This Issue's Rounds Question - "What is the Harris Growth Arrest Line?" (responses to be published in next issue)

In the last issue of Body Cast, Rounds asked: “Define a Chopart Fracture”.

The following responses were received:

From Tony Bellon and Mary Young:

The Chopart fractures articular space was described by Francois Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxapedis (an essential functional join) and the calcaneocuboidal joint, which can be considered to be an “adaptive joint” within a normal foot. Trauma to this region may cause fractures, dislocations and, in high-energy trauma, compartment syndromes. Treatments are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation are often indicated to restore the “coax pedis”. Open reconstruction or fusion in correct length of the calcaneocuboid joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneocuboidal bone block fusions. Treatment of joint destruction, especially involving the talo-navicular joint, include triple arthrodesis.

From Mary Perkins:

With help from the orthopaedic resident of the year, Markku Nousiainen, I discovered that a Chopart fracture is a fracture dislocation through the talar-navicular and calcanealcuboid joint, located in the mid-foot, hind-foot area of the foot. It is named after Francois Chopart (surgeon to Napoleon), who performed amputations through the midtarsal joint, allowing weight-bearing and low infection rates. Though frequently misjudged and underestimated with respect to foot function, it’s a rare fracture that can be difficult on physical examination to diagnose due to early swelling. Diagnosis and treatment with stable internal fixation result in good outcome.