Minimally invasive biological fixation of comminuted navicular fracture using semi-circular external fixator combined with Kirschner wire: a case report
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: This case report describesthe surgical technique and clinical outcome of biologic fixation using a semiring external fixator combined with limited-incision Kirschner wire (K-wire) stabilization in the treatment of a Sangeorzan type III navicular fracture-a complex injury typically associated with comminution, medial column shortening, and challenges in maintaining reduction without extensive soft-tissue dissection. Case Description: A 33-year-old woman presented with a comminuted right navicular body fracture (Sangeorzan type III) following a traffic accident. A minimally invasive approach guided by biologic fixation principles was employed. A semiring external fixator was applied to achieve ligamentotaxis-assisted indirect reduction through distraction across the surrounding talonavicular and naviculocuneiform capsuloligamentous structures with mild forefoot abduction, restoring navicular height and midfoot alignment. Through a limited dorsal incision over the dorsal aspect of the navicular, two 2.0-mm K-wires were inserted under limited direct visualization and fluoroscopic guidance in a point-to-point manner to stabilize key fracture fragments. The external fixator was adjusted weekly, removed at 4 weeks, and the fracture-fixation K-wires were removed at 6 weeks, followed by a staged weight-bearing rehabilitation protocol. At 12-month follow-up, radiographic evaluation demonstrated solid bony union. The patient was able to bear full weight without pain or tenderness. The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score was 90, indicating excellent functional recovery. Conclusions: The combination of semiring external fixation and limited-incision K-wire fixation enabled effective, blood-supply-sparing reduction and elastic stabilization in a complex Sangeorzan type III navicular fracture. This biologic fixation strategy may offer a valuable alternative to conventional open reduction and internal fixation (ORIF) in selected comminuted navicular fractures.
Source: Annals of Joint
Authors: Haixiang Sun, Zhenglin Niu, Yue Lian, Changlong Shi
Language: English
Topic: Foot and Ankle Surgery
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7222601962