Rammelt Stefan, Missbach Tobias
University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl-Gustav Carus at TU Dresden, Dresden, Germany; and.
Departement for Orthopaedics, Trauma and Hand Surgery, Klinikum Chemnitz gGmbH, Chemnitz, Germany.
J Orthop Trauma. 2023 Jan 1;37(1):e14-e21. doi: 10.1097/BOT.0000000000002465.
To investigate injury patterns and long-term outcomes of midtarsal (Chopart) injuries in a sizeable number of patients.
Prospective study.
Level 1 trauma center.
One hundred twenty-two patients (average age 37.6 years) with 128 Chopart injuries over a 15-year period, 27% of who were polytraumatized. In 47%, more than 1 of the 4 bones of the midtarsal joint was fractured. The navicular and cuboid were fractured most often. Purely ligamentous dislocations occurred in 4%.
Operative treatment tailored to the individual fracture pattern was performed in 91.4%.
Foot Function Index, American Orthopaedic Foot and Ankle Society score, SF-36 physical (PCS) and mental component summary (MCS).
Seventy-three patients with 75 Chopart injuries were available for follow-up at an average of 10.1 years. The Foot Function Index averaged 26.9, the American Orthopaedic Foot and Ankle Society score averaged 71.5, and the SF-36 PCS and MCS averaged 43.5 and 51.2, respectively. Negative prognostic factors were a high injury severity score, work-related accidents, open and multiple fractures, purely ligamentous dislocations, staged surgery, delay of treatment >4 weeks, postoperative infection, and primary or secondary fusion. Open reduction and internal fixation led to significantly better results than attempted closed reduction and percutaneous fixation. Radiographic signs of posttraumatic arthritis were observed in 93%, but only 4.7% of cases required a late fusion at the Chopart joint.
Chopart joint injuries lead to functional restrictions in the long term. Purely ligamentous dislocations have the worst prognosis, whereas fractures of a single bone have a favorable outcome after anatomic reduction and internal fixation.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
调查大量跗中（Chopart）损伤患者的损伤模式及长期预后。
前瞻性研究。
一级创伤中心。
15年间122例患者（平均年龄37.6岁）发生128例Chopart损伤，其中27%为多发伤。47%的患者跗中关节4块骨头中不止1块发生骨折。舟骨和骰骨骨折最为常见。单纯韧带脱位占4%。
91.4%的患者根据个体骨折模式进行了手术治疗。
足部功能指数、美国矫形足踝协会评分、SF-36身体（PCS）和精神健康综合评分（MCS）。
73例发生75例Chopart损伤的患者接受了随访，平均随访时间为10.1年。足部功能指数平均为26.9，美国矫形足踝协会评分平均为71.5，SF-36 PCS和MCS分别平均为43.5和51.2。不良预后因素包括损伤严重程度评分高、工伤事故、开放性和多发性骨折、单纯韧带脱位、分期手术、治疗延迟>4周、术后感染以及一期或二期融合。切开复位内固定的效果明显优于尝试的闭合复位经皮固定。93%的患者出现创伤后关节炎的影像学表现，但只有4.7%的病例需要后期进行Chopart关节融合。
Chopart关节损伤长期会导致功能受限。单纯韧带脱位预后最差，而单骨骨折在解剖复位内固定后预后良好。
治疗性四级。有关证据级别的完整描述，请参阅作者指南。
