Isolated Dorsal Midtarsal (Chopart) Dislocation: A Case Report

Abstract

A case of isolated dorsal midtarsal (Chopart) dislocation resulting from blunt trauma is reported. The mechanism of injury, management, and longterm outcome are discussed. A 45-year-old inebriated man fell from a 4-m height and landed on his feet. He had immediate bilateral foot and back pain. Radiographs showed a burst fracture of the second lumbar vertebra, a left Pott's fracture, and an isolated dorsal dislocation of the right midtarsal (Chopart) joint. No neurovascular deficits or signs of compartment syndrome were noted. The image intensifier showed the unstable midtarsal joint with dorsal translation of the navicular and cuboid from the talus and calcaneum, respectively. Closed reduction of the midtarsal joint was performed with 2 transfixing 3.5-mm AO cortical screws. The right foot was immobilised in a short leg cast for 6 weeks; screws were removed 14 weeks later. At 76-month follow-up, the patient had returned to work as a construction worker, but still had right midfoot pain on prolonged walking or standing, because of persistent plantar opening up and dorsal ossification of the midtarsal joints and degenerative change at the talonavicular

Isolated dorsal dislocations of the talonavicular and calcaneocuboid articulations (Chopart joints) from a low-energy mechanism

“…In this series, only 2 cases of transverse tarsal joint dislocations were reported: pure plantar transverse tarsal joint dislocation and plantar subtalar dislocation associated with plantar dislocation of the talonavicular joint [4]. Current literature review reveals 2 cases of isolated dorsal transverse tarsal joint dislocations resulting from high-energy mechanisms including falls from height [2,6]. To the best of our knowledge, this is the first reported case of isolated dorsal transverse tarsal joint dislocation from a low-energy mechanism.…”

“…The inferior calcaneocuboid ligament, calcaneonavicular (spring) ligament, and bifurcate ligament all confer stability to the transverse tarsal joints and are important to the support of the foot arch. For this reason, dislocations in the dorsal direction are infrequent, requiring disruption of these plantar ligaments [6].…”

Luxation dorsale médiotarsienne (Chopart) isolée

“…Dans notre observation, les forces ascendantes exercées lors de la chute sur la plante du pied ont probablement endommagé les structures ligamentaires plantaires et ont entraîné une luxation dorsale ; celle-ci semble moins fréquente que les autres formes. À notre connaissance, seulement deux cas de luxation de l'AMT dorsale isolée ont été rapportés dans la littérature : le premier cas de Ip et Lui [7] a été traité par double vissage à l'aide d'une vis de 3,5 mm AO corticales, l'une talonaviculaire, l'autre calcanéocuboïdienne ; le deuxième cas de Puthezhath et al [8] a été traité par embrochage à foyer ouvert. Il s'agit d'une lésion rare en raison des fortes structures ligamentaires autour de l'AMT : la plus forte structure ligamentaire de l'AMT est plantaire ; elle comporte les ligaments plantaires, long et court, le ligament bifurqué et le ligament calcanéonaviculaire plantaire qui sont importants comme support de l'arche du pied [9].…”

“…Dans tous les cas publiés [7,8] de luxation de l'AMT dorsale isolée et malgré une réparation ligamentaire, les patients développent une arthrose calcanéocuboïdienne et …”

Results and complications of operative and non-operative navicular fracture treatment

“…Associated foot injuries are common [10] and should always be ruled out before final treatment decision [44]. Furthermore, most often, this injury is derived from a high energy mechanism [17,29,30,[44][45][46] and additional associated injuries of other body areas and organs can be expected, which might influence patient outcome [47,48]. Having a foot injury can prevent patients from returning to full employment leading to subsequent psychological, social and economical problems [47].…”