Operation for non-union of stress fracture of the tarsal navicular

Abstract

Stress fractures of the tarsal navicular do not heal predictably with conservative treatment, so we recommend operation if the fracture remains symptomatic, and radiographs show wide separation of a complete fracture, extension of an incomplete fracture, delayed healing, or a medullary cyst. An autologous bone graft is inserted after en-bloc resection of the fracture surfaces. It is important that the fracture is fully exposed to its distal limits before the graft is inserted. We have grafted 19 fractures in 18 patients. Six fractures were complete, 12 incomplete and one had a residual medullary cyst. Of the 15 patients with adequate follow-up, 12 had been able to return to a pre-injury level of activity by five to 12 months.

Fracture de fatigue du naviculaire tarsien compliquée d’une pseudarthrose : à propos d’un cas

“…Certains auteurs ont insisté sur la fréquence d'une brièveté du premier rayon [9] ou un metatarsus adductus [10]. Devant ce tableau clinique incomplet, il faut mettre en route un bilan paraclinique.…”

Tarsal navicular stress fractures

“…Fitch and colleagues described an "uncertainty" of non-operative management as they observed that navicular stress fractures were slow to heal and frequently went on to nonunion [8]. They also observed that athletes with partial fractures seen on CT would typically experience significant improvement with rest, only to become symptomatic again upon return to play.…”

“…They also observed that athletes with partial fractures seen on CT would typically experience significant improvement with rest, only to become symptomatic again upon return to play. Of 37 navicular stress fractures, 19 (51%) failed non-operative treatment and underwent bone grafting with good results; average return to sport was 8 months [8]. In a more recent study, Mallee et al demonstrated an earlier return to sport at 16.4 weeks in patients treated operatively compared to 21.7 weeks when treated nonoperatively in a cast for 6 weeks [1•].…”

“…According to the literature, an overwhelming amount of these injuries are seen in short-distance runners and basketball players [4][5][6]. Navicular stress fractures are more likely in these subgroups because these athletes do a lot of jumping, rapid cutting, and explosive movements; they frequently engage in forceful push off, with frequent and repetitive loading of the forefoot [7,8].…”

Stress fractures of the tarsal navicular bone: CT findings in 55 cases.

“…CT scanning is increasingly used in the diagnosis of these fractures [2,3], but to our knowledge the CT appearance of these lesions has not been previously reviewed in the madiologic literature. We present the CT findings in 55 cases of navicular stress fractures before and after treatment and describe the CT protocol we have found most useful for detecting these fractures.…”