Complications and radiographic outcomes of operatively treated navicular fractures.

OBJECTIVES

To examine fracture patterns and surgical data to assess radiographic outcomes and complications after open reduction and internal fixation of navicular fractures.

DESIGN

Retrospective cohort study.

SETTING

A single level 1 trauma center.

PATIENT PARTICIPANTS

Patients who underwent operative treatment of a navicular fracture. Patients exclusion criteria included nonoperative management, less than 6 months of follow-up, patients younger than 18 years, or if they underwent a fusion at index operation.

INTERVENTION

Operative treatment of the navicular.

OUTCOME MEASURES AND COMPARISONS

Clinical and radiographic postoperative complications and patient-reported outcomes.

RESULTS

Thirty-eight patients met inclusion criteria. Seven patients had at least 1 postoperative complication. Radiographically, there were 7 cases of talonavicular joint (TNJ) arthritis, 6 cases of navicular avascular necrosis (AVN), and 7 cases of foot collapse. Navicular fractures with TNJ dislocation are associated with an increased rate of progression to TNJ arthritis ( = 0.009) while those requiring TNJ spanning fixation are associated with increased rates of navicular AVN ( = 0.047) and reoperation ( = 0.007). The mean PROMIS Physical Function (PF) score was 46.48 (9.99) ( = 0.088) and Pain Interference (PI) score was 56.79 (8.10) ( = 0.002) after a minimum of 2 years of follow-up. The PROMIS PF score was 46.48 (9.99) ( = 0.088) and PI score was 56.79 (8.10) ( = 0.002) after a minimum of 2 years of follow-up.

CONCLUSION

Patients with a TNJ dislocation have increased rates of TNJ arthritis while TNJ spanning fixation is associated with increased rates of navicular AVN and reoperation.

LEVEL OF EVIDENCE

Level IV.