Chopart joint fracture-dislocation: initial open reduction provides better outcome than closed reduction

Area of Science:

• Orthopaedic surgery
• Traumatology
• Foot and ankle surgery

Background:

• Chopart joint injuries, encompassing dislocations and fracture-dislocations, present complex management challenges.
• Long-term outcomes and optimal treatment strategies for these injuries require further elucidation.

Purpose of the Study:

• To evaluate the injury patterns, treatment modalities, and long-term functional outcomes of patients with Chopart joint dislocations or fracture-dislocations.
• To identify factors influencing patient outcomes using validated scoring systems.

Main Methods:

• Retrospective analysis of 110 Chopart joint injuries (dislocations, fracture-dislocations, combined Chopart-Lisfranc injuries) treated between 1972 and 1997.
• Patient outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score, Hannover Scoring System, and Hannover Outcome Questionnaire after an average 9-year follow-up.
• Treatment was categorized as operative or nonoperative, with injury patterns classified into pure dislocations, fracture-dislocations, and combined injuries.

Main Results:

• Operative treatment was primary in 83% of cases. Mean follow-up scores were: AOFAS 75, Hannover Scoring System 69, and Hannover Outcome Questionnaire 68.
• Pure dislocations and Chopart fracture-dislocations showed similar outcomes, while combined Chopart-Lisfranc injuries had significantly lower scores.
• An initial anatomic reduction was crucial for good results across all injury types. Open reduction was particularly beneficial for fracture-dislocations.

Conclusions:

• Anatomic reduction is essential for favorable outcomes in Chopart joint injuries.
• Open reduction is recommended for Chopart fracture-dislocations to mitigate functional deficits.
• Closed reduction may yield good results only in pure dislocations with achievable anatomic restoration or when surgery is contraindicated.