The Operative Management of Navicular Stress Fractures in Adolescence

Kyung Tai Lee; Ki Chun Kim; Ki Won Young; Chang Ho Cho

doi:10.14193/jkfas.2016.20.4.170

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Lee, Kim, Young, and Cho: The Operative Management of Navicular Stress Fractures in Adolescence

Original Article

J Korean Foot Ankle Soc 2016;20(4):170-175.

Published online: 19 January 2016

DOI: https://doi.org/10.14193/jkfas.2016.20.4.170

The Operative Management of Navicular Stress Fractures in Adolescence

Kyung Tai Lee, Ki Chun Kim^*, Ki Won Young^†, Chang Ho Cho^*

KT Lee’s Orthopaedic Hospital, Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea

^*Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea

^†KT Lee’s Orthopaedic Hospital, Department of Orthopaedic Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea

Corresponding Author: Ki Chun Kim Department of Orthopaedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul 02053, Korea Tel: 82-2-2276-7841, Fax: 82-2-539-1262, E-mail: 711000e@naver.com

Received 18 September 201627 September 2016 Accepted 24 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The aim of this study is to evaluate the effectiveness of surgical treatment in adolescent patients suffering from navicular stress fracture.

Materials and Methods:

A total of 11 adolescent patients aged 14 to 19, who underwent an operation for navicular stress fracture between 2005 and 2008 were recruited. Clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) score.

Results:

The mean VAS score before the operation was 7.7. A score of 2.9 was confirmed at final follow up after the operation. The mean final follow-up period was 22.1 months. There was a statistically significant improvement in the VAS score between before and after the operation (p=0.01), and similarly, the AOFAS score also showed an improvement, from 46.5 to 80.7 (p=0.01). The pain that remained after the operation, according to the VAS score, was severe in three patients (27.3%), tolerable in seven patients (63.6%), and free of pain in one patient (9.1%).

Conclusion:

In navicular stress fracture in adolescents, careful selection of patients who could benefit from surgical treatment is recommended.

Keywords: Adolescence, Navicular bone, Stress fracture, Surgery

REFERENCES

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Figure 1.

Magnetic resonance images are demonstrating type I navicular stress fracture (A), type II navicular stress fracture (B), and type III navicular stress fracture (C).

Figure 2.

(A) Longitudinal incision was done over navicular body and explorated by needle insertion. (B) Sclerotic bone protuberance was resected. (C) Calcaneal anterior process strut bone graft was fit in ostectomy site.

Figure 3.

Navicular bone fixated with a cannulated screw through medial to lateral side is observed in postoperative foot standing anteroposterior view (A) and lateral view (B).

Figure 4.

Diffuse high signal over the navicular bone and ambiguous fracture line is observed.

Table 1.

Descriptive Data on 11 Navicular Stress Fractures

Case No.	Sex/age (yr) at injury	Sport and level of activity	Concomitant disorder	Routine radiograph		Bone scan	CT	MRI	Type of fractures	Treatment before operation	Method of operation	Result of treatment	Time from treatment to full activity (mo)	Length of follow-up (mo)
Case No.	Sex/age (yr) at injury	Sport and level of activity	Concomitant disorder	Initial	Review	Bone scan	CT	MRI	Type of fractures	Treatment before operation	Method of operation	Result of treatment	Time from treatment to full activity (mo)	Length of follow-up (mo)
1	M/18	Volleyball	-	Neg.	Neg.	-	-	Pos.	Partial/I	None	Open and IF	Clinically healed	3.5	17
2	M/18	Soccer	-	Neg.	Pos.	Pos.	-	Pos.	Partial/II	Mx, ESWT (4 wk)	AIBG and IF	Clinically healed	5	31
3	F/18	Police University	-	Neg.	Pos.	Pos.	-	Pos.	Partial/I	None	ACBG and IF	Talonavicular joint arthritis	–	39
4	M/18	Volleyball	-	Neg.	Neg.	-	-	Pos.	Partial/I	Mx	Open and IF	Clinically healed	4	8
5	M/17	Rugby	-	Pos.	Pos.	Pos.	-	Pos.	Complete/III	Mx	ACBG and IF	Radiological union	4	6
6	M/15	Soccer	-	Neg.	Neg.	Pos.	-	Pos.	Partial/I	Physical therapy	ACBG and IF	Radiological union	3.5	48
7	M/17	Soccer	-	Neg.	Neg.	Pos.	-	Pos.	Partial/I	Physical therapy	ACBG and IF	Radiological union	6	21
8	M/14	Baseball	Calcaneonavicular coalition	Neg.	Neg.	-	-	Pos.	Complete/III	None	ACBG and IF	Clinically healed	–	21
9	M/14	Soccer	Chronic ankle instability	Neg.	Neg.	Pos.	-	Pos.	Complete/III	None	ACBG and IF	Radiological union	6	20
10	M/17	Taekwondo	-	Neg.	Pos.	-	-	Pos.	Complete/III	None	ACBG and IF	Radiological union	6	19
11	F/19	Track	-	Neg.	Pos.	Pos.	Pos.	-	Partial/I	Physical therapy, local injection	ACBG and IF	Radiological union	–	13

M: male, F: female, Neg.: negative, Pos.: positive, CT: computed tomography, MRI: magnetic resonance imaging, Mx: medication, ESWT: extracorporeal shock wave treatment, IF: internal fixation, AIBG: autogenous iliac bone graft, ACBG: autogenous calcaneal bone graft.

Table 2.

Clinical Data on 11 Navicular Stress Fractures

Case No.	VAS		AOFAS midfoot score		Final result
Case No.	Preoperative	Follow-up	Preoperative	Follow-up	Final result
1	9	1	32	84	Tolerable pain
2	9	2	57	98	Asymptomatic state
3	7	6	47	63	Chopart joint fusion
4	9	3	52	90	Tolerable pain
5	7	2	31	87	Tolerable pain
6	8	2	45	85	Tolerable pain
7	8	2.5	41	65	Poor
8	6	2	52	90	Tolerable pain
9	7	2	37	82	Tolerable pain
10	8	3	67	90	Tolerable pain
11	7	6	51	54	Poor

VAS: visual analogue scale, AOFAS: American Orthopaedic Foot and Ankle Society.

Table 3.

Summary of Success and Mean Time to Return to Activity of Non-weight-bearing Cast Immobilization for More than 6 Weeks and Surgery

Author	Success of initial treatment		Mean time to return to activity (mo)
Author	Non-weightbearing/cast (≥6 wk)	Surgery	Non-weightbearing/cast (≥6 wk)	Surgery
Torg et al.¹⁶	5/5	2/2	4.8	6
Fitch et al.¹²	-	7/7	-	3.9
Burne et al.¹⁴	0/1	-	-	-
Saxena and Fullem¹⁵	-	4/4	-	4.3
Total	5/6 (83.3)	13/13 (100)	-	-

Values are presented as number only or number (%).

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