![]() ![]() ![]() ![]() In the presented case, the patient's CT was interpreted by two musculoskeletal radiologists as a comminuted navicular fracture with areas of central impaction the os supranaviculare and navicular OCD were not recognised. Another potential challenge is that of misidentifying the combination of a stress fracture, accessory ossicle, and osteochondral lesion as a comminuted fracture. An os supranaviculare will be found in its typical position on the proximal dorsal cortex of the navicular bone with well-corticated edges, while a fracture fragment will have more irregular edges and possible history of trauma. It can be difficult to distinguish an os supranaviculare from a fracture fragment of the talus or navicular bone. This case highlights a potential diagnostic challenge in orthopaedic sports medicine. A timeline of the patient's course is available in Table 1. After screw placement, the patient exhibited full passive dorsiflexion with clearance of the talus by the navicular bone and fixation was deemed satisfactory ( Fig. 3, Fig. 4). This was possibly contributing to talonavicular impingement with increased forces on the dorsal aspect of the navicular bone, so a dorsal talus exostectomy was included. Intra-operatively, a small osteophyte on the dorsal aspect of the talus was identified. Surgical fixation involved the insertion of 2.0-mm and 3.5-mm screws fixating the major fragments. The patient underwent open reduction internal fixation (ORIF) with autograft bone harvest from the ipsilateral calcaneus, debridement and curettage of the OCD with application of minced allograft cartilage (BioCartilage Arthrex, Naples, FL), and the addition of a bone stimulator. Pre-operatively, the athlete was diagnosed with a linear NSF, navicular OCD, and os supranaviculare. Given the patient's strong desire to return to sport safely, he and his parents chose to proceed with surgical management. The podiatrist ordered a computed tomography (CT) scan, and he referred the patient to an orthopaedic foot and ankle surgeon. Initial radiographs indicated the presence of an os supranaviculare, loss of the sharp cortical line of the navicular bone where it articulates with the talus, and sclerosis of the navicular bone ( Fig. 1). After one year of intermittent pain with physical activity, the patient presented to an outside podiatry clinic for evaluation. He had not tried any therapeutic interventions. Walking and running exacerbated his symptoms, and the pain was relieved with rest. Training hours increased to approximately 16 h per week when high school sport seasons overlapped with competitive lacrosse, which was the case for ten months per year. His competitive lacrosse involvement averaged 10 h of training per week at baseline. In addition to high school lacrosse, he played lacrosse on a competitive travelling club team with intense training and high competition year-round. He participated in two field sports for his high school team: football and lacrosse. KeywordsĪ healthy adolescent male experienced an insidious onset of right foot pain during sports with no inciting event or direct trauma to the foot. Understanding navicular stress fractures and concomitant bony pathology contributing to injury is crucial to successful diagnosis, management, and prevention of recurrence. While repetitive loading on the navicular bone can independently produce a stress fracture, the patient had an increased risk for this injury the presumably pre-existing navicular osteochondral lesion and os supranaviculare may have resulted in decreased effective articular surface area, thereby increasing force on the navicular bone and producing a stress fracture. Diagnosis of a navicular stress fracture in the setting of both an os supranaviculare and osteochondral lesion of the navicular bone have not been reported elsewhere in the literature. The patient underwent successful operative fixation and returned to painless full function with imaging demonstrating healing at six months. Radiographs and computed tomography demonstrated a triad of a navicular stress fracture, an os supranaviculare, and an osteochondral defect of the navicular bone. This case details the injury and outcome of an adolescent male athlete who experienced one year of intermittent foot pain without acute trauma. Stress fractures of the tarsal navicular bone can be problematic in the athlete. ![]()
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