J Korean Fract Soc.  2016 Oct;29(4):276-282. 10.12671/jkfs.2016.29.4.276.

Fractures of the Tarsal Bone

• Park YH
• Kim HJ
• Kim SH

• KMID: 2355434
• DOI: http://doi.org/10.12671/jkfs.2016.29.4.276

Abstract

Fractures of the tarsal bone, such as the navicular, cuboid, and cuneiform, are very rare. These injuries can lead to serious walking difficulties due to pain and deformity of the foot with delayed diagnosis of tarsal bone fractures during an injury to multiple lower extremities. The diagnosis can be done on simple radiographs. Sometime weight bearing radiographs or stress radiographs may be needed for further evaluation. Computed tomography is the most widely available diagnostic tool. Navicular and cuneiform account for the medial column of the foot, whereas cuboid for the lateral column. The treatment of tarsal bone fractures is primarily conservative management, but operative treatment is recommended for intra-articular displacement, dislocation, or shortening of the medial or lateral column of the foot. The operative treatments include screw fixation, plate fixation, or external fixation. Complications include malunion, nonunion, posttraumatic arthritis, avascular necrosis, and deformity of the foot. Tarsal bone fracture has to be evaluated carefully to prevent serious complications.

Keyword

Tarsal bone; Navicular; Cuboid; Cuneiform; Fracture

MeSH Terms

Arthritis
Congenital Abnormalities
Delayed Diagnosis
Diagnosis
Dislocations
Foot
Lower Extremity
Necrosis
Tarsal Bones*
Walking
Weight-Bearing

Figure

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  Fig. 1 Simple radiograph revealed the accessory navicular bone (white arrows).

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  Fig. 2 Sangeorzan's classification of navicular fracture. Type I: Dorsal or tuberosity Avulsion fracture, the primary fracture line traverse in the coronal plane, which is seen on a lateral radiograph. Type II: Navicular body fracture, in which the fracture line is traverse from dorsolateral to plantarmedial across the body, which is seen on an anteroposterior radiograph. Type III: Navicular body fracture with central or lateral comminution.

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  Fig. 3 (A) Type II navicular fracture and medial cuneiform subluxation were seen on an oblique radiograph. (B) Navicular fracture fragment and medial cuneiform were reduced and fixed with plate and screws.

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  Fig. 4 (A) Nutcracker fracture of cuboid was seen on an anteroposterior radiograph. (B) Bridging plate fixation was performed from the calcaneus to the fifth metatarsal bone to restore the length of the lateral column.

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  Fig. 5 Medial cuneiform fracture with Lisfranc injury was seen on simple radiograph and computed tomography.

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  Fig. 6 Fracture of the medial cuneiform and Lisfranc joint were reduced and fixated with plate and screws.

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