Fractures of the carpal navicular: analysis of ninety-one cases and review of the literature

Abstract

The various forms of treatment for fractures of the carpal navicular have been briefly reviewed, and ninety-one such fractures have been analyzed in detail. Thirty-eight were acute, three were subacute, and fifty were old when first seen.From this study the following conclusions were reached: 1. Acute fractures of the navicular should be completely immobilized until union has occurred, even though this may require many months. 2. Concomitant injuries, such as dislocation of one or more carpal bones, should be appropriately treated. 3. Gross displacement of fragments should be reduced, by open surgery if necessary. 4. Fractures of the carpal navicular a year old or more have a good chance of uniting if immobilized for many months provided the fragments are not grossly displaced, sclerosis is not present at the fracture line, and there are no arthritic changes visible by roentgenogram. 5. Excision of part or all of the navicular often results in a painful wrist with limited function. 6. Styloidectomy is not recommended for general use. It was effective in relieving pain in only two of eleven cases of old non-union. 7. Styloidectomy combined with a bone graft of the Murray type was the most effective means of securing union of the fracture and relieving wrist pain in the surgically treated cases in this series. The Murray bone graft alone was not nearly so effective. 8. Wrist fusion relieves pain but eliminates wrist motion. It may salvage a comparatively useless wrist. 9. Active treatment of every non-union is not necessary. Persons who do not do manual work are often able to live useful happy lives with some limitation of wrist motion and occasional discomfort, despite an old ununited fracture.