59 Mavicular stress fractures: outcomes of conservative and surgical management

Abstract

Navicular stress fractures are a common and debilitating condition in running athletes, hence the need for early accurate treatment strategies. The two predominant treatment modalities are nonweightbearing cast immobilization (NWBCI), and surgical fixation. While both effective over the shorter term, there is controversy as to the superior treatment over the longer term. AIMS: To investigate long-term treatment outcomes of navicular stress fractures. METHODS: A cross-sectional research design was used. Subjects had been treated for a navicular stress fracture and had returned to full competition after the injury more than 2 years previously. They completed a questionnaire then underwent a physical examination and CT scan. RESULTS: Thirty two stress fractures in 26 subjects were investigated by questionnaire. Of these, 29 fractures in 23 subjects were examined clinically and by CT scan. No statistically significant difference was found between surgical and conservative management for any of Current Pain (p = 0.984), CurrentFunction, (p = 0.170) or Abnormality on CT (p = 0.173). However surgically treated patients more often remained tender over the 'N spot' (p = 0.005) even after >2 years return to competition. A difference was found between injured and noninjured foot for Current Pain (p < 0.001) and Current Function (p = 0.019).CONCLUSION:The evidence from this study suggests that surgical fixation of navicular stress fractures is an equally effective treatment, compared to conservative management, over the longer term. However there remains a small, though measurable degree of pain and loss of function for patients over this period.