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A lateral drawing of the foot, depicting the navicular as the keystone of the medial longitudinal arch.
Source publication
The tarsal navicular plays an integral role in hind-foot motion and gait, and is the keystone of the foot's medial longitudinal arch. As such, injuries to the navicular can be devastating. Acute avulsion, tuberosity, and body fractures have been described. Fractures of the body result from high-energy trauma and are often seen in conjunction with a...
Context in source publication
Context 1
... navicular derives its name from its resemblance to a small boat, as suggested by its concave proximal articu- lar surface. The bone articu- lates distally with the 3 cu- neiforms, proximally with the talar head, and laterally with the cuboid (Figures 1-2). It is located in the uppermost por- tion of the medial longitudinal arch of the foot, acting as the keystone of the arch ( Figure 3). 2 The body of the navicular is a 6-sided, horseshoe-shaped disk. The navicular's distal articulation with the cunei- forms is via 3 facets that share a common synovial cavity. Its medial surface slopes posteri- orly, ending in the tuberosity. Plantar and dorsal ligaments reinforce each articulation, with further stability provided by the posterior tibial tendon and plantar calcaneonavicular (spring) ligament, which in- sert distally and medially on the tuberosity, as well as the Abstract: The tarsal navicular plays an integral role in hind- foot motion and gait, and is the keystone of the foot's medial longitudinal arch. As such, injuries to the navicular can be devastating. Acute avulsion, tuberosity, and body fractures have been described. Fractures of the body result from high- energy trauma and are often seen in conjunction with addi- tional ipsilateral foot injuries. Plain radiographs are the gold standard for diagnosis, with computed tomography helpful in the presence of intra-articular fracture extension. Non- operative treatment is reserved for avulsion injuries and non- displaced body fractures. Open reduction and internal fixation must be performed for all other types, as failure to achieve an anatomic reduction can impede proper locomotion. Com- plications following operative intervention include pain, stiff- ness, posttraumatic arthritis, avascular necrosis, nonunion, and hindfoot deformity. [Orthopedics. 2014;37(8):541-546.] n trauma update anterior fibers of the deltoid ligament, which enhance me- dial talonavicular joint stabil- ity. 9 This robust ligamentous network can only be disrupted with significant force, which is why displaced navicular body fractures are most fre- quently seen in the setting of high-energy ...
Citations
... 2 Acute navicular body fractures occur most commonly as a result of axial loading. 3 They can occur as a progression of a stress fracture. Vertical stress is transmitted through the medial ...
... These fractures are conservatively managed using a weight-bearing short leg cast and walking boot. 6 The displaced navicular fractures are best managed with open reduction and internal fixation using screws or small plates. The main intention of the surgical management of navicular displaced fractures is an anatomical reduction by restoring the length of the medial column which in turn helps in early mobilization with fewer complications. ...
... This complex influences the mobility of the entire foot, particularly in pronation and supination. From a biomechanical point of view, the talocalcaneonavicular joint is responsible for the efficiency of gait [4,10]: when the hindfoot is everted, the talonavicular and calcaneonavicular joints have parallel axes, allowing flexion movements; on the other hand, when the hindfoot is not everted, these joints allow little motions inside the midfoot, forming a rigid lever arm, useful for the propulsive phase of gait [11,12]. Considering this key role in the medial longitudinal arch, fractures (or avascular necrosis) of the navicular bone can lead to arch collapse, painful flatfoot deformity, and progressive valgus deformity of the subtalar joint [12]. ...
Background:
Clear recommendations about the optimal treatment of traumatic tarsal navicular fractures are still very debated in the literature, and this is due to several factors: navicular fractures are rare and often misdiagnosed injuries, they are frequently associated with other fractures or a dislocation of the midfoot, and the current knowledge is based on few papers mainly considering a limited number of cases and dealing with different therapeutic approaches. The treatment of navicular body fractures is controversial and burdened by a high incidence of complications; in particular, Sangeorzan type III comminuted fractures represent a real challenge for the orthopedic surgeon. An accurate preoperative planning, a scrupulous surgical technique aimed at restoring volume and bony anatomy, and the use of low-profile angular-stability plates can lead to optimal clinical and functional results, decreasing the chances of arthritic evolution of mid-foot joints.
... Gövde kırıkları yüksek enerjili travmalar sonucu gelişir ve aynı taraf diğer kemik kırıkları ile sıklıkla birliktelik gösterir. 29 BT kırığın intraartiküler uzanımının değerlendirilmesinde esastır. ...
... Other common causes of fractures include stress fractures and those due to twisting forces as seen in individuals participating in competitive sports. [18] The management of navicular fractures is challenging. Usually the simple undisplaced fractures are treated by use of a weight-bearing short leg cast for six weeks followed by the use of a walking boot for an additional four to six weeks. ...
