Correct diagnosis is difficult by clinical examination alone. Commonly the diagnosis is delayed for several months; therefore, clinical suspicion of a navicular stress fracture must be high. Plain radiographs are frequently negative.
Figure 70-9 An anteroposterior radiograph demonstrating the surgical repair of an isolated Lisfranc injury. The clamp has reduced the first-second metatarsal gap. The depth gauge measures the length of an appropriate screw prior to insertion.
The fracture is commonly incomplete and nondisplaced. The fracture tends to propagate from the proximal/dorsal cortex of the navicular and extends distally and plantarly.24 Again, the fracture line is characteristically in the sagittal plane and within the central one third of the bone (Fig. 70-11). A three-phase bone scan is helpful if the scan is positive; however, false-positive results are not uncommon (Fig. 70-12).
A thin-section computed tomography scan provides excellent fracture detail. In contrast, magnetic resonance imaging is a sensitive, but expensive, imaging modality with the added capability of detecting subtle soft-tissue pathology. T2-weighted images are extremely sensitive for detecting a stress reaction/fracture of bone. This modality can be extremely valuable, especially when the history and physical examination are suggestive with inconclusive radiographs.
Was this article helpful?
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.