Summary Tarsal Navicular Fractures are rare fractures of the midfoot that may occur due to trauma or due to repetitive microstress. Diagnosis can be made with plain radiographs of the foot. Treatment is generally nonoperative with cast immobilization and non weight-bearing for the majority of fractures. Surgical management is indicated for nonunions, significantly displaced fractures, and for elite athletes. Etiology Navicular fractures can be traumatic navicular avulsion fractures login to view 2 more bullets navicular tuberosity fractures login to view 2 more bullets navicular body fractures login to view 1 more bullet 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 Spontaneous navicular AVN (Mueller-Weiss syndrome) Spontaenous navicular AVN is a rare disease that and can be seen in middle aged adults with chronic midfoot pain 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 III 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 login to view 1 more bullet 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 login to view 1 more bullet Operative open reduction and internal fixation indications login to view 3 more bullets Treatment of Traumatic Fractures Nonoperative cast immobilization with no weight bearing indications login to view 3 more bullets Operative fragment excision indications login to view 2 more bullets open reduction and internal fixation indications login to view 3 more bullets technique login to view 2 more bullets ORIF followed by external fixation vs. primary fusion indications login to view 2 more bullets technique login to view 2 more bullets