Anatomic Reconstruction of Malunited Chopart Joint Injuries

Abstract

Fractures and dislocations at the mid-tarsal (Chopart) joint are frequently overlooked or misinterpreted at first presentation. Inadequate joint reduction and stabilization almost invariably lead to painful malunions or nonunions, residual instability, and deformity. Because of the central position and the essential function of the mid-tarsal joint, malunions lead to a considerable impairment of global foot function and the rapid development of posttraumatic arthritis. While secondary anatomical reconstruction with joint preservation would be desirable in order to restore normal foot function, it is amenable only if no symptomatic arthritis or avascular necrosis is present. Over a course of 6 years, eight patients have been treated with secondary correction, joint realignment, and internal fixation. In four of these cases, nonunions of the tarsal navicular were debrided and bone-grafted; in the remaining cases, a corrective osteotomy at the navicular or cuboid was carried out. At 2 years followup, all but one patient were satisfied with the result. One patient underwent fusion of the talonavicular joint for avascular necrosis and collapse of the navicular. The mean American Orthopaedic Foot and Ankle Score (AOFAS) improved significantly from 38.8 preoperatively to 80.8 at follow-up. However, the majority of malunited mid-tarsal fracture-dislocations will require corrective fusion of the affected joint(s) with axial realignment because of manifest posttraumatic arthritis at the time of patient presentation.

Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results

“…Malunited fractures of the talar head are typically the result of a malunited mid-tarsal (Chopart) fracture-dislocation with residual incongruity of the talonavicular joint [9]. Correction is carried out via an anteromedial or dorsomedial approach to the talonavicular joint.…”

“…Fractures of the lateral and posterior processes are frequently overlooked at first presentation and if displaced will rapidly lead to symptomatic arthritis of the subtalar joint [6,7]. Malunions of the talar head result from overlooked or underestimated fracture-dislocations at the midtarsal (Chopart) joint and severely affect function of the talonavicular joint [8,9]. In addition, malaligned bony fragments or osteophytes lead to impingement of the posterior tibial tendons, tarsal tunnel or sinus tarsi syndrome [10].…”

Joint-Preserving Osteotomy for Malunited Intra-articular Calcaneal Fractures

“…16 In our experience, posttraumatic arthritis evolves more rapidly at the subtalar joint than at the ankle, limiting the possibility of joint-preserving reconstruction after intra-articular calcaneal malunions. During the last decade, while performing just 5 joint-sparing osteotomies, we performed more than 50 corrective fusions of the subtalar joint, either as bone block distraction fusion 8 or in combination with corrective osteotomies for malunited intra-articular calcaneal FIGURE 2.…”

Foot and Ankle Injuries

“…Shortening of the lateral or medial foot column are caused by impaction zones in the head of the talus/ navicular and/or anterior process of the calcaneus or cuboid resulting in a pes adductus or abductus [ 150 ]. Shortening of the medial column can be seen after avascular necrosis of the navicular.…”

“…In selected cases without signs of post-traumatic arthritis or avascular necrosis, corrective osteotomies with joint preservation, anatomical realignment, and secondary osteosynthesis are possible [ 150 ]. For isolated calcaneocuboid arthritis, one should use the lateral approach and perform a calcaneocuboid arthrodesis [ 139 ].…”