Vascularized pedicle bone grafting for chronic navicular stress fractures with non‐union in elite athletes provided good bony union and ability to return to sports

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PURPOSE: Navicular stress fractures are difficult to treat with high risks of non-union, and there are few studies evaluating treatment strategies and outcomes for chronic navicular stress fractures with non-union, particularly in professional elite athletes. Hence, the aim of this study is to evaluate the outcomes of vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes while reporting on the complications, rate of reoperations and ability to return to sports (RTS). METHODS: Seventeen elite athletes with isolated chronic navicular stress fracture non-union treated with vascularized pedicle bone grafting from 2018 to 2023 were reviewed. Demographic details, intraoperative findings, return to training (RTT), ability to RTS, player status at last visit and complications were analyzed and reported. RESULTS: Fifteen out of 17 elite athletes were males (88.2%), and the average age was 22.4 years (standard deviation [SD] = 3.7). More than 75% of them had a failed prior surgical fixation, with only four athletes (23.5%) who had no prior surgical intervention but failed conservative management for an average duration of 8.7 months before the vascularized pedicle bone grafting. These athletes had an average follow-up duration of 42.8 months (SD = 13.5). All of them achieved bony union with no major complications or reoperations. The average time taken to RTT was 16.1 weeks (SD = 1.8). There was one case of superficial wound infection and another with deep peroneal nerve sensory injury. Sixteen out of 17 athletes were able to RTS to their preinjury level. One rugby player failed to return to competitive sports due to persistent pain in the navicular despite union on CT scan and had developed early arthritic changes at his final follow-up. CONCLUSION: Vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes yielded good bony union and ability to RTS without significant complications. LEVEL OF EVIDENCE: Level IV.

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