Management of tarsal navicular stress fractures: conservative versus surgical treatment: a meta-analysis.
OBJECTIVE
This study was conducted to provide a statistical analysis of previously reported tarsal navicular stress fracture studies regarding the outcomes and effectiveness of conservative and surgical management.


METHODS
Systematic review.


METHODS
A systematic review of the published literature was conducted utilizing MEDLINE through Ovid, PubMed, ScienceDirect, and EBSCOhost. Reports of studies that provided the type of tarsal navicular stress fracture (ie, complete or incomplete), type of treatment, result of that treatment, and the time required to return to full activity were selected for analysis. Using a mixed generalized linear model with study as a random effect and treatment as a fixed effect, cases were separated and compared based on 3 different types of treatment: conservative, weightbearing permitted (WBR); conservative, non-weightbearing (NWB); and surgical treatment. The outcome of the treatment was recorded as either successful or unsuccessful based on radiographic and/or clinical healing of the fracture and time from onset of treatment to return to activity.


RESULTS
There was no statistically significant difference between NWB conservative treatment and surgical treatment regarding outcome (P = .6441). However, there is a statistical trend favoring NWB management (96% successful outcomes) over surgery (82% successful outcomes). Weightbearing as a conservative treatment was shown to be significantly less effective than either NWB (P = .0001) or surgical treatment (P <.0003).


CONCLUSIONS
Non-weightbearing conservative management should be considered the standard of care for tarsal navicular stress fractures. The authors could find no advantage for surgical treatment compared with NWB immobilization. However, there is a statistical trend favoring NWB over surgery. Rest or immobilization with weightbearing was inferior to both other treatments analyzed. The authors concluded that conservative NWB management is the standard of care for initial treatment of both partial and complete stress fractures of the tarsal navicular.
Torg
Joseph S
JS
Department of Orthopedic Surgery, Temple University, Philadelphia, Pennsylvania 19140, USA. torgmd@aol.com
Moyer
James
J
Gaughan
John P
JP
Boden
Barry P
BP
D000293:Adolescent; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D013639:Tarsal Bones / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult