Navicular Fracture 825.22

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

• Foot 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

• Cuboid fracture
• Lisfranc Fracture
• Talar head fracture
• Navicular stress fracture
• Metatarsal fractures

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

• Rockwood and Green's Fractures in Adults 6th ed, 2006
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