To Evaluate The Surgical Treatment Of Tarsal Navicular Fractures

Objective To investigate the surgical treatment method and effectiveness of tarsalnavicular fractures.Methods A retrospective study was undertaken in90tarsal navicular fractures patients(90feet). All the cases (from July2002to March2012) received the surgical treatment,and had obtained complete date of follow-up. The left feet were involved in46cases (46feet), the right feet in44cases (44feet). There were62males and28females, aged rangefrom17to62years (mean,31.6years). Injuries were caused by falling from height in38cases, by traffic accident in26cases, by sprain in18cases, and by heavy pound in8cases. All patients were taken the checking of X-ray and three-dimensional CT scanning.According to the conventional fracture classification,6of them had dorsal avulsionfractures,18tuberosity avulsion fracture, and the other66body fractures. The bodyfractures were further classified by the Sangeorzan system: there were type Ⅰin4cases,type Ⅱ in44cases,and18cases in type Ⅲ. The time from injury to surgery ranged from1day to16days (mean,6.75days). Different surgical treatment were selected fordifferent types of90tarsal navicular fractures patients. Bone union was evaluated by X-ray and complications were recorded. Post operation plaster external fixation, About5weeks after the surgery it was taken out. We guide the function exercises for the foot andankle at the moment. Postoperation no plaster fixation, to guide the function exercises forthe foot and ankle early stage. Kirschner wire fixed talonavicularis articulatio, will betaken out after the surgery6weeks. Final outcome was evaluated by the Ankle andMidfoot score system of American Orthopacdic Foot and Ankle Society (AOFAS), theefficacy levels were divided into excellent, good, middle and bad. We measure thepreoperative first ankle metatarsus angle and first astragalus metatarsus angle, and thepostoperative first ankle metatarsus angle and first astragalus metatarsus angle of Ⅱ, Ⅲnavicular body fracture, to judge the position of the forefoot.Results All the patients were followed up for45.6months on average (rang,15to103months). The mean time of bone union was12.29±1.72weeks (rang,10to15weeks). ByAOFAS ankle and midfoot score system, the mean score was87.94±10.93at the lastfollow-up. dorsal avulsion fractures was98.56±1.49score, tuberosity avulsion fracture was91.04±2.81score,Ⅰ navicular body fracture was95.15±2.79score, Ⅱ navicularbody fracture was82.78±9.93score, Ⅲ navicular body fracture was72.14±6.59score.By SF-36score system, in the aspect of pain: dorsal avulsion fractures was89.11±3.36score, tuberosity avulsion fracture was76.23±5.16score,Ⅰ navicular body fracture was50.10±8.53score, Ⅱ navicular body fracture was63.81±11.67score, Ⅲ navicularbody fracture was81.52±3.18score.55excellent,22good,9middle and4bad, The totalexcellent and good rate was85.6%. dorsal avulsion fractures, tuberosity avulsion fractureandⅠnavicular body fracture was100%, Ⅱ navicular body fracture was88.6%, Ⅲnavicular body fracture was55.6%.12patients suffered from post-traumatic arthritis.Arthrosis fusion wasn’t underwent at the time of the late follow-up.4patients occur pastof the ischemia necrosis. With failure of several months conservative treatment, Towarthrosis fusion was underwent.1patients occur all of the ischemia necrosis. With failureof several months conservative treatment, Three arthrosis fusion was underwent.Conclusions To achieve satisfactory outcomes for tarsal navicular fractures, differentsurgical treatment were selected for different types of the fracture. Surgical curativeeffect of dorsal avulsion fractures, tuberosity avulsion fracture andⅠnavicular bodyfracture was better. By contrast, Surgical curative effect of Ⅲ navicular body fracturewas poorer.