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Chopart Complex Injury

From WikiSM
(Redirected from Chopart Joint Sprain)

Other Names

  • Chopart Injury
  • Chopart Fracture-Dislocation
  • Chopart joint avulsion fracture
  • Chopart Complex Injury (CCI)
  • Swivel dislocations

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 per 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

Introduction

Schematic drawings show typical inversion and eversion injury mechanisms of Chopart joint complex[4]
Ligaments of Chopart joint. Joint is stabilized dorsally, from medial to lateral, by dorsal talonavicular ligament (TN) and bifurcate ligament with its two components (calcaneonavicular and calcaneocuboid), dorsolaterally by dorsal calcaneocuboid (DCC) ligament (two-band variant is shown), and plantarly by short and long plantar ligaments. Spring ligament complex (not shown) stabilizes joint medioplantarly.[5]

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[6]
    • 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

Injury Categorization

  • Can be broken down into 4 broad groups
    • Ligamentous injury with or without dislocation
    • Fracture with or without dislocation
    • Injury must occur at the TNJ and/or CCJ
  • Pure dislocation: dislocation of the navicular and/or cuboid without associated fracture
  • Fracture-dislocation: dislocation of the navicular and/or cuboid with associated fracture of one or more of talus, navicular, calcaneus or cuboid
  • Complete Chopart dislocation: dislocation of both the TNJ and CCJ

Anatomy of the Chopart Joint

  • General
  • Talonavicular Joint (TNJ)
    • Belongs to the talo-calcaneo-navicular joint (coxa pedis)[7]
    • Essential for pronation and supination of the whole foot
  • Calcaneocuboid Joint (CCJ)
    • 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

Differential Diagnosis Foot Pain

Clinical Features

Platnar ecchymosis seen in chopart joint injury[8]

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

  • Needs to be updated

Evaluation

Dorsoplantar Illustration of the Chopart joint and cyma line dividing the midfoot and hindfoot. This congruent S-shaped line corresponds to the Chopart joint[9]
Chopart TNJ fracture-dislocation example. Anteroposterior radiograph (A) and axial CT (B) of a talar head dislocation with medial talar head and lateral navicular impaction injury[9]

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

  • Needs to be updated

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

Proposed management algorithm for Chopart Injury[10]

Nonoperative

  • Indications
    • Ligament only
    • Bony contusion
    • Extra-articular avulsion
    • Non-displaced intra-articular
  • Immobilization
    • Short Leg Cast for 6 to 8 weeks[11]
    • 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)
  • Technique
    • ORIF

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

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[11]

Complications

See Also

Internal

External

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. ↑ Walter, William R., et al. "Imaging of Chopart (midtarsal) joint complex: normal anatomy and posttraumatic findings." American Journal of Roentgenology 211.2 (2018): 416-425.
  5. ↑ Hirschmann, Anna, et al. "Acute fracture of the anterior process of calcaneus: does it herald a more advanced injury to Chopart joint?." American Journal of Roentgenology 210.5 (2018): 1123-1130.
  6. ↑ 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
  7. ↑ Scarpa A (1839) Atlante delle opere complete di Antonio Scarpa e spiegazione delle tavole che lo compongono. Volume unico. Ed: V. Batelli, Firenze.
  8. ↑ Sferopoulos, N. K. “Subtalar and Chopart Dislocations in Children and Adolescents.” Journal of Orthopedics and Orthopedic Surgery 1.2 (2020).
  9. ↑ 9.0 9.1 Metcalfe, Tobias SN, Junaid Aamir, and Lyndon W. Mason. "Chopart dislocations: a review of diagnosis, treatment and outcomes." Archives of Orthopaedic and Trauma Surgery 144.1 (2024): 131-147.
  10. ↑ Kutaish, Halah, et al. "Injuries to the Chopart joint complex: a current review." European Journal of Orthopaedic Surgery & Traumatology 27.4 (2017): 425-431.
  11. ↑ 11.0 11.1 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:
12 October 2024 17:16:28
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