From the Guidelines
The treatment of a non-displaced navicular fracture should initially involve simple immobilization, as this approach is appropriate for small, nonarticular, or minimally displaced fractures. This recommendation is based on the guidelines from the American College of Foot and Ankle Surgeons, as reported in the American Family Physician journal 1. The immobilization can be achieved with a non-weight bearing short leg cast or a removable boot for a period that may vary depending on the specific characteristics of the fracture and patient factors.
Key aspects of the treatment algorithm include:
- Immobilization to prevent further injury and allow healing
- Pain management, which may include NSAIDs like ibuprofen or naproxen for the initial period, with acetaminophen as an alternative
- Gradual weight bearing after the immobilization period, facilitated by a supportive shoe
- Physical therapy to restore range of motion, proprioception, and strength
- Regular follow-up with radiographs to assess healing progress
It's crucial to monitor the patient's progress closely, as the presence of persistent pain or delayed healing may necessitate advanced imaging to rule out complications such as occult displacement or avascular necrosis. The decision to proceed with surgical intervention should be made on a case-by-case basis, typically reserved for fractures that fail to respond to conservative management or exhibit signs of displacement during follow-up. The approach outlined is grounded in the principle of minimizing morbidity, mortality, and optimizing quality of life for the patient, by initially adopting a conservative strategy that can effectively manage non-displaced navicular fractures, as suggested by the study 1.
From the Research
Non-Displaced Navicular Fracture Treatment Algorithm
- The treatment of non-displaced navicular fractures typically involves a period of non-weight bearing cast immobilization, usually 6-8 weeks 2.
- Surgical treatment, such as screw fixation with or without bone graft, may be considered for non-displaced complete fractures, although some authors advocate for aggressive treatment in these cases 2.
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of fracture pain is a topic of debate, with some studies suggesting that they may impair bone healing 3, 4.
- However, other studies have found that NSAIDs can reduce post-trauma pain and the need for opioids, with a small effect on non-union 5.
- The decision to use NSAIDs in the treatment of non-displaced navicular fractures should be made on a case-by-case basis, taking into account the potential benefits and risks 5, 4.
- It is essential to maintain a high index of suspicion when treating patients with vague mid-foot or ankle pain associated with weight bearing, as navicular stress fractures can be difficult to diagnose 2.