... The plantar and dorsal cuboideo-navicular ligaments connect navicle with cuboid. This robust ligamentous network can only be disrupted in the setting of high-energy trauma causing displaced navicular fractures [11]. Foot pain is a very common symptom in patients with orthopaedic problems [12]. ...
... mm. Internal fixation has been used to treat acute navicular fractures that cannot be managed conservatively [11]. Knowing the mean length in a population helps in designing of the screw, plates and screw constructs used for internal fixation. ...
The navicular bone is supplied by more than one artery. The knowledge about the vascular foramina is important to understand the pathogenesis and management of navicular fractures. The objective of the present study is to analyze the morphology and morphometry of vascular foramina of dried human navicular bone in Indian population. The study was carried out by using 100 navicular bones (50 right and 50 left) collected from our institute and other medical institutes in and around Puducherry. The bones were macroscopically studied for vascular foramina with respect to its location, number, size, and shape. The data collected were statistically analyzed. The vascular foramina were present on dorsal, plantar, medial, and lateral surfaces of navicular bone. Kruskal-Wallis test followed by series of Mann-Whitney test for post hoc analysis showed the number of nutrient foramina observed on dorsal surface were significantly greater than those observed on the plantar (U=2,755, P=0.001), medial (U=43, P=0.001), and lateral (U=626.5, P=0.001) surfaces of the navicle. About 97.6% of foramina were circular and 2.5% were oval in appearance. About 96.7% of vascular foramina were <1 mm in size and 3.3% were ≥1 mm in size. Spearman's rank correlation coefficient done showed a strong, positive correlation between vascular foramina of <1 mm size and circular shape, which was statistically significant (rs=0.981, P=0.001). We believe the present study has provided additional information on the vascular foramina of navicular bone and useful to surgeons in foot surgeries.
... Although an AN is rarely associated with painful syndromes, clinicians must be familiar with these variants to avoid misinterpreting them as avulsion fractures (Requejo et al., 2000;Nwawka et al., 2013). Many authors have indicated the need to distinguish a tuberosity avulsion fracture from an AN (Mellado et al., 2003;Rosenbaum et al., 2014). Radiographically, the fractures are usually sharp with jagged edges, while the AN usually has smooth, rounded edges. ...
Introduction:
The accessory navicular (AN) is an accessory ossicle anatomically located on the medial side of the foot, proximal to the navicular and continuous with the tibialis posterior tendon. It is occasionally a source of pain and local tenderness. Knowledge of the AN and its morphological variations can help identify the source of a patient's symptoms and prevent misinterpreting them as fractures.
Materials and methods:
Foot radiographs from 1240 patients who presented in two centers with chronic foot pain, or persistent pain developed after trauma, were retrospectively reviewed to determine the incidence and variations of the AN in relation to gender.
Results:
The AN was found in 20.9% (259/1240). Among 259 feet with AN, Type 1 was identified in 25.4% (66/259), Type 2 in 42.4% (110/259) (20.0% (52/259) Type 2A and 22.4% (58/259) Type 2B), and Type 3 in 32.0% (83/259). After 13 patients with incomplete medical records had been excluded, the remaining records showed that foot pain was associated with an AN in 10.6% of patients (26/246). In 1.2% of cases, two additional ossicles were found proximal to the navicular, possibly the result of multiple ossification centers that did not unite at the time of development.
Conclusions:
Patient symptomatology was related to the presence of an AN in 2% of patients with chronic foot pain. The AN could vary morphologically. Our data can enhance our diagnostic skills in detecting these ossicles. This article is protected by copyright. All rights reserved.
... Avulsion fractures can also occur involving the posterior tibial tendon or the spring ligament. 6 These fragments can be mistaken for accessory bones, but are distinguishable by fragment morphology, sharp-edged appearance on radiography and a history of trauma and point tenderness. 5 Higher energy trauma and crush injuries are more likely to result in fractures to the body, which can be divided into navicular body or tuberosity fractures. ...
Injuries to the foot are a common cause for presentation to the emergency department (ED), and imaging is often used to aid in the diagnosis. The foot can be divided into three distinct anatomic regions: the forefoot, midfoot and hindfoot. Our manuscripts comprise a three-part imaging review in which we address the use of radiography as well as advanced imaging modalities. We provide pearls to radiographic interpretation and discuss prognostic implications and classification systems. Part 1 addressed forefoot injuries, Part 2 reviews midfoot injuries and Part 3 covers the hindfoot.
... The split or stress fractures are as a rule not associated with any deformity. The higher-energy injuries are associated not only with marked soft-tissue trauma but also with other injuries to the foot, and deformity is more likely to be present [6]. ...
