SLR - January 2016 - Jennifer A. Lipman

Title: Results and Complications of Operative and Non-operative Navicular Fracture Treatment

Reference: Coulibaly MO, Jones CB, Sietsema DL, Schildhauer TA. Results and Complications of Operative and Non-operative Navicular Fracture Treatment. Injury. 2015 Aug;46(8): 1669-77.

Scientific Literature Review
 
Reviewed By: Jennifer A. Lipman, DPM
Residency Program: Cambridge Health Alliance
 
Podiatric Relevance: Navicular fractures are rarely encountered by the podiatric physician. Because individual practitioners may have limited experience in the treatment protocols of such fractures, it is important to evaluate different treatment options and their outcomes should the podiatric practitioner be presented with such a fracture.  This article sought to compare outcomes of operative intervention versus non-operative treatment.

Methods: This was a retrospective cohort study at a level 1 trauma center of operative and non-operative intervention for navicular fractures between March 2002 and June 2007. Stress fractures and less than three months of follow up were excluded. Operative technique consisted of open reduction and internal fixation (ORIF) with a one-quarter tubular plate, 2.0 mini T-plate or 2.7 plate. An external fixator was sometimes added for support. If the joint was too badly destroyed, a primary arthrodesis was performed. The patients were kept non weight bearing for 8-10 weeks in first a splint and then a short leg cast. In both groups, weight bearing was progressed based on radiographic and clinical healing. Outcomes measures included healing disturbances both osseous and soft tissue, clinical and functional outcome and adequacy of reduction.  

Results: One hundred and ten patients were originally included with 48 patients being excluded. Sixty-two patients with 64 navicular fractures were analyzed. Average follow-up time was 23 ± 15.4 months. Thirty-five (54.7 percent) fractures were treated with ORIF and 29 (45.3 percent) were treated non-operatively. For patient’s in the non-operative group, 73.5 percent had a good result as compared to 39 percent in the ORIF group. Full recovery was made by 79.2 percent in the non-operative group as compared to 68.4 percent in the ORIF group. Twenty-two of 41 patients who had ORIF needed secondary surgeries for implant removal due to local irritation, breakage or prominence.

Conclusions: From these results, the authors concluded that operative treatment is at high risk for complications. Even with good alignment after reduction, secondary arthritis and pain are common. From these results, I can personally conclude that non-operative management of navicular fractures is a good alternative to ORIF and can produce as good, if not better, outcomes than surgical intervention in some situations. This will help me in determining treatment for a patient with a navicular fracture and considering a conservative approach if I feel the situation warrants it.

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