Cerclage Fixation of Navicular Fractures

Abstract

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Navicular fractures are commonly seen midfoot fractures that can be easily missed and difficult to treat. More severe fractures result from forces that compress the talar head into the navicular causing the navicular to displace radially like staves of a barrel. In a case report from Foot and Ankle International, Naidu and Singh (2005) showed a displaced comminuted intra-articular navicular fracture that was treated innovatively with a cerclage wiring technique. To our knowledge, this is the only published report of a navicular fracture treated with this approach. Since that time the senior author has treated over 25 of these severe fractures with a similar cerclage wiring technique. Over time this technique has evolved and now preferentially involves use of an Arthrex FiberTape cerclage system. Methods: The surgical technique is described as follows. First a small incision is made over the medial pole of the navicular. A lead suture is then passed after subperiosteal dissection along the plantar surface of the navicular and received at a similar incision at the lateral pole. The original technique we employed involved the use of a Dall-Miles cable and cable passer but has been supplanted by the lead suture technique or by using the needle of an Arthrex FiberTape. Once control of the plantar surface is accomplished, subperiosteal dissection is made along the dorsal surface with a Kelly clamp or small periosteal elevator. The lead suture is then delivered to the medial pole which then allows for circumferential control of the fracture fragments. The FiberTape is then passed by pulling the lead suture which delivers the FiberTape circumferentially. This provides indirect reduction by radial compression as it is sequentially tightened. Results: We have performed over 25 cases in a similar manner and in our experience have found this to be the best fixation and reduction technique available (Image 1 & 2). Conclusion: This approach demonstrates a safe, expedient, minimal incision surgical approach that provides optimal fixation of these difficult navicular fractures.