatment. Injury. 2015;46:1669-1677.
Go to original source...
Go to PubMed...
- Cronier P, Frin JM, Steiger V, Bigorre N, Talha A. Internal fixation of complex fractures of the tarsal navicular with locking plates. A report of 10 cases. Orthop Traumatol Surg Res. 2013;99(4 Suppl):241-250.
Go to original source...
Go to PubMed...
- Diab HS. Outcome of ligamentotaxis and percutaneous screws for navicular fractures. Curr Orthop Pract. 2019;30:42-46.
Go to original source...
- DiGiovanni CW. Fractures of the navicular. Foot Ankle Clin. 2004;9:25-63.
Go to original source...
Go to PubMed...
- Dungl P. Ortopedie a traumatologie nohy. Avicenum, Praha, 1989.
- Evans J, Beingessner DM, Agel J, Benirschke SK. Minifragment plate fixation of high-energy navicular body fractures. Foot Ankle Int. 2011;32:485-578.
Go to original source...
Go to PubMed...
- Marshall D, MacFarlane RJ, Molloy A, Mason L. A review of the management and outcomes of tarsal navicular fracture. Foot Ankle Surg. 2020;26:480-486.
Go to original source...
Go to PubMed...
- McKeon KE, McCormick JJ, Jonson JE, Klein SE. Intraosseous and extraosseous arterial anatomy of the adult navicular. Foot Ankle Int. 2012;33:857-918.
Go to original source...
Go to PubMed...
- Patel NG. Navicular fractures: aetiology and management. Orthop Trauma. 2018;32:423-427.
Go to original source...
- Penner MJ. Late reconstruction after navicular fracture. Foot Ankle Clin. 2006;11:105-124.
Go to original source...
Go to PubMed...
- Ramadorai UE, Beuchel MW, Sangeorzan BJ. Fractures and dislocations of the tarsal navicular. J Am Acad Orthop Surg. 2016;24:379-389.
Go to original source...
Go to PubMed...
- Rammelt S, Missbach T. Chopart joint injuries: assessment, treatment, and 10-year results. J Orthop Trauma. 2023;37:e14-e21
Go to original source...
Go to PubMed...
- Rammelt S, Schepers T. Chopart injuries when to fix and when to fuse? Foot Ankle Clin. 2017;22:163-180.
Go to original source...
Go to PubMed...
- Rammelt S, Swords M, Dhillon MS, Sands AK. Manual of fracture management - foot and ankle. Thieme, Stuttgart, 2019.
Go to original source...
- Rosenbaum AJ, Uhl RL, DiPreta JA. Acute fractures of the tarsal navicular. Orthopedics. 2014;37:541-547.
Go to original source...
Go to PubMed...
- Sanders R, Serrano R. Navicular body fractures-surgical treatment and radiographic results. J Orthop Trauma. 2020;34(Suppl 1):38-44.
Go to original source...
Go to PubMed...
- Sangeorzan BJ, Benirschke SK, Mosca V, Mayo KA, Hansen ST Jr. Displaced intra-articular fractures of the tarsal navicular. J Bone Joint Surg Am. 1989;71:1504-1510.
Go to original source...
- Schmid T, Krause F, Gebel P, Weber M. Operative treatment of acute fractures of the tarsal navicular body: midterm results with a new classification. Foot Ankle Int. 2016;37:501-507.
Go to original source...
Go to PubMed...
- Tejwani NC. Fractures of the foot and ankle. Springer, Switzerland, 2018.
Go to original source...