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Chopart Complex Injury
From WikiSM
Contents
Other Names
- Chopart Injury
- Chopart Fracture-Dislocation
- Chopart joint avulsion fracture
- Chopart Complex Injury (CCI)
Background
- This page refers to injuries involving or including the Chopart Joint
History
- Named after French surgeon François Chopart (1743-1795), who performed amputations through this joint in cases of necrosis of the forefoot[1]
Epidemiology
- Incidence
- Estimated at 3.6/100,000/year[2]
- Other
- Chopart fracture-dislocations are missed or misdiagnosed in up to 41% of cases[3]
- Average age of 37 years old
Pathophysiology
- General
- Rare disease, poorly described in the literature
- Spectrum of isolated soft tissue injury to fracture-dislocations depending on etiology
- Only 10-25% are purely ligamentous, most have concomitant fractures
- Sometimes mis diagnosed as lateral ankle sprain due to spontaneous reduction
- Loss of stability jeopardizes the whole function of the foot
Etiology
- High energy
- Fracture-dislocations most commonly due to MVC or fall from height
- The foot is usually dislocated medially and superiorly as it is plantarflexed and inverted
- Low energy
- Twisting force applied to plantarflexed foot[4]
- Avulsion fractures are from low energy trauma
- Crush injury
- Direct blow onto the dorsum of the midfoot may lead to this injury
- Associated with significant neurovascular, soft tissue injuries
Associated Conditions
- Concomitant fractures
- Occur in 75-90% of chopart injuries
- Cuboid Fracture
- Calcaneus Fracture
- Navicular Fracture
Pathoanatomy
- Chopart Joint
- Two articulations connect the hindfoot and midfoot
- The talonavicular joint, calcaneocuboid joint
- Primarily allows for inversion and eversion of the foot
- Talonavicular Joint
- Belongs to the talo-calcaneo-navicular joint (coxa pedis)[5]
- Essential for pronation and supination of the whole foot
- Calcaneocuboid Joint
- Adapts the lateral column of the foot to the plantar buttress
- Adds flexibility to the osteoarticular structure, suspends the pulley of the Peroneus Longus tendon
Risk Factors
- Unknown
Differential Diagnosis
- Fractures & Osseous Disease
- Traumatic/ Acute
- Stress Fractures
- Other Osseous
- Dislocations & Subluxations
- Muscle and Tendon Injuries
- Ligament Injuries
- Plantar Fasciopathy (Plantar Fasciitis)
- Turf Toe
- Plantar Plate Tear
- Spring Ligament Injury
- Neuropathies
- Mortons Neuroma
- Tarsal Tunnel Syndrome
- Joggers Foot (Medial Plantar Nerve)
- Baxters Neuropathy (Lateral Plantar Nerve)
- Arthropathies
- Hallux Rigidus (1st MTPJ OA)
- Gout
- Toenail
- Pediatrics
- Fifth Metatarsal Apophysitis (Iselin's Disease)
- Calcaneal Apophysitis (Sever's Disease)
- Freibergs Disease (Avascular Necrosis of the Metatarsal Head)
Clinical Features
- History
- Patient typically is able to describe an acute mechanism
- Endorses pain, swelling
- Trouble weight bearing
- Deformity may be present
- Physical Exam: Physical Exam Foot
- Large plantar ecchymosis is present (due to rupture of strong plantar ligaments)
- Tenderness along the chopart joint
- Special Tests
Evaluation

Proposed management algorithm for Chopart Injury[6]
Radiographs
- Standard Radiographs Foot
- Often insufficient to make the diagnosis
- Cyma line
- Sign of the smooth joining of the midtarsal joint lines as a "lazy S-shape" of the talonavicular and calcaneocuboid joints
- Can be disrupted in a Chopart Injury
CT
- Useful to delineate osseous injuries
- Fractures
- Dislocations
MRI
- Useful to help
- Evaluate osseous contusions
- Degree of soft tissue involvement
Classification
Main and Jowett Classification
Zwipp Classification
- General
- Most commonly used
- Based upon the affected ligaments and bones
- Type 1. Transligamentous
- Type 2. Transtalar
- Type 3. Transcalcaneal
- Type 4. Transnavicular
- Type 5. Transcuboidal
- Type 6. Combined (any combination of 2–5).
- Make up more than 40% of all Chopart injuries
Management
Nonoperative
- Indications
- Ligament only
- Bony contusion
- Extra-articular avulsion
- Non-displaced intra-articular
- Immobilization
- Short Leg Cast for 6 to 8 weeks[7]
- When cast is removed, ankle brace for an additional 6 weeks
- Weight bearing status
- Can allow up to 10 kg of weight bearing for the first 8 weeks
- Consider prophylactic anticoagulation
- Physical Therapy
- Begin when out of cast
- Emphasis lymphatic drainage, strengthening exercises, mobility and flexibility
- Goals: normal gait, prevent stiffness
Operative
- Indications
- Displaced intra-articular
- Dislocation
- Intra-articular impaction
- Combined (Zwipp Type 6)
Rehab and Return to Play
Rehabilitation
- Postoperative
- Short Leg Cast for 6-8 weeks
Return to Play/ Work
- Unknown/ needs to be updated
Complications and Prognosis
Prognosis
- Delayed diagnosis
- Small cohort of 9 patients by Van Drop et al found delayed diagnosis did not lead to worse outcomes[7]
Complications
- Post traumatic Pes Planus
See Also
- Internal
- External
- Sports Medicine Review Foot Pain: https://www.sportsmedreview.com/by-joint/foot/
References
- ↑ Wolf JH. Francois Chopart (1743-1795)dinventor of the partial foot amputation atthe tarsometatarsal articulation. Orthop Traumatol 12:341–344, 200
- ↑ Klaue K. Chopart fractures. Injury 35(suppl 2):SB64–SB70, 2004.
- ↑ Main BJ, Jowett RL. Injuries of the midtarsal joint. J Bone Joint Surg Br 57:89–97,1975.
- ↑ Rammelt S (2014) Chopart and Lisfranc joint injuries. In: Bentley G (ed) European surgical orthopaedics and traumatology. The EFORT textbook, Springer, Berlin, Heidelberg (Germany), New York, pp 3835–3857
- ↑ Scarpa A (1839) Atlante delle opere complete di Antonio Scarpa e spiegazione delle tavole che lo compongono. Volume unico. Ed: V. Batelli, Firenze.
- ↑ Kutaish, Halah, et al. "Injuries to the Chopart joint complex: a current review." European Journal of Orthopaedic Surgery & Traumatology 27.4 (2017): 425-431.
- ↑ 7.0 7.1 Van Dorp KB, De Vries MR, Van Der Elst M et al (2010) Chopart joint injury: a study of outcome and morbidity. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg 49:541–545
Created by:
John Kiel on 13 December 2021 19:34:58
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Last edited:
4 October 2022 12:38:12
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