Navicular fracture
Navicular fractures along with cuboid fractures form the most common isolated mid-foot fractures.
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Clinical presentation
May present with pain, swelling or hematoma directly over the mid-foot. Stress fractures in athletes and construction workers may present with vague pain and swelling over the mid-foot which worsens with exercise. Patients generally have normal range of motion and a normal neurovascular examination 1.
Pathology
The fracture occurs via two main mechanisms:
- chronic overuse injuries causing a stress fracture (often in athletes)
- acute trauma
Classification
The Sangeorzan classification is used to assess the severity of isolated navicular fractures and to determine management:
- type I: the fracture line is in the coronal plane and there is no angulation of the forefoot
- type II: the fracture line is dorsal-lateral to plantar-medial and the forefoot is medially displaced
- type III: there is a comminuted fracture in the sagittal plane and the forefoot is displaced laterally 4
Radiographic features
Plain radiograph
Plain radiographs are the best initial test in a suspected navicular fracture. Their sensitivity for identifying navicular fracture is low, however lateral and oblique radiographs provide the greatest chance of identifying a fracture. Rarely fractures of an accessory navicular bone (if present) are also possible and may be visible.
CT
CT is more sensitive for identifying navicular fractures. It also allows for the assessment of the extent of the fracture line and the degree of communition.
MRI
- T2: may demonstrate areas of hyperintensity over the fracture site indicating bone edema
It should be noted that MRI is more sensitive than CT however in identifying stress fractures 3.
Treatment and prognosis
Displaced type I and II fractures typically require open reduction and internal fixation with screw lag fixation. Type II fractures require open reduction and internal fixation followed by external fixation. Undisplaced fractures can be managed conservatively in a cast 3.
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fracture
- terminology
- fracture location
- diaphyseal fracture
- metaphyseal fracture
- physeal fracture
- epiphyseal fracture
- fracture types
- avulsion fracture
- articular surface injuries
- complete fracture
- incomplete fracture
- infraction
- compound fracture
- pathological fracture
- stress fracture
- fracture displacement
- fracture location
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facial fractures
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spinal fractures
- classification (AO Spine classification systems)
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cervical spine fracture classification systems
- AO classification of upper cervical injuries
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- Anderson and D'Alonzo classification (odontoid fracture)
- Roy-Camille classification (odontoid process fracture)
- Gehweiler classifcation (atlas fractures)
- Levine and Edwards classification (hangman fracture)
- Allen and Ferguson classification (subaxial spine injuries)
- subaxial cervical spine injury classification (SLIC)
- thoracolumbar spinal fracture classification systems
- three column concept of spinal fractures (Denis classification)
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cervical spine fracture classification systems
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upper limb fractures
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- Milch classification (lateral humeral condyle fracture)
- Weiss classification (lateral humeral condyle fracture)
- Bado classification of Monteggia fracture-dislocations (radius-ulna)
- Mason classification (radial head fracture)
- Frykman classification (distal radial fracture)
- Mayo classification (scaphoid fracture)
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scapular fracture
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carpal bones
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- pelvis
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- Pipkin classification (femoral head fracture)
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- Cooke and Newman classification (periprosthetic hip fracture)
- Johansson classification (periprosthetic hip fracture)
- Vancouver classification (periprosthetic hip fracture)
- femoral
- knee
- Schatzker classification (tibial plateau fracture)
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- tibia/fibula
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- ankle
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- Berndt and Harty classification (osteochondral lesions of the talus)
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hip
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