Navicular Fractures

Eric Perloff

Joseph Young

Andrew J. Rosenbaum

Positioning

The patient is placed supine with a bump under the ipsilateral hip.
A calf or thigh tourniquet is used.
The patient is draped and prepared in a sterile manner.

Surgical Approaches

Anteromedial and Dorsolateral Approach to Navicular Fractures

Anteromedial is usually sufficient to be utilized for type 1 navicular fractures. This approach for the navicular was originally described by Sangeorzan et al.¹
- Allows access to the medial navicular body and navicular tuberosity
A second dorsolateral is often necessary for type 2 and 3 fractures, fractures with additional lateral column involvement, or in injuries with a large dorsolateral fragment.²
In the anteromedial approach, a line is demarcated 1 cm below the tip of the medial malleolus, through the navicular, toward the first metatarsal head (Figure 29-1).
The tibialis anterior (TA) tendon should be retracted dorsally and the posterior tibialis (PT) plantarly.³
Dissect the periosteum to allow visualization of the navicular bone.

Capsulotomies of the TN joint can be made from this approach to assess the joint surface.

Figure 29-1. Illustration demonstrating the starting point and plane for the anteromedial approach. Incision is made 1 cm below the tip of the medial malleolus, extending through the navicular prominence. Reprinted with permission from Teasdall R, Allen PG. Surgical fixation of navicular body fractures. Tech Foot Ankle Surg. 2007;6(2):108-112. doi:10.1097/01.btf.0000235416.51876.36.

If access to the lateral aspect navicular is needed, an additional incision can be made on the dorsolateral surface.⁴
- Location of incision should be determined via fluoroscopy.⁴
Incision is made between the planes of the extensor hallucis longus (EHL) and extensor digitorum brevis (EDB).³
- In this approach, one must locate the motor branch of the deep peroneal and the superficial peroneal sensory nerves.³