Application of modified internal fixation and fusion for type <b>Ⅱ</b> painful accessory navicular in adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Weixin ¹ , ZHANG Yan ² , LIANG Jingqi ² , ZHAO Hongmou ² ,  LIANG Xiaojun ²

1. Xi’an Medical University, Xi’an Shaanxi, 710021, P.R.China;
2. Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding?author：

LIANG Xiaojun, Email: liangxj33369@163.com

Keywords：

Painful accessory navicular; fusion; internal fixation; adults

DOI：

10.7507/1002-1892.201904142

Video：

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Objective To explore the effectiveness of modified internal fixation and fusion in treatment of type Ⅱ painful accessory navicular (PAN) in adults.Methods Between January 2016 and December 2017, 29 patients (37 feet) with type Ⅱ PAN were treated with modified internal fixation and fusion. There were 12 males and 17 females with an average age of 41.4 years (range, 18-50 years). The injury caused by sprain in 24 cases and no obvious inducement occurred in 5 cases. All patients received conservative treatment for more than 6 months with no significant improvement. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score before operation and at last follow-up. The inclination angle of calcaneus, the first metatarsal angle of talus, the inclusion angle of talonavicular joint, and the second metatarsal angle of talus were measured on X-ray films.Results Superficial infection of incision occurred in 1 case after operation, and the incision healed after enhanced dressing change. The incisons of the other patients healed by first intention. There was no deep infection or osteomyelitis. All patients were followed up 12-33 months (mean, 25.1 months). X-ray films showed that the articular surfaces healed at 2-5 months after operation, with an average of 3.4 months. No loosening or rupture of internal fixator was found during the follow-up. At last follow-up, the pain, function, alignment scores, and total score of AOFAS were significantly improved when compared with those before operation (P<0.05). The inclusion angle of talonavicular joint, the first metatarsal angle of talus, and the second metatarsal angle of talus were also significantly improved when compared with those before operation (P<0.05). But there was no significant difference in the inclination angle of calcaneus between pre- and post-operation (t=1.097, P=0.276).Conclusion Modified internal fixation and fusion in treatment of type Ⅱ PAN can effectively relieve the symptoms and obtain good recovery of feet function with less complications.

Citation： ZHENG Weixin, ZHANG Yan, LIANG Jingqi, ZHAO Hongmou, LIANG Xiaojun. Application of modified internal fixation and fusion for type Ⅱ painful accessory navicular in adults. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1498-1502. doi: 10.7507/1002-1892.201904142 Copy

1.	聶宇, 徐海林, 周納新. 雙固定錨釘內固定融合術治療成人Ⅱ型足副舟骨臨床觀察. 中華骨與關節外科雜志, 2018, 11(8): 578-580, 587.
2.	Jegal H, Park YU, Kim JS, et al. Accessory navicular syndrome in athlete vs general population. Foot Ankle Int, 2016, 37(8): 862-867.
3.	Perdikakis E, Grigoraki E, Karantanas A. Os naviculare: the multi-ossicle configuration of a normal variant. Skeletal Radiol, 2011, 40(1): 85-88.
4.	Knapik DM, Guraya SS, Conry KT, et al. Longitudinal radiographic behavior of accessory navicular in pediatric patients. J Child Orthop, 2016, 10(6): 685-689.
5.	張存, 俞光榮. 痛性足副舟骨診斷和治療進展. 國際骨科學雜志, 2011, 32(6): 360-363.
6.	Shurnas PS, Sanders A. A novel approach to the symptomatic accessory navicular. Tech Foot Ankle Surg, 2007, 6(3): 195-200.
7.	Jang HS, Park KH, Park HW. Comparison of outcomes of osteosynthesis in type Ⅱ accessory navicular by variable fixation methods. Foot Ankle Surg, 2017, 23(4): 243-249.
8.	謝興, 郭秦煒, 焦晨, 等. 足副舟骨損傷的臨床病理研究. 中國運動醫學雜志, 2015, 34(1): 10-14.
9.	Scott AT, Sabesan VJ, Saluta JR, et al. Fusion versus excision of the symptomatic Type II accessory navicular: a prospective study. Foot Ankle Int, 2009, 30(1): 10-15.
10.	Malicky ES, Levine DS, Sangeorzan BJ. Modification of the Kidner procedure with fusion of the primary and accessory navicular bones. Foot Ankle Int, 1999, 20(1): 53-54.
11.	Chung JW, Chu IT. Outcome of fusion of a painful accessory navicular to the primary navicular. Foot Ankle Int, 2009, 30(2): 106-109.
12.	胡永成, 邱貴興, 馬信龍, 等. 骨科疾病療效評價標準. 北京: 人民衛生出版社, 2012: 231-267.
13.	唐康來, 王正義. 足踝外科手術學. 北京: 科學技術文獻出版社, 2006: 432-434.
14.	魏世雋, 蔡賢華, 俞光榮. 成人獲得性平足的軟組織重建. 中國修復重建外科雜志, 2012, 26(10): 1259-1262.
15.	曹洪輝, 唐康來, 鄧銀栓, 等. 副舟骨切除結合脛后肌腱止點前置重建治療副舟骨源性平足癥. 中國修復重建外科雜志, 2012, 26(6): 686-690.
16.	Kiter E, Günal I, Karatosun V, et al. The relationship between the tibialis posterior tendon and the accessory navicular. Ann Anat, 2000, 182(1): 65-68.
17.	Ugolini PA, Raikin SM. The accessory navicular. Foot Ankle Clin, 2004, 9(1): 165-180.
18.	解冰, 田競, 劉欣偉, 等. 副舟骨融合術治療成人Ⅱ型痛性足副舟骨臨床療效分析. 中國骨傷, 2014, 27(10): 870-873.
19.	Dennis KJ, McKinney S. Sesamoids and accessory bones of the foot. Clin Podiatr Med Surg, 1990, 7(4): 717-723.
20.	Choi HJ, Lee WC. Revision surgery for recurrent pain after excision of the accessory navicular and relocation of the tibialis posterior tendon. Clin Orthop Surg, 2017, 9(2): 232-238.

