Name: Navicular Fracture Surgical Stabilization
Uploaded: 2019-05-23T00:00:00Z
Channel: Arthrex

Foot and Ankle

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VID1-000206-en-US | A | Navicular Fracture Surgical Stabilization

Kaitlin C. Neary

Human

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

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Cirurgiões que apresentam um ou mais casos clínicos.

Vídeos apresentações de casos

Cirujanos que presentan uno o más casos clínicos.

Video presentaciones de casos

Navicular Fracture Surgical Stabilization

Hi, I'm Doctor Caitlin Neary from Boise, Idaho, and I will be discussing a case presentation highlighting the Arthrex mesh plate for navicular fracture. The patient was a 26 year old male who presented to clinic after sustaining a left foot injury while riding his dirt bike. He was complaining of pain over the dorsal aspect of his midfoot, but otherwise did not sustain any other injuries. He had no significant past medical history and was otherwise a very healthy 26 year old male. On exam, he had swelling and ecchymosis over the dorsal aspect of his midfoot, as well as tenderness to palpation directly over his navicular. He otherwise had no open wounds and his skin was intact. He was grossly neurovascular intact distally. Here are his injury films, which reveal evidence of a comminuted fracture. He appears to have collapsed through the talonavicular and navicular cuneiform joints, but otherwise his medial longitudinal arch remains fairly well maintained. A CT scan was obtained to further evaluate the extent of the fracture pattern. The CT scan confirmed the presence of essentially a three part navicular fracture with a with a central die punch fragment. There was also dorsal displacement of the medial fragment. The sagittal images from the CT scan confirm not only the presence of the three part navicular fracture, but also presence of a significant amount of plantar comminution. Due to the inherent unstable nature of this fracture pattern, and in order to restore alignment and stability of the navicular. The patient elected to proceed with surgery. I approached his navicular through a dorsal incision in which the navicular was able to be fully exposed. The Arthrex small joint distractor was used with a pin in the medial cuneiform and the Taylor neck, in order to distract through both the Taylor navicular and navicular cuneiform joints. This allowed increased exposure and ease with reduction of the navicular fracture. I was able to reduce the navicular fracture into what I considered anatomic alignment, and this was held in place with multiple K-wires. When considering fixation options for his fracture, I felt that screws would be unlikely to provide the required stability for his fracture, and would also be unable to hold his joint surfaces reduced. Further, I felt that there would be a high risk of collapse through the plantar combination when considering plating options. I knew that I needed a plate that would adequately span all three fracture fragments. I also needed a plate that would allow for buttress type fixation of both the talonavicular and the navicular cuneiform joints. I needed multiple options for fixation due to the multiple fragments and the geometry of his navicular. I also knew that I needed a plate that would anatomically fit the contour of the navicular in order to overall increase the strength of the construct, as well as to avoid irritation of the surrounding soft tissues. In order to fulfill all these plating requirements, I felt that the mesh plate was the best option for fixation. The nice part about the mesh plate is that this can be fashioned and cut and shaped into size, required for its intended use. The plate comes in long and short lengths, and also comes in both titanium and stainless steel. Here are his intraoperative images showing final reduction and fixation of his navicular. The overall geometry of the navicular has been well restored, and his talonavicular and navicular cuneiform joints are well aligned. The length of his medial and middle columns has been restored as well. In terms of post-operative protocol, I kept the patient non-weight bearing in a splint for the first two weeks. From weeks 2 to 6 he was kept non-weight bearing in a boot, but it was allowed to remove the boot for showering and light ankle range of motion only from week six to week ten. I allowed him to start to advance his weight bearing in the boot, and from weeks 10 to 12, he was allowed to wean out of the boot into a regular shoe. At 12 weeks post op, he was able to wean out of the boot, and at that point in time, I saw him for his final follow up. Here are the patients weight bearing radiographs when he was approximately three months out from surgery. His fracture appears to be well healed and overall his mid-foot alignment is well maintained. He was very happy with the outcome of his surgery and had returned to full activity with minimal pain and was doing well. In conclusion, I have found the mesh plate to have multiple indications where it can be very helpful. This includes hindfoot, midfoot and forefoot fractures in which the fracture morphology does not match previously contoured anatomic plates. I have also found it helpful with midfoot fusions, particularly Charcot and other types of deformity, where once again pre contoured plates does not match the shape of the bone. Thank you.

Navicular Fracture Surgical Stabilization

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