Navicular stress fractures treated with minimally invasive fixation

Abstract

Background:Stress fractures of the naviculum bone are uncommon injuries occurring predominantly in athletes. These fractures are usually treated nonoperatively with a nonweight bearing cast for a minimum of 6 weeks followed by rehabilitation. Further, there is a paucity of literature on the long term clinical followup of these patients. These fractures do not heal predictably with conservative management, which does not inspire great compliance and their clinical outcome is variable. We report on the outcome of these fractures following early operative intervention by minimally invasive fixation and early weight bearing and rehabilitation. We propose that this is reliable and a successful treatment regimen and its role as the definitive management of this clinical problem should be explored.Materials and Methods:Nine athletes with ten stress fractures of the navicular treated at our institution between April 1991 and October 2000. The mean age of the patients was 22.8 years (range 18-50 years). All patients were treated by minimally invasive screw fixation and early weight bearing mobilization without a cast. The average followup was 7 years (range 2-11 years).Results:Seven of the nine patients returned to their pre-fracture level of sporting activity at an average of 5 months (range 3-9 months). One patient returned to full sporting activity following a delay of 2 years due to an associated tibial stress fracture and one patient had an unsatisfactory result. Long term review at an average of 7 years showed that six of these eight patients who returned to sports remained symptom free with two patients experiencing minimal intermittent discomfort after prolonged activity.Conclusions:We recommend percutaneous screw fixation as a reliable, low morbidity procedure allowing early return to full sporting activity without long term complications or recurrences.

Fractures of the Tarsal Navicular Bone: A Retrospective Study of Thirty Cases

“…Similar findings were reported by Jacob KM et al who reported the mean age of patients with navicular fractures to be 22.8 years. [13] Daniel K. Ostlie et al have reported cases of navicular fractures in young athletes youngest being a girl of 13-year-old girl. [14] The authors recommended that tarsal navicular stress fractures should be considered in any patient presenting with vague, ill-defined foot especially if the patient is a young athlete.…”

Visualization of stress fractures of the foot using PET-MRI: a feasibility study

“…While low-risk stress fractures have a good chance to heal with conservative treatment, high-risk fractures are prone to delayed unions or non-unions more often [ 7 ]. An operative regimen with open reduction and internal fixation (ORIF) has been described by a few authors in current literature [ 26 , 27 ]. Rongstad et al showed the benefits of operative treatment of fourth metatarsal stress fractures in a retrospective study on 14 patients.…”