Type 2 is a larger ossicle that is adjoined to the navicular by a synchondrosis attachment. 88,89 Type 1 is characterized by a distinct ossicle that is contained within the posterior tibial tendon (PTT). The incidence of an AN has been found to be between 4% and 21%. Mark Fisher, in Atlas of Orthoses and Assistive Devices (Fifth Edition), 2019 Accessory NavicularĪn accessory navicular (AN) bone is an anatomic variant that has been classified into three types. A below-knee, non–weight-bearing cast is then applied. If soft tissue injury has occurred, compression and elevation are required until the problem is resolved. If closed anatomic reduction cannot be achieved, open reduction and internal fixation are indicated. The authors recommend anatomic reduction and percutaneous pinning with a threaded Steinmann pin. Even though the small chip may not unite to the navicular body, the symptoms subside.ĭisplaced fractures of the tarsal navicular bone in children are usually associated with severe trauma and possible dislocation. A below-knee walking cast is applied for 3 to 4 weeks. Treatment of this injury is usually uncomplicated because of the lack of or minimal displacement. This injury may represent an avulsion pull-off of an apophyseal fragment from the dorsal tarsal ligament. The most frequent navicular fracture in children is a dorsal proximal chip fracture, which is best seen on a lateral radiograph of the foot ( Fig. The average time required for complete restoration of normal bone structure was 1 year 4 months, with a minimum of 4 months and a maximum of 4 years. ![]() Treatment with a below-knee walking cast for about 8 weeks rendered the individual pain-free in the shortest period. Patients treated with casting were completely asymptomatic within an average of 3 months. Treatment of this injury is usually uncomplicated because the bone is minimally displaced, if at all.īorges and colleagues 6 found that patients treated without casting had symptoms lasting an average of 10 months. It is still questioned whether Köhler disease is a normal variant or represents overuse. Radiographs of the foot taken for other reasons often show irregularity of tarsal navicular ossification. In Waugh’s study of 52 boys and 52 girls, 170 on radiographs taken at 6-month intervals from 2 to 5 years, 10 boys and 16 girls showed abnormal ossification. The radiographic picture of a sclerotic, thin, fragmented tarsal navicular bone, commonly called Köhler disease, may represent repetitive microtrauma, an abnormal ossification pattern, or an overuse syndrome ( Fig. 22īecause of the variability in ossification, a fracture may be confused with Köhler disease. Nine navicular fractures were seen in 175 fractures reviewed from the Cincinnati Children’s Hospital. The tarsal navicular bone is injured only occasionally in children, and the fracture is rarely displaced. Parikh, in Green's Skeletal Trauma in Children (Fifth Edition), 2015 Navicular Bone Note: Some images also show associated injuries and before and after results.Alvin H. The images below show different fractures. Whether you will need surgery or just casting depends on the severity of the ankle injury. Identifying if fracture ankle surgery is necessary for medial malleolus ankle fractures is usually straightforward. Medial malleolus fractures are classified by the actual orientation of the fracture line. ![]() You step wrong and twist your foot inward or outward to cause the break. A majority of ankle fractures are the result of rotational forces. The break may occur by itself but it normally accompanies injuries to the outside of the ankle or a fibula fracture of the smaller of the two lower leg bones. Medial malleolar fractures involve the articular surface of the ankle joint, which is where the bones meet in the joint. It bears 90% of the weight-bearing load, so this is a common fracture. You can feel this area as the bump on the inner side of your ankle joint. ![]() The medial malleolus is an anatomical region of the tibia bone, which is the larger of the two lower leg bones. When you break the inner bone of your ankle, it is called a medial malleolus ankle fracture.
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