Vascularized Pedicle Bone Grafting for Nonunions of the Tarsal Navicular

Fishman, Felicity G.; Adams, Samuel B.; Easley, Mark E.; Nunley, James A.

doi:10.3113/fai.2012.0734

Cited by 19 publications

(17 citation statements)

References 18 publications

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“…For example, non-union of a stress fracture of the tarsal navicular can lead to degenerative joint disease of the talonavicular and naviculocuneiform joints. 140 High-risk stress reactions and stress fractures include those to the pars interarticularis of the spine, the tension side of the femoral neck, the patella, the anterior tibia (the 'dreaded black line'), the medial malleolus, the talus, the tarsal navicular, the metaphyseal/diaphyseal junction of the fifth metatarsal ( Jones' fracture) and the sesamoids. 62 (table 2) The incidence and prevalence of these injuries in children are not well described.…”

Section: Stress Fracturesmentioning

confidence: 99%

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

DiFiori¹,

et al. 2014

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BackgroundYouth sport participation offers many benefits including the development of self-esteem, peer socialisation and general fitness. However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership and even professional contracts, has seemingly become widespread. This has resulted in an increased pressure to begin high-intensity training at young ages. Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout. PurposeTo provide a systematic, evidenced-based review that will (1) assist clinicians in recognising young athletes at risk for overuse injuries and burnout; (2) delineate the risk factors and injuries that are unique to the skeletally immature young athlete; (3) describe specific high-risk overuse injuries that present management challenges and/or can lead to long-term health consequences; (4) summarise the risk factors and symptoms associated with burnout in young athletes; (5)provide recommendations on overuse injury prevention. MethodologyMedical Subject Headings (MeSHs) and text words were searched on 26 March 2012 from MEDLINE, CINAHL and PsycINFO. The search yielded 953 unique articles. Additional articles were found using cross-referencing. The process was repeated on 10 July 2013 to review any new articles since the original search. Screening by the authors yielded a total of 208 relevant sources that were used for this article. Recommendations were classified using the Strength of Recommendation Taxonomy (SORT) grading system. Definition of overuse injuryOveruse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. Injury can involve the muscletendon unit, bone, bursa, neurovascular structures and the physis. Overuse injuries unique to young athletes include apophyseal injuries and physeal stress injuries. EpidemiologyIt is estimated that 27 million US youth between 6 and 18 years of age participate in team sports. The National Council of Youth Sports survey found that 60 million children aged 6-18 years participate in some form of organised athletics, with 44 million participating in more than one sport. There is very little research specifically on the incidence and prevalence of overuse injuries in children and adolescents. Overall estimates of overuse injuries versus acute injuries range from 45.9% to 54%. The prevalence of overuse injury varies by the specific sport, ranging from 37% (skiing and handball) to 68% (running). Overuse injuries are underestimated in the literature because most of the epidemiological studies define injury as requiring a time loss from participation. Risk factorsPrior injury is a strong predictor of future overuse injury. Overuse injuries may be more likely to occur during the adolescent growth spurt. The physes, apophyses and articular surfaces in skeletally immat...

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Section: Stress Fracturesmentioning

confidence: 99%

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

DiFiori¹,

et al. 2014

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“…12,21,22 In a study comparing operative with nonoperative treatment, Fitch et al 21 reported successful outcomes with 12 of 16 fractures treated surgically with an average return to sport at 8 months. Overall, 72.2% treated with immobilization or rest with continued weight bearing had worse outcomes with return to activity at 10 months.…”

Section: Treatmentmentioning

confidence: 96%

“…7) and has been an excellent secondary procedure for these difficult patients with avascular necrosis or previous surgery and nonunion. 22 Postoperatively, we place the patient in a bulky Jones dressing for 2 weeks. At 2 weeks, we place the patient into a non-weight bearing cast for 4 more weeks.…”

Section: Author's Recommended Treatmentmentioning

confidence: 99%

Medial-sided Stress Fractures: Medial Malleolus and Navicular Stress Fractures

Gross

Nunley

2014

Operative Techniques in Sports Medicine

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“…These local flaps have been used with success for navicular nonunion when a small segment of bone is required and there is minimal surrounding trauma. 12 Our algorithm for free bone flap to the foot and ankle includes the fibula flap and the MFC flap. The MFC flap is used for defects of < 4 cm when structural support is not required.…”

Section: Preoperative Planningmentioning

confidence: 99%

“…Care is then taken to perform a retrograde dissection back toward the dorsalis pedis. The bone flap can then be positioned into the defect 12. …”

mentioning

confidence: 99%

Pedicle and Free Vascularized Bone Transfers to the Foot and Ankle

Haddock

Wapner

Levin

2013

Techniques in Foot &Amp; Ankle Surgery

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Vascularized bone flaps provide an alternative option for complex foot and ankle problems. In the foot and ankle, large bone gaps can occur as result of avascular necrosis, trauma, or infection. In these situations, conventional bone grafting is not always successful leading to failed union. Vascularized bone is the ideal treatment for these scenarios. The fibula flap and the medial femoral condyle (MFC) flap are both good options for the foot and ankle. The MFC provides smaller portions of corticocancelous bone with a large periosteal covering. The fibula provides a large surface area of rigid cortical bone. We have successfully used these flaps for tibiotalar arthrodesis, pantalar arthrodesis, navicular revascularization, calcaneous nonunion, and persistent nonunion of the talus. The MFC is ideal when a small segment of vascularized bone is required, but when structural support is necessary, the fibula offers a larger cortical surface area providing more rigidity. Both flaps are valid options for foot and ankle reconstruction and salvage.

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Vascularized Pedicle Bone Grafting for Nonunions of the Tarsal Navicular

Cited by 19 publications

References 18 publications

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

Medial-sided Stress Fractures: Medial Malleolus and Navicular Stress Fractures

Pedicle and Free Vascularized Bone Transfers to the Foot and Ankle

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