Navicular, multifragmentary
History
Navicular fractures are often the result of high-energy injuries, and are often associated with other injuries, both in the foot and the rest of the body.
In the multiply-injured patient, navicular fractures can be overlooked. These injuries are often picked up on the secondary survey. In the case of unconscious patients, care should be taken to check for unusual swelling or crepitus. If suspected, foot x-rays are indicated.
Physical exam
In many cases there is swelling and tenderness. In comminuted fractures, deformity may be present.
Imaging
Conventional x-rays will often show the fracture.
CT with sagittal and coronal reformation is useful in obtaining a three-dimensional understanding of the injury. The CT protocol should call for thin cuts with large overlap. The fragments are small and easily missed on thicker cuts.
