Case for small group discussion Chopart joint injury Case for small group discussion AOTrauma—Foot & Ankle Module 4b: Midfoot trauma—Chopart, navicular fractures Stefan Rammelt and Hans Zwipp, DE

Case description 22-year-old man Fell from a scaffold (3 m)

Diagnosis What is the type and mechanism of the injury? Is any further information needed?

Fracture mechanism Medial stress (adduction) Lateral stress (abduction) Plantar stress Axial stress Crush

Preoperative CT scans

Talar head and lateral process fracture and dislocation of the cuboid How would you treat this fracture/dislocation?

Treatment K-wires removed at 6 weeks Weight bearing gradually increased subsequently

5 years and 3 months follow-up

Take-home messages Exact radiographic projections High index of suspicion—CT scan Look for injury in both columns of the foot Transfixation for ligamentous instability Restoration of medial and lateral column References: Rammelt S, Grass R, Schikore H, Zwipp H. [Injuries of the Chopart joint]. Unfallchirurg. 2002 Apr;105(4):371–383; quiz 384–385. German. Rammelt S, Zwipp H, Schneiders W, Heineck J. Anatomical reconstruction after malunited Chopart joint injuries. Eur J Trauma Emerg Med. 2010;36: 196–205. Main BJ, Jowett RL. Injuries of the midtarsal joint. JBJS. 1975;57B:89–97. Rammelt et al. Unfallchirurg. 2002;105:371–383. Rammelt et al. Eur J Trauma Emerg Med. 2010;36:196–205.