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Chopart Complex Injury

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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

Pathoanatomy


Risk Factors

  • Unknown

Differential Diagnosis


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

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


See Also


References

  1. Wolf JH. Francois Chopart (1743-1795)dinventor of the partial foot amputation atthe tarsometatarsal articulation. Orthop Traumatol 12:341–344, 200
  2. Klaue K. Chopart fractures. Injury 35(suppl 2):SB64–SB70, 2004.
  3. Main BJ, Jowett RL. Injuries of the midtarsal joint. J Bone Joint Surg Br 57:89–97,1975.
  4. 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
  5. Scarpa A (1839) Atlante delle opere complete di Antonio Scarpa e spiegazione delle tavole che lo compongono. Volume unico. Ed: V. Batelli, Firenze.
  6. 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. 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
Authors:
Last edited:
4 October 2022 12:38:12