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Complications and radiographic outcomes of operatively treated navicular fractures
Thomas R Johnston1, William Fray McCormick1, Connor J Donley1
1Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
Objectives:
To examine fracture patterns and surgical data to assess radiographic outcomes and complications after open reduction and internal fixation of navicular fractures.
Design:
Retrospective cohort study.
Setting:
A single level 1 trauma center.
Patient Participants:
Patients who underwent operative treatment of a navicular fracture. Patients exclusion criteria included nonoperative management, less than 6 months of follow-up, patients younger than 18 years, or if they underwent a fusion at index operation.
Intervention:
Operative treatment of the navicular.
Outcome Measures And Comparisons:
Clinical and radiographic postoperative complications and patient-reported outcomes.
Results:
Thirty-eight patients met inclusion criteria. Seven patients had at least 1 postoperative complication. Radiographically, there were 7 cases of talonavicular joint (TNJ) arthritis, 6 cases of navicular avascular necrosis (AVN), and 7 cases of foot collapse. Navicular fractures with TNJ dislocation are associated with an increased rate of progression to TNJ arthritis (P = 0.009) while those requiring TNJ spanning fixation are associated with increased rates of navicular AVN (P = 0.047) and reoperation (P = 0.007). The mean PROMIS Physical Function (PF) score was 46.48 (9.99) (P = 0.088) and Pain Interference (PI) score was 56.79 (8.10) (P = 0.002) after a minimum of 2 years of follow-up. The PROMIS PF score was 46.48 (9.99) (P = 0.088) and PI score was 56.79 (8.10) (P = 0.002) after a minimum of 2 years of follow-up.
Conclusion:
Patients with a TNJ dislocation have increased rates of TNJ arthritis while TNJ spanning fixation is associated with increased rates of navicular AVN and reoperation.
Level Of Evidence:
Level IV.
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