Clinical and Computed Tomography Evaluation of Surgical Outcomes in Tarsal Navicular Stress Fractures

McCormick, Jeremy J.; Bray, Christopher C.; Davis, W. Hodges; Cohen, Bruce E.; Jones, Carroll P.; Anderson, Robert B.

doi:10.1177/0363546511401899

Cited by 25 publications

(23 citation statements)

References 23 publications

(36 reference statements)

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“… 98 Despite this recommendation, it should be noted that displaced fractures may have a higher risk of nonunion and poorer outcomes even with surgical treatment. 59 …”

Section: High-risk Stress Fracturesmentioning

confidence: 99%

Stress Fractures of the Foot and Ankle in Athletes

Mayer

Joyner

Almekinders³

et al. 2013

Sports Health: A Multidisciplinary Approach

122

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Context:Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings.Evidence Acquisition:Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, medial malleolus, lateral malleolus, calcaneus, talus, metatarsal, cuboid, cuneiform, sesamoid, or athlete.Study Design:Clinical review.Level of Evidence:Level 5.Results:Stress fractures of the foot and ankle can be divided into low and high risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors, such as activity type, desire to return to sport, and compliance. Operative management has proven superior in several high-risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving.Conclusion:A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely work-up and treatment is successful in returning these athletes to sport in many cases. Low-risk stress fracture generally requires only activity modification while high-risk stress fracture necessitates more aggressive intervention. The specific treatment of these injuries varies with the location of the stress fracture and the goals of the patient.

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“… 98 Despite this recommendation, it should be noted that displaced fractures may have a higher risk of nonunion and poorer outcomes even with surgical treatment. 59 …”

Section: High-risk Stress Fracturesmentioning

confidence: 99%

Stress Fractures of the Foot and Ankle in Athletes

Mayer

Joyner

Almekinders³

et al. 2013

Sports Health: A Multidisciplinary Approach

122

View full text Add to dashboard Cite

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“…Similar to our study, in which no singular foot characteristic was broadly associated with navicular stress fracture, other studies have not been able to demonstrate a direct causal relationship between any specific anatomic abnormality and the occurrence of this pathology. 7 , 14 , 18 Another hypothesized risk factor is dynamic navicular motion, as in “navicular drop” (plantar) or “navicular drift” (medial). 2 , 12 Navicular drop is a method to measure pronation and medial column function by calculating the perpendicular distance between the navicular tuberosity and the line between the calcaneus and first metatarsal.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete’s Prospective NFL Career

Vopat

Beaulieu‐Jones

Waryasz

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Navicular injuries can result in persistent pain, posttraumatic osteoarthritis, and diminished performance and function.Purpose:To determine the epidemiology of navicular fracture in players participating in the National Football League (NFL) Scouting Combine and evaluate the impact of a navicular injury on the NFL draft position and NFL game play compared with matched controls.Study Design:Cohort study; Level of evidence, 3.Methods:Data were collected on players who previously sustained a navicular injury and participated in the NFL Combine between 2009 and 2015. The epidemiology of navicular injury was determined through an evaluation of the number of injuries, surgeries, and collegiate games missed as well as the position played, a physical examination, the surgical technique, and imaging findings. Players with a previous navicular injury (2009-2013) were compared with a set of matched controls. NFL performance outcomes included the draft position, career length ≥2 years, and number of games played and started within the first 2 years.Results:Between 2009 and 2015, 14 of 2285 (0.6%) players were identified as having sustained a navicular injury. A total of 11 of 14 (79%) athletes had sustained an overt navicular fracture, while 3 of 14 (21%) were diagnosed with stress reactions on magnetic resonance imaging. Eight patients who sustained a navicular fracture underwent surgery. There was evidence of ipsilateral talonavicular arthritis in 75% of players with a navicular fracture versus only 60% in the uninjured foot (odds ratio, 1.3; P = .04). Fifty-seven percent of players with navicular injury (72.7% of fractures) were undrafted versus 30.9% in the control group (P = .001). Overall, 28.6% of players with navicular fracture played ≥2 years in the NFL compared with 69.6% in the control group (P = .02).Conclusion:A previous navicular fracture results in a greater risk of developing posttraumatic osteoarthritis. Although only a low prevalence of navicular injury in prospective NFL players was noted, players with these injuries had a greater probability of not being drafted and not competing in at least 2 NFL seasons when compared with matched controls without an injury history to the NFL Combine.

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“…The navicular bone receives its blood supply from vessels entering on the medial, plantar and dorsal aspects and projecting centrally, resulting in a relatively avascular middle third 5. It is in this region that the majority of stress fractures are located.…”

Section: Discussionmentioning

confidence: 99%

Delayed healing of a navicular stress fracture, following limited weight-bearing activity

Robinson¹,

Fulcher²

2014

BMJ Case Reports

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This report describes a 21-year-old man, a semiprofessional football (soccer) player, with a navicular stress fracture. It highlights the difficulty in diagnosing the condition and the complications arising from inadequate management. The case discusses the optimal management of these stress fractures and the detrimental role of weight-bearing recovery. The diagnosis of navicular stress fractures is challenging, and a high index of suspicion is required. The available literature indicates that limited weightbearing is not an appropriate treatment for navicular stress injuries. Non-weight-bearing (NWB) cast immobilisation for 6-8 weeks appears to be the gold standard treatment; however, open reduction with internal fixation (ORIF) has similar success rates and an equal return-to-play time but should also be followed by a period of NWB. NWB cast immobilisation for 6 weeks remains a good second option at any time following failed limited weight-bearing activity.

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Clinical and Computed Tomography Evaluation of Surgical Outcomes in Tarsal Navicular Stress Fractures

Cited by 25 publications

References 23 publications

Stress Fractures of the Foot and Ankle in Athletes

Stress Fractures of the Foot and Ankle in Athletes

Epidemiology of Navicular Injury at the NFL Combine and Their Impact on an Athlete’s Prospective NFL Career

Delayed healing of a navicular stress fracture, following limited weight-bearing activity

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