Sharkey Brandon, Yatsonsky David, Huffman Nickelas, Dong Tony, Lewis Adrian
Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Science, Toledo, USA.
Department of Pediatric Orthopaedic Surgery, ProMedica Toledo Hospital, Toledo, USA.
Cureus. 2023 Oct 28;15(10):e47881. doi: 10.7759/cureus.47881. eCollection 2023 Oct.
We present the case of a symptomatic patient with two separate accessory navicular bones, a novel finding that does not fall within current classification standards. Furthermore, there is a paucity of current literature with regard to the management of symptomatic cases. Accessory navicular bones, sometimes referred to as os naviculare, are ossicles that can occur in multiple configurations and are considered developmental anomalies. The accessory navicular is an accessory bone found on the medial side of the navicular bone of the foot. While often asymptomatic, they can occasionally lead to clinically significant pain and/or deformity that can cause patients to seek out treatment and sometimes surgical correction. Diagnosis relies on clinical suspicion and imaging studies. A nine-year-old female patient presented initially with complaints of sharp pain over the medial side of her left foot, after which X-rays were obtained that demonstrated an accessory navicular bone. Upon diagnosis, conservative measures were implemented, including placing the patient in a short-leg cast with limited activity. After a failed trial of conservative measures, the patient underwent surgical excision of the accessory navicular bone, with imaging and intraoperative findings of two separate accessory navicular bones, a unique finding in patients with accessory navicular bones. During the six-week follow-up, the patient improved with no new complaints or concerns and was informed she could begin weight-bearing as tolerated with two crutches; she was then weaned from the crutches and returned to normal activity. In the current case, we followed the same route of treatment used to treat a single accessory navicular bone, utilizing first non-surgical interventions and then ultimately surgical excision after continual pain despite conservative measures. This case highlights the promising outcome for a patient with two separate accessory navicular bones when following the guidelines for the treatment of a single accessory navicular bone.
我们报告了一例有症状的患者，其有两块独立的副舟骨，这是一项新发现，不属于当前的分类标准。此外，目前关于有症状病例管理的文献较少。副舟骨，有时也称为舟状籽骨，是一种可以以多种形态出现的小骨，被认为是发育异常。副舟骨是在足舟骨内侧发现的一块附属骨。虽然通常无症状，但它们偶尔会导致临床上显著的疼痛和/或畸形，从而使患者寻求治疗，有时还需要手术矫正。诊断依赖于临床怀疑和影像学检查。一名9岁女性患者最初因左脚内侧剧痛前来就诊，随后进行的X线检查显示有一块副舟骨。确诊后，采取了保守措施，包括给患者佩戴短腿石膏并限制活动。在保守治疗试验失败后，患者接受了副舟骨的手术切除，影像学和术中发现有两块独立的副舟骨，这在副舟骨患者中是一个独特的发现。在六周的随访中，患者病情好转，没有新的不适或问题，并被告知可以在耐受的情况下使用双拐开始负重；随后她逐渐停用拐杖并恢复正常活动。在当前病例中，我们遵循了用于治疗单个副舟骨的相同治疗路径，首先采用非手术干预，然后在尽管采取了保守措施但仍持续疼痛的情况下最终进行手术切除。该病例突出了遵循单个副舟骨治疗指南时，有两块独立副舟骨的患者可能获得的良好治疗效果。
