Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected foot elevated and accessible for both medial and lateral approaches. A sterile tourniquet was applied to control intraoperative bleeding.

Anatomical surgical approach:  Medial approach to the navicular. (No lateral incision was made; the lateral column was managed using a laterally tensioned external fixator.)

Intraoperatively, it was noted that perfect anatomical reduction of the navicular was not achievable due to its comminuted nature. Bridging fixation was emphasized as critical to maintaining column length and preventing talar displacement. The surgeon expressed the importance of restoring foot morphology as a primary goal, with articular reduction being secondary yet still significant. The cuboid was reduced using a laterally tensioned frame, which was planned as definitive treatment.

Postoperative protocol:   Postoperatively, the patient was placed in a non-weight-bearing cast for 6 weeks to allow for initial healing. Progressive weight-bearing was introduced thereafter, with physical therapy focusing on range of motion and strengthening exercises.

Follow up:   Not specified.

Orthopaedic implants used:   Medial and lateral distractors, external fixator components for bridging fixation, tensioned frame for cuboid reduction.