title: Treatment of Spontaneous Osteonecrosis of the Tarsal Navicular With a Free Medial Femoral Condyle Vascularized Bone Graft: A New Approach to Managing a Difficult Problem.
abstract: Adult-onset spontaneous osteonecrosis of the tarsal navicular joint, or Mueller-Weiss syndrome (MWS), is an uncommon debilitating disease characterized by a painful clinical course with progressive midfoot deformity. Treatment options include nonoperative management and/or operative intervention, including percutaneous decompression of the navicular bone, stabilization of existing structures, and cancellous bone grafting from the tibia or iliac crest. To our knowledge, there have been no reported cases of treatment of MWS with a vascularized bone graft. We report an unusual case of unilateral MWS in a 25-year-old male who failed nonoperative therapy and was successfully treated with a novel operative approach using debridement followed by a free medial femoral condyle vascularized bone graft. At 18-month follow-up, the patient demonstrated an excellent outcome with return to previous level of function, including work-related and recreational activities.
  
  
  METHODS
  Therapeutic, Level IV: Case study.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Departments of Surgery and Pathology (HL, KJM), Duke University Medical Center, Durham, North CarolinaDepartment of Orthopaedic Surgery (SBA), Duke University Medical Center, Durham, North CarolinaNorth Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery (SGP), Duke University Medical Center, Durham, North CarolinaFuqua School of Business, Duke University, Durham, North Carolina (SGP) howard.levinson@duke.edu.
authors.forename: Howard
authors.initials: H
authors.lastname: Levinson
authors.affiliation: Division of Plastic and Reconstructive Surgery, Departments of Surgery and Pathology (HL, KJM), Duke University Medical Center, Durham, North CarolinaDepartment of Orthopaedic Surgery (SBA), Duke University Medical Center, Durham, North CarolinaNorth Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery (SGP), Duke University Medical Center, Durham, North CarolinaFuqua School of Business, Duke University, Durham, North Carolina (SGP).
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Miller
authors.affiliation: Division of Plastic and Reconstructive Surgery, Departments of Surgery and Pathology (HL, KJM), Duke University Medical Center, Durham, North CarolinaDepartment of Orthopaedic Surgery (SBA), Duke University Medical Center, Durham, North CarolinaNorth Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery (SGP), Duke University Medical Center, Durham, North CarolinaFuqua School of Business, Duke University, Durham, North Carolina (SGP).
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Adams
authors.affiliation: Division of Plastic and Reconstructive Surgery, Departments of Surgery and Pathology (HL, KJM), Duke University Medical Center, Durham, North CarolinaDepartment of Orthopaedic Surgery (SBA), Duke University Medical Center, Durham, North CarolinaNorth Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery (SGP), Duke University Medical Center, Durham, North CarolinaFuqua School of Business, Duke University, Durham, North Carolina (SGP).
authors.forename: Selene G
authors.initials: SG
authors.lastname: Parekh
keywords: Mueller–Weiss syndrome; avascular necrosis; medial femoral condyle vascularized bone graft; navicular; spontaneous osteonecrosis