Navicular stress fractures: a prospective study on athletes.
BACKGROUND
Navicular stress fractures of the foot often are difficult to diagnose and treat.


METHODS
Nineteen athletic patients seen from 1999 to 2003, were compared to a previously treated group of 22 athletes with similar injuries treated from 1994 to 1998. Based on the frontal plane CT images, a previously described classification system was used to assess the injury: type I dorsal cortical break; type II fracture extending into the navicular body; and type III fracture breaches two cortices. Nonoperative treatment was recommended for patients with type I injuries and open reduction and internal fixation (ORIF) were recommended for those with type II and III injuries. The time to return to activity and ability to return to competition were assessed, along with differences between fracture type and gender.


RESULTS
Return to activity (RTA) was 4.0 months for the entire group. RTA for type I (four injuries), type II (eight injuries), and type III (seven injuries) was 3.8, 3.7, and 4.2 months, respectively. Fifteen of 16 competitive athletes returned to full competition, including all who had ORIF.


CONCLUSIONS
Navicular stress fractures can take 4 months to heal with nonoperative or operative treatment. Surgery should be considered for more severe injuries, which can be assessed by CT scan.
Saxena
Amol
A
Palo Alto Medical Foundation, Department of Sports Medicine, PAMF 795 El Camino Real, Palo Alto, CA 94301, USA. heysax@aol.com
Fullem
Brian
B
D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005413:Flatfoot / Q000150:complications; D005500:Follow-Up Studies; D005530:Foot Deformities / Q000150:complications; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D015775:Fractures, Stress / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012420:Running / Q000293:injuries; D012737:Sex Factors; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016474:Weight-Bearing