A new technique of treatment of fracture-subluxation of chopart joint

INTRODUCTION:: Injuries to Chopart joint are uncommon but debilitating injuries. It has been well demonstrated that for the best outcome, initial anatomic reduction is essential. However, even if this is achieved, function is usually impaired and arthrodesis a frequent sequelae. We describe a new technique for treatment of fracture-subluxation of the Chopart joint using pretensioned hamstring autograft for reconstruction that does not violate the articular surface and reconstructs the damaged medial ligamentous complex. METHOD:: A 39-year-old male (height 188 cm, weight 114.1 kg) slipped from a roof solely injuring his left foot. He had both medial and lateral hindfoot pain and tenderness. Computed tomography scan revealed an intra-articular calcaneal fracture at the calcaneocuboid joint. As there was anatomic alignment, conservative treatment was initiated. By 8 weeks the talonavicular joint had subluxated and reconstruction was performed. He underwent a calcaneal neck lengthening with iliac crest bone graft harvest combined with a spring ligament reconstruction with a pretensioned allograft hamstring ligament. The calcaneal neck lengthening was undertaken 1.5 cm from the calcaneocuboid joint, using a 1 cm rectangle of tricortical iliac crest graft. This corrected the abduction deformity; however, had no effect upon the talonavicular subluxation. The graft was placed within the medial talar neck and directed plantar and distal to the medial cuneiform, deep to the posterior tibial tendon. Fixation of the pretensioned hamstring allograft was achieved using interference screws into the bony tunnels of the talus and medial cuneiform, with the foot placed in adduction and plantarflexion and fluoroscopic confirmation of reduction of the talonavicular subluxation. He was kept non-weight-bearing for 6 weeks and then WBAT in an unlocked ROM walker with an arch support for a further 6 weeks. He received physical therapy from 6 weeks postoperatively. RESULTS:: At 28 weeks he had fully returned to manual labor as well as his main hobbies of running, weight-training, and Greco-roman wrestling. His AOFAS score was 100 with full functional arc of movement of ankle and hindfoot and normal clinical and radiographic position. At final review at 1 year his AOFAS remained at 100. His excellent function, as well as clinical and radiographic position were retained. CONCLUSIONS:: We present a new technique for treatment of fracture-subluxation of the Chopart joint using pretensioned hamstring autograft for reconstruction. This joint-sparing method of reconstruction provides excellent clinical and functional outcome, surpassing the previously reported in the literature.