The dorsomedial approach to the navicular can be used for comminuted, displaced, intraarticular fractures.
The talo-navicular joint is very important. Loss of the talo-navicular joint can result in loss of 90% or greater of complex hindfoot motion/circumduction.
If fracture care requires a more extensile approach, the advantages of better reduction are balanced against wider dissection causing stripping/loss of blood supply which may impede healing. If the dorsomedial approach is required, care should be taken to minimize dissection.
The approach can be extended onto the distal talus. A small distractor can be used. This allows visualization and palpation of the concavity of the navicular to assure anatomical reduction.