Navicular Fracture
synonyms: tarsal navicular fracture
Navicular Fracture ICD-9
- 825.22 Fracture of navicular (scaphoid), foot
Navicular Fracture Etiology / Epidemiology / Natural History
- Uncommon
- Untreated fracture can lead to medial column shortening, cavus foot, pain and arthritis.
- Dorsal lip fracture typically result from plantar flexion with inversion or eversion injuries.
- Tuberosity avulsion fractures typically result from sudden, eversion and/or valgus injuries.
Navicular Fracture Anatomy
- Largely covered by articular cartilage with limited blood supply and increased risks of osteonecrosis.
- Posterior tibial tendon inserts into navicular tuberosity. Anterior portion of deltoid ligament inserts dorsomedially.
- Articulates with the talar head proximally and the cuneiforms distally. Maintains the longitudinal arch of the foot.
- Navicular injury with shortening results in cavus deformity. Lengthening results in planus deformity..
Navicular Fracture Clinical Evaluation
- Pain, swelling over navicular
- Difficult walking
Navicular Fracture Xray / Diagnositc Tests
- Xray: A/P, Oblique, Lateral foot views generally demonstrate fracture.
- CT: generally indicated to availuate comminution / impaction and for associated injuries.
- MRI: consider if evaluating for navicular stress fracture.
Navicular Fracture Classification / Treatment
- Tuberosity Avulsion fracture: avulsion of the posterior tibial tendon insertion.
-Nondisplaced: Treatment = 8-12 wks NWB, recovery may take 6 months.
-Displaced: Treatment = ORIF.
-Avulsion of posterior tibial tendon insertion requires ORIF / fragment excision and tendon advancement.
- Navicular Body:
-Nondisplaced =NWB, SLC.
-Displaced=ORIF. Must provide anatomic reconstruction of the proximal articular surface, reestablish medical column length and treat associated injuries. Consider temporary bridge plating for severe injuries (Schildauer TA, JOT 2003;17:513).
- Dorsal lip: represent avulsion of the dorsal talonavicular ligament and/or anterior division of the deltoid ligament.
-Nondisplaced or small fragment displaced: Treatment = hard soled shoe, NWB.
-Displaced/large articular fragment: ORIF
- Navicular stress fracture
Navicular Fracture Associated Injuries / Differential Diagnosis
Navicular Fracture Complications
- Stiffness
- Nonuion
- Osteonecrosis
- Deformity
- Postraumatic Arthritis
Navicular Fracture Follow-up Care
- NWB for 3 months
- Semirigid custom-molded arthosis
Navicular Fracture Review References
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