Minifragment plate fixation of high-energy navicular body fractures.

Abstract

The purpose of this study was to assess the ability of miniplate fixation in navicular fractures to restore medial column stability, maintain reduction, and determine the impact this approach may have on the development of avascular collapse of the navicular. We hypothesized that comminuted fractures of the navicular can be safely reduced and maintained to union with minifragment plate fixation with a low incidence of avascular collapse. A retrospective chart review was performed on 24 patients with navicular fractures treated with open reduction and internal fixation with minifragment plate fixation at a level one trauma center over a period of 6 years. All fractures united. No patient developed a deep infection. There was no loss of reduction. Isolated broken screws were evident in three patients (12.5%), with no plate breakage, and no implant failure by pullout. Four patients (17%) underwent plate removal for painful prominent hardware following fracture healing. Four patients (17%) developed radiographic arthrosis of the talonavicular joint. One patient (4%) had radiographic avascular collapse evident at 6 months and was treated with plate removal and an orthotic device. Minifragment fixation was a good alternative to independent lag screws for rigid stabilization of navicular body fractures.