Table 4.
Cohort Studies and case series identified by literature review on Chopart dislocation and fracture-dislocation functional outcomes, including: 2 retrospective cohort studies, 1 prospective cohort study and 4 case series
| Paper | Paper type and aim | Patient number and injury type | Patient characteristics | Diagnosis and radiology | Management | Follow-up group and time | Outcomes |
|---|---|---|---|---|---|---|---|
| Mittlmeier et al. [11] | Case series—Gait function following Chopart ± lisfranc fracture-dislocation |
25 patients: 5 Chopart fracture-dislocations 9 combined Chopart-Lisfranc fracture-dislocations |
Not reported | Not reported | ORIF (screws and/or K-wires) ± Ex-fix | Follow up range 1–8 years |
Patients tended to load on the non-injured column Severity of post-traumatic arthritis did not greatly influence gait function Loss of either foot column length had a substantial influence in gait quality |
| Richter et al. [12] | Retrospective cohort study—Midfoot injury outcomes |
155 midfoot injuries: 25 Chopart fracture-dislocations 26 combined Chopart-Lisfranc fracture dislocations |
Average age—35 years 114 males and 41 females. (2.78:1 M:F) Principal aetiology—MVA (112/155) |
Not reported |
148/155 (95%)—Operatively 115/155 (74.2%)—OR 30/155 (19.4%)—CR 116/155 (74.8%)—Internal fixation typically with K-wires ± screws 55/155 (35.5%)—additional Ex-fix 3/155 (1.9%)—Primary Below knee amputation (all Chopart-Lisfranc fracture-dislocations (3/26, 11.5%)) 18/155 (11.6%)—Required foot compartment fasciotomy |
92 patients—average follow up 9 years |
Mean AOFAS-midfoot for Chopart fracture-dislocations—67 (n = 15) Mean AOFAS-midfoot for Chopart-Lisfranc fracture-dislocation—55 (n = 14) Mean AOFAS-midfoot for Isolated Chopart fracture—81 (n = 18) High correlation between correct column length and good functional outcome Early ORIF provided the highest scores in all groups |
| Richter et al. [6] | Retrospective cohort study—Chopart dislocation outcomes |
110 Chopart dislocations: 28 pure-dislocations 60 Chopart fracture-dislocations 22 combined Chopart-Lisfranc fracture-dislocations |
Average age—32 years 68 men and 32 women (2.13:1 M:F) Principal Aetiology was MVA (90/110) |
Not reported Author recommendation: XR + CT |
Pure-dislocations—19/28 CR ± internal fixation (6/19) ± Ex-fix (1/19) Chopart fracture-dislocations—ORIF (50/60) ± Ex-fix (14/60). Primary amputation (3/60) Combined Chopart-Lisfranc dislocations—primary amputation (9/22), ORIF (11/22) ± Ex-fix (5/22) Average time between injury and operative treatment—3 days 28/110 (25.5%)—required foot compartment fasciotomy |
58 patient with 59 Chopart dislocations: average follow-up 9 years |
Mean AOFAS whole group 75 (n = 59) Mean AOFAS Pure-dislocation—79.0 (n = 14) Mean AOFAS Chopart fracture-dislocation—78.0 (n = 33) Mean AOFAS Chopart Lisfranc fracture-dislocation—61 (n = 12) No significant differences for age or gender Negative prognostic factors: MVA, Open injury, associated fractures, polytrauma, combined Chopart lisfranc injuries, delayed surgery > 1 day Positive prognostic factors: closed or isolated injuries, compartment syndrome Open reduction prior to internal fixation had significantly better outcomes than closed reduction prior to internal fixation |
| Rammelt et al. [13] | Case series—secondary reconstruction of malunited Chopart fracture-dislocations | 8 patients with malunited Chopart fracture-dislocations |
Average age: 38 years Surgical Revision: average 10 months post injury |
Not reported |
ORIF—7/8 TNJ fusion—1/8 |
8 patients average follow-up of 2 years |
Mean post-operative AOFAS—80.8 (n = 6) Mean pre-operative AOFAS—38.8 (n = 6) Highly significant difference Active inversion/eversion: averaged 18 degrees preoperatively and 41 degrees postoperatively |
| Van Dorp et al. [5] | Case series—Chopart dislocation outcomes |
9 patients: 7 fracture-dislocations, 2 Pure-dislocations |
Average age: 41.6 years 2:1 M:F Sprain/sport injury: 5 MVA: 3 Fall from height:1 |
XR + CT 2 patients the injury was initially 3 patients with underestimated injury prior to CT |
Average time between injury and surgery—7 days 5 patients non-operative 1 patient CREF 3 ORIF (2 + Ex-fix) Complications of surgery: 1 Ex-fix pin track infection 1 persistent dislocation of TNJ 1 secondary dislocation 5 days post-op requiring further surgery |
7 patients average follow-up—31.3 months |
Mean AOFAS—72 (n = 7) Mean VAS patient satisfaction score—7.1/10 (n = 7) 4/7—pain free 1/7—moderate pain 2/7—daily pain 4/7—stiffness 5/7—returned to work, 1 unable and 1 already retired 5/7—limitations performing sports or leisure |
| Kosters et al. [14] | Case series—Chopart fracture-dislocation | 24 patient cohort with 6 fracture-dislocations |
Mean BMI: 23.0 Median Age: 42 years |
Not reported | ORIF/CREF | Median follow up: 2.6 years |
Mean AOFAS—66.0 (n = 6) Maryland foot score—80.8 (n = 6) SF-36 (quality of life score)—61.4 (n = 6) |
| Rammelt et al. 2023 [15] | Prospective cohort study—Chopart injury outcomes |
128 Chopart joint injuries: 5 (4%) pure-dislocations 21.1%—transnavicular/transcuboidal fracture-dislocations 23.4% Combined Chopart-Lisfranc fracture dislocation |
Average age—37.3 years 83 male, 39 female patients. (2.13:1 M:F) MVA—45.9% Direct trauma to foot—24.6% Fall from height—26.2% Low energy trauma—4% |
XR + CT Diagnosis delayed for > 24 h in 27 patients (22.1%) |
11/128 (8.6%)—non-operatively 87/128 (68%)—Single stage surgery 30/128 (23.4%)—Staged treatment 19/128 (14.8%)—Pure-dislocations/fracture–dislocations had OR/CR followed by K-wire fixation ± Ex-fix 12/128 (9.4%)—Compartment syndrome (immediate release) 33/128 (25.8%)—required bone grafts 7/128 (5.5%)—required primary arthrodesis |
73 patients with 75 Chopart injuries average follow-up: 10.2 years |
Mean AOFAS for Chopart Injuries (fractures, pure-dislocations, fracture-dislocations)—71.5 (n = 75) Negative prognostic factors: High injury severity score, work-related accidents, open and multiple fractures, pure-dislocations, staged surgery, delay of treatment > 4 weeks, post-operative infection and primary/secondary fusion ORIF provided significantly better outcomes than closed reduction and percutaneous fixation Pure-dislocations had worst prognosis |
Open Reduction (OR), Closed Reduction (CR), Medial Column Length (MCL), Lateral Column Length (LCL), Open Reduction and Internal Fixation (ORIF), External Fixation (Ex-fix), Talonavicular joint (TNJ), American Orthopaedic Foot and Ankle Society Score (AOFAS), Motor Vehicle Accident (MVA). Number of patients (n), Male to female ratio (M:F).