Surgical fixation of type 2 navicular fractures - evolution of a technique

G. Wright, G. Smith

Introduction: Fractures of the Navicular are both rare and potentially devastating injuries. The type 2 or medial displacement fracture pattern is particularly associated with boney comminution. Various techniques for surgical fixation have been proposed in an attempt to restore and maintain reduction with variable results. The senior surgeon has developed a reduction manoeuvre which greatly simplifies the process of reduction and fixation. We report on six patients with a Type 2 injury managed in this way and the one-year follow-up.

Methods: All patients underwent dual anteromedial and anterolateral incisions. The key to the technique is the constant large medial fragment. Upon relocation and temporary fixation of this fragment the medial column length is restored. This allows excellent access to the comminuted lateral half of the navicular for appropriate reduction and fixation. All cases were held with a navicular specific plate and an additional bridge-plate from the talus to the cuneiforms. The bridge-plate was removed at approximately nine months.

Results: All six patients were successfully treated with the technique. The mean age was 22 years. Five patients sustained the injury in high-energy motorcycle or road traffic accidents. Post operatively all remained non-weight bearing for 6-8 weeks then protected weight bearing in a walker boot for a further 4-6 weeks. At six months post-surgery all patients had no or minimal symptoms and all had returned to their previous occupation. Twelve month radiographic follow up confirmed maintenance of the reduction and no loss of either the medial arch or medial column length.