Tuesday, May 24, 2011

Minifragment Plate Fixation of High-Energy Navicular Body Fractures

Jason Evans, MD; Daphne M. Beingessner, MD; Julie Agel, MA; Stephen K. Benirschke, MD

The purpose of this study was to assess the ability of miniplate
fixation in navicular fractures to restore medial column stability,
maintain reduction, and determine the impact this approach may have on
the development of avascular collapse of the navicular. We hypothesized
that comminuted fractures of the navicular can be safely reduced and
maintained to union with minifragment plate fixation with a low
incidence of avascular collapse. Materials and Methods: A retrospective
chart review was performed on 24 patients with navicular
fractures treated with open reduction and internal fixation with
minifragment plate fixation at a level one trauma center over a period
of 6 years. Results: All fractures united. No patient developed a deep
infection. There was no loss of reduction. Isolated broken screws were
evident in three patients (12.5%), with no plate breakage, and no
implant failure by pullout. Four patients (17%) underwent plate removal
for painful prominent hardware following fracture healing. Four
patients (17%) developed radiographic arthrosis of the talonavicular
joint. One patient (4%) had radiographic avascular collapse evident at
6 months and was treated with plate removal and an
orthotic device. Conclusion: Minifragment fixation was a good
alternative to independent lag screws for rigid stabilization of
navicular body fractures

Level of Evidence: IV, Retrospective Case Series
Key Words: Navicular; Avascular Necrosis; Talonavicular Arthritis;
Midfoot Injuries; High-Energy

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