Navicular Body Fractures
By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.
Navicular fractures are relatively infrequent injuries. They can occur with major traumatic events such as an auto accident or a fall from a height. When they occur, they often occur with other midfoot injuries. Treatment of navicular body fractures often requires a CT scan to evaluate the injury to its fullest extent. Because the navicular has cartilage on the front and back end of the joints, displacement of navicular body fractures can predispose the patient to osteoarthritis to the midfoot region. If the fracture appears nondisplaced, conservative care would include nonweightbearing for eight or more weeks. Slow recovery is often the norm and running athletes may take six months or more before they get back to their running activities. If the fracture is displaced or in multiple pieces, open reduction and internal fixation is necessary to avoid long term problems.
Pre and Postop Displaced Comminuted Navicular Fracture with ORIF
In the picture above is a sequence of navicular fracture repair. An x-ray of a displaced navicular bone fracture (furthest left). Surgical repair inter-operative picture of placed plate with screw fixation to hold the fracture fragment in place and provide stability (center top). Lateral view of post-operative x-ray repair of fracture (center bottom). Anterior Posterior x-ray of post-operative repair of navicular fracture with screws and surgical plate visible (furthest right).
The following x-rays in sequence are that of a case of a navicular fracture which was repaired with open reduction and internal fixation with screws and surgical plate. The first two images are pre-operative images showing a fracture that is difficult to see. Given the clinical picture it is always a good idea to order advanced imaging to be sure of diagnosis. The last three images are post-surgical repair of the fracture.
The images below demonstrate in CT scan (left) a fracture of the navicular bone and post-surgical repair of the fracture on a lateral x-ray (right) with surgical screws and pin.