It was a biplanar injury in both saggital & coronal planes. Could do CRIF, in both the planes with CCS.

A-P view

Thank you Mohit for your positive input

The management done is ideal and done here worth applause. Sir, what would be further protocol by your side like length of immobilisation, time to weight bear, whether complete non weight bearing or toe touch from start...  etc.

NBW in a cast for 6 weeks followed by Pneumatic Aircast boot with slowly increasing weight bearing

this is Navicular fracture with talonavicular joint subluxation. Must operate. can do open reduction and internal fixation with navicular plate and reduce the TNJ subluxation. 

That's what done by closed means 

The Calcaneo navicular joint is badly damaged . The postoperative lateral view show some irregularity though fixation has been done very satisfactorily. Now the patient is 72 yrs old. Why shouldn't I think of arthrodesis of calcaneo- navicular joint.

Why primary arthrodesis

I agree with Mohit that instead of primary arthrodesis an attempt at ORIF/CRIF should be made.

age is a factor with other co morbidity, repeated operation after primary fixation is posible only when patient is young and the proximal articular surface is not so badly comminuted

Key are soft tissues, vascular assessment and whether Diabetic or not

If all ok, then treatment of choice is open reduction and internal fixation. Synthes do a very nice well contoured navicular plate.

well done

I have used navicular plate, gives you more options for screws

ORIF is preferred to primary fusion due to lengthy recovery period and risk of non union

In the long term, these fractures heal well 

patients have some residual pain which is manageable with orthotics and foot wear

Poor results in my practice has been in Diabetics 

mechanism of injury forceful planterflexion with axial loading.Isolated navicular fracturxise dislocation is very rare.

ligamentotacxis with pins at metatarsal and Talus/Calcaneum after close reduction is advocated by a case report by Ambarish A,Mathesul ms

I agree

A debate is present in literature regarding the choice of the right internal fixation: Before the study by Sangeorzan et al. [1] reporting 20 cases of internal fixation by screws and pins, only four other cases of internal fixation of the navicular had been reported. Recently, techniques including supplementary wires [4] temporary bridging by plate on the medial column [5] or external fixation [6] have been published as case reports. The only series with internal plate fixation reported 24/30 cases over a 6-year period [7]. " A debate is present in literature regarding the choice of the right internal fixation: Before the study by Sangeorzan et al. [1] reporting 20 cases of internal fixation by screws and pins, only four other cases of internal fixation of the navicular had been reported. Recently, techniques including supplementary wires [4] temporary bridging by plate on the medial column [5] or external fixation [6] have been published as case reports. The only series with internal plate fixation reported 24/30 cases over a 6-year period [7]. " 

Article · Jan 2016 · Revue de Chirurgie Orthopédique et Traumatologique

Caff GCaff GCoppolino MCoppolino M

Thank you for the valuable information