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18 Cards in this Set
- Front
- Back
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Acetabulum pedis
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Talonaviucalar, facets of subtalar joint, spring lig, navicular cunieform, part of the bifracate lig---> transitions forces from the mid foot/rear foot to forefoot----NEED tHIS FOR GAIT
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NAVICULAR FRACTURES
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> Uncommon injuries
- May be due to underdiagnosis > High energy injuries > Body - Axial load component > Requires high index of suspicion > High morbidity -Pain -Disability |
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clinical exam of Navicular Fx
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> Pain, Swelling, Ecchymosis, Deformity
> Inability to bear weight > Condition of soft tissue envelope > Consider compartment syndrome > Common to have associated injuries |
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Navicular Fractures:
Dorsal Lip |
50% of incidence
> Avulsion fracture: -Low energy -Talonavicular ligament --Plantarflexion/inversion > Deltoid ligament > Plantarflexion/eversion > PT/spring ligament avulsion ␣ Evaluate for other injuries |
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D/DX of Dorsal Lip Navucular Fx
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␣ Os supranaviculare (Pirie's)
␣ Os supratalare |
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****Treatment of Dorsal lip Navicular Fx****
Non-displaced: > SLC NWB ---> 4-6wks Displaced &/or >20% of articular surface: = Closed reduction = ORIF-----> K-wire/Screws |
know
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NAVICULAR FRACTURES Tuberosity Fx
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Forced eversion
-PT avulses portion of tuberosity -DDX -Type II accessory navicular -1% symptomatic ---> 2 sub types > Usually minimally displaced > May have CCJ impaction |
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Treatment of Navicular tuberosity Fracture -->
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Evaluate:
- Displacement - Size - Comminution/Bonestock Non-displaced: - SLC NWB ---->4-6wks Displaced: - Early ORIF - Excision/reattachPT (if the bone stock is not good then you have excise the bone and do a modified kinder ) |
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Navicular body Fractures
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␣ High injury axial loading with compression between cuneiforms and talus
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Navicular Fractures of body treatment
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Nondisplaced:
-Casting vs ORIF Displaced - ORIF - May need stabilization/fusion to cuneiforms |
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Navicular Fracture of Stress
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know the N-spot---> high is point of the navicular where there will be pain when you have Stress fracture
Next step -No consenus -Bone scan/CT/MRI - CT classification |
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Treatment of Navicular Fractures of stress
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-- Incomplete Fracture--> NWB cast
-- Complete fracture/ nonunion > ORIF/Possible bone graft |
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NAVICULAR FRACTURES
> Surgical approaches |
Tuberosity/Avulsion Fx:
> Incision overlying fracture Body fracture: -Anteromedial >Between interval of Ant/Post Tibial Tendons - Anterolateral > May be needed to aid in reduction > Centered over dorsal aspect of calcaneal cuboid joint External Fixation: ␣ Aids in reduction ␣ Restoration of med/lat column--for distraction and reposition if the foot ␣ Primary or supplemental maintenance of reduction |
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POST-OP CARE for navicular
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Cuboid fracture
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most common cause of injury is forced abduction of the foot
NUTCRACKER FRACTURE--> forced abduction--- crushed between the calcaneus and metatarsals -there will be a shorten lateral column--> now you have a flatfoot |
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Cuboid Fx treatment
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Cuneiform Fracture
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- Pain swelling of forefoot
-Gap sign pasted on Davies--> lisfrancs rupture but not lissfrancs dislocation - Standard is X-ray - Also use CT scan |
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Cuneiform Fractures treatment
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> Chip/nondisplacedfx
- NWB BK cast > Displaced/crush Fx ORIF - Incision similar to Lisfranc Inj - Restore length of medial column |
