Langenhan R, Kohler G
Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Frauenfeld, Pfaffenholzstr. 4, CH-8501, Frauenfeld, Schweiz.
Unfallchirurg. 2009 Jun;112(6):596-600. doi: 10.1007/s00113-009-1594-1.
The case of an initially overlooked transligamentary Chopart dislocation following distorsion trauma of the foot is presented and the treatment and long-term course are discussed. A 55-year-old female patient sustained severe injury to the left foot after falling from a height of 4 m.. The instep was severely swollen and there was deformity with adduction of the forefoot and supination position. The peripheral pulse and sensitivity were intact. The conclusion from local radiographic investigations was that there were no signs of fracture or dislocation. The patient travelled home in pain 1 week after the accident and registered in the casualty department at our hospital. Assessment of the radiographs revealed a transligamentary Chopart dislocation with dorsolateral dislocation of the talus head, avulsed navicular fragments and a depressed fracture at the medial talus head. Treatment was initiated immediately after diagnosis with closed reduction and percutaneous K-wire fixation and 8 weeks immobilization in a lower leg plaster cast. Chopart dislocation is a rare consequence of accidental distortion trauma of the foot. Peritarsal dislocations represent approximately 15% of tarsal injuries and 1% of joint dislocations overall. Therefore, if a high energy accident has occurred, it is necessary to specifically search for dislocations and fractures. Immediate reduction reduces the risk of complications.
本文介绍了一例足部扭曲外伤后最初被忽视的经韧带Chopart脱位病例,并讨论了其治疗方法及长期病程。一名55岁女性患者从4米高处坠落,左脚受到严重损伤。脚背严重肿胀,前足内收、旋后位畸形。外周脉搏和感觉正常。局部影像学检查结论为无骨折或脱位迹象。事故1周后,患者疼痛回家,并在我院急诊科挂号。对X光片的评估显示为经韧带Chopart脱位,距骨头背外侧脱位,舟骨碎片撕脱,距骨头内侧凹陷骨折。诊断后立即进行治疗,采用闭合复位和经皮克氏针固定,并在小腿石膏固定8周。Chopart脱位是足部意外扭曲外伤的罕见后果。跗骨周围脱位约占跗骨损伤的15%,占所有关节脱位的1%。因此,如果发生高能事故,有必要专门检查是否存在脱位和骨折。立即复位可降低并发症风险。