$navicular bone fracture$

$navicular bone fracture$

#Navicular bone fracture serial

However, incomplete fractures may propagate from dorsal to plantar and it is important to follow the CT to assess healing. There are situations where I will address both the navicular fracture and the biomechanical problem, e.g., for example tarsal coalition, in the same operative setting.Īnderson: I will consider and offer a nonoperative course of treatment for those fractures that are truly incomplete and which occur in recreational athletes or general population. Operative care is for complete navicular fractures and for patients who have contributing biomechanical problems. If the fracture persists, then we discuss operative fixation. I re-image at 4 months before I return them back to pre-injury activities. In the case of nonoperative treatment, I keep my patients non-weight-bearing for 8 weeks and begin ambulating in a boot walker with pain being the guide. Nonoperative care for navicular fractures is reserved for incomplete fractures in a patient with an over-training etiology but otherwise has good biomechanical structure. If there is a complete navicular fracture, then I am pessimistic that this will heal with nonoperative care. Type 1 navicular fracture with a cyst is shown.īerlet: The decision regarding operative and nonoperative care has both structural and anatomic influences.

#Navicular bone fracture serial

If these patients are followed with serial CT scans, then a complete 100% union rate is much lower than reported. However, Malleee and colleagues called into question the methodology and conclusions, and many of the studies used plain radiographs to determine healing, which we know is inaccurate. Torgs meta-analysis concludes that all these fractures should be treated nonoperatively. I believe all type 2 and type 3 fractures should be treated operatively. In high-level athletes, I will offer percutaneous screw fixation for type 1 as well, in addition to 6 weeks non-weight-bearing. I would consider treating a type 1 stress fracture nonoperatively (Figure 1) as long as there are no cystic changes which I believe will lead to re-fracture (Figure 2). O’Malley: For me, this is the most controversial fracture as it is an incomplete fracture and the screw would only serve to prevent propagation of the fracture rather than provide compression. Sferra: Which navicular stress fractures do you consider treating nonoperatively? Therefore, a baseline CT study is invaluable. When managing a navicular stress fracture, regardless of the treatment method chosen, a CT is the best tool to follow healing. If the MRI notes edema in the navicular, then CT is preformed to determine if there is a stress reaction or fracture, and if fractured, to what degree. If a running athlete presents with vague “ankle or midfoot” pain, inconclusive exam and normal radiographs, then I proceed directly to MRI for further evaluation. Anderson, MD: As noted in the literature, approximately 30% of navicular stress fractures will not be identified on initial plain radiographs. The quality of the CT is sometimes not the same as what you would get with diagnostic CT, so be aware of the CT capabilities before selecting this imaging option. We also now use single-photon emission CT which combines the advantages of CT with bone scan in one imaging modality. If I am doing a screening test for navicula stress reaction, then I use MRI instead of bone scans. The radiograph is poor to identify navicular stress fractures, but it addresses other factors, such as abnormal joint mechanics due to tarsal coalition or foot shape considerations like cavus foot or forefoot adductus.įor advanced imaging, CT provides the best resolution for the fracture plane and differentiating between partial and complete fractures of the navicula. Berlet, MD: My work-up for a suspected navicular stress fracture includes standing radiographs of the ankle and foot. I also will look for any anterior ankle osteophytes on the preoperative CT scan as they may be one of the etiologic factors in navicular stress fractures. In addition, CT is used to determine healing so one needs to have a baseline study to monitor progress. In most cases, the CT scan is also obtained to get better delineation of the fracture anatomy and determine classification. If the radiograph shows an obvious fracture, then I would bypass MRI and proceed directly to a CT scan. The symptoms are so vague that pathology in both the ankle and midfoot can mimic navicular symptoms, and MRI is an excellent screening tool for ankle and hindfoot stress fractures. O’Malley, MD: My work-up for navicular stress fractures begins with a MRI if the plain radiographs are negative. Sferra, MD: In addition to plain radiographs, do you typically obtain a CT scan, MRI scan or both in your work-up for navicular stress fractures?

$navicular bone fracture$