title: Operative Treatment of Acute Fractures of the Tarsal Navicular Body: Midterm Results With a New Classification.
abstract: BACKGROUND
  Treatment of displaced tarsal navicular body fractures usually consists of open reduction and internal fixation. However, there is little literature reporting results of this treatment and correlation to fracture severity.
  
  
  METHODS
  We report the results of 24 patients treated in our institution over a 12-year period. Primary outcome measurements were Visual-Analogue-Scale Foot and Ankle score (VAS-FA), AOFAS midfoot score, and talonavicular osteoarthritis at final follow-up. According to a new classification system reflecting talonavicular joint damage, 2-part fractures were classified as type I, multifragmentary fractures as type II, and fractures with talonavicular joint dislocation and/or concomitant talar head fractures as type III. Spearman's coefficients tested this classification's correlation with the primary outcome measurements. Mean patient age was 33 (range 16-61) years and mean follow-up duration 73 (range 24-159) months.
  
  
  RESULTS
  Average VAS-FA score was 74.7 (standard deviation [SD] 16.9), and average AOFAS midfoot score was 83.8 (SD = 12.8). Final radiographs showed no talonavicular arthritis in 5 patients, grade 1 in 7, grade 2 in 3, grade 3 in 6, and grade 4 in 1 patient. Two patients had secondary or spontaneous talonavicular fusion. Spearman coefficients showed strong correlation of the classification system with VAS-FA score (r = -0.663, P < .005) and talonavicular arthritis (r = 0.600, P = .003), and moderate correlation with AOFAS score (r = -.509, P = .011).
  
  
  CONCLUSIONS
  At midterm follow-up, open reduction and internal fixation of navicular body fractures led to good clinical outcome but was closely related to fracture severity. A new classification based on the degree of talonavicular joint damage showed close correlation to clinical and radiologic outcome.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Berne, Bern, Switzerland timoschmid@insel.ch.
authors.forename: Timo
authors.initials: T
authors.lastname: Schmid
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Berne, Bern, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Krause
authors.affiliation: Department of Traumatology, Spital Wallis, Visp, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gebel
authors.affiliation: Department of Orthopaedic Surgery, Orthosiloah, Gümligen, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery; D000072039:Fracture Dislocation / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction; D010003:Osteoarthritis / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult
keywords: classification; internal fixation; outcome; tarsal navicular body fractures