Dislocation fractures of the midtarsal and tarsometatarsal joints - injuries of the Chopart's and Lisfranc's joint

Dislocation fractures of the Chopart and Lisfranc joint line result from rough force and lead to articular incongruities, complex derangement of the plantar are geometry and shortening of the medial or lateral column of the foot. These injuries are often complicated by severe soft tissue damage causing a high incidence of compartment syndrome. Beside careful clinical examination radiographs in 3 standard projections are essential for the exact diagnosis, if necessary completed by conventional tomographies or CT. To avoid residual joint incongruities and derangements of the anatomic architecture resulting in disabling arthrosis the indications for open reduction and functionally stable osteosynthesis should be broad. Concerning injuries of the Chopart joint any shortening of the medial or lateral column - especially if there is a substantial impression of the articular surface - should be reduced. Osseous defects have to be filled with autogenous cancellous bone and are stabilized with transarticular K-wires, 2.7mm or 3.5mm screws or small plates. Dislocation-fractures of the Lisfranc joint can be fixed by percutaneous K-wires if a closed reduction is possible. Open reduction and internal fixation are indicated in cases of instable and irreponible fractures, and in open fractures as well as in lesions presenting with a compartment syndrome. A precise anatomic reduction of the tarsometatarsal joints is critical after this kind of injuries to avoid long-term disability.