Vascularized pedicle bone grafting for chronic navicular stress fractures with non‐union in elite athletes provided good bony union and ability to return to sports
File(s)
Accepted version
Author(s)
Calder, James
hong, Choon
Type
Journal Article
Abstract
Purpose
Navicular stress fractures are difficult to treat with high risks of non-union and there are few studies evaluating treatment strategies and outcomes for chronic navicular stress fracture with non-union particularly in professional elite athletes. Hence, the aim of this study is to evaluate the outcomes of vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes while reporting on the complications, rate of reoperations and ability to return to sports.
Methods
Seventeen elite athletes with isolated chronic navicular stress fracture non-union treated with vascularized pedicle bone grafting from 2018 to 2023 were reviewed. Demographic details, intraoperative findings, return to training (RTT), ability to return to sports (RTS), player status at last visit and complications were analysed and reported.
Results
Fifteen out of 17 elite athletes were males (88.2%) and the average age was 22.4 years old (SD=3.7). More than 75% of them had a failed prior surgical fixation with only 4 athletes (23.5%) who had no prior surgical intervention but failed conservative management for an average duration of 8.7 months before the vascularized pedicle bone grafting. These athletes had an average follow-up duration of 42.8 months (SD=13.5). All of them achieved bony union with no major complications or reoperations. The average time taken to RTT was 16.1 weeks (SD=1.8). There was one case of superficial wound infection and another with deep peroneal nerve sensory injury. Sixteen out of 17 athletes were able to RTS to their preinjury level. One rugby player failed to return to competitive sports due to persistent pain in the navicular despite union on CT scan and had developed early arthritic changes at his final follow-up.
Conclusion
Vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes yielded good bony union and ability to return to sports without significant complications.
Level of Evidence: Level III
Navicular stress fractures are difficult to treat with high risks of non-union and there are few studies evaluating treatment strategies and outcomes for chronic navicular stress fracture with non-union particularly in professional elite athletes. Hence, the aim of this study is to evaluate the outcomes of vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes while reporting on the complications, rate of reoperations and ability to return to sports.
Methods
Seventeen elite athletes with isolated chronic navicular stress fracture non-union treated with vascularized pedicle bone grafting from 2018 to 2023 were reviewed. Demographic details, intraoperative findings, return to training (RTT), ability to return to sports (RTS), player status at last visit and complications were analysed and reported.
Results
Fifteen out of 17 elite athletes were males (88.2%) and the average age was 22.4 years old (SD=3.7). More than 75% of them had a failed prior surgical fixation with only 4 athletes (23.5%) who had no prior surgical intervention but failed conservative management for an average duration of 8.7 months before the vascularized pedicle bone grafting. These athletes had an average follow-up duration of 42.8 months (SD=13.5). All of them achieved bony union with no major complications or reoperations. The average time taken to RTT was 16.1 weeks (SD=1.8). There was one case of superficial wound infection and another with deep peroneal nerve sensory injury. Sixteen out of 17 athletes were able to RTS to their preinjury level. One rugby player failed to return to competitive sports due to persistent pain in the navicular despite union on CT scan and had developed early arthritic changes at his final follow-up.
Conclusion
Vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes yielded good bony union and ability to return to sports without significant complications.
Level of Evidence: Level III
Date Acceptance
2025-11-03
Citation
Knee Surgery, Sports Traumatology, Arthroscopy
ISSN
0942-2056
Publisher
Wiley
Journal / Book Title
Knee Surgery, Sports Traumatology, Arthroscopy
Copyright Statement
Copyright This paper is embargoed until publication. Once published the author’s accepted manuscript will be made available under a CC-BY License in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy).
License URL
Publication Status
Accepted