Anatomic Reconstruction of Malunited Chopart Joint Injuries

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery
• Trauma Surgery

Background:

• Mid-tarsal (Chopart) joint fractures and dislocations are often missed, leading to malunions and impaired foot function.
• Malunions cause significant disability, instability, deformity, and rapid post-traumatic arthritis development.
• Joint preservation is ideal but only feasible if symptomatic arthritis or avascular necrosis is absent.

Purpose of the Study:

• To evaluate the outcomes of secondary anatomical reconstruction for malunited mid-tarsal fracture-dislocations.
• To assess the effectiveness of joint realignment and internal fixation in restoring foot function.

Main Methods:

• Retrospective review of eight patients treated for malunited mid-tarsal fracture-dislocations over six years.
• Treatments included debridement and bone-grafting for navicular nonunions, corrective osteotomies, and internal fixation.
• Follow-up included clinical assessment and the American Orthopaedic Foot and Ankle Score (AOFAS).

Main Results:

• Seven of eight patients reported satisfaction at 2-year follow-up.
• One patient required talonavicular joint fusion for avascular necrosis and navicular collapse.
• The mean AOFAS score significantly improved from 38.8 preoperatively to 80.8 postoperatively.

Conclusions:

• Secondary reconstruction with joint realignment and internal fixation can yield satisfactory outcomes for malunited mid-tarsal fracture-dislocations.
• However, many patients present with established post-traumatic arthritis, necessitating corrective fusion for axial realignment and functional restoration.