Eighty-two athletes with 86 clinical navicular stress fractures, all imaged with computerized tomography, were followed for an average of 33 months (range, 6 to 108) after diagnosis. Initial treatment consisted of at least 6 weeks of nonweightbearing cast immobilization for 22 fractures, at least 6 weeks of limitation of activity with continued weightbearing for 34 fractures, and a period of less than 6 weeks of conservative treatment for another 19 fractures. Five patients attempted to continue playing sports. Six patients had immediate surgery. Nineteen of 22 patients (86%) who had initial non-weightbearing cast immobilization treatment returned to sports, compared with only 9 of 34 patients (26%) who initially continued weightbearing with limited activity (P < 0.001). After failure of the latter treatment, successful outcomes were seen for 6 of 7 patients (86%) treated with nonweightbearing cast immobilization, while 11 of 15 patients (73%) who had one surgical procedure were able to return to sports. These results indicate that nonweightbearing cast immobilization is the treatment of choice for navicular stress fractures. Also, this treatment compares favorably with surgical treatment for patients who present after failed weightbearing treatments. Computerized tomographic appearances of healing fractures do not necessarily mirror clinical union, and postimmobilization management should be monitored clinically.

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for the experiment. Throughout the study they were fed a pathogen-free balanced diet suitable for humans. Using strict aseptic precautions and with the animals sedated with phencyclidine or ketamine hydrochloride, 0 5 ml (20 mg) methyl prednisolone was injected into one knee joint of each animal. An equivalent volume of vehicle used in the same commercial preparation of methyl prednisolone was injected into the opposite knee. The vehicle consisted ofpolyethylene glycol 29 mg, sodium chloride 8f7 mg, mynistylgamma picolinium chloride 019 mg, and water to 1 ml. The accurate placing of the injections was confirmed by adding 0-2 ml of a radio-opaque dye (Conray) to the injection fluid and performing x-rays immediately after injection. Tibial biopsies were obtained from both knees of 2 animals 4 weeks later and injections were repeated at the same time in the other 8 animals. 4 of these underwent a further series of four injections into each knee at 2-week intervals (total of 6 injections). X-rays of the joints were taken immediately before the experiment and again 14 weeks later at which time all 10 animals were sacrificed.The surfaces of the femoral condyles, menisci, and tibiae were examined with the naked eye for surface defects. The fresh femoral specimens were coated with India ink diluted with physiological saline, examined for evidence of fibrillation in the manner described by Bullough and Goodfellow (1968) and then photographed.The biopsies and the whole joints were fixed in on 9 May 2018 by guest. Protected by copyright.