title: Navicular stress fractures: outcomes of surgical and conservative management.
abstract: OBJECTIVE
  To compare the long term outcomes of the two treatment options for navicular stress fractures: non-weightbearing cast immobilisation and surgical fixation.
  
  
  METHODS
  Retrospective case study.
  
  
  METHODS
  Subjects aged 18 years and older who had been treated for a navicular stress fracture more than two years previously.
  
  
  METHODS
  Questionnaire based analogue pain score and function score; tenderness on palpation; abnormality detected on computed tomography (CT).
  
  
  RESULTS
  In all, 32 fractures in 26 subjects were investigated. No significant differences were found between surgical and conservative management for current pain (p = 0.984), current function (p = 0.170), or abnormality on CT (p = 0.173). However, surgically treated patients more often remained tender over the "N spot" (p = 0.005), even after returning to competition for two years or more.
  
  
  CONCLUSIONS
  Surgical fixation of navicular stress fractures appears to be as effective as conservative management over the longer term. However, there remains a small but measurable degree of pain and loss of function over this period. The value of using "N spot" tenderness as the sole clinical predictor of treatment success requires further investigation, as some patients remained tender despite successful completion of treatment and return to competition.
authors.affiliation: Centre For Health, Exercise and Sports Medicine, The University of Melbourne, Victoria 3010, Australia.
authors.forename: N J
authors.initials: NJ
authors.lastname: Potter
authors.forename: P D
authors.initials: PD
authors.lastname: Brukner
authors.forename: M
authors.initials: M
authors.lastname: Makdissi
authors.forename: K
authors.initials: K
authors.lastname: Crossley
authors.forename: Z S
authors.initials: ZS
authors.lastname: Kiss
authors.forename: C
authors.initials: C
authors.lastname: Bradshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000601:surgery*; D002370:Casts, Surgical; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D015775:Fractures, Stress / Q000601:surgery*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D020127:Recovery of Function; D012189:Retrospective Studies; D013639:Tarsal Bones / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome