Introduction Navicular fractures can be traumatic navicular avulsion fractures mechanism is plantarflexion or eversion/inversion can involve talonavicular or naviculocuneiform ligaments navicular tuberosity fractures mechanism is eversion with simultaneous contraction of PTT may represent an acute widening/diastasis of an accessory navicular navicular body fractures mechanism is axial loading stress fracture mechanism of injury is usually due to chronic overuse often seen in athletes running on hard surfaces also common in baseball players considered a high risk injury due to risk of AVN most common complications include delayed union and non-union Anatomy Articulations navicular bone articulates with cuneiforms cuboid calcaneus talus Biomechanics navicular bone and its articulations play an important role in inversion and eversion biomechanics and motion Classification Sangeorzan Classification of Navicular Body Fractures(based on plane of fracture and degree of comminution) Type I Transverse fracture of dorsal fragment that involves < 50% of bone.No associated deformity Type II Oblique fracture, usually from dorsal-lateral to plantar-medial.May have forefoot aDDuction deformity. Type IIII Central or lateral comminution.ABDuction deformity. Presentation Symptoms vague midfoot pain and swelling Physical exam midfoot swelling tenderness to palpation of midfoot usually full ROM of ankle and subtalar joint Imaging Radiographs may be difficult to see and are often missed recommended views AP lateral oblique 45 degree radiograph best to visualize tuberosity fractures CT more sensitive to identify fracture than radiographs MRI will show signal intensity on T2 image due to inflammation Treatment of Stress Fractures Nonoperative cast immobilization with no weight bearing indications any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success Operative open reduction and internal fixation indications high level athletes nonunion of navicular stress fracture failure of cast immobilization and non weight bearing Treatment of Traumatic Fractures Nonoperative cast immobilization with no weight bearing indications acute avulsion fractures most tuberosity fractures minimally displaced Type I and II navicular body fractures Operative fragment excision indications avulsion fractures that failed to improve with nonoperative modalities tuberosity fractures that went on to symptomatic nonunion open reduction and internal fixation indications avulsion fractures involving > 25% of articular surface tuberosity fractures with > 5mm diastasis or large intra-articular fragment displaced or intra-articular Type I and II navicular body fractures technique medial approach used for Type I and II navicular body fractures ORIF followed by external fixation vs. primary fusion indications Type III navicular body fractures technique must maintain lateral column length
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.256) A 21-year-old recreational baseball player presents for evaluation of anterior ankle pain that has been persistent for the past 6-8 weeks. On physical exam he is tender over the midfoot, but has full strength with dorsiflexion, plantarflexion and inversion. His radiographs are read as normal; radiographs are shown in Figure A. Representative MRI sequences are shown Figures B and C. What is the most appropriate treatment for this patient? Review Topic QID: 4616 FIGURES: A B C 1 Observation alone 4% (102/2410) 2 Cortisone injection in to the anterior tibial tendon sheath 1% (20/2410) 3 Partial weight bearing in a boot 13% (304/2410) 4 Non-weightbearing in a cast for planned 6-8 weeks 78% (1889/2410) 5 Open reduction internal fixation of the fracture 3% (82/2410) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (SBQ07SM.35) What is the most common complication associated with the injury seen in Figure A? Review Topic QID: 1420 FIGURES: A 1 Malunion 7% (315/4556) 2 Non-union 81% (3710/4556) 3 Infection 1% (23/4556) 4 Longitudinal arch instability 10% (455/4556) 5 Neurovascular injury 1% (30/4556) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (OBQ06.61) A 24-year-old female who is training for her first marathon presents with six weeks of increasing foot pain. An AP radiograph and representative axial cut of her CT scan of her injury are seen in figures A and B. Management should consist of which of the following? Review Topic QID: 172 FIGURES: A B 1 Weight bearing as tolerated in a hard soled shoe 6% (103/1760) 2 Non weight bearing cast immobilization 69% (1223/1760) 3 Fragment excision and posterior tibial tendon advancement 2% (32/1760) 4 Percutaneous screw fixation 16% (278/1760) 5 Open reduction with autologous bone graft 7% (118/1760) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 2
bilateral navicular lesions (C2374) Foot & Ankle - Tarsal Navicular Fractures HPI - gradual onset progressive course now interfering with activities What is the most likely diagnosis of the right foot condition? 9/22/2015 557 2 5 Tarsal navicular bilateral lesions (C2366) Foot & Ankle - Tarsal Navicular Fractures HPI - An otherwise healthy male complains of right foot pain that has gradually progressed over the last year. He denis any history of trauma. Now the pain is severe and limiting his function. The patient has a history of a similar condition in left foot 11 years ago (patient reports "death" of navicular) that was treated by bone grafting years ago. He reports relief of his symptoms and now he has tolerable left foot pain. What is the most likely diagnosis of the RIGHT foot pain? 9/19/2015 50 2 2 Tarsal navicular fracture (C2241) Foot & Ankle - Tarsal Navicular Fractures HPI - 4 days ago fell of the bike How would you treat this patient? 5/21/2015 213 1 9 See More See Less