A rare case of isolated Dorso-Medial fracture dislocation of navicular bone

Abstract

The tarsal navicular bone is strategically located in the uppermost portion of the medial longitudinal arch of the foot, and hence, plays a major role in weight bearing during ambulation. It acts as the keystone for vertical stress on the arch. Multiple deforming forces act on the navicular during various sporting activities and dancing and in high energy injuries resulting in varied degrees of fracture, subluxation or dislocation involving the tarsus and metatarsus. A 40-year-old male patient with history of Road Traffic accident presented in casualty with chief complain of pain and swelling over his right foot. Patient was examined and a bony swelling was palpated clinically over medial aspect of foot and it had severe tenderness. Patient was sent for X-ray and was diagnosed with isolated navicular fracture dislocation in AP, Oblique and lateral view of foot. Patient was posted for emergency reduction in OT under IITV guidance under anaesthesia. Closed reduction was tried and was successful. The navicular was then fixed with percutaneous K-Wire. Post op a below knee slab was given for 6 weeks and pt. was under strict nonweight bearing. At 6 weeks follow up K wires were removed and pt. was allowed weight bearing. Patient had no complains. Follow up radiographs showed no dislocation of navicular. Isolated navicular bone fracture dislocation can be managed with closed reduction and K-Wire fixation with no other complains in subsequent follow up. Although we have 6 months of follow up, with no any complains, we feel the patient should still be examined till 1 year with regular follow up.