Navicular Fracture Mapping: A New Perspective on Fracture Patterns and Surgical Strategies

Background: Navicular fractures are rare and pose significant surgical challenges. This study aimed to define the location and frequency of fracture lines using both two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) mapping. We hypothesized that fracture mapping could reveal constant fragments, as well as patterns of impaction and comminution, to help optimize surgical management. Methods: A retrospective analysis of CT scans from 44 patients was performed. Fractures were classified according to the Sangeorzan system. Three-dimensional reconstructions were used to identify key fracture patterns, zones of impaction, and the presence of a constant plantar fragment, based on a 360-degree quadrant mapping approach. Results: Type I fractures (n = 8) were simple transverse fractures with no reproducible pattern. Type II fractures (n = 10) followed an oblique dorsolateral-to-plantar-medial trajectory, with 43% showing impaction in the lateral quadrant. Type III fractures (n = 26) were associated with comminution in 96% of cases and impaction in 81%, with fracture lines converging at the talonavicular joint. A constant plantar fragment was identified in 56% of Type II and 73% of Type III fractures. Conclusion: 3D navicular fracture mapping may improve understanding of fracture morphology and injury mechanisms. By identifying consistent fracture features, this technique may assist in preoperative planning and inform reduction and fixation strategies. Level of evidence : IV