ALGORHYTHM FOR NONOPERATIVE TREATMENT OF PARTIAL TARSAL NAVICULAR STRESS-FRACTURES IN ATHLETES

Purpose of the study The purpose of the study was to propose an algory thm for nonoperative treatment of partial tarsal navicular stress frac tures in athletes, based on the results of the authors prospective res earch, conducted in 17 athletes. Materials and methods The series incl uded 17 patients with 18 partial tarsal navicular stress fractures (9 women and 8 men), average age 20.1, years. Patients were 16 track and field athletes mainly sprinters, 3 basketball players, two handball pl ayers, one soccer player and one volleyball, player. After undergoing detailed physical examination which included x-ray examination, all pa tients also underwent bone scanning, and some kind of tomographic imag ing (CT, MR) was done in all patients. Since all patients suffered fro m partial tarsal navicular stress fracture (fracture spreaded sagitall y to maximal dorsal half of the bone) nonoperative treatment was condu cted. immobilization in a non weight bearing short-leg cast for a peri od of 6-8 weeks was followed by rehabilitation treatment consisting of 4 consecutive stages, each lasting 2 weeks. Control examination after each stage determined if patients could proceed to the following stag e or if they should remain in the same stage for-another two weeks.Res ults Patients were followed up from one to five years (average 33.9 mo nths) and proposed algorythm of nonoperative treatment resulted in all , except two athletes, returning to their previous level of competitio n activity. The average time period between initiation of treatment an d resumption of full sports activity was 24 weeks (range 17 to 32 week s). One stress fracture recurrence was encountered although all patien ts returned to sports activities and are constantly being monitored. D iscussion No complexe tarsal navicular stress fractures was found in o ur series. In our opinion the diminishing number of complete fractures is a consequence if quicker and more precise diagnosis. The period be tween the onset of symptoms and the time of correct diagnosis is becom ing shorter. In our patients, this period was 3,3 months, The nonopera tive treatment for tarsal navicular stress fractures was suggested wit h a wide variety of procedures. Based on the results if their prospect ive study the authors propose an algorythm of conservative procedures in the treatment of partial tarsal navicular stress fracture. Conclusi on If clinical indication of tarsal navicular stress fracture is confi rmed by a positive bone-scan, a CT or MRI exploration is required to d istinguish stress reaction from stress fracture. In partial tarsal nav icular stress fractures, immobilisation in a short-leg cast with nonwe ightbearing for 6 to 8 weeks depending of the magnitude of the fractur e is required, This is followed by a treatment consisting of 4 two-wee ks stages which clinically monitored. The previous phase can be repeat ed for another two weeks, depending of clinical findings. This algoryt hm of nonoperative treatment of partial tarsal navicular stress fractu res allowed in all athletes a return to competitive activity.