Internal fixation of fracture dislocation of the navicular
Subscribe to get full access to this operation and the extensive Foot Surgery Atlas.
Learn the Internal fixation of fracture dislocation of the navicular surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Internal fixation of fracture dislocation of the navicular surgical procedure.
The navicular is the keystone of the medial longitudinal arch and forms part of a “ball and socket” arrangement with the head of the talus, termed by some as the coxa pedis. Together with the talus, three cuneiforms and the medial three rays, the navicular is a key component of the medial column of the foot with the lateral column comprising of the calcaneum, cuboid and the lateral two rays. Owing to its intimate relationships with its surrounding architecture, the navicular is rarely injured in isolation, especially in higher energy injuries.
The talonavicular joint, together with the calcaneo-cuboid joint, forms the transverse tarsal joint, crucial for effective gait – absorbing energy in heel strike and stiffening to aid in propulsion. The combination of these two joints is commonly referred to the Chopart joint. Acute, traumatic fractures of the navicular are relatively uncommon with an incidence of 1.7/100,000/year. In addition, the severity of injuries to the navicular lie on a spectrum dependent upon the amount and nature of the energy imparted across the bone. Injuries range from simple ligamentous avulsions associated with ankle sprains through to crush injuries not only involving the navicular but also the cuboid and have been comprehensively classified into five groups in a recent paper from the Sheffield Foot and Ankle Unit. These latter, high-energy injuries have been shown to correlate with significant long-term morbidity and adverse function especially in the multiply injured patient. Failure to restore the anatomic relationships of the bony components within both columns, together with their relative column length, can result in significant morbidity. Navicular fractures can be subtle and diagnosis is frequently delayed, either through inadequate imaging or the presence of other significant, distracting injuries in the multiply injured patient.
One final crucial element to navicular fractures lies in common with fractures of the talus, namely that the navicular has a poor vascular supply. The bone receives blood via radial vessels leaving the central area prone to avascular change. These radial vessels emirate from both the dorsalis pedis and posterior tibial arteries with an indirect supply through the tendon insertion of the posterior tibial tendon. This means that, with injury, the navicular is prone to avascular necrosis and collapse.
Author: Mark Davies FRCS (Tr & Orth)
Institution: The Northern General Hospital, Sheffield ,UK.
0 of 14 questions completed
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
You must first complete the following:
0 of 14 questions answered correctly
Time has elapsed
Question 1 of 14
Which of the following is not considered part of the medial column of the foot?CorrectIncorrect
Question 2 of 14
Which of the following statements least applies to high energy fractures of the navicular?CorrectIncorrect
Question 3 of 14
Which of the following does not provide an arterial source to the navicular?CorrectIncorrect
Question 4 of 14
Which one of the statements does not follow the principles of midfoot trauma reconstructive surgery?CorrectIncorrect
Question 5 of 14
Which one of the following statements does not apply to the use of K-wire fixation?CorrectIncorrect
Question 6 of 14
When planning your surgical incision, which of the following landmarks are not particularly help to mark on the skin?CorrectIncorrect
Question 7 of 14
Which of the following structures is most likely to lie close to any dorsal longitudinal incisions to access the navicular?CorrectIncorrect
Question 8 of 14
Which one of the following intra-operative fluoroscopic views is not helpful in imaging the midfoot?CorrectIncorrect
Question 9 of 14
Which one of the following steps is mandatory after bridge plating the talonavicular joint for navicular fractures?CorrectIncorrect
Question 10 of 14
Which three midfoot joints are regarded as the most crucial to preserve function when treating midfoot fractures?CorrectIncorrect
Question 11 of 14
Which of the following constitutes an absolute indication for urgent definitive internal or temporising external fixation of a navicular fracture?CorrectIncorrect
Question 12 of 14
Which of the following is not necessary when creating an ideal set-up in the operating theatre for internal fixation of a navicular fracture?CorrectIncorrect
Question 13 of 14
Which one of the following is not a good technique when applying a locked bridge plate from talus to medial cuneiform?CorrectIncorrect
Question 14 of 14
Which one of the following navicular fracture patterns is least likely to lead to poor clinical outcomes?CorrectIncorrect