1. 聶宇, 徐海林, 周納新. 雙固定錨釘內固定融合術治療成人Ⅱ型足副舟骨臨床觀察. 中華骨與關節外科雜志, 2018, 11(8): 578-580, 587.
2. Jegal H, Park YU, Kim JS, et al. Accessory navicular syndrome in athlete vs general population. Foot Ankle Int, 2016, 37(8): 862-867.
3. Perdikakis E, Grigoraki E, Karantanas A. Os naviculare: the multi-ossicle configuration of a normal variant. Skeletal Radiol, 2011, 40(1): 85-88.
4. Knapik DM, Guraya SS, Conry KT, et al. Longitudinal radiographic behavior of accessory navicular in pediatric patients. J Child Orthop, 2016, 10(6): 685-689.
5. 張存, 俞光榮. 痛性足副舟骨診斷和治療進展. 國際骨科學雜志, 2011, 32(6): 360-363.
6. Shurnas PS, Sanders A. A novel approach to the symptomatic accessory navicular. Tech Foot Ankle Surg, 2007, 6(3): 195-200.
7. Jang HS, Park KH, Park HW. Comparison of outcomes of osteosynthesis in type Ⅱ accessory navicular by variable fixation methods. Foot Ankle Surg, 2017, 23(4): 243-249.
8. 謝興, 郭秦煒, 焦晨, 等. 足副舟骨損傷的臨床病理研究. 中國運動醫學雜志, 2015, 34(1): 10-14.
9. Scott AT, Sabesan VJ, Saluta JR, et al. Fusion versus excision of the symptomatic Type II accessory navicular: a prospective study. Foot Ankle Int, 2009, 30(1): 10-15.
10. Malicky ES, Levine DS, Sangeorzan BJ. Modification of the Kidner procedure with fusion of the primary and accessory navicular bones. Foot Ankle Int, 1999, 20(1): 53-54.
11. Chung JW, Chu IT. Outcome of fusion of a painful accessory navicular to the primary navicular. Foot Ankle Int, 2009, 30(2): 106-109.
12. 胡永成, 邱貴興, 馬信龍, 等. 骨科疾病療效評價標準. 北京: 人民衛生出版社, 2012: 231-267.
13. 唐康來, 王正義. 足踝外科手術學. 北京: 科學技術文獻出版社, 2006: 432-434.
14. 魏世雋, 蔡賢華, 俞光榮. 成人獲得性平足的軟組織重建. 中國修復重建外科雜志, 2012, 26(10): 1259-1262.
15. 曹洪輝, 唐康來, 鄧銀栓, 等. 副舟骨切除結合脛后肌腱止點前置重建治療副舟骨源性平足癥. 中國修復重建外科雜志, 2012, 26(6): 686-690.
16. Kiter E, Günal I, Karatosun V, et al. The relationship between the tibialis posterior tendon and the accessory navicular. Ann Anat, 2000, 182(1): 65-68.
17. Ugolini PA, Raikin SM. The accessory navicular. Foot Ankle Clin, 2004, 9(1): 165-180.
18. 解冰, 田競, 劉欣偉, 等. 副舟骨融合術治療成人Ⅱ型痛性足副舟骨臨床療效分析. 中國骨傷, 2014, 27(10): 870-873.
19. Dennis KJ, McKinney S. Sesamoids and accessory bones of the foot. Clin Podiatr Med Surg, 1990, 7(4): 717-723.
20. Choi HJ, Lee WC. Revision surgery for recurrent pain after excision of the accessory navicular and relocation of the tibialis posterior tendon. Clin Orthop Surg, 2017, 9(2): 232-238.

Chinese Journal of Reparative and Reconstructive Surgery

Application of modified internal fixation and fusion for type Ⅱ painful accessory navicular in adults

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