Lag screw fixation of navicular avulsion fracture

For the procedure, a range of screws can be utilized:

Cannulated screws
Non-cannulated screws
Headless compression screws

We will here demonstrate the use of cannulated and non-cannulated screws.

Cannulated, non-cannulated, and headless compression screw

Insert the pointed reduction forceps at the tip of the navicular tubercle and the body of the navicular. The latter thought a stab incision.

$Reduction of a navicular avulsion fracture with forceps$

K-wire insertion

When cannulated screws are used, insert the guidewire perpendicular to the fracture line under image intensification to temporarily secure the fixation.

Care must be taken to avoid joint penetration of the concave articular surface of the navicular.

$K-wire insertion for cannulated lag screw fixation of a navicular avulsion fracture$

Screw insertion

Insert a cannulated cortical lag screw according to the standard lag screw technique, using cannulated instruments. A washer is typically used.

A headless cannulated lag screw can also be used.

In contrast to lag screws inserted in the diaphysis, these lag screws will typically not penetrate the far cortex, as this would damage the opposite articular surface.

$Cannulated screw insertion for fixation of a navicular avulsion fracture$

Temporary fixation

A K-wire may be inserted to fix the fragment temporarily.

Pearl: It is advantageous to maintain compression with the reduction clamp to secure the reduction during drilling.

$Drilling for lag screw fixation of a navicular avulsion fracture$

Screw insertion

Insert a lag screw with a washer according to the standard technique. In contrast to lag screws inserted in the diaphysis, these lag screws will typically not penetrate the far cortex, as this would damage the opposite articular surface.