LUNAM Université, CHU, Angers, France.
Orthop Traumatol Surg Res. 2013 Jun;99(4 Suppl):S241-9. doi: 10.1016/j.otsr.2013.03.001. Epub 2013 Apr 26.
Tarsal navicular fractures are rare and treatment of comminuted fractures is especially difficult. Since 2007, the authors have had access to 3D reconstruction from CT scan images and specific locking plates, and they decided to evaluate whether these elements improved management of these severe cases.
Between 2007 and 2011, 10 comminuted tarsal navicular fractures were treated in a prospective study. All of the fractures were evaluated by 3D reconstruction from CT scan images, with suppression of the posterior tarsal bones. The surgical approach was chosen according to the type of lesion. Reduction was achieved with a mini-distractor when necessary, and stabilized by AO locking plate fixation (Synthes™). Patient follow-up included a clinical and radiological evaluation (Maryland Foot score, AOFAS score). Eight patients underwent postoperative CT scan.
All patients were followed up after a mean 20.5 months. Union was obtained in all patients and arthrodesis was not necessary in any of them. The mean Maryland Foot score was 92.8/100, and the AOFAS score 90.6/100. One patient with an associated comminuted calcaneal fracture had minimal sequella from a compartment syndrome of the foot.
The authors did not find any series in the literature that reported evaluating tarsal navicular fractures by 3D reconstruction from CT scan images. The images obtained after suppression of the posterior tarsal bones systematically showed a lateral plantar fragment attached to the plantar calcaneonavicular ligament, which is essential for stability, and which helped determine the reduction technique. Locking plate fixation of these fractures has never been reported.
Comminuted fractures of the tarsal navicular were successfully treated with specific imaging techniques in particular 3D reconstructions of CT scan images to choose the surgical approach and the reduction technique. Locking plate fixation of the navicular seems to be a satisfactory solution for the treatment of these particularly difficult fractures.
Level IV.
跗骨舟状骨骨折较为罕见，粉碎性骨折的治疗尤其困难。自 2007 年以来，作者可以通过 CT 扫描图像的 3D 重建和特定的锁定板获得这些信息，他们决定评估这些元素是否改善了这些严重病例的治疗效果。
在一项前瞻性研究中，2007 年至 2011 年，10 例粉碎性跗骨舟状骨骨折患者接受了治疗。所有骨折均通过 CT 扫描图像的 3D 重建进行评估，同时抑制后跗骨。手术入路根据病变类型选择。需要时，使用微型牵开器进行复位，并通过 AO 锁定板固定（Synthes™）进行稳定。患者随访包括临床和影像学评估（Maryland 足部评分、AOFAS 评分）。8 例患者术后接受 CT 扫描。
所有患者平均随访 20.5 个月。所有患者均获得愈合，无任何患者需要融合。Maryland 足部评分平均为 92.8/100，AOFAS 评分为 90.6/100。1 例合并粉碎性跟骨骨折的患者因足部间隔综合征出现轻微后遗症。
作者未在文献中找到任何评估 CT 扫描图像 3D 重建的跗骨舟状骨骨折的系列研究。抑制后跗骨后获得的图像系统地显示附着在足底跟舟韧带上的外侧跖骨碎片，这对稳定性至关重要，并有助于确定复位技术。这些骨折的锁定板固定从未有过报道。
通过特定的成像技术，特别是 CT 扫描图像的 3D 重建，成功治疗了粉碎性跗骨舟状骨骨折，以选择手术入路和复位技术。锁定板固定舟状骨似乎是治疗这些特别困难骨折的满意解决方案。
IV 级。
