Case for small group discussion Midfoot injury Case for small group discussion Complex midfoot deformity AOTrauma—Foot & Ankle Module 4b: Midfoot trauma—Chopart, navicular fractures Stefan Rammelt, DE

Case description 58-year-old man Sprained his foot when jumping from a truck

Discussion What is the type of injury? Is any more information needed? Diagnosed as “midfoot sprain” Not good enough x-rays as midfoot not evaluated adequately

12 weeks post injury Still painful at the midfoot Someone marked something on the x-ray but did not take any further action

Discussion What could have been done at this point?

18 months post injury Weight-bearing x-ray Patient walking on crutches with a big boot and in severe pain

18 months post injury Dorsoplantar weight-bearing x-ray Standing

Postoperative x-rays Arthrodesis to correct deformity Standing

Correction Preoperative Standing 2 years postoperative

Correction Preoperative 2 years postoperative Standing

Take-home messages Chopart joint injuries are frequently missed or underestimated With fracture on one column, always suspect at least ligamentous injury to the other column Restore column length Restrict fusion to arthritic joints Rammelt et al. Eur J Trauma Emerg Med. 2010;36:196–205