Outcome of ligamentotaxis and percutaneous screws for navicular fractures

Abstract

Background: The tarsal navicular bone plays a pivotal role in hindfoot motion and gait and is considered as a keystone of the foot’s medial longitudinal arch. Despite being relatively uncommon, navicular fractures are difficult to treat and may end up with devastating complications. The purpose of this study was to evaluate the effectiveness of fracture reduction with ligamentotaxis and maintenance of the reduction through percutaneous screw fixation. Methods: Twelve patients with comminuted navicular fractures were surgically treated and enrolled in this prospective study. Patients were evaluated through Foot and Ankle Outcome score (FAOS) and Ankle-Hindfoot scale. A composite questionnaire, including the EuroQol-5D (EQ-5D) and Visual Analog Scale (VAS) for pain and satisfaction with the surgical result was executed. Results: All patients returned to their preinjury activity level at their final follow-up. Eleven patients presented excellent FAOS score of ≥90. The mean FAOS score for all patients included in the study was 92.91 (SD; 3.26, range 86 to 98), and the mean Ankle-Hindfoot scale was 92.67 (SD 2.84). The mean health-related quality of life (EQ-5D) index score was 9.50, with an overall satisfaction scale of 9.83 (SD 0.39). Conclusions: Adequate reduction of navicular fractures can be achieved with axial traction through temporary Steinmann pins in the calcaneus and medial cuneiform. Minimally invasive percutaneous screws can maintain reduction, with excellent functional outcome