Authors Preferred Surgical Technique

The author's approach to nondisplaced navicular fractures is through a lateral surgical approach, either via a percutaneous or limited incision. Localization of the incision adjacent to the lateral navicular can be confirmed with intraoperative fluoroscopy (Fig. 70-13). Careful dissection is carefully performed through the subcutaneous tissues with care to avoid injury to branches of the superficial peroneal nerve. The extensor reti-naculum is divided longitudinally. The long toe extensors are retracted, exposing the lateral aspect of the navicular. Since most stress fractures are nondisplaced, fracture reduction is usually unnecessary.

A guidewire is inserted in a lateral-to-medial direction. Appropriate orientation is confirmed with biplanar fluoroscopy. The guidewire is overdrilled with a cannulated drill, and a short-threaded cancellous screw is inserted over the guidewire. For a proper lag screw effect, all threads must pass beyond the frac-

Figure 70-13 An intraoperative fluoroscopic radiograph demonstrating localization of the lateral aspect of the navicular. This facilitates the determination of the proper entry site for a lateral to medial-based screw for osteosynthesis of a navicular fracture.

Figure 70-15 A lateral foot radiograph demonstrating the position of the foot within an athletic shoe. Appropriate shoewear performs the vital function of foot support and protection.

Figure 70-14 An anteroposterior foot radiograph demonstrating lag screw position for internal fixation of the central one third fracture of the navicular.

Figure 70-15 A lateral foot radiograph demonstrating the position of the foot within an athletic shoe. Appropriate shoewear performs the vital function of foot support and protection.

ture line into the medial fracture fragment; otherwise, the "near fragment" must be overdrilled. Although two parallel screws can be used, a single well-positioned lag screw has been quite successful in my experience (Fig. 70-14).

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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