Navicular Stress Fractures in Adolescent Athletes: Injury Characteristics and Outcomes of Surgical Fixation

Abstract

Background: Surgical treatment of navicular stress fractures (NSF) in athletes has been recommended secondary to the poor blood supply of the navicular and frequency of delayed union and refracture. Regardless of treatment, nonunion and persistent pain are complications described in adults. The purpose of this study was to describe patient and fracture characteristics and outcomes of surgical treatment of NSF in adolescents. Methods: An IRB approved retrospective review was performed of patients less than 18 years of age treated with surgical screw fixation of NSF from 2014 – 2019. All patients were contacted for collection of patient reported outcome measures (PROMs). Results: Five patients with a median age of 15.8 years (range 14 – 17 years) were included. Three patients, all baseball catchers, had a dorsal navicular osteophyte. All fractures were in the lateral third of the navicular. There were 3 type 2 fractures and 2 type 3 fractures. Median clinical follow-up was 7.1 months (range 5 – 14 months). No patient developed avascular necrosis. PROMs at a median of 61 months following surgery demonstrated that all patients returned to their primary sport at the same level and no patients reported refracture or subsequent surgeries. Conclusions: In a cohort of adolescent patients, operative fixation of type 2 and 3 NSF results in reliable healing, no evidence for AVN, and excellent mid-term outcomes with full return to sports. These outcomes are in contrast to higher rates of non-union and inability to return to sports reported in the adult literature.