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Wednesday, March 05, 2008

Navicular Fracture: Yao on the mend

Yao Ming (27) has had successful surgery to repair the stress fracture on the navicular at Memorial Hermann-Texas Medical Center. The big man will also have a the long road to recovery but optomists are hopeful he may play at the Beiijing Olympics 2008 because the experts believe his recovery time will be about four months. The symptoms of a stress fracture of the navicular can be vague but the person usually complains of aching pain in the dorsal (top) midfoot which often then radiates along the medial arch. The condition gets worse with activity and continued participation means the athlete takes longer to recover. Symptoms are usually restricted to the one foot. The condition was first described in humans in a 1970 study but identifying the location of the lesion on plain radiographs was difficult. It was soon recognised to be an injury common to track and field athletes as better scanning technology became available. A triple-phase bone scan helps to localise the early lesion and this is followed by a computed tomographic scan to confirm anatomical detail. When the fracture is simple, non-displaced, non-comminuted then it responds well (86% recovery) to six week immobilisation in a nonweight-bearing cast. Once the pain (or N stop) is asymptomatic then functional rehabilitation can begin. However more complex displacements, comminution, and delayed or non-union fractures need surgical intervention with open reduction screw internal fixation, with possible bone graft inlay. According to Dr Kevin Kirby, the screw is placed across the fracture site to compress it and bring about faster healing. The bone graft placement at the fracture site is optional. As in the case of Yao, surgical intervention may be indicated in athletes who need quick healing to allow them to return to play. The average time for athletes to return to play after surgical intervention compared with conservative management using a nonweight-bearing cast is 3.8 months and 5.6 months, respectively. Any reduction in non-playing salary is cost benefit to a commercial sports club.

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