title: Results and complications of operative and non-operative navicular fracture treatment.
abstract: BACKGROUND
  Navicular fractures (NF) are uncommon. The purpose of this study was to compare results of operative (ORIF) and non-operative (NOT) treatment in NF.
  
  
  METHODS
  A retrospective analysis was undertaken on patients diagnosed with NF between March 2002 and June 2007 at a Level I teaching trauma centre. Clinical outcome consisted of functional ability and complications.
  
  
  RESULTS
  Eighty-eight patients with 90 fractures were identified including 56 males and 32 females with a mean age of 38 (range 17-72) and body mass index of 28.2 (range 18.7-48.9). Twenty-one of 90 (23.3%) injuries were isolated. Ten of 90 (11.1%) injuries were open. Treatment was 49/90 (55%) NOT and 41/90 (45.6%) ORIF. 11/41 (30%) ORIF required bone grafting. Complications included one ipsilateral deep vein thrombosis, one avascular necrosis, one nonunion, seven infections (two deep and five superficial), and 56 cases of secondary osteoarthrosis (SOA). ORIF had significantly more SOA (χ(2)=0.000). Secondary surgery was 25 hardware removals (16 for irritation, five for prominent or broken plates), nine arthrodeses/-plasties, two debridements for infection, and one tarsal tunnel release. Pain was present at final follow up in 39/90 (43.3%) feet. Work status was 64 without restrictions, 17 with restrictions, and 5 did not return to work. Sixty-two of 88 (69%) patients were able to wear normal shoes, which were related to return to work without restrictions (ρ=-0.508, p=0.000). Inability to return to previous work was related to pain (ρ=-0.394), SOA (ρ=-0.280), and poor reduction quality (ρ=-0.384) with significance at p<0.01. Increased BMI (>35) related to pain (ρ=0.250) and poor reduction quality (ρ=0.326) at a σ<0.05.
  
  
  CONCLUSIONS
  Despite modern surgical techniques, operative treatment of displaced fractures is at high risk for complications. Obesity, pain, and secondary osteoarthrosis determine shoe wear, return to function, and employment status.
  
  
  METHODS
  Level III.
authors.affiliation: Orthopaedic Research Fellowship, Grand Rapids Medical Education and Research Center, Grand Rapids, MI, United States; Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany. Electronic address: marlon.coulibaly@bergmannsheil.de.
authors.forename: Marlon O
authors.initials: MO
authors.lastname: Coulibaly
authors.affiliation: Orthopaedic Associates of Michigan, Grand Rapids, MI, United States; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, United States.
authors.forename: Clifford B
authors.initials: CB
authors.lastname: Jones
authors.affiliation: Orthopaedic Associates of Michigan, Grand Rapids, MI, United States; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, United States.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Sietsema
authors.affiliation: Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schildhauer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D017102:Fracture Healing; D015775:Fractures, Stress / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D062707:Return to Work; D012959:Socioeconomic Factors; D013639:Tarsal Bones / Q000000981:diagnostic imaging* / Q000293:injuries*; D016896:Treatment Outcome
keywords: Navicular fracture; Open reduction internal fixation; Operative fixation; Spanning external fixation; Spanning plates