Dallas Stars Centre Roope Hintz told the media during his locker room cleanout following a series loss to the Edmonton Oilers that he suffered a fractured foot in Game 2 following the slash from Oilers Defenseman Darnell Nurse. Hintz was slashed across the top of his foot directly over his skate laces. The anatomy underneath leads us to believe it was either the talus or the navicular. However, talus fractures are extremely rare so it is highly likely the navicular was fractured.
Traumatic fractures to the navicular can be broken down into three categories: avulsion, tuberosity, and body fractures. An avulsion fracture occurs when the foot is plantar flexed, inverted, or everted and involves the talonavicular and naviculocuneiform ligaments. Tuberosity fractures occur when eversion is simultaneous with contraction of the posterior tibial tendon. It may present like an acute diastasis of an accessory navicular. Body fractures happen when an axial load is too strong, causing the bone to crack.
The fractures are also classified into different types. Type I includes a transverse fracture of the dorsal fragment that involves < 50% of the bone with no associated deformity. Type II consists of an oblique fracture, usually from dorsal-lateral to plantar-medial. May have forefoot adduction deformity. Type III is defined by a central or lateral comminution and an Abduction deformity.
Due to the traumatic mechanism of injury, with Hintz treatment can vary. The non-operative approach opts for immobilization with a cast and non-weight-bearing status. Conservative care is typically done for acute avulsion fractures, most tuberosity fractures, and minimally displaced Type I and II navicular body fractures. When conservative treatment fails for avulsion fractures fails and if tuberosity fractures went on to symptomatic nonunion, then a surgical procedure for fragment excision can be done. In more severe cases, such as: avulsion fractures involving > 25% of articular surface, tuberosity fractures with > 5mm diastasis or large intra-articular fragments, and displaced or intra-articular Type I and II navicular body fractures, an open reduction and internal fixation (ORIF) can be done through a medial approach. Lastly, an external fixation or primary fusion might be considered for Type III navicular body fractures and navicular avascular necrosis. While maintaining the lateral column length, a fusion of the talonavicular and naviculocuneiform joints can be performed.
The middle portion of the navicular bone is notorious for a poor blood supply, making bone remodeling and recovery longer. Michael Jordan, during his sophomore season, notably took 4 months to return from a fractured navicular following a flat-footed landing from a jump. Based on human biomechanics, the kinetic chain force is primarily dispersed through the first and second metatarsals before reaching the navicular, making it either impossible or extremely painful to do any athletic movements. Hintz, dressed for Game 3 however, was unable to compete at a high enough level and was scratched. He made a return to the lineup in Game 4 and Game ,5 even scoring and logging 17 minutes in Game 5. Hintz could be seen in a CAM boot while leaving the arena, traveling with the team, and watching Game 3.
