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Navicular Fracture S92.253A 825.22

 navicular foot bone xray

synonyms: tarsal navicular fracture

Navicular Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

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

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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