Navicular stress fractures: outcomes of surgical and conservative management * Commentary

Objective: To compare the long term outcomes of the two treatment options for navicular stress fractures: non-weightbearing cast immobilisation and surgical fixation. Design: Retrospective case study. Participants: Subjects aged 18 years and older who had been treated for a navicular stress fracture more than two years previously. Main outcome measures: Questionnaire based analogue pain score and function score; tenderness on palpation; abnormality detected on computed tomography (CT). Results: In all, 32 fractures in 26 subjects were investigated. No significant differences were found between surgical and conservative management for current pain (p = 0.984), current function (p = 0.170), or abnormality on CT (p = 0.173). However, surgically treated patients more often remained tender over the “N spot” (p = 0.005), even after returning to competition for two years or more. Conclusions: Surgical fixation of navicular stress fractures appears to be as effective as conservative management over the longer term. However, there remains a small but measurable degree of pain and loss of function over this period. The value of using “N spot” tenderness as the sole clinical predictor of treatment success requires further investigation, as some patients remained tender despite successful completion of treatment and return to competition.