![]() Management of Tarsal Navicular Stress Fractures. ![]() Displaced Intra-Articular Fractures of the Tarsal Navicular. Sangeorzan B, Benirschke S, Mosca V, Mayo K, Hansen S. Imaging of Tarsal Navicular Stress Injury with a Focus on MRI: A Pictorial Essay. This is also required when there is evidence of navicular avascular necrosis. Type III fractures require open reduction and internal fixation, followed by external fixation. ORIF is also indicated when avulsion fractures involve more than 25% of the articular surface or when tuberosity fractures have more than 5 mm of diastasis or have a large intra-articular fragment. Operative management may either be fragment excision or ORIF +/- external fixation / primary fusion.įragment excision is indicated in those patients where avulsed fragments have failed to improve clinically despite non-operative management as well as symptomatic non-union of tuberosity fractures.ĭisplaced/intra-articular type I and II navicular body fractures typically require open reduction and internal fixation. Minimally displaced type I and type II body fractures Other indications for non-operative management include: Most undisplaced fractures can be managed conservatively in a cast 3. Non-operative management consists of cast immobilization and non-weight bearing. Management may be operative 5 or non-operative 6. It should be noted that MRI is more sensitive than CT however, in identifying stress fractures 3. T2: may demonstrate areas of hyperintensity over the fracture site indicating bone edema It also allows for the assessment of the extent of the fracture line and the degree of comminution. CTĬT is more sensitive for identifying navicular fractures. Their sensitivity for identifying navicular fracture is low however, lateral and oblique radiographs provide the greatest chance of identifying a fracture. Rarely fractures of an accessory navicular bone (if present) are also possible and may be visible. Plain radiographs are the best initial test in a suspected navicular fracture. Type III: there is a comminuted fracture in the sagittal plane, and the forefoot is displaced laterally 4 Type II: the fracture line is dorsal-lateral to plantar-medial, and the forefoot is medially displaced Type I: the fracture line is in the coronal plane, and there is no angulation of the forefoot The Sangeorzan classification is used to assess the severity of isolated navicular fractures and to determine management: The fracture occurs via two main mechanisms:Ĭhronic overuse injuries causing a stress fracture (often in athletes)Īcute high-energy trauma where the head of the talus impacts the concavity of the navicular bone Patients generally have a normal range of motion and a normal neurovascular examination 1. Stress fractures in athletes and construction workers may present with vague pain and swelling over the mid-foot, which worsens with exercise. May present with pain, swelling or hematoma directly over the mid-foot. Navicular fractures are responsible for approximately 5% of all foot fractures and 35% of all midfoot fractures 7.
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