Peml Marek, Holub Karel, Pompach Martin, Pešta Michal, Dráč Pavel, Kloub Martin
Department of Trauma Surgery, Ceske Budejovice Hospital, a.s., Ceske Budejovice.
Department of Trauma Surgery, Pardubice Hospital, Pardubice.
Acta Chir Orthop Traumatol Cech. 2025 Mar;92(1):28-35. doi: 10.55095/achot2024/034.
Inadequate treatment of displaced fractures of the navicular bone may result in malalignment, formation of non-union, accelerated development of osteoarthritis or avascular necrosis and thus a fundamental limitation of mobility and gait disturbance. The aim of our study was to evaluate the results in our group of patients undergoing surgery for navicular fractures.
Our retrospective monocentric study included all surgically treated navicular fractures in patients over 18 years of age performed in our department between 2009 and 2018. A total of 18 patients met these criteria and were invited for clinical and radiographic follow-up. One patient refused to attend and two were lost to follow-up. The remaining 15 patients underwent clinical assessment, including the use of AOFAS midfoot and VAS scores, and the grade of osteoarthritis was determined using radiographs.
Our final group of patients consisted of six women and nine men. The mean age of the patients at the time of surgery was 43 (21-67) years, with mean follow-up duration of 68 (18-130) months. The most common mechanism of trauma was high-energy injury occurring in nine of cases. According to the Schmid classification, six fractures were Type I and II each whereas three cases were Type III fractures. Concomitant injuries involving the foot and ankle were present in six cases. All fractures healed.Open reduction and internal fixation (ORIF) was performed in 14 cases. The radiographs showed the presence of osteoarthritis grade 0 or I in nine patients and osteoarthritis grades II and III in six patients. The AOFAS Midfoot scale was excellent and good in eleven cases, satisfactory in two and poor also in two cases. The average AOFAS Midfoot scale was 87.7 points. A procedure-related complication was a case of skin necrosis in a patient eventually undergoing cuneonaviculotalar arthrodesis in another hospital.
Consistent with literature data, our group showed a higher incidence of concomitant injuries in the foot region. Use of two approaches was not associated with an increased risk of developing avascular necrosis. We do not recommend the use of Kirschner wires for definitive osteosynthesis although we do use them as part of staged treatment or as an additional type of fixation. Like other authors, we observed higher grades of post-traumatic osteoarthritis in the subgroup of patients with more severe injuries.
Open reduction and stable osteosynthesis of navicular fracture-displacements are associated with good outcomes in most patients. The most serious consequences of these fractures are post-traumatic arthritis and pain. It is critical to search for concomitant injuries. Given the rarity of these fractures, they should be preferably treated in specialised medical centres.
舟状骨移位骨折治疗不当可能导致畸形愈合、骨不连形成、骨关节炎加速发展或缺血性坏死，从而严重限制活动能力并导致步态障碍。本研究的目的是评估我们组中接受舟状骨骨折手术患者的治疗结果。
我们的回顾性单中心研究纳入了2009年至2018年间在我们科室对18岁以上患者进行手术治疗的所有舟状骨骨折病例。共有18例患者符合这些标准，并被邀请进行临床和影像学随访。1例患者拒绝参加，2例失访。其余15例患者接受了临床评估，包括使用美国足踝外科协会（AOFAS）中足评分和视觉模拟评分（VAS），并通过X线片确定骨关节炎的分级。
我们的最终患者组包括6名女性和9名男性。患者手术时的平均年龄为43（21 - 67）岁，平均随访时间为68（18 - 130）个月。最常见的创伤机制是9例发生的高能损伤。根据施密德分类，6例骨折为I型和II型，各6例，3例为III型骨折。6例伴有足踝部的合并损伤。所有骨折均愈合。14例患者进行了切开复位内固定（ORIF）。X线片显示9例患者存在0级或I级骨关节炎，6例患者为II级和III级骨关节炎。AOFAS中足评分在11例中为优或良，2例为满意，2例为差。AOFAS中足评分的平均值为87.7分。与手术相关的并发症是1例患者发生皮肤坏死，最终在另一家医院接受了楔舟距关节融合术。
与文献数据一致，我们组显示足部合并损伤的发生率较高。采用两种手术入路与发生缺血性坏死的风险增加无关。尽管我们确实将克氏针作为分期治疗的一部分或作为额外的固定方式使用，但不推荐将其用于确定性骨固定。与其他作者一样，我们观察到在损伤更严重的患者亚组中创伤后骨关节炎的分级更高。
舟状骨骨折移位的切开复位和稳定的骨固定在大多数患者中可取得良好的治疗效果。这些骨折最严重的后果是创伤后关节炎和疼痛。寻找合并损伤至关重要。鉴于这些骨折较为罕见，最好在专业医疗中心进行治疗。
