There are four types of navicular fractures:
Cortical avulsionfractures are due to excessive flexion or eversion of the midfoot, resulting in avulsion of the dorsal lip of the navicular by the talonavicular or naviculocuneiform ligaments. Cortical avulsion fractures are the most common, and they are treated with a boot or short leg cast.
Tuberosity fractures are due to a forced eversion injury, resulting in avulsion of the tuberosity by the tibialis posterior tendon without joint surface disruption. Tuberosity fractures require ORIF if tibialis function is disrupted.
Body fractures are further divided into three radiographic types based on the direction of the fracture line, the direction of the displacement of the forefoot and midfoot, and the pattern of joint disruption. Type I fractures are classified by the primary fracture line being transverse in the coronal plane with no angulation of the forefoot. In type II fractures, the primary fracture line is dorsal-lateral to plantar-medial with dorsal and medial subluxation of the talonavicular joint (and the major dorsomedial fragment) and adduction of the forefoot. Type III are comminuted fractures of the body in the sagittal plane with lateral displacement of the forefoot and cuneonavicular joint disruption. This classification is frequently associated with injuries to the cuboid or the anterior process of the calcaneus. Body fractures result from high energy trauma and are intra-articular. These fractures are associated with a high risk of post-traumatic arthritis and usually requires an ORIF.
In stress fractures, the fracture line is sagittally oriented in the relatively avascular middle third in a proximal dorsal to distal plantar direction and may either be complete or incomplete. Stress fractures are treated with short leg casts and non-weightbearing for six weeks and may need surgery.
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