Bone-specific plate fixation
The fractured navicular is secured at the end once reduced with a special navicular plate.
This plate is contoured and any extra holes are removed. When inserting the screws (in the proximal row, adjacent to the talonavicular joint), care must be taken to prevent the screws from entering the dome-shaped joint. If one is using the new generation of navicular plates, which provide the variable-angle screw insertion, the screws should be aimed distally, away from the talonavicular joint. This can also be accomplished by contouring non variable-angle locking plates, or using non-locking plates.
In the case of severely comminuted fractures where stable / rigid internal fixation is not possible, the medial column distractor is replaced by means of a bridging plate. Instead of a bridging plate, one can also leave the distractor or an external fixator in its place. This is then left, until the bone heals.
In plating, we can avoid extensive dissection by sliding subcutaneously the contoured plate along the medial aspect of the navicular. A small medial incision is made to facilitate placement of the more proximal screws.