Minimally invasive biological fixation of comminuted navicular fracture using semi-circular external fixator combined with Kirschner wire: a case report.
- 1Department of Orthopaedic Trauma, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Abstract
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. 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. 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.
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BibTeX
@article{sun2026minimally,
title = {{Minimally invasive biological fixation of comminuted navicular fracture using semi-circular external fixator combined with Kirschner wire: a case report.}},
author = {Haixiang Sun and Zhenglin Niu and Yue Lian and Changlong Shi},
journal = {Annals of joint},
year = {2026},
month = jul,
doi = {10.21037/aoj-2026-0028},
url = {https://europepmc.org/article/MED/42999479},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Minimally invasive biological fixation of comminuted navicular fracture using semi-circular external fixator combined with Kirschner wire: a case report.
AU - Haixiang Sun
AU - Zhenglin Niu
AU - Yue Lian
AU - Changlong Shi
PY - 2026
DA - 2026/07/24
JO - Annals of joint
DO - 10.21037/aoj-2026-0028
UR - https://europepmc.org/article/MED/42999479
AB - 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. 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. 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.
SN - 2415-6809
ER -