percutaneous navicular orif: a novel technique...navicular fractures are common midfoot fractures...
TRANSCRIPT
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Percutaneous Navicular ORIF:
A Novel Technique I have no potential conflicts with the presentation.
Paul Kupcha MD; Geary Gutowski PA-C.
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Introduction Navicular fractures are common midfoot fractures that are commonly missed
and difficult to treat. Navicular fractures compromise 62% of all midfoot
injuries.
Forces translating from distal to proximal cause the navicular to compress
upon the talar dome. These forces cause the navicular to displace radially
like staves of a barrel.
Cerclage cable wiring has been described to neutralize the mechanism of
injury.
Note: Post-operative
image of the
fractures.
Note: Radial
displacement of
fracture
fragments.
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Methods We employed a technique for a circumferential cabling to act like a barrel hoop
to reverse and neutralize the deforming radial forces. A 2005 case report in
Foot and Ankle International described a single case fixed with an open wiring
technique.
Initially a transverse open technique with a large wire passer was utilized. This
was abandoned in favor of a percutaneous method using two -1cm incisions.
A single surgeon performed all 20 surgical cases of cabling.
Open Technique Percutaneous Technique
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Surgical Technique
The approach evolved from an open transverse
dorsal incision to a percutaneous technique. Two
small incisions were made over medial and lateral
poles of the navicular to pass the cable. The cable
was either passed with the trochanteric cable
passer or was pulled into place after first passing
a more malleable high tension suture. Fluoroscopy
was used intra-operatively.
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A small incision made over
medial pole of the navicular.
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The Dahl-Miles cable passer is
passed from either pole plantar
along the navicular.
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Flouroscopy can be utilized for incision
positioning. The Dahl-Miles cable passer is
passed from either pole plantar along the
navicular. Note: passer being inserted from lateral to medial pole.
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Pass tip of cable through the
cannulation of the cable passer.
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The cable is then passed dorsally
with a kelly or curved hemostat into
the same incision
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Blocking (positional) K-wires can be
placed to fine tune position of the cable
prior to tensioning if needed.
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Crimping block is placed and the wire
tensioned. After which the cable is cut.
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Intra-operative images
before cutting the cable.
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Results We believe that this technique results in superior
fixation of navicular fractures.
Circumferential cabling neutralizes the deforming
forces by reversing the mechanism of injury
These cases demonstrate a safe, quick, minimal
incision surgical technique which provides
excellent fixation of the navicular fracture
fragments.
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Conclusion Percutaneous cerclage cabling of navicular fractures is an innovative technique to fixate these fractures.
This surgical technique is safe and expedient.
We believe that this series patients conclusively shows excellent reduction and
fixation.
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Additional Illustrative Pre-
operative Case Images
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Additional Illustrative Post-
operative Case Images
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Pre-Operative Images
Post-Operative Images
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References
1. Naidu V, Singh S, et al. Cerclage Wire Fixation of
Navicular Body Fractures – A Treatment Based on
Mechanism of Injury. Foot & Ankle International. 26
(3): 267-269. 2005
2. Kupcha P, Freeland E et al. Fixation of Navicular
Body Fractures With a Cerclage Wire Technique.
Techniques in Foot & Ankle Surgery. 14(4):177-180,
December 2015