Outcome of conservative and surgical management of navicular stress fracture in athletes

Abstract

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.

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

“…Le scanner est l'examen clé pour l'évaluation précise de ces fractures. Contrairement à la scintigraphie osseuse, la résolution anatomique de la tomodensitométrie est excellente [13,14], elle visualise le trait de fracture et permet de suivre l'évolution en dépistant un élargissement du trait, une pseudarthrose ou un retard de consolidation, un kyste intramédullaire [9]. L'IRM reste un choix raisonnable, en particulier si la scintigraphie osseuse n'est pas disponible, car il s'agit d'un examen très sensible qui propose une bonne résolution spatiale [15].…”

Tarsal navicular stress fractures

“…Furthermore, the study lacks confirmation of healing on cross-sectional imaging. A more recent study provided more support for the non-operative treatment of navicular stress fractures with 19 of 22 patients going on to return to sport at an average of 5.6 months after injury; CT confirmation of fracture healing in these cases was also not presented [20]. Furthermore, the authors discuss that there remained a fracture line in some cases but that athletes were still able to return to activity withoutsymptoms.The longevity of an athletic career in a patient with an asymptomatic persistent fracture line is yet unknown.…”

“…Talar neck osteophytes are often seen concurrently with navicular stress fractures and may be removed at the time of surgery. There is likely some genetic predisposition in certain patients with bilateral fractures occasionally occurring in 3% [20]. A recent case series was published on a set of monozygotic twin athletes with similar navicular stress fractures [21].…”

“…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•]. Khan et al described a return to sport at 3.8 months after surgery as compared to 5.6 months when treated non-operatively [20].…”

Stress Fracture / Stress Reaction of the Lower Leg and Foot

“…Exceptions to this general pattern exist. It is known that with some mild stress reactions or stress fractures, pain and injury can resolve without the need for relative rest (Burr et al 1990;Chisin et al 1987), and in some cases fractures may not resolve despite extended rest or other conservative treatment approaches (Batt et al 2001;Brukner et al 2000;Khan et al 1992). Unfortunately, formal reports of the natural history of pain changes through the course of the disease are not available, as research efforts have primarily focused upon the identification of predisposing factors, and interventions to expedite healing and rehabilitation.…”