Functional Outcome of Chopart Injuries Involving Combined Fractures of the Navicular and Talar Head

Chopart injuries are often misdiagnosed due to subtle presentations affecting a combination of the talar head, navicular, calcaneus, or cuboid bone. These injuries typically occur on both medial and lateral sides, but rarely both structures at a single side are injured. The aim of this study was to investigate functional outcome and complications in Chopart injuries with a transnavicular-transtalar fracture pattern.

This retrospective cohort study examined patients with Chopart injury with concomitant navicular and talar head fractures. Patient characteristics, trauma mechanism, fracture classification, surgical management, follow-up, and complications were reported. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and Foot Function Index (FFI). Quality of life was measured with the EuroQol-5D (EQ-5D). Patient satisfaction and general health were scored on a 0-10 visual analogue scale (VAS).

Twenty-two patients with Chopart injuries with concomitant navicular and talar head injuries were included. Four common injury pattern combinations were identified based on anatomical affected structures. Most cases underwent ORIF. Two underwent primary arthrodesis of the talonavicular joint. Mean follow-up was 57.6 months. Secondary talonavicular arthrodesis due to painful osteoarthritis (n = 3) was performed after a mean of 12.3 months. Implants were removed in 47% due to complaints after a mean of 10.5 months. There were no postoperative wound infections or cases of avascular necrosis. All fractures showed union. Functional outcome was good (median AOFAS 80.6; median FFI 20.5). Mean EQ-5D index was 0.46. Patient-reported outcomes were good (mean VAS treatment satisfaction 8.4; mean VAS perceived health 8.1).

There is a significant amount of diversity among Chopart injuries. If treated correctly, outcomes are good, although a substantial number of patients require secondary surgery. Considering the rarity and complexity of these injuries with concomitant foot fractures, prompt referral to specialized foot surgeons and centralization of complex foot surgery are recommended.Levels of Evidence: 4.