Navicular stress fractures: outcomes of surgical and conservative management

Nicholas Potter ¹, Peter Brukner ^1*, Michael Makdissi ¹, Kay Crossley ¹ and Zoltan S Kiss ²

¹ Centre for Health, Exercise and Sports Medicine; University of Melbourne, Australia
² East Melbourne Radiology, Melbourne, Australia

^* To whom correspondence should be addressed. E-mail: p.brukner{at}unimelb.edu.au.

Accepted 8 March 2006

Abstract

Objective: To compare the two predominant long- term treatment options for navicular stress fractures - nonweightbearing cast immobilisation and surgical fixation.

Methods: Twenty six subjects, 18 years and older, were recruited who had been treated for a navicular stress fracture greater than 2 years previously (mean time 10.3 years). Treatment outcomes were assessed by analogue pain and function score,tenderness to palpation on examination, and abnormality detected on CT.

Results: A total of 32 fractures in 26 subjects were investigated. No statistically significant difference was found between surgical and conservative management for:Current Pain (p = 0.984),Current Function (p = 0.170), and abnormality on CT (p = 0.173). However surgically treated patients more often remained tender over the 'N spot' (p = 0.005) even after greater than 2 years return to competition.

Conclusions: Surgical fixation of navicular stress fractures is an equally effective treatment, compared to conservative management, over the longer term. However there remains a small, though measurable degree of pain and loss of function for patients over this period. Additionally, the effectiveness of using 'N spot' tenderness as the sole clinical predictor of treatment success requires further investigation, as some patients remained tender despite a successful treatment completion and return to competition.

Key Words: navicular, outcomes, stress fracture

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