Fractures of the navicular

Abstract

Generally, large or significantly displaced intra-articular navicular fractures are treated best by surgical intervention. Open reduction and internal fixation of these injuries allow anatomic restoration of adjacent joint surfaces and preservation of length and stability along the medial column of the foot; intervention must not disrupt the already tenuous blood Supply of the tarsal navicular because of the associated risks of avascular necrosis and nonunion. The unique morphology and vital role of the navicular as a cornerstone of the talonavicular joint require every effort to maintain the congruity and motion of this joint to avoid later fusion. The likelihood for successful reduction decreases with increasing grades of injury. The naviculo-cuneiform joint, alternatively, requires stability for proper foot function and can be fused, if necessary, to improve fixation or enhance vascularity to the navicular. External fixation, bone grafting (often and early), and limited peritarsal fusion also have evolved into useful aids, under certain circumstances, to facilitate the goals of navicular fracture management. Early postoperative range of motion, prolonged protected weight bearing, and aggressive patient counseling as to the severity and long-term implications of these injuries also are paramount to success. Caution also must be exercised in managing navicular dislocations because of the potential long-term complications of redislocation or painful flatfoot deformity if alignment is not maintained. Navicular fracture care remains a challenge to the orthopedic surgeon; successful surgical intervention continues to hinge upon a careful balance between an operative exposure that is limited enough to avoid further devascularization but extensive enough to permit anatomic reduction and rigid internal fixation.