Fractures of the navicular

Area of Science:

• Orthopedics
• Podiatry
• Trauma Surgery

Background:

• Navicular fractures, particularly intra-articular types, pose significant challenges in foot and ankle surgery.
• The navicular bone's unique anatomy and central role in the talonavicular joint necessitate precise management to preserve function.
• Displaced navicular fractures risk joint incongruity, avascular necrosis, and nonunion, impacting long-term foot mechanics.

Purpose of the Study:

• To outline optimal surgical strategies for managing large or significantly displaced intra-articular navicular fractures.
• To emphasize the importance of preserving the navicular's blood supply during surgical intervention.
• To discuss adjunctive techniques and postoperative care essential for successful navicular fracture healing and functional recovery.

Main Methods:

• Review of surgical principles for open reduction and internal fixation of navicular fractures.
• Discussion of techniques to maintain talonavicular joint congruity and medial column stability.
• Consideration of external fixation, bone grafting, and limited peritarsal fusion as adjuncts.

Main Results:

• Anatomic restoration of joint surfaces and preservation of foot length/stability are achievable with surgical intervention.
• Careful surgical exposure is key to balancing adequate reduction and fixation with minimizing devascularization.
• Successful outcomes depend on meticulous surgical technique, appropriate adjunctive procedures, and comprehensive postoperative care.

Conclusions:

• Surgical management, primarily open reduction and internal fixation, offers the best outcomes for complex navicular fractures.
• Preserving the tenuous blood supply to the tarsal navicular is paramount to prevent avascular necrosis and nonunion.
• Achieving anatomic reduction, stable fixation, and appropriate postoperative management are critical for restoring foot function and avoiding long-term complications.