Uspešno operativno lečenje previđene čiste luksacije Šopartovog zgloba: prikaz dva slučaja i pregled literature
Sažetak
Introduction. Chopart joint dislocation (CJD) represents a rare injury that is often initially unrecognized. Because of this, but also because of the increased morbidity it leads to, and due to poor treatment outcomes, this injury represents a significant clinical problem. Case report. We present two patients with overlooked CJD admitted to our institution within one year. The first case was a 63-year-old male, who suffered an injury after falling down the stairs, while the second case was a 33-year-old female injured in a traffic accident. Both patients were initially treated under the diagnosis of foot and ankle sprain. Upon their admission and subsequent computed tomography diagnostics, overlooked pure CJD was diagnosed in both patients. They both underwent open reduction and internal fixation of the Chopart joint using K-wires. Six weeks after the surgery, the K-wires were removed, a below-knee orthosis was applied for walking, and partial weight-bearing was allowed with a gradual increase to full weight-bearing over the next six weeks. Physical therapy was initiated. After the six-month follow-up, both patients were successfully rehabilitated, with a final American Orthopaedic Foot and Ankle Society score of 76 out of 100 for the female patient and a score of 84 out of 100 for the male patient. Conclusion. Despite the delayed diagnosis and postponed operative treatment, the functional outcomes of pure CJD treated by open reduction and percutaneous K-wiring can be satisfactory. Additional studies are required to gain a better insight into the prevalence and causative factors of the possible complications in such a treatment approach to the mentioned injury.
Reference
Ponkilainen VT, Laine HJ, Mäenpää HM, Mattila VM, Haapasa-lo HH. Incidence and Characteristics of Midfoot Injuries. Foot Ankle Int 2019; 40(1): 105–12.
Metcalfe TSN, Aamir J, Mason LW. Chopart dislocations: a re-view of diagnosis, treatment and outcomes. Arch Orthop Trauma Surg 2024; 144(1): 131–47.
Van Dorp KB, de Vries MR, van der Elst M, Schepers T. Chopart joint injury: a study of outcome and morbidity. J Foot Ankle Surg 2010; 49(6): 541–5.
Viegas G. Midtarsal joint dislocations: acute and chronic man-agement with review of the literature and case presentation. The Foot 2000; 10(4): 198–206.
Klaue K. Chopart fractures. Injury 2004; 35 Suppl 2: SB64–70.
Elftman H. The transverse tarsal joint and its control. Clin Or-thop 1960; 16: 41–6.
Blackwood CB, Yuen TJ, Sangeorzan BJ, Ledoux WR. The midtar-sal joint locking mechanism. Foot Ankle Int 2005; 26(12): 1074–80.
Walter WR, Hirschmann A, Alaia EF, Tafur M, Rosenberg ZS. Normal anatomy and traumatic injury of the midtarsal (chopart) joint complex: An imaging primer. Radiographics 2019; 39(1): 136–52.
Richter M, Thermann H, Huefner T, Schmidt U, Goesling T, Krettek C. Chopart joint fracture-dislocation: initial open re-duction provides better outcome than closed reduction. Foot Ankle Int 2004; 25(5): 340–8.
Main BJ, Jowett RL. Injuries of the midtarsal joint. J Bone Joint Surg Br 1975; 57(1): 89–97.
Rammelt S, Missbach T. Chopart joint injuries: Assessment, treatment, and 10-year results. J Orthop Trauma 2023; 37(1): e14–21.
Honeycutt MW, Perry MD. The Chopart variant dislocation: Plantar dislocation of the cuboid and navicular. Foot Ankle Orthop 2019; 4(3): 2473011419876262.
Rammelt S, Schepers T. Chopart injuries: When to fix and when to fuse? Foot Ankle Clin 2017; 22(1): 163–80.
Rammelt S. Chopart and Lisfranc Fracture-Dislocations. In: Bentley G, editor. European Surgical Orthopaedics and Trau-matology. Berlin, Heidelberg: Springer; 2014. p. 3835–57.
Kotter A, Wieberneit J, Braun W, Rüter A. The Chopart disloca-tion: results of a frequently underestimated injury and its se-quelae. A clinical study. Unfallchirurg 1997; 100(9): 737–41. (German)