Navicular Body Fractures-Surgical Treatment and Radiographic Results.

Abstract

To assess injury patterns and outcomes after navicular fractures. Retrospective radiographic review using the Schmid classification. Academic Level 1 Trauma Center; PATIENTS/PARTICIPANTS:: Thirty-nine navicular fractures associated with additional foot injuries. Open reduction internal fixation. Radiographic evaluation of nonunion, malunion, and post-traumatic arthritis; secondary operations. A total of 12/18 (67%) Schmid type II fractures healed without complications. Ten fractures were treated with tension band plates (56%) and 8 with screws (44%). Three complications were in cases treated with screws (3/8 = 37.5%). No case went on to develop avascular necrosis. In the 21 Schmid type III fractures, radiographic results were uniformly poor. Only 3 healed after the index procedure without evidence of radiographic post-traumatic arthritis. Four required a primary talonavicular (TN) fusion for an unreconstructable articulation found at the time of the index surgical treatment. The remaining 14 (67%) all had radiographic evidence of severe collapse, end-stage post-traumatic arthritis, and/or a significant midfoot deformity at the time of follow-up examination. Three of these required a late triple arthrodesis. Type II navicular body fractures are substantial injuries in which the amount of comminution belies the amount of damage to the talonavicular articulation. Tension band plate augmentation seemed to keep the navicular fracture secure and prevent lag screw loosening. Schmid type III navicular body fractures are devastating injuries. They are associated with additional severe trauma to the foot and require extensive surgical reconstruction of the medial column, lateral column, or both. Residual problems should be expected and may not be due to the navicular injury, but rather to the associated fractures and dislocations. Patients should be aware that their foot will be stiff and may require further reconstructive treatment. Level IV. See Instructions for Authors for a complete description of levels of evidence.