Fusion of the Chopart joint with screws

Summary

Objectives

Arthrodesis of the Chopart joint. Should a malalignment exist, it must be corrected prior to fusion. Elimination of painful functional disturbances and reduced need for custommade shoes.

Indications

Osteoarthritis and malalignment of the Chopart joint accompanied by painful limitation of function. Paralytic deformities. Pes planovalgus (flexible flat foot).

Contraindications

Diabetic arthropathy, vascular insufficiencies. Severe osteoporosis.

Surgical Technique

Resection of the articular surfaces, correction of malalignment, and compression arthrodesis using the “Double Rail Technique”. Addition of autogenous iliac bone grafts may be necessary.

Postoperative Care

Early functional exercises. After approximately 2 weeks, application of a below-knee walking cast and permission to partial weight bearing (about 15 kg) of the limb. Control radiographs after 6 and 12 weeks. After removal of the cast physiotherapy, prescription of inserts.

Results

Between January 1979 and July 1997, this operation was performed in 12 patients (between 18 and 70 years of age. 37±20 years). In 6 patients the indication was a remote comminuted fracture of the scaphoid, in 4 patients a nonunion after previous attempts at fusion, in 1 patient an osteoarthritis of the calcaneocuboid joint and in another patient an idiopathic osteoarthritis. Follow-up of the 12 patients after 2.7±1.7 years. Assessment using the Hannover Medical School (HMS) and the Kitaoka scores: out of 100 possible points, patients reached 81.3±13 points with the HMS score. Similar results were observed using the Kitaoka score.