Navicular fracture

Case contributed by Weiling Tan

Presentation

Patient was involved in a road traffic accident. Was hit from the back by a bus. He fell into his right leg which got caught in the motorcycle clutch. Sustained heel laceration and complains of heel pain. Swelling seen over dorsum of the foot with tenderness.

Patient Data

Age: 60 years
Gender: Male
x_ray

In the internal oblique view, a small density is seen adjacent to the talus that possibly represents the fracture fragment. 

An acute displaced fracture on the dorsal aspect of the navicular is seen, best demonstrated on the lateral view. 

Case Discussion

Navicular fractures (also known as tarsal navicular fractures), are fractures of the mid foot, caused by acute trauma or chronic use. Common fractures are avulsion, tuberosity, body, or stress fractures. They can be classified according to the part of the navicular affected which is dependent on the nature of the trauma and its mechanism. 

Avulsion fractures (as per above) refer to avulsion fractures of the dorsal or medial aspect of the navicular. Such fractures occur during excessive force in plantar flexion, or eversion/inversion. Avulsion fractures would be best demonstrated on the lateral view of the foot.

Tuberosity fractures occur on the navicular tuberosity, on the medial aspect of the navicular. This is due to eversion injuries, and is often associated and confused with the accessory navicular. An additional external oblique view may be performed to better demonstrate the medial aspect of the navicular. 

Body fractures occur over the main body of the navicular. They largely occur due to axial loading, with high impact mechanisms such as fall from height or road traffic accidents. The different fracture types of the body can be classified according to the Sangeorzan classification.

Stress fractures occur due to repetitive stress and overloading on the navicular. They represent about a third of all stress fractures of the foot and are most often diagnosed via MRI. 

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