Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Duke University Health System, Durham, NC, USA.
Department of Basic Sciences, Duke University, Durham, NC, USA.
Foot Ankle Int. 2022 Jan;43(1):12-20. doi: 10.1177/10711007211034812. Epub 2021 Aug 17.
Navicular stress fractures are becoming increasingly more common. There is no universal consensus on treatment. We provide an algorithm that we feel will be useful in determining treatment.
A retrospective study was performed on all patients having operative treatment of navicular stress fractures during a 10-year period. Acute fractures were treated with open reduction internal fixation. Chronic fractures greater than 3 months were treated with open reduction and internal fixation (ORIF) and iliac crest bone grafting. Chronic fractures with evidence of sclerosis, avascular changes, or those who failed previous surgery were treated with ORIF, iliac crest bone grafting, as well as vascular bone grafting. Patients' pain scores were recorded and a return-to-sports scale was used. Radiographic union was compared among the 3 groups using computed tomographic (CT) scans or radiographs.
Forty-three patients were identified. Fifteen received ORIF alone, 12 were treated with ORIF and bone graft, and 16 had ORIF with vascularized bone grafting. No difference was found among the median age of the 3 groups. In terms of radiographic healing, 3 patients in the ORIF group received radiographs alone. All other patients had follow-up CT scans. ORIF alone group had 80% union, ORIF with bone graft had 75% union, and ORIF with vascularized bone grafting had 100% union. Return to sports did not show any difference among the 3 groups.
The algorithm dividing navicular stress fractures into 3 distinct groups with different operative techniques helped us address these difficult cases. Vascularized bone grafting certainly appeared to be beneficial for the more difficult cases.
Level IV, case series.
舟骨应力性骨折的发病率越来越高。目前对于该病的治疗方法尚未达成共识。我们提供了一种算法，旨在帮助临床医生确定治疗方案。
对 10 年间接受手术治疗的舟骨应力性骨折患者进行回顾性研究。急性骨折采用切开复位内固定治疗，病程大于 3 个月的慢性骨折采用切开复位内固定联合髂嵴骨移植治疗，有硬化、缺血性改变或既往手术失败的慢性骨折采用切开复位内固定、髂嵴骨移植联合带血管骨移植治疗。记录患者的疼痛评分，并采用重返运动量表进行评估。采用 CT 扫描或 X 线片比较 3 组患者的影像学愈合情况。
共纳入 43 例患者，其中 15 例行切开复位内固定治疗（ORIF 组），12 例行切开复位内固定联合骨移植治疗（ORIF+BG 组），16 例行切开复位内固定联合带血管骨移植治疗（ORIF+VBG 组）。3 组患者的年龄中位数无差异。在影像学愈合方面，ORIF 组中有 3 例仅接受 X 线检查，其余患者均接受 CT 扫描。ORIF 组、ORIF+BG 组和 ORIF+VBG 组的影像学愈合率分别为 80%、75%和 100%。3 组患者的重返运动情况无差异。
根据不同的手术技术将舟骨应力性骨折分为 3 组的算法有助于处理这些复杂病例，带血管骨移植对较难处理的病例可能更有益。
IV 级，病例系列研究。
