Mouad Miloudi 1*, El bachir Mghabar 1, Abid Hatim 1, Mohammed El Idrissi 1, Abdelmajid El mrini 2
1Departement of Traumatology, Hassan II University Hospital, Fez, Morocco., Faculty of Medicine, Pharmacy, and Dental Medicine of Fez, University Sidi Mohamed Ben Abdellah, Fez, Morocco., FEZ, MAR.
2Departement of Traumatology, Hassan II University Hospital, Fez, Morocco., Faculty of Medicine, Pharmacy, and Dental Medicine of Fez, University Sidi Mohamed Ben Abdellah, Fez, Morocco., fez, MAR.
*Corresponding Author: Mouad Miloudi, Departement of Traumatology, Hassan II University Hospital, Fez, Morocco., Faculty of Medicine, Pharmacy, and Dental Medicine of Fez, University Sidi Mohamed Ben Abdellah, Fez, Morocco., FEZ, MAR.
Received Date: January 13, 2025
Accepted Date: January 17, 2025
Published Date: January 20, 2025
Citation: Miloudi M, El bachir Mghabar, Hatim A, Mohammed El Idrissi, Abdelmajid El mrini. (2025) “Trans-Cuboid Dislocation of the Chopart Joint: A Case Report.”, International Surgery Case Reports, 7(1); DOI: 10.61148/2836-2845/ISCR/085
Copyright: © 2025. Mouad Miloudi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The midtarsal or Chopart joint dislocation is an uncommon injury, typically resulting from high-energy trauma. Chopart dislocations are classified into pure dislocations and fracture-dislocations. We report the case of a plasterer who suffered a talonavicular joint dislocation with a cuboid fracture after falling from a height of 4 meters. A good functional outcome was achieved after closed reduction of the talonavicular joint and K-wire stabilization, followed by complementary cast immobilization.
talonavicular joint; cuboid fracture; reduction; chopart dislocation
Introduction
Chopart fracture-dislocations are rare traumatic injuries. Nearly all the rare cases reported in the literature are secondary to high-energy trauma, causing significant disruption of the ligamentous structures of the midfoot, which partly explains the residual instabilities after treatment [1].We report the case of a dorsal talonavicular dislocation associated with an oblique fracture of the cuboid.
Case Presentation
A 47-year-old male, plasterer by profession, with no significant medical history, was admitted to the emergency department for the management of a closed right foot injury following a fall from a ladder approximately 4 meters high, resulting in pain and total functional impairment.
Clinical examination revealed significant swelling of the midfoot with the appearance of a bony prominence on its dorsal side, without any skin opening or neurovascular complications.Standard radiographs of the midfoot, both anteroposterior and lateral views (Figure 1), showed a dorsal dislocation of the talonavicular joint .
Figure 1: Standard Lateral (A) and Anteroposterior (B) Radiographs of the Midfoot.
demonstrating talonavicular joint dislocation (red arrows (A, B)).
The patient underwent reduction under sedation with an external maneuver (on a flexed knee, performing a dorsiflexion movement of the midfoot followed by traction and plantar flexion, applying force to reposition the navicular bone). The control radiograph revealed a residual subluxation of the talonavicular joint with an oblique fracture of the cuboid bone(Figure 2).
Figure 2: Control Anteroposterior (A) and Lateral (b) Radiographs of the Midfoot.
demontrating a residual subluxation of the talonavicular joint (red arrow (B)),with an oblique fracture of the cuboid bone(yellow arrow (B)).
Twelve hours later, the patient underwent open reduction of the dislocation, stabilized with Kirschner wires for the talonavicular joint, as well as closed pinning of the cuboid bone (Figure 3).
Figure 3: Postoperative Lateral (A) and Anteroposterior (B) Radiographic of the Midfoot.
demonstrating a reduced talonovaicular jointstabilized with two Kirschner wires (red arrows (A, B)) , and pinning of the cuboid bone fracture (yellow arrows (A,B)).
The patient had additional plaster immobilization with a cast boot for 6 weeks. Hardware removal was done at 2 months, followed by rehabilitation with progressive weight-bearing, and the patient returned to work at 5 months. One year after the injury, the functional outcome was satisfactory.
Discussion
The midtarsal joint, or Chopart joint, named after the French surgeon François Chopart, who described an amputation between the midfoot and hindfoot [2], is composed of the talonavicular joint, which allows supination and pronation of the tarsus [3], as well as the calcaneocuboid joint, which stabilizes the midfoot during the propulsion phase of walking [4].
This fundamental role requires solid ligament support. The stability of the talonavicular joint is ensured by the dorsal talonavicular ligament and the navicular bundle of the bifurcate ligament in the dorsal aspect, as well as the plantar calcaneonavicular ligament. The calcaneocuboid joint is supported by the dorsal calcaneocuboid ligament, the dorsomedial bundle of the bifurcate ligament, the plantar calcaneocuboid ligament, and the long plantar ligament [4].
The likely mechanism of trauma is an axial compressive force on the foot in hyperplantar flexion transmitted along the metatarsal rays, causing compression of the foot columns, according to the Main and Jowett’s classification [5].
The literature reports that up to 41% of Chopart joint dislocations go unnoticed during the first consultation. Haapamaki et al. found that plain radiographs missed 33% of associated fractures, which highlights the importance of CT imaging for precise lesion diagnosis, particularly of associated fractures, and its usefulness in preoperative planning [1].
The therapeutic approach begins with closed reduction of the dislocation and supplementary plaster immobilization in the absence of associated lesions. In cases of failure or instability, open reduction and internal fixation are frequently used to stabilize the joint and restore the joint space [6].
In some cases where the progression leads to joint instability causing persistent pain, it is helpful to perform a double arthrodesis of the talonavicular and subtalar joints in the presence of severe joint collapse or irreparable articular surface lesions. Arthrodesis helps relieve pain and restore foot function at the cost of limiting joint mobility [7].
The prognosis of trans-cuboid dislocation depends on several factors, such as the severity of the lesion, the presence of associated fractures, and the timing of intervention. Poor prognostic factors include skin opening and delayed intervention. Long-term complications include chronic pain, post-traumatic arthritis, and stiffness [8].
Conclusions
Trans-cuboid dislocation of the Chopart joint is a rare injury that presents a diagnostic and therapeutic challenge for orthopedic surgeons. Understanding the injury mechanism and the different therapeutic options is essential to optimize treatment outcomes. This case of trans-cuboid dislocation highlights the complex nature of foot anatomy and the importance of rapid and effective management.
Additional Information
Disclosures
Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.