{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:17Z","timestamp":1783509257270,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:p>A case presentation of an adolescent with tarsal navicular avascular necrosis is presented. External fixation with tarsal navicular diastasis is a simple, straightforward management option to allow osseous regrowth and bone healing. In this case, the external fixator was well tolerated and the patient demonstrated a quick return to function without pain or discomfort. The external fixation technique with tarsal navicular diastasis is an uncommon but effective means of reversing the tarsal navicular avascular process and avoiding an open technique such as arthrodesis.<\/jats:p>","DOI":"10.7547\/17-140","type":"journal-article","created":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T20:59:26Z","timestamp":1596142766000},"source":"Crossref","is-referenced-by-count":2,"title":["External Fixation Diastasis Management of Kohler's Disease in a 14-Year-Old Boy: A Case Report"],"prefix":"10.3390","volume":"110","author":[{"given":"Jeffrey C.","family":"Karr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-110-3-Article_11-b01","series-title":"Pediatric Orthopedics","author":"Tachdjian","year":"1972","unstructured":"Tachdjian\n              MO\n            (ed):\n\t\t\t\t\t\n          \n            Pediatric Orthopedics\n          ,\n\t\t\t\t\tWB Saunders,\n\t\t\t\t\tPhiladelphia,\n\t\t\t\t\t1972."},{"key":"i8750-7315-110-3-Article_11-b02","series-title":"J Bone Joint Surg Am","first-page":"84","article-title":"Kohler's disease of the tarsal scaphoid","volume":"19","author":"Karp","year":"1937","unstructured":"Karp\n              MG:\n            \n          \n          Kohler's disease of the tarsal scaphoid.\n\t\t\t\t\tJ Bone Joint Surg Am19: 84,\n\t\t\t\t\t1937."},{"key":"i8750-7315-110-3-Article_11-b03","series-title":"J Bone Joint Surg Br","first-page":"765","article-title":"The ossification and vascularization of the tarsal navicular and their relation to Kohler's disease","volume":"40","author":"Waugh","year":"1958","unstructured":"Waugh\n              W:\n            \n          \n          The ossification and vascularization of the tarsal navicular and their relation to Kohler's disease.\n\t\t\t\t\tJ Bone Joint Surg Br40: 765,\n\t\t\t\t\t1958."},{"key":"i8750-7315-110-3-Article_11-b04","series-title":"Bull Hosp Jt Dis Orthop Inst","first-page":"285","article-title":"Necrosis of the navicular bone","volume":"47","author":"Viladot","year":"1987","unstructured":"Viladot\n              A\n            \n            \n              Rochera\n              R\n            \n            \n              Viladot\n              A:\n            \n          \n          Necrosis of the navicular bone.\n\t\t\t\t\tBull Hosp Jt Dis Orthop Inst47: 285,\n\t\t\t\t\t1987.\n\t\t\t\t2825889"},{"key":"i8750-7315-110-3-Article_11-b05","series-title":"Diabet Med","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1046\/j.1464-5491.2001.00566.x","article-title":"Avascular necrosis not Charcot's","volume":"18","author":"Samarasinghe","year":"2001","unstructured":"Samarasinghe\n              YP\n            \n            \n              Brunton,\n              SL\n            \n            \n              Feher\n              MD:\n            \n          \n          Avascular necrosis not Charcot's.\n\t\t\t\t\tDiabet Med18: 846,\n\t\t\t\t\t2001.\n\t\t\t\t10.1046\/j.1464-5491.2001.00566.x"},{"issue":"(suppl 1)","key":"i8750-7315-110-3-Article_11-b06","series-title":"J Bone Joint Surg Br","first-page":"56","article-title":"Aseptic necrosis of the navicular bone: 25 cases","volume":"86","author":"Catonne","year":"2004","unstructured":"Catonne\n              Y\n            \n            \n              Ribeyre\n              D\n            \n            \n              Pascal-Mousselard\n              H\n            \n            :\n\t\t\t\t\t\n          Aseptic necrosis of the navicular bone: 25 cases.\n\t\t\t\t\tJ Bone Joint Surg Br86(suppl 1): 56,\n\t\t\t\t\t2004."},{"key":"i8750-7315-110-3-Article_11-b07","series-title":"Foot Ankle Clin","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/S1083-7515(03)00173-6","article-title":"Fractures of the navicular","volume":"9","author":"DiGiovanni","year":"2004","unstructured":"DiGiovanni\n              CW:\n            \n          \n          Fractures of the navicular.\n\t\t\t\t\tFoot Ankle Clin9: 25,\n\t\t\t\t\t2004.\n\t\t\t\t10.1016\/S1083-7515(03)00173-615062213"},{"key":"i8750-7315-110-3-Article_11-b08","series-title":"Clin Orthop Relat Res","first-page":"142","article-title":"Fractures of the tarsal navicular bone","volume":"34","author":"Eichenholtz","year":"1964","unstructured":"Eichenholtz\n              SN\n            \n            \n              Levine\n              DB:\n            \n          \n          Fractures of the tarsal navicular bone.\n\t\t\t\t\tClin Orthop Relat Res34: 142,\n\t\t\t\t\t1964.\n\t\t\t\t4968587"},{"key":"i8750-7315-110-3-Article_11-b09","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1097\/00003086-199307000-00035","article-title":"Midtarsal fracture-subluxation: case report and review of the literature","volume":"292","author":"Davis","year":"1993","unstructured":"Davis\n              GA\n            \n            \n              Lubowitz\n              J\n            \n            \n              Thordarson\n              DB:\n            \n          \n          Midtarsal fracture-subluxation: case report and review of the literature.\n\t\t\t\t\tClin Orthop Relat Res292: 264,\n\t\t\t\t\t1993.\n\t\t\t\t10.1097\/00003086-199307000-00035"},{"key":"i8750-7315-110-3-Article_11-b10","series-title":"J Bone Joint Surg Br","first-page":"89","article-title":"Injuries to the midtarsal joint","volume":"57","author":"Main","year":"1975","unstructured":"Main\n              BJ\n            \n            \n              Jowett\n              RL:\n            \n          \n          Injuries to the midtarsal joint.\n\t\t\t\t\tJ Bone Joint Surg Br57: 89,\n\t\t\t\t\t1975.\n\t\t\t\t234971"},{"key":"i8750-7315-110-3-Article_11-b11","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.2106\/00004623-198971100-00008","article-title":"Displaced intra-articular fractures of the tarsal navicular","volume":"71","author":"Sangeorzan","year":"1989","unstructured":"Sangeorzan\n              BJ\n            \n            \n              Benirschke\n              SK\n            \n            \n              Mosca\n              V\n            \n            :\n\t\t\t\t\t\n          Displaced intra-articular fractures of the tarsal navicular.\n\t\t\t\t\tJ Bone Joint Surg Am71: 1504,\n\t\t\t\t\t1989.\n\t\t\t\t259239010.2106\/00004623-198971100-00008"},{"key":"i8750-7315-110-3-Article_11-b12","series-title":"JAPMA","first-page":"41","article-title":"Bilateral spontaneous avascular necrosis of the navicular: case presentation with comparative imaging","volume":"88","author":"Boc","year":"1988","unstructured":"Boc\n              SF\n            \n            \n              Feldman\n              G:\n            \n          \n          Bilateral spontaneous avascular necrosis of the navicular: case presentation with comparative imaging.\n\t\t\t\t\tJAPMA88: 41,\n\t\t\t\t\t1988."},{"key":"i8750-7315-110-3-Article_11-b13","series-title":"Bone and Joint Imaging","first-page":"959","article-title":"\u201cOsteonecrosis,\u201d","author":"Resnick","year":"1989","unstructured":"Resnick\n              D\n            \n            \n              Niwayama\n              G\n            \n            \n              Sweet\n              DE\n            \n            :\n\t\t\t\t\t\n          \u201cOsteonecrosis,\u201d\n          in\n          \n            Bone and Joint Imaging\n          ,\n\t\t\t\t\tedited byResnick,Dp959,\n\t\t\t\t\tWB Saunders,\n\t\t\t\t\tPhiladelphia,\n\t\t\t\t\t1989."},{"key":"i8750-7315-110-3-Article_11-b14","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1097\/01241398-198408000-00019","article-title":"Talonavicular coalition following avascular necrosis of the tarsal navicular","volume":"4","author":"Ertel","year":"1984","unstructured":"Ertel\n              AN\n            \n            \n              O'Connell\n              FD:\n            \n          \n          Talonavicular coalition following avascular necrosis of the tarsal navicular.\n\t\t\t\t\tJ Pediatr Orthop4: 482,\n\t\t\t\t\t1984.\n\t\t\t\t643284310.1097\/01241398-198408000-00019"},{"key":"i8750-7315-110-3-Article_11-b15","series-title":"Curr Opin Orthop","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1097\/00001433-200204000-00005","article-title":"Midfoot trauma, bony and ligamentous: evaluation and treatment","volume":"13","author":"Lawerence","year":"2002","unstructured":"Lawerence\n              SJ:\n            \n          \n          Midfoot trauma, bony and ligamentous: evaluation and treatment.\n\t\t\t\t\tCurr Opin Orthop13: 99,\n\t\t\t\t\t2002.\n\t\t\t\t10.1097\/00001433-200204000-00005"},{"key":"i8750-7315-110-3-Article_11-b16","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/00003086-200110000-00005","article-title":"Complications of forefoot and midfoot fractures","volume":"391","author":"Adelaar","year":"2001","unstructured":"Adelaar\n              RS:\n            \n          \n          Complications of forefoot and midfoot fractures.\n\t\t\t\t\tClin Orthop Relat Res391: 26,\n\t\t\t\t\t2001.\n\t\t\t\t10.1097\/00003086-200110000-00005"},{"key":"i8750-7315-110-3-Article_11-b17","series-title":"Curr Opin Orthop","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/01.bco.0000192870.53952.38","article-title":"Osteonecrosis of the second metatarsal head, navicular and talus","volume":"17","author":"Ahmed","year":"2006","unstructured":"Ahmed\n              J\n            \n            \n              Raikin\n              SM:\n            \n          \n          Osteonecrosis of the second metatarsal head, navicular and talus.\n\t\t\t\t\tCurr Opin Orthop17: 103,\n\t\t\t\t\t2006.\n\t\t\t\t10.1097\/01.bco.0000192870.53952.38"},{"key":"i8750-7315-110-3-Article_11-b18","series-title":"Curr Opin Orthop","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1097\/00001433-199906000-00008","article-title":"Fractures of the midfoot and forefoot","volume":"10","author":"Lee","year":"1999","unstructured":"Lee\n              EW\n            \n            \n              Donatto\n              KC:\n            \n          \n          Fractures of the midfoot and forefoot.\n\t\t\t\t\tCurr Opin Orthop10: 224,\n\t\t\t\t\t1999.\n\t\t\t\t10.1097\/00001433-199906000-00008"},{"key":"i8750-7315-110-3-Article_11-b19","series-title":"Anatomy of the Foot and Ankle","author":"Sarrafian","year":"1983","unstructured":"Sarrafian\n              SK.\n            \n          \n          \n            Anatomy of the Foot and Ankle\n          ,\n\t\t\t\t\tJB Lippincott,\n\t\t\t\t\tPhiladelphia,\n\t\t\t\t\t1983."},{"key":"i8750-7315-110-3-Article_11-b20","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"355","DOI":"10.2214\/ajr.151.2.355","article-title":"Spontaneous osteonecrosis of the tarsal navicular in adults: imaging findings","volume":"151","author":"Haller","year":"1988","unstructured":"Haller\n              J\n            \n            \n              Santoris\n              DJ\n            \n            \n              Resnick\n              D\n            \n            :\n\t\t\t\t\t\n          Spontaneous osteonecrosis of the tarsal navicular in adults: imaging findings.\n\t\t\t\t\tAJR Am J Roentgenol151: 355,\n\t\t\t\t\t1988.\n\t\t\t\t326072710.2214\/ajr.151.2.355"},{"key":"i8750-7315-110-3-Article_11-b21","series-title":"J Orthop Trauma","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1097\/00005131-200308000-00007","article-title":"Temporary bridge plating of the medial column in severe midfoot injuries","volume":"17","author":"Schildhauer","year":"2003","unstructured":"Schildhauer\n              TA\n            \n            \n              Nork\n              SE\n            \n            \n              Sangeorzan\n              BJ:\n            \n          \n          Temporary bridge plating of the medial column in severe midfoot injuries.\n\t\t\t\t\tJ Orthop Trauma17: 513,\n\t\t\t\t\t2003.\n\t\t\t\t10.1097\/00005131-200308000-0000712902790"},{"key":"i8750-7315-110-3-Article_11-b22","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1053\/j.jfas.2006.06.002","article-title":"Management of complex open fracture injuries of the midfoot with external fixation","volume":"45","author":"Chandran","year":"2006","unstructured":"Chandran\n              P\n            \n            \n              Puttaswamaiah\n              R\n            \n            \n              Dhillon\n              MS\n            \n            :\n\t\t\t\t\t\n          Management of complex open fracture injuries of the midfoot with external fixation.\n\t\t\t\t\tJ Foot Ankle Surg45: 308,\n\t\t\t\t\t2006.\n\t\t\t\t1694952810.1053\/j.jfas.2006.06.002"},{"key":"i8750-7315-110-3-Article_11-b23","series-title":"J Orthop Trauma","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1097\/00005131-200210000-00012","article-title":"Temporary external fixation for the management of complex intra- and periarticular fractures of the lower extremity","volume":"16","author":"Haidukewych","year":"2002","unstructured":"Haidukewych\n              GJ:\n            \n          \n          Temporary external fixation for the management of complex intra- and periarticular fractures of the lower extremity.\n\t\t\t\t\tJ Orthop Trauma16: 678,\n\t\t\t\t\t2002.\n\t\t\t\t1236865110.1097\/00005131-200210000-00012"},{"issue":"(suppl 3)","key":"i8750-7315-110-3-Article_11-b24","series-title":"J Bone Joint Surg Br","first-page":"232","article-title":"Mini external fixator for tarsal navicular fractures: a biomechanical study","volume":"82","author":"Melamed","year":"2000","unstructured":"Melamed\n              EA\n            \n            \n              Seligson\n              D:\n            \n          \n          Mini external fixator for tarsal navicular fractures: a biomechanical study.\n\t\t\t\t\tJ Bone Joint Surg Br82(suppl 3): 232,\n\t\t\t\t\t2000."}],"container-title":["Journal of the American Podiatric Medical